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"There is a better way"

"There is a better way"

That was the message delivered by Ed Potter, Managing Director of Arriva Specialist Mobility, in a speech to highlight the urgent need for greater innovation in both the commissioning and delivery of non-emergency patient transport.

Ed addressed delegates at an event organised by the Community Transport Association (CTA) to launch a thought leadership paper on how quality and sustainability of patient transport services can be achieved through innovation.

The paper was produced by the CTA in partnership with Arriva Transport Solutions. For more information and to read the full report click here.

Below is the full transcipt of Ed's speech, delivered at the Institution of Mechanical Engineers, Westminster, on Tuesday, November, November 21, 2017:

We chose to work with the CTA on this report because we earnestly believe that patient transport needs to transform if it’s going to be sustainable. You only have to look around the sector to see that it’s not working very well at the moment – providers struggle to deliver, and patients don’t always get the service they deserve. But financial sustainability and good patient experience aren’t enemies – in fact you can’t have one without the other. Yet large and small providers, both public and private, are exiting the market because the financial or the reputational cost of staying in it is too high. And when business no longer wants to work in your industry, or can’t afford to, this should provoke serious reflection on the way in which the industry is functioning.

Patient transport is a critical cog in the machinery of the health service. We bring patients in and out of hospital for care which they might not be able to access in any other way. We help to keep the big system flowing by moving patients from one care setting to another. And we form part of patients’ day-to-day experiences of healthcare.

But the way PTS is designed and purchased has to evolve – urgently – if we’re serious about the role of PTS in healthcare, and its sustainability into the future. Despite all the lessons we’ve learnt from years of challenged service delivery, in 2017 commissioners are still releasing specifications for the next five years’ worth of PTS which look like they were written a decade ago – and probably were.

Imagine, for a moment, a busy kitchen in a school which usually caters for a thousand pupils. You wouldn’t expect that kitchen, without any notice or prior warning, suddenly to have to serve 1,500 people. You certainly wouldn’t also expect it to provide some of those 500 extra meals for free. If the kitchen was told to make a thousand hot meals but only 500 pupils chose to dine, you wouldn’t ask for 500 meals’ worth of money back – the kitchen staff would have done the work and the ingredients would be wasted.

This might sound preposterous – but if you substitute the school for the health service, pupils for patients and meals for seats on PTS vehicles, what I’ve described is life in patient transport. Not every now and then, but every single day.

PTS providers across the country are commissioned, with very little scientific insight, to carry out a crudely estimated number of journeys. But the volatile nature of patient transport means that the number and the profile of these journeys fluctuates wildly. It’s not unusual for a provider to be faced with the challenge of having too many ambulances available, and too few, in the course of the same day. Now, a provider usually only gets paid for patients it actually transports – so planning responsibly and having capacity available that goes unused, because nobody is allowed to have any control over how journeys are booked, is in fact a loss-making exercise. By the same token, if a provider pays overtime or brings in some expensive extra capacity at short notice in order to deal with an unexpected spike in demand, it’s not allowed to charge any kind of premium for those journeys – so again, actually just doing a good job is also probably loss-making.

At really busy times, which might come totally out of the blue, a provider will struggle to transport everyone in a way that meets a key performance indicator. At times like this, journeys that don’t happen on time are statistical failures – even though some patients might really enjoy their journey and might understand the extra wait. The PTS provider is punished because healthcare is difficult and unpredictable. Some patients might be transported on time but because of pressure to deliver, they might not get the usual attentiveness from the ambulance crew. Nonetheless these journeys are statistical successes. Even if, just to make sure a patient travels on time, a provider sends an ambulance with eight seats to make a 40 mile round-trip for that one patient alone, this journey would be seen as a success.

A responsible PTS provider like Arriva would want to work with CT operators to carry out particular cohorts of journeys on its behalf – perhaps a group of regular patients, or patients with sensitive individual needs. But if the main contract holder doesn’t even know if it’s going to break even, it’s understandably hard to make a commitment to another organisation, even if it’s the right thing to do for patient experience and service quality. 

The thing is, there is a better way. With forward-looking CCGs in Nottinghamshire we’re already cautiously exploring serious change, but change is needed system-wide. By redefining measures of success, by allowing some control over demand, by paying and judging providers fairly, and by commissioning for efficiency as well as experience, PTS can be delivered better, and more cost-effectively. Then we can put all our energy into improving quality rather than constantly agonising about whether the service is commercially sustainable. The opportunities for community transport to play a big role in this modernised model are big and wide-ranging, and I’m excited to be able to contribute to this debate so we can help the whole industry mature and improve.


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