Agenda item

1.1.        The Committee considered a report by the Assistant Chief Executive, East Sussex County Council, on the performance of the Patient Transport Service (PTS) in Sussex following a change of provider on 1 April 2016.

1.2.        High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG) and Coperforma apologised unreservedly for the failures of the PTS since 1 April, and promised to look at the learning from the independent incident review.

1.3.        Michael Clayton, Managing Director of Coperforma, updated HOSC regarding a meeting on 29 June following the news that VM Langford (a provider of ambulances for the PTS) had gone into administration. At the meeting Coperforma met with staff-side representatives and local management to assure staff that, whatever happened to VM Langfords, their pay, staff benefits, and pension contributions for June would be funded by Coperforma. All staff would also be able to take employment with designated Coperforma ambulance providers in the area that would protect their terms and conditions. Staff-side representatives were comfortable with the proposed changes and staff were appreciative.

1.4.        HOSC expressed concern at the performance of the PTS over recent weeks and more than one HOSC member spoke about the effect the PTS had on local residents who had contacted them directly with their experiences of the service.

1.5.        The Committee asked the witnesses from HWLH CCG, Coperforma and South East Coast Ambulance Service NHS Foundation Trust (SECAmb) a number of questions relating to the Patient Transport Service.

The tendering process and due diligence by CCGs

1.6.        HOSC queried the extent to which HWLH CCG had carried out due diligence on Coperforma, and asked whether the CCG was concerned that there was only one formal tender. The Committee also asked whether the CCG had considered the concerns of the GMB trade union about the tendering process.

1.7.        Alan Beasley, Chief Finance Officer, HWLH CCG, said that although Coperforma was the only organisation that submitted a final tender, the CCGs had looked into why the two other organisations which were invited to tender did not ultimately submit a bid. The feedback from SECAmb was that the Trust could not provide a substantive bid within the financial envelope that was offered. Arriva Transport Ltd. responded that it did not have the capacity to submit a tender in line with the timescale required.

1.8.        Alan Beasley did not take the view that the issues with the performance of the contract since 1 April were due to the funding provided by the CCGs for providing the PTS. He said that Coperforma did not express concerns about the funding offer during the tendering process.

1.9.        Alan Beasley assured the Committee that, although only one tender was submitted, the same process was followed as if there had been multiple submissions, for example, the same financial evaluations and due diligence.

1.10.      Alan Beasley said that HWLH CGG did review the capacity and capability of Coperforma and in turn Coperforma reviewed the capacity and capability of its subcontractors. Assurance was given by Coperforma for each main subcontractor, alongside HWLH CCG’s own high level financial viability checks, which allowed the CCG to be able to embed them within the contract. Because VM Langfords was a going concern when it went into receivership, the finances may not have been the focus of the problems at that company.

1.11.      Alan Beasley added that the independent investigation into the PTS transition will look at the due diligence the CCGs undertook and he recommended that HOSC wait to consider the conclusions of that review.

1.12.      Wendy Carberry, Chief Officer, HWLH CCG, said that content of the GMB letter was reviewed at a programme board meeting against the assurance process that was in place and decisions were made at the programme board accordingly. She confirmed that there was a response to the letter by the CCGs.

Use of subcontractors

1.13.      HOSC asked why the CCG did not see any inherent risk in the proposed structure of commissioning a managed service provider (Coperforma) that would then subcontract the patient transport provision to other providers.

1.14.      Alan Beasley said that the previous PTS contract with SECAmb involved around 20% of journeys being undertaken by private sector vehicles. The issues since 1 April were system wide and to say that they were wholly due to the subcontractors was not a fair statement. The independent investigation has looked at all areas and was unlikely to conclude that fault lay entirely with the subcontractors.

1.15.      Michael Clayton said that the contract involved 18 subcontractors to allow flexibility and resilience in the service. This meant that although Coperforma did not predict the failure of VM Langford, the broad range of providers allowed Coperforma to put the work and staff onto other providers to avoid the receivership having a detrimental effect on the service.

Due diligence by Coperforma

1.16.      HOSC asked the extent to which Coperforma had conducted due diligence on its subcontractors and how it could be sure that more subcontractors would not go into receivership like V M Langfords.

1.17.      Michael Clayton said that Coperforma’s Clinical Assurance Team puts all potential subcontractors through a quality assessment review that looks at the company and its directors, its attitude to continuous improvement and its willingness to work in an open and transparent way. The review also includes an inspection of the vehicles, crews, and crew training records.

1.18.      Michael Clayton said that Coperforma undertook detailed financial analysis of VM Langfords. The organisation had been working successfully with Coperforma for five years. A reinvestigation by Coperforma was triggered by the arrival of new management following an aggressive takeover of the company. It became clear during mid-May that Coperforma had concerns about the new management and their ability to deliver on promises to grow the company. A contingency plan was then put in place for the 70 staff who would potentially be affected, which has now been successfully implemented. Mr Clayton said that it was unlikely that the other providers would go into receivership in the same way as VM Langford, as its receivership has raised concerns about aggressive takeovers for companies that were growing well and is likely to put off other providers from following suit.

SECAmb decisions and changes to the contract

1.19.      HOSC asked why SECAmb gave notice on the previous contract and whether its decision not to bid for the new contract should have concerned HWLH CCG.

1.20.      Alan Beasley clarified that the contract was coming to the end of its original term and SECAmb was entitled not to continue with the contract under its existing terms and conditions. He assured HOSC that the contract was not redesigned as a cost saving measure. The financial envelope offered was the same as the previous contract and no additional activity was added. However, there were more challenging performance indicators than in the previous contract meaning that the new provider would be expected to achieve higher standards for the same amount of money. Wendy Carberry added that HWLH CCG had benchmarked what CCGs spent on PTS contracts and the Sussex contract was mid-range.

1.21.      Alan Beasley confirmed that there is a continual growth in the number of people using PTS. The Patient Transport Bureau operated a ‘paper-driven’ service, so there was an expectation that Coperforma’s use of an ICT-driven service would absorb the impact of this growth in demand over the coming five years.

1.22.      Geraint Davies, Acting Chief Executive, SECAmb, explained that the contract was extended for a year beyond its original end date, enabling the CCG to develop a revised service specification and commission the new service. Mr Davies added that SECAmb did raise some concerns about the standards the CCGs were requesting, and the costs associated with those standards, which were fed back to the CCGs.

1.23.      Geraint Davies explained that SECAmb did not wish to bid for the contract to be the managed service provider, i.e. the provider that manages subcontractors that in turn provide the patient transport – in effect a “booking agency”. SECAmb did, however, consider taking on the role of one of the subcontractors providing the transport, as this is the Trust’s core business. Once the managed service provider contract was awarded to Coperforma, SECAmb entered discussions with them as a potential subcontractor, but concluded that the terms were not commercially viable for the Trust.

1.24.      Geraint Davies clarified that the equivalent of the managed service provider for the previous PTS was the Patient Transport Bureau – managed by the CCGs – and SECAmb was a service provider directly commissioned by the CCGs, rather than subcontracted by the Patient Transport Bureau.

Responsibility for the decision

1.25.      HOSC asked who was responsible for the decision to award Coperforma with the contract.

1.26.      Wendy Carberry said that the decision about awarding the contract to Coperforma was made by a programme board with representatives of all seven Sussex CCGs that was then ratified by each CCG Governing Body. There was no one person responsible for the decision. The procurement process was coordinated by HWLH CCG and the decision making process was through the programme board.

1.27.      HOSC questioned whether spreading the responsibility for designing  and awarding the contract across multiple CCGs through the programme board had led to failures in the process. 

1.28.      Alan Beasley explained that the skill sets of the predecessor Primary Care Trusts have been spread out over seven CCGs. The ability to draw skills from other organisations onto the project team was very important for this project and the difficulty in co-ordinating staff from seven CCGs was compensated by the access gained to the skilled staff within those CCGs.

Learning from previous contracts

1.29.      HOSC asked whether HWLH CCG had taken lessons from the previous PTS contract into account when drafting the PTS contract.

1.30.      Alan Beasley said that an EU procurement process had to be followed as the contract was over a certain value, and HWLH CCG used external procurement specialists to assist with the process. However, there were lessons that were learned from the previous contract because a significant part of the engagement process with stakeholders involved seeking feedback on the existing service. This feedback was then taken on board for the new PTS contract, for example, the timeliness of the previous service informed the performance indicators of the new contract.

Mobilisation and transition arrangements

1.31.      HOSC queried the robustness of the transitional arrangements, in particular arrangements to ensure the most vulnerable people were safeguarded.

1.32.      Sally Smith, HWLH CCG, said that as part of the procurement process, Coperforma provided a detailed mobilisation plan that covered all of the areas to be addressed during the transition. For example, TUPE arrangements for transport and support staff transferring from SECAmb, and booking staff transferring from the Patient Transport Bureau; and the technology and ICT around the new service provision and online booking function. The CCG project team agreed the plan. The project team was reporting to the programme board which included directors from all seven CCGs and Coperforma during the transition period.

1.33.      Sally Smith said that during the transition period, HWLH CCG held joint meetings with SECAmb, the other CCGs, Patient Transport Bureau and Coperforma to go through all of the stages of the transition plan and assure the organisations that they were on track and completing all of the necessary actions for a successful transition. Clearly there had been failings in this process as it was not delivering in the way that the CCGs had wished it to, but they were waiting for the independent review for an objective perspective on the transition.

1.34.      Michael Clayton said that Coperforma had put in place an overlay team to train staff transferring to Coperforma (and new staff) on the new computer systems and the more customer focussed role. He said that not all staff did choose to transfer, leading to a shortfall, and some staff who did transfer decided it was not for them and took employment elsewhere. The overlay team provided Coperforma with resilience to cover that shortfall.

1.35.      Michael Clayton said that the data Coperforma was provided with did not allow it to drill down sufficiently to anticipate peaks in demand, and some of those peaks had left Coperforma short of transport at certain points during the day. Coperforma introduced an additional 29 shifts from the end of May to the beginning of June to deal with these peaks in demand, which drove the improvement in performance. By the end of July and beginning of August there will be a further 84 shifts coming on stream which is more than is needed to hit the performance indicators in the contract. This excess number of shifts was a risk contingency designed to help Coperforma manage the risk during the winter months, which were expected to see increased demand on patient transport due to increased travel times and greater health issues.

The purpose of an independent review

1.36.      HOSC questioned the value and purpose of the independent review.

1.37.      Alan Beasley said that the he believed the review to be of value. He explained that the investigation was mandatory because it was a “level 3” investigation that formed part of the serious incident process. Furthermore, the review will result in a ‘lessons learned’ document which would be of value in informing future procurements.

Financial penalties for failure to meet performance indicators

1.38.      HOSC asked whether there was a clause in the contract that meant Coperforma would receive financial penalties for failing to meet required performance standards, and whether there was a clause for terminating the contract.

1.39.      Wendy Carberry explained that HWLH CCG was using the remedial action plan as well as utilising the levers within the standard NHS contract to improve the performance of Coperforma to where it should be. However, contingency plans are also being looked at.

1.40.      Alan Beasley confirmed that there are financial penalties built into the NHS standard contract that would apply for failure to meet targets.

Performance of Coperforma and the reliability of performance data

1.41.      HOSC welcomed the apparent improvement in Coperforma’s performance but questioned how long it would take to reach the full expected standard, and how accurate the data supporting the improvement was.

1.42.      Alan Beasley said that the CCGs had agreed an eight week remedial action plan on Coperforma that lasted until the end of June. It was anticipated that by the end of the first week of July, Coperforma would be close to hitting the performance indicators in the contract. He said, however, that HWLH CCG now had to consider the impact of the VM Langford receivership – which took place during the remedial action plan period – on the trajectory for improvement and whether there is justification to extend the remedial action plan for one week to mitigate its impact.

1.43.      Alan Beasley said that looking beyond the data it was ultimately people being let down by the service which was unacceptable. He explained that there were 1,000 patient journeys per day, so even if Coperforma was achieving its 95% on time standard then that would be 50 people per day who did not receive the service that they deserved. A key concern for the CCG is that too often the same patients are being affected by delays on multiple occasions.

1.44.      Alan Beasley said that HLWH CCG is working to improve the analysis of performance data. Coperforma had been open in providing the data and it appeared that the data matched the company’s claims regarding performance – both when it improved and when there were issues. The CCG was comfortable that the data presented also reflected qualitative feedback on Coperforma’s performance.

Driver standards and deployment

1.45.      HOSC had heard concerns about a number of patients not being picked up at their designated time by the PTS, particularly early in the morning; alleged driver behaviour, particularly for patients who felt nauseous during the drive; and the requirement that volunteer drivers had to purchase smart phones capable of running a mobile worker application.

1.46.      Michael Clayton  made the following points in response:

·           There are 56 volunteer staff and 230 full time employed staff.

·           early morning transport work is pre-allocated (not allocated on the day) and the issues relating to early morning transportation were being rectified by additional training and earlier shift starts for the earlier journeys.

·           he was particularly concerned at the lack of vomit bowls as this was a requirement and he would look into that particular incident.

·           the London congestion charge was paid for by subcontractors (or reimbursed) and that they should be informing their staff of that fact.

·           one of the reasons for providing a mobile worker application to the drivers was that it has built in satnav. Some volunteer drivers had raised concerns about having to buy a smart phone, but many of the drivers who now use the application like it. The application also allows Coperforma to know driver locations, identify any delays, and is a more effective way of protecting patient identifiable data than paper print outs.

1.47.      The Committee RESOLVED to:

1)    Request a further update on the Patient Transport Service at the 29 September 2016 meeting.

2)    Request comparative data between the current and previous patient transport service contract on:

a.    The unit cost per patient journey

b.    Drivers’ caseloads, e.g., the number of journeys or miles travelled per driver

c.    Management charges

d.    Quality targets

3)    Request a copy of the CCG’s response to  the GMB letter