Agenda item

1.1.        The Committee considered a report which provided a further update on the performance of the Patient Transport Service (PTS) in Sussex.

1.2.        Wendy Carberry, Chief Officer; Alan Beasley, Chief Finance Officer; and Sally Smith, Director of Delivery, attended on behalf of High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG). Michael Clayton, Chief Executive, attended on behalf of Coperforma.

Accuracy of PTS data

1.3.        HOSC asked what the PTS data anomalies were; why there was a mismatch between the large improvements in the data and the continued negative anecdotes HOSC members have been receiving; how occasions when no ambulance arrived for a booked journey were recorded; and to what extent HWLH CCG trusted the data it received.

1.4.        Michael Clayton said that all journeys which do not meet the standards agreed in the service level agreement are recorded by Coperforma as ‘service exceptions’. They are then categorised on their severity and investigated accordingly – the categories are critical, high, medium or low. Medium or low exceptions are dealt with together whereas each high or critical level exception – for example, a vehicle not arriving at all – is investigated individually. The continuous improvement team works together with the operations team to record and resolve the service exceptions.

1.5.        Alan Beasley confirmed that Coperforma is providing the data as requested by the CCG. The data is of a good quality but it requires further analysis, which is being undertaken by the specialist Patient Transport Advisor who has now been recruited by the CCG. The Patient Transport Advisor had identified data anomalies and is working with Coperforma to understand whether the anomalies represent issues with the service or faulty recording methods. These findings will be fed into the CCG’s contractual discussions with Coperforma.

1.6.        Wendy Carberry added that the PTS contract specifies exactly what information the providers must provide to CCGs, rather than this being determined by the provider. One of the performance notices issued to Coperforma was around the data being provided. The CCG also triangulates Coperforma data with other sources, such as feedback from Trusts, in order to gain assurance about its accuracy.

1.7.        Alan Beasley said that HWLH CCG had not seen any evidence from the data that if one patient’s pick-up slot is missed they are then de-prioritised in favour of a different patient on the grounds that the target had already been missed. 

Complaints about PTS

1.8.        HOSC asked how the CCGs are recording and addressing complaints about the PTS.

1.9.        Sally Smith said that reports from patients about delays to their patient transport appointments are classed in the CCG’s complaints process as ‘incidents’. CCGs analyse the complaints through their Patient Safety Groups –whose remit is to investigate incidents and complaints. All acute trusts and other healthcare providers have an incident reporting process and any complaints about the PTS made to them are shared with Coperforma. HWLH CCG also holds a monthly forum with the patient transport leads of all acute trusts that use the PTS service to consider the number and nature of the complaints; whether there are trends; and how the acute trusts feel about the impact on the patients in their units and hospitals. Sally Smith said that the number of incidents has gone down and patients are generally reporting that the service improvement is being maintained.

Future procurement processes

1.10.      HOSC asked HWLH CCG what lessons had been learnt from the PTS procurement which could be applied to similar future commissioning processes.

1.11.      Alan Beasley said that the two key lessons for any future procurement process were:

·         ensure that the commissioner has access to specialist advice from a provider perspective as well as on the commissioning side.

·         when there is a change in both service provider and service delivery model, the service change should be implemented in phases to reduce the risk to the service.

Recognising impact on patients

1.12.      HOSC asked whether the CCG recognised the stress the failures in service had caused patients.

1.13.      Sally Smith said that although the ongoing investigation led by a GP had not identified any physical harm, HWLH CCG fully recognised the stress the quality of the service had caused patients.

Training requirements for subcontractors

1.14.      HOSC asked what training is required of subcontractor staff, and how standards are monitored.

1.15.      Sally Smith said that HWLH CCG has written into the PTS contract that Coperforma, as managed service provider, must fulfil certain training obligations. Michael Clayton confirmed that all subcontractors go through a training programme and they are assessed before the contract goes live, and assessed via random spot reviews after the service has commenced. The outcomes of service exception reports are also fed back to the relevant subcontractors, and performance data is reviewed with all subcontractors on a monthly basis. Michael Clayton confirmed that two subcontractors had contracts terminated since April (out of 22).

1.16.      Sally Smith said that the CCG’s monitoring arrangements require Coperforma to provide evidence that its subcontractors are registered with CQC and Monitor; quality and safety checks have been performed on the vehicles; and training records of staff are available. HWLH CGG’s Patient Transport Advisor will also visit Coperforma and its subcontractors to corroborate this evidence.

ICT system used by Coperforma

1.17.      HOSC asked whether the ICT system used by Coperforma was fit for purpose.

1.18.      Michael Clayton said that there were no concerns about the ICT system and he was confident that it provided all of the information that is needed in a suitable format for both Coperforma’s operations team and its commissioners.  Sally Smith added that HWLH CCG’s Patient Transport Advisor will check whether the ICT system is fit for purpose when he visits Coperforma’s operations team.

Reason for continued delays

1.19.      HOSC asked why vehicles continue not to arrive on time.

1.20.      Michael Clayton said that there are a large number of reasons for vehicles running late, for example, heavy traffic, breakdowns, weather or staff sickness. He said that these are underlying issues with patient transport and would occur regardless of whether the service is provided in house or by subcontractors.

1.21.      Michael Clayton said that any provider should track each and every incident and be diligent about identifying the route cause. He said Coperforma had recorded each incident of lateness as a service exception and analyse it to discern whether there are lessons that can be learned which had led to service improvements. Contingency plans

1.22.      HOSC asked what contingency plans were in place in the event of another major issue such as the loss of a subcontractor, or the failure of the overall contract.

1.23.      Wendy Carberry said that HWLH CCG had put in place contingency plans for a number of scenarios including if the service were to cease immediately, or if a single subcontractor failed. These plans are built around the way the service was delivered previously and HWLH CCG has had discussions with transport providers to make sure that arrangements can be put in place.

1.24.      Michael Clayton added that Coperforma had planned to have surplus capacity in the first year of the contract as a contingency and this had made it possible to absorb some of the issues that have emerged since the contract started, for example the loss of two subcontractors. However, not all reasons for lateness can be resolved by having surplus capacity.

Scheduling of travel times

1.25.      HOSC asked whether the travel times allowed for vehicles to reach patients was causing problems with performance, and whether sending vehicles to patients closer to them would improve travel times.

1.26.      Michael Clayton agreed that scheduling was a key aspect of the PTS. When the contract was set up, Coperforma estimated the average journey time based on road information provided by third party sources. As part of the process, when a service exception is caused by a vehicle arriving late, Coperforma reviews its proposed journey time and compares it to the actual time it took. After three months of the service being in operation the original estimates now appear to have been optimistic, particularly around the coastal area. As a result, most of the estimated journey times built into the software used by Coperforma have been increased by nearly 60%, allowing drivers longer to reach their pick-up point. The settings in the system can also be changed to account for potential bad weather to allow more precise scheduling.

Procurement process

1.27.      HOSC asked a number of questions about the procurement process, the additional costs of the contract to the CCGs, and whether Coperforma was willing to pay for patients who have missed appoints to see a consultant privately.

1.28.      Alan Beasley noted that the procurement process had been subject to an independent report and it had been discussed at HOSC previously. He reiterated that the previous contract had come to a natural end so it was not the case that a decision was made proactively to outsource the contract.

1.29.      Alan Beasley said that HWLH CCG agreed a fixed cost envelope as part of the contract but some additional costs have been incurred for management, oversight and scrutiny of the contract, for example, for the independent investigation into the procurement process.

1.30.      Michael Clayton said he would look into whether it is feasible to pay for private consultants. He said that Coperforma has paid considerable sums to reimburse patients who have had to make their own travel arrangements. Alan Beasley said that HWLH CGG agreed a programme budget with Coperforma that included an agreement that Coperforma would reimburse additional transport costs incurred by healthcare trusts as a result of the PTS performance issues.

Contract specification

1.31.      HOSC asked what weighting was given to performance during the procurement process; and whether the CCGs believe that the budget was enough, or the service provided was as good as could be expected within the financial envelope.

1.32.      Alan Beasley said that the ratification report has been published in full and that describes the weighting and scoring system: finance was 20% of the overall score and 80% was issues around service quality, clinical safety etc. The report also says that no potential provider chose not to submit a tender due to the financial envelope.

1.33.      He reiterated that the financial envelope for the new PTS contract was the same as the previous contract, but there was an expectation that increased demand for PTS services over the period of the contract would be absorbed by the new provider by making efficiencies. The contract did not allow the provider to deliver this efficiency by increasing the eligibility criteria for patients to receive patient transport.

1.34.      Alan Beasley accepted that the increased demand for a service with the same budget amounted to a reduced expense by the CCGs for each person using the service. He explained that there was an inbuilt 2% efficiency in all new NHS contracts and this would be the same for any other contract.

Contract management

1.35.      HOSC asked what the level of failure would need to be for the contract to be terminated.

1.36.      Wendy Carberry said the NHS contract encourages the CCG and provider to work together to try and make the service work for the local population. CCGs do not want to change service providers as it has an impact on patients, but HWLH CCG is using all levers within the contact, for example, it has served some contract performance notices and a breach notice on Coperforma.

1.37.      Wendy Carberry said that the Key Performance Indicators (KPIs) in the contract are not set at 100%, so even if Coperforma meets all targets, there will still be some people who do not receive the service that the CCGs want; this is similar to the 95% target for A&E waiting times.

1.38.      Wendy Carberry said that the feedback from a visit by HWLH CCG to patients and staff at the renal unit in Crawley was that the service was getting better and was comparable to the service offered to patients from Surrey by a different provider.

Coperforma shareholder

1.39.      HOSC asked for comment on the Chair of Coperforma’s position as a shareholder in a British Virgin Islands company.

1.40.      Michael Clayton confirmed that the Chairman is an international investor who invests in hospital groups in China, USA and UK and that his details are on the Coperforma website.

Payment of Docklands Medical Services employees

1.41.      HOSC asked for confirmation of when Docklands Medical Services employees will be paid.

1.42.      Alan Beasley said that the matter was being treated by HWLH CCG with the utmost urgency. The CCG had funds available to make the payments but the payroll was being processed independently and it was the receipt of payroll information that would determine when staff were paid. Alan Beasley said he was working directly with the unions GMB and Unison who are collating the payroll information and engaging with the payroll provider.

Effect on emergency ambulance services

1.43.      HOSC asked whether there had been an impact from the PTS issues on  emergency ambulance services provided by South East Coast Ambulance Service NHS Foundation Trust (SECAmb).

1.44.      Wendy Carberry said that she had not had any communication from SECAmb to say that there had been any effect.

1.45.      The Committee RESOLVED to:

1)            Request that Coperforma provide the number of critical incidents where no transport has arrived for a booked journey.

2)            Request that HWLH CCG provide figures for the number of incidents being investigated as safeguarding concerns

3)            Request that HWLH CCG provide comparative figures for the number of service users before and after the new PTS contract.

4)            Request a further update on PTS at the 1 December 2016 HOSC meeting.