Delivering non-emergency patient transport

James Coe, policy and public affairs executive at the Community Transport Association, discusses the benefits of pursuing a ‘Total Transport’ approach to non-emergency patient transport

Community Transport Association’s and Urban Transport Group’s latest paper, Total Transport: A Better Approach to Commissioning Non-Emergency Patient Transport, shows that by taking a ‘Total Transport’ approach to non-emergency patient transport’ (NEPT), the NHS could save millions through better commissioning practices, and patients could receive more suitable transport to and from health settings.

The Community Transport Association (CTA) is a national charity working with over 1,600 charities and community groups across the UK that all provide local transport services that fulfil a social purpose and community benefit. Community transport is about providing flexible and accessible community-led solutions in response to unmet local transport needs, and often represents the only means of transport for many vulnerable and isolated people.

Every year, at least £150 million is provided by the NHS to individual local clinical commissioning groups to provide NEPT. These journeys are commissioned by NHS trusts or Clinical Commissioning Groups (CCGs) who tender services to a mixture of private providers, in house fleets, and not-for-profit transport providers such as community transport operators.

NEPT services provide eligible patients who require non-urgent and planned treatment with free transport to an NHS site. It is intended for patients where medical or mobility needs mean that it would be detrimental to their condition or recovery if they were to travel by other means. This may be, for example, because they need staff support during or after the journey or because their level of mobility means they would be otherwise unable to access healthcare.

Total transport
CTA’s own surveying found 74 per cent of community transport operators in England worked in providing transport to health settings but only 24 per cent were remunerated by any local NHS body. Moreover, funding is vital for all charities but often community transport operators feel a lack of recognition of the work that community transport does within this area which is of equal concern.

CTA is aware that much of their members work will be off the radar of health service commissioners, evidenced by this disconnect between the number of charities helping people to reach health settings and those that are remunerated or recognised for the work. This is also an indication that hospital transport services are not being coordinated in a way that makes the most of the plurality of patient transport provision.

There is no set model or scale for taking a ‘Total Transport’ approach to NEPT. Some local authorities and CCG’s are exploring retain separate fleets but coordinating services centrally through a joint booking line. Other models aim to fully integrate their fleets and budgets into a shared pool. Ultimately, the model selected should fit local circumstances, taking account of where NEPT is coordinated and who manages the NEPT budget. At its heart ‘Total Transport’ involves working across different areas of public policy and spending divides to deliver better outcomes for communities and taxpayers through the sharing of resources and expertise.

This is why CTA wanted to champion the importance of community transport and those members who are already delivering more efficient use of vehicles, which not only provide a better experience for patients but are making significant savings to the public purse. CTA’s and Urban Transport Group’s report, Total Transport: A Better Approach to Commissioning Non-Emergency Patient Transport?, examines how NEPT is currently commissioned and how a Total Transport approach could lead to improvements in efficiency, value for money and passenger experience

CTA hope this briefing is used as a tool for community transport operators across the country to discuss how they can play a role in delivering NEPT in their area. In addition, it’s hoped that this report will start new conversations on how CCG’s can engage with a broader plurality of providers in commissioning patient transport.

CTA believe that patient transport can be commissioned more effectively through a number of steps. A more coordinated, cross sector ‘Total Transport’ approach to the provision of patient transport could help ensure that patients are provided with vehicles suited to their needs; that fleets owned or commissioned by the public sector are fully utilised; and that patients get to and from where they need to be in a timely manner. Applying this model to health, ‘Total Transport’ would see multiple fleets brought together in a shared pool (and potentially a single budget,) and under a single point of access.

These services would be commissioned centrally, allowing them to be coordinated with appointment times, ensuring the right vehicle is deployed, and down time is better used. Directly involving local authorities in NEPT could help bring a wealth of expertise and experience to its delivery. Indeed, whilst it is usually commissioned by the NHS, NEPT has more in common with the social care transport commissioned by local authorities or with community transport than it does with emergency ambulances.

Service integration
This paper estimates that a more integrated transport service which prevented only 10 per cent of the 5.6 million missed hospital appointments each year could save the NHS £74.5m per year. This is the equivalent to; 83 new MRI scanners; 8,793 heart bypasses; or 13, 252 hip replacements. Despite some of the difficulties in adopting a new approach to transport commissioning, there have already been some benefits realised in NEPT provision. There has been a number of ‘Total Transport’ pilots and a number of long-standing integrated transport schemes, which means there is now a growing bank of good practice and experience to draw upon which should assist in overcoming many of the challenges identified.

In particular, there are already examples of the great work community transport does in health. For example, North Herts CVS recently expanded their services to take over the voluntary car scheme at their local NHS Trust, Lister Hospital, in Stevenage. They doubled their number of drivers, and saw a massive increase in demand with 900 new service users registering with them last year.

This is just one example of what can be achieved when services are integrated, and the appropriate service providers are in place to offer NEPT. The quality and efficiency of health related transport could be markedly improved through more innovative models of commissioning delivery which build cross-sector partnerships and networks of provision where people are transported in a vehicle and service most appropriate to their own circumstances and needs.

Community transport’s contribution to the health service, however, is about much more than helping manage demand and capacity. It is about giving people who are already feeling anxious one less thing to worry about through a service they trust and is more personal to them, meaning care starts at the front door of their home and not the waiting room.

CTA will shortly be publishing another paper which looks in greater depth at innovations in provision and exploring ideas for creating a stronger role for community transport organisations within patient transport services.