For the last two weeks I've been in the UK. My mother, aged 94, is having outpatient hospital treatment which means she has to go to the Churchill Hospital, Oxford each Monday – Friday for three weeks. (Fifteen treatments all told). I go with her. It's a fascinating exercise in trying to guess the organizational design alignment (or not) behind the scenes.
The service is run by South Central Ambulance Service NHS Trust (SCAS) . From their website I learned that they "signed a two-year contract, with NHS Oxfordshire to manage Oxfordshire patients' eligibility for non emergency transport by the ambulance service from 1 June 2010. In April 2010 SCAS undertook 24,053 patient transport journeys. SCAS' Patient Transport Service regularly receives around 4,000 telephone calls a week" And from another NHS Oxfordshire website I found out that:
"The service is free and is provided to enable patients to get to appointments in out patient departments or for minor treatments or investigations. It is available for patients registered within NHS Oxfordshire travelling within the areas of Oxfordshire, Buckinghamshire and Berkshire.
The patient transport service costs the NHS in Oxfordshire over £3 million a year and in the last financial year we spent £350,000 of this on patients who were able to use 'walk on' transport. That is patients who could travel by car and need no assistance in getting in and out of a vehicle. We think that we can save as much as £200,000 by tightening up on who can use this service."
On the NHS "Have your say" website members of the public are invited to "Influence change in your local NHS – Tell us what you think about the patient transport service." Good enough so here goes.
Scheduling: In the 20 – 10 out and 10 back – trips we have made (19 together, once I went by bus for reasons I will explain in a moment) we have had the same driver out/back only once, and a second driver twice so that means we have had 18 different drivers. Some come with a second driver and some don't. I haven't found out why this is yet. Drivers work a shift pattern – and are deployed from any one of several depots in the area. They get their work schedule for the day when they report to work each morning.
Scheduling involves not just routes and pick-ups but also patient mobility considerations – some are on stretchers, some need a wheelchair from their door to the vehicle, some are in electric wheelchairs of their own, and some (my mother included) can walk to the vehicle themselves. Someone, somewhere is working out who and how many can fit onto each vehicle by pick up on what one driver described as the 'back of an envelope' IT system.
- Split off the regularly transported patients from the one-off transported for scheduling purposes. This could mean more efficient route planning and less patient wait time.
- Schedule by geographic proximity of patient to patient – this seems obvious but doesn't happen consistently.
- Have different interior designs for vehicles to have a flexibility of use. All the vehicles I've been in have had the same layout.
Pick up window: We have been told to expect a pick up from the house anytime between 8:30 and 11:00 for a 10:00 appointment. That's ok except my mother grimly noted having waited till close on 11:00 one morning and angsting madly about missing her 10:00 appointment that "it certainly is patient transport. I've never had to be so patient!" On the other hand on Friday the pick up came – for the first time ever – at 8:30 before my mother was quite ready. Thinking quickly she both rang me (I am staying nearby) to tell me she was setting off, and threw her toothbrush and toothpaste into her purse in order to clean her teeth when she got to the hospital. In fact I got to her place while she was walking to the vehicle so we went together.
- Send text alerts to patients to tell them where the vehicle is and how long they can expect to wait. Airlines, taxis, and buses can all do this – so could the SCAS' Patient Transport Service. (Twice the drivers have telephoned to let us know when they will arrive. This is great service).
Routes: Because of the vagaries of Oxford City Council taxis and buses are allowed down the High Street but other vehicles (including SCAS' Patient Transport Service ones) are not. Some drivers ignore this regulation – noticeably mainly the women drivers – and go down the High Street, saving time and gas. Others comply meaning a long trip around the ring road.
In fact in the 19 trips I have been in the vehicle I think we have done 16 different routes from A to B. I am getting to know the city quite well, and learning my own form of patience when my mother comments at every junction and turning: "No driver in their right mind would take this route. It's ridiculous." I did in fact run up one last Saturday from her house to the hospital to check the distance. It is 2.45 miles but I estimate that we usually drive between 6 and 10 to get there from her house. I asked drivers if they have GPS systems for route planning but they don't
- Lobby Oxford City Council to allow NHS Patient Transport to use the High Street. It seems odd that a vehicle carrying several patients does not fall under the same regulations as a bus or taxi. (My mother and I are going to write to the Council on this).
- Work out how much would be saved in gas costs by taking the High Street route through the city. Make this part of the business case.
- Get GPS systems for vehicles and encourage the shortest route from A to B to save as much gas as possible.
Qualifying patients: I think the service is right in saying that people seriously capable of taking a bus or car should not be eligible to use the service. However, some caveats. There is no bus service to the Churchill departments that many patients go to – it has just been axed. Car parking is very expensive not very available, and a good walk from the hospital building (much as airport parking but without the shuttle buses). So people who can walk but have limited mobility would find this very hard. Having to take more than one bus would make it very difficult for some people, so the qualifying statement about 'walking' needs to be refined and thought through. (The money could be saved by gas savings on smarter routes and planning)
I did think of renting a car to take my mother to the hospital to avoid using the Transport Service but I discovered that if I dropped her off at the right entrance and went to park the car she could not easily find her way to the right reception area. If we parked and walked together it was too long a walk for her. I don't think I need to be with her in the vehicle as I could bike there and back and be at both A and B points before the vehicle even setting off at the same time. (See routes comment above).
However, my mother asked for an escort and although the Day 1 people said it was not on their manifest sheet they allowed me out but not back. So on day two the outward journey I went by bus, but on the return and on subsequent days all had me on the manifest sheet, saying I was allowed because of my mother's age – even though one of the drivers did describe her as 'spritely' and she utterly refuses to use their wheelchair to get from the house to the vehicle.
- Set up some form of SCAS' Patient Transport Service car-pool website where people could ask for rides from others who were driving in. Much as a commuter car-pool operates.
- Charge people the same as they would pay if they did go by bus to their appointment. It may not be a lot of money but it would help some. (If the political outcry could be managed when this was suggested).
- Work out the cost/benefit of shuttle buses from the car parking areas – would this mean fewer people asking for Patient Transport?
So a week to go on this, meanwhile my mother is bearing up extremely well all things considered. And despite my suggestions I am tremendously impressed with the Patient Transport service, the professionalism and friendliness of the drivers, and the fact that it actually works well most of the time.