Agenda item

This report provides the Committee with a performance update on the non-emergency Patient Transport Service (PTS) for Kent and Medway, which is delivered by G4S.

Discussion

The Accountable Officer of West Kent Clinical Commissioning Group introduced the report. The new patient transport contract for Kent and Medway patient transport services had commenced, with G4S as the provider, in July 2016. Mobilisation of the contract for transport to London hospital trusts had followed in February 2017. The delay of the London mobilisation had been due to there being a lack of accurate activity data available. This had been more problematic than expected due to the unpredictability of journeys into London. It was considered that the renal transport element of the contract was running well.

Performance for the main part of the contract was not good with most failings being connected to transport to London hospitals and hospital discharge. A new G4S management team had started in February, although some key members had been replaced in the last month. The working relationships between hospitals and G4S had been strengthened and these were now considered to be good. New ways of working were being developed to manage patient transport.

There had been significant issues with regards to complaints management, which had resulted in G4S being issued a performance notice. The backlog of complaints had now been cleared and the process for managing complaints improved. A performance notice had also been issued in relation to quality of information. This area was now also improving. There had been difficulties with regards to the eligibility of patients for transport. Work had been undertaken to clarify eligibility criteria and there had not been any significant issues of patient eligibility for transport for approximately five months.

The Care Quality Commission had visited the CQC a week before the Committee meeting. It was understood that this visit had not identified any serious issues of concern. Independent expertise had been utilised to review patient transport activity, including the suitability of the vehicle fleet and personnel requirements. The illness levels of patients being transported was increasing which would require an increased number of vehicles able to accommodate stretchers and wheelchairs.

Questions and points raised by the Committee were responded to as follows:

G4S Representation: A Member was disappointed that no one from G4S was present at the Committee. The Accountable Officer advised that that the relevant person was new in post and therefore he had not considered it reasonable to expect them to attend. However, he would ask them to attend when the next update was presented to the Committee.

Difficulty in foreseeing significant issues and complaints: A Committee Member was very disappointed that it had not been possible to accurately predict the illness levels of patients being transported, particularly the poor condition of patients being transported to London hospitals. Other Members also raised this as being a concern and were particularly concerned given that across the healthcare system, the aim was now to keep people living in their own homes as long as possible. The inevitable consequence of this was that patients being transported would be increasingly frail.  Members expressed concern that the appointment of a new executive team could be seen as a possible reason for poor performance. There had been 115 complaints about the patient transport service in July 2017. The Member considered this number to be far too high and questioned what type of issues were complained about the most.

The Accountable Officer said that it had been known at contract award that the information about patients being transported to London hospitals was poor but it had not being appreciated that the previous provider had only charged for 30% of the London journeys being undertaken.

The number of patient transports was in line number forecast in the contract. Although there had been an awareness that the patients being transported would be increasingly ill and frail, this level had been underestimated by commissioners. Newly appointed senior staff were responsible for delivery of the patient transport service. The Accountable Officer considered these individuals to be both competent and experienced. All policies and procedures of G4S had been vetted prior to contract award and it was considered that the procurement process had been undertaken correctly. There was confidence that the best possible provider had been selected. However, there were an increasingly small number of providers in the patient transport market. No NHS ambulance trusts had tendered for the contract. The service provided was improving but it was acknowledged that improvement was not taking place quickly enough. The tendering process had looked at both quality and price with there being a particular emphasis on quality. The provider chosen would need to score the highest for quality, subject to being affordable. It was confirmed that the independent expertise utilised with a view to improving the service had been paid for by G4S.

Monthly contract monitoring meetings took place between G4S and the commissioner. There were also weekly phone calls. G4S was kept under  constant scrutiny and it was considered that G4S managers were much more directly involved in the performance management process than managers had been under the previous transport provider. It was also recognised that G4S had been poor at communicating changes to journey times and scheduling to hospitals. Measures were being taken to address this.

It was acknowledged that 115 complaints was too many but it was noted that this represented a small number of the 18,000 journeys undertaken. The vast majority of complaints were due to patients not being picked up or collected on time. There was a particular issue in relation to journeys following hospital discharge. Service modelling would provide hospitals with a clear indication of the capacity of the transport service. This would enable alternative arrangement to be made where there was insufficient capacity. It was noted that patient transport was currently funded to a level that would cover an average number of patient transport but would not cover every peak in activity. Any change to this would require funding to be found from elsewhere.

Amount of data provided and blame culture: A Member felt that the data provided in the report was not comprehensive enough, particularly in relation to Key Performance Indicators (KPIs) and complaints. They were also concerned that there appeared to be a blame culture whereby individual staff were blamed for system failure. The Accountable Officer said that there was no attempt to hide data and that he had taken the decision not to provide more detailed information in the report. Local G4S management personnel had been replaced following discussion with commissioners. This decision was based upon it being considered that the new management team had skills better suited to delivering the service required.

Personal experience of patient transport service: A Member shared his personal experience of the patient transport service while his partner had been seriously ill and had required transport to London hospitals. The Member’s need to travel with his partner had been questioned, although this had ultimately been resolved satisfactorily. Transport had initially been provided by a G4S team based in Kent and subsequently by a London based team. Transport for journeys to hospital had normally arrived in good time but there had often been delays of two to three hours when returning home. There had often been several other patients in the ambulance resulting in there being inadequate space for the Member’s partner, given that she had needed to be transported on a stretcher.

The Accountable Officer said that transport to all London trusts had initially been incorporated into the G4S contract. With the exception of Guys and Kings, responsibility for transport to London hospitals had now been transferred to the trusts. A list of patients who had been provided with a poor service on more than one occasion had been made. These patients would be prioritised in the future. It was recognised that the service from Kent to London hospitals remained poor and it was possible that this would be removed from the G4S contract in the future. Patient transport had historically being treated as a standalone cost that needed to be contained but there was now a growing realisation that it should be considered as part of the wider healthcare system.

A Member noted that there was an expectation that once a contract had been signed, it would be fulfilled and that it was up to the commissioner to ensure that this happened.

Decision

Members considered and commented on the update provided and agreed that a further update should be presented to the Committee in January 2018.