New proposals to improve non-emergency patient transport services and make them more patient-centred were announced today by Health Minister Edwina Hart.

Non-emergency patient transport enables people to access outpatient, day treatment and other services at NHS hospitals. Around 1.4 million such journeys are undertaken every year.

Users of the service are often seriously ill, such as those needing dialysis or chemotherapy. They are usually vulnerable, with physical or other disabilities, and are dependent on such transport, as they often live in rural locations.

A review undertaken by Win Griffiths, Chairman of Abertawe Bro Morgannwg Health Board - commissioned by Mrs Hart and published today - says that the current system is fragmented, could be better managed and does not offer a patient-led service.

Examples of the service not being patient-centred include inconvenient and uncomfortable multiple-stop, long journeys for patients, seriously ill patients furthest away from the hospital being picked up first and dropped back home last, and carers not being able to travel with their patient.

The review proposes that four pilot projects road-test the best ways of delivering improvements, including:
obetter use of voluntary organisations to provide more services - currently, only seven per cent of journeys are undertaken by the sector;

ocementing stronger management arrangements to ensure more co-ordinated provision between public service providers and voluntary organisations;

ousing other vehicles instead of minibuses for more comfortable modes of travel; and

ooffering bespoke services catering for the specialist needs of vulnerable patients.

Each pilot will be to develop a partnership model, based around the central Health Board-Wales Ambulance Service Trust relationship, with a specific focus for each one - locality planning, rural service delivery, or development of the third sector. The pilots will be reviewed after 12 months.

Announcing a consultation on the review's findings, Mrs Hart said:
"Non-emergency patient transport provides a vital service for thousands of patients across the whole of Wales.

"However, I commissioned this review because I was concerned that services were patchy across Wales and not patient-centred.

"Users are full of praise for the frontline staff and volunteers that deliver services, but they feel the current system itself is not geared to their needs.

"The pilot projects would look at testing out various approaches such as better use of community transport services, expanding provision from the traditional minibus service to more use of car services, and better procurement and leasing arrangements.

"Opportunities to integrate fleets across a range of providers - using vehicles from local government, NHS Health Board and WAST as well as the voluntary sector - will also be explored.

"I am especially keen for the voluntary sector and unions to engage, as key to the success of the proposed arrangements will be these groups. Currently, only seven per cent of journeys are undertaken by the voluntary sector but with 1500 such organisations in Wales - many of them willing to help deliver services - the potential for better utilisation of the sector is great.

"I am grateful to Win Griffiths for his thorough review. The NHS must aim to go beyond just delivering services to ensuring services are patient-led and of high quality. Non emergency patient transport is no exception and Win's proposals have been drawn up with this firmly in mind."

Mr Griffiths said:
"The review does not shrink from the fact that the service has been through periods of variable performance. The whole system must serve citizens better, and must be driven by citizens' needs.v "With the structural reforms of NHS Wales, I am confident that - providing we can collectively generate the right partnership arrangements - the seven Health Boards, the ambulance service and partners in the third sector can deliver an improved service.
"The best way to manage the system and improve performance needs to be tested, hence the pilot studies to investigate how the service can be improved."

Notes

1.Four pilot projects will be run within the following Health Boards:

Cwm Taf Health Board

Current service provision in the area is fragmented and uneconomical. Although performance of the current regional booking centre and WAST is of a high quality, the service is disjointed with each provider focusing on their own performance rather than working in partnership to improve delivery. Patients determined to be eligible for transport and currently passed to individual Ambulance Liaison Desks in each receiving hospital for transport to be managed. Those not eligible for transportation are signposted to the voluntary sector or public transport.

The pilot will roll out an integrated transport and booking service based in a communications hub - a one-stop contact centre for accessing health and social services in the area. The hub - with a single telephone number - will become the sole point of contact for all bookings of patient journeys to hospital. Patients requesting transport will be assessed by a call handler who will determine the best mode of transport based on their condition and utilising all resources including those in health, social care and the voluntary sector.

The hub was announced in January by the Health Minister, and will be the largest in Wales, managing call-handling and co-ordination of several health services in one location, including non-emergency ambulance bookings, GP out-of-hours, district nursing services, as well as day-to-day local authority services.

Hywel Dda Health Board

An integrated public services, rural transport model, working with the Community Transport Association, the three local authorities in Carmarthenshire, Ceredigion and Pembrokeshire, the Health Board and WAST.
Cardiff and the Vale University Health Board

An enhanced service based on the existing St John Cymru model will be trialled. Cardiff and Vale has for a number of years provided a Rapid Discharge Service which is over and above the patient transport service provided by WAST. The whole purpose is to enhance patient experience, reduce delays for patients on discharge and free up beds.

The service currently provides delivers an effective and efficient use of patient transport to patients' homes and nursing homes together with inter-hospital patient transport as the need arises. Ambulances and staff are based at major hospitals for the duration of their shift under local management, providing flexibility and responsiveness for urgent discharges. The pilot will extend the model to cover all discharges and inter-hospital transport.

Betsi Cadwaladr University Health Board

A control model with WAST operating a regional pilot under their current partnership arrangements within the Health Board.

2.Patient transport services are provided free of charge to eligible NHS patients travelling to and from secondary care facilities for outpatient or inpatient treatment. Patients are eligible for free transport if they meet the criteria for medical need. Medical need criteria were revised in February 2007. A number of factors determine eligibility, including whether the patient receives regular dialysis or cancer treatment or has other medical or communication difficulties. The policy also indicates that eligibility should take account of factors such as where a person lives, whether they need an escort or carer to travel with them and the impact on the patient if they were required to use alternative transport.

The Welsh Ambulance Trust Patient Care Service is one of the largest non-emergency ambulance operations in the UK. The service employs over 700 staff and transports over 1.3 million patients a year in 230 bespoke vehicles. On top of this, voluntary organisations provide other patient transport services.

Source
Welsh Assembly Government