Getting patients from A to B

Today’s healthcare landscape is in the greatest period of transition since the NHS was established nearly 60 years ago. Virtually every aspect is being put under the microscope, socially, economically and politically, and legislators are making policy decisions which are having irrevocable impact on the future of the independent ambulance industry.

The Care Quality Commission (CQC) has brought the industry under regulation for the first time, setting minimal quality standards of patient transport services. At the same time the new Health & Social Care Bill currently passing into law will change the rules for business procurement, creating opportunities for the private ambulance industry.

Against this backdrop, the Independent Ambulance Association (IAA) was established to give a strong voice to the independent ambulance sector on changing policy matters.

Procurement decisions
Given today’s tough financial climate, what criteria should NHS managers consider when awarding private transport contracts to new suppliers? “The most compelling answer to this question is value for money,” says David Davis, the IAA’s director of communications.

”But in today’s tough economic climate, the easy option is for NHS managers to make their decision based on price alone and go for the lowest tender.

“That said, NHS decision makers also have a special responsibility not only to protect the interests of patients but to ensure that the taxpayers’ funds are being spent well.”

And this is by no means an easy or enviable task, argues Davis. “At present time, healthcare providers only have the CQC quality benchmark to base their service provision on.”

The CQC benchmark explains the rights of patients, including how they should be informed at every stage of their care and the right to receive care that meets their needs, provided by qualified staff.

“There is no perfect, scientific method in awarding contracts, particularly in such sensitive services such as patient transport,” continues Davis. “NHS managers rely heavily on reviewing tick box answers on electronic forms and scoring against predetermined weightings. This might be the quickest and most mathematically accurate route to a final decision but one wonders if they should also take into account the professional reputation and integrity of the company and the commitment and training of the staff that will actually be caring for the patients.”

Potential pitfalls
So what are the problems that could arise when NHS budget managers procure independent ambulance services? “Many problems arise from putting out to tender a badly constructed contract,” explains Davis. ”Such a contract would contain inadequate information and would set unrealistic demands on service delivery targets, as well as fail to recognise the financial value of the operational skills, managerial resources and qualified people required to deliver an efficient, cost-effective patient transport service. A lack of understanding of the fleet and communication technology requirements also make for a potentially flawed contract.

“Falling into any one of these traps will create problems from the outset and could result in a breakdown of trust and confidence between the provider and the hospital staff.”

Outsourcing services
Many hospital trusts recognised several years ago that they could save money and get better service from independent transport providers by putting their needs out to competitive contract instead of relying solely on a regional NHS ambulance service. Davis explains: “Nowadays awarding independent providers contracts after a public tender process or calling them in on an ad-hoc basis has largely become the norm. This is because NHS ambulance services are finding it increasingly difficult to consistently meet the demands on the emergency services.”

Using independent ambulance providers is a win-win situation for both ambulance trusts and patients, finds Davis: “Trusts save money and find the pressure upon their resources is eased, while patients enjoy a better service.

Diverse operations

What type of transporting operation is most appropriate to be outsourced to the private sector? “The simple answer is most,” says Davis. “As a whole, the independent industry is well resourced with qualified ambulance crews and fully-equipped vehicles and aircraft to take on the majority of non-clinical transport operations.

“In any single year, private ambulances undertake millions of journeys, including taking patients to and from home for pre-arranged hospital visits, between hospitals to undergo special treatment, helping A&E with assignments, providing first aid ambulance cover, and repatriating patients from around the world.”

That said, there is a changing perception of what an independent healthcare provider can do. While the work traditionally put out to tender has been non-urgent patient transport there are already a number of organisations that provide higher clinical-need transport. Davis explains: “Many companies operate vehicles which have been specially built to transport patients weighing 30st or more and others run ambulances designed and equipped as mobile intensive care units for critically ill babies and children up to the age of 16.”

Future challenges
“The next 12 months could see a turning point in the relationship between the public and independent sectors,” says Davis. “This is prompted by the recognition from both sides that neither can alone meet all the nation’s surging demands for patient transport services.

“The challenge will be to find the common ground on which both sides can feel comfortable and protected and the IAA has set such a relationship as its prime objective.

“The challenge for the public ambulance service is to look ahead to a future where it can survive and thrive in a professional working relationship with independent colleagues. For the independents the biggest challenge is to win greater political and public acceptance to take its rightful place at the policy decision making table.”

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