This project was for the development of a rural health transport co-ordination pilot in the South Cotswold District of Gloucestershire, England.
The idea for the pilot was first conceived during discussions between senior management staff of the Gloucestershire Ambulance Service National Health Service Trust (GAS) and Cotswold Council for Voluntary Service (CCVS), formerly South Cotswold Council for Voluntary Service, at a time when the eligibility criteria for Patient Transport Services (PTS) was under review. This review, which commenced in 1999 and was implemented in 2000, resulted in the criteria for PTS being tightened, at the time creating tension between GAS and a number of the (voluntary) social car schemes in the County who were concerned they would be left to “fill the gap”. However GAS and CCVS saw the solution to this to lie in closer working between them and wanted to examine how this might best be achieved.
A desk exercise to examine the schedules of GAS and the CCVS social car scheme journeys to hospital at the time, suggested there could be scope for up to 30% savings in the use of vehicle resources if the demands met by both operators were co-ordinated.
The aim established for the pilot was:
“Through the co-ordinated use of GAS non-emergency ambulances and volunteer drivers with the CCVS social car scheme, to provide more transport, to more patients and to more diverse medical destinations, than is currently possible with the services operating separately.”
Its overall objectives were:
- to investigate the potential savings in transport costs for providers;
- to examine the possibility of using such savings to allow for more journeys and to address issues of social exclusion;
- to identify any other benefits of co-ordination;
- to identify any barriers to co-ordination;
- to produce recommendations for the future operation of similar schemes and the possible extension of the project scheme into neighbouring counties.
- Stage 1 - familiarisation and design, including the specification of appropriate IT systems;
- Stage 2 - consultation on design; procurement and installation (including training) of the IT systems; implementation and monitoring of integrated operations; adjusting systems as appropriate;
- Stage 3 - assessing the feasibility of using volunteer driver down time more productively through the use of communications technology; implementing and monitoring any subsequent changes in operations; identifying any other opportunities for closer integration between CCVS and GAS, implementing and monitoring accordingly.
The pilot achieved some significant success in terms of co-ordination, including:
- A more flexible service more able to respond to passenger needs now and better suited to meeting more diverse demands, expected in the future
- Improvements in identification of needs for and provision of social transport
- Improvements (of 11%) in the efficiency of journeys provided by volunteer drivers
- A reduction of, on average, around £3.00 in the costs per journey provided by volunteer drivers
- Reductions in the time surgeries spend arranging transport
- Improvements in the quality of booking systems
- Improvements in provider and passenger liaison
- Improvements in journey time and convenience
- Reductions in the time out-patients spend waiting for transport following an appointment
- Streamlined reimbursement of the Hospital Travel Costs Scheme
- Improvements in the recruitment and support available to volunteer drivers, resulting in an increase in the number of volunteers available from 24 to 64
- Increased capacity to provide for after-hours services, transport of samples, hospital transfers, etc
- Improved co-ordination through base to driver communications.
In addition to the benefits of co-ordination identified there have been a number of further benefits obtained as a result of the pilot being undertaken. These include:
- Base to driver communication improvements
- Drivers Manual and health and safety procedures produced
- Formal procedures for driver and vehicle checks established
- CRB Disclosures introduced for all volunteer drivers
- Increased links with GCC (including specific support for driver & vehicle checks)
- Improved monitoring data and systems
- Improved accuracy of driver claims
- Improved awareness and understanding of health transport systems, parameters and procedures
- Raised profile of providers involved.
There are now solid foundations laid for partnership working between GAS, CCVS and health trusts and there are clear signs that co-ordination has increased efficiency in the use of volunteer cars. C1 medical and social demand is being co
It was recommended that co-ordinated operations should continue and this remains the case as of January 2009. It was also recommended that in doing so the project should include examination of:
- The means to add to the co-ordination taking place
- Improved IT links (inc online booking)
- Improved links to appointment times
- Opportunities to create capacity to redeploy vehicle resources
- Opportunities to improve capacity for hospital transfers
- Links to other door to door and conventional public transport services
- Links to a central transport demand centre for the County.
However, operations need to be on a larger scale to better engage stakeholders and make benefits more apparent. Expansion would also remove the anomalies caused by the catchment making up only a small part of the area covered, increase co-ordination opportunities and make benefits more measurable. It is therefore also recommended that a clear plan for staged expansion is drawn up, including improved risk management and protocols to manage the transfer of demand, alongside proposals for investment to bring it about.
There have already been a number of potential funders identified to assist investment.
Recommendations included advice on seeking funds from the identified sources, to draw up and test agreements and protocols, to establish a clear plan for staged expansion and to put in place all arrangements necessary to commence expansion in 2006/2007, and further expansion the following year.
In taking forward the recommendations it will be necessary to take into account the following external factors that may impact on the situation:
- General Practitioner doctors (GP's) in Gloucestershire have agreed to continue to book transport until the end of their current contract. After this the plan is to incorporate transport requests into the new system of e-referrals (from GP's to hospital), with the hospital then being responsible for booking the transport to match the appointment. In any area the pilot approach were to be adopted there would be need for someone to assess the criteria of passengers before booking this. Ideally this would continue to be GP's in Gloucestershire, as these are the health staff that first see the potential passenger, know their medical history and therefore are best placed to judge.
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