In August 2002, the Department for Transport (DfT) commissioned consultant Paul Beecham & Associates (PBA) to assist with the development of a rural health transport co-ordination pilot in the South Cotswold District of Gloucestershire. The idea for the pilot was first conceived during discussions between senior management staff of the Gloucestershire Ambulance Service NHS 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 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. I
In addition to the aim and objectives specified in the project brief initial consultation with stakeholders revealed they also had the following aspirations for the project:
- To achieve benefits at no additional cost;
- To obtain more effective use of volunteers and vehicles;
- To provide a better service to passengers and providers;
- To try to reduce costs for end users;
- To demonstrate the prospective benefits of co-ordination to others;
- To examine opportunities to co-ordinate booking of appointments with hospital transport;
- To provide more transport;
- To quantify the savings to the public purse of using volunteers;
- To relieve bed blocking;
- To improve emergency ambulance response times;
- To simplify and streamline the administration of the Fares to Hospital Scheme;
- To examine opportunities for joint working between GCC and health bodies.
The project design phase was undertaken between November 2002 and June 2003. This took a little longer than expected mainly because of the extent of consultation required and some particular difficulties identifying those in the health sector with transport responsibilities. A wide range of stakeholders were consulted both initially on the design requirements and subsequently on the model proposed. A number of different potential co-ordination models were examined. The model eventually adopted divided responsibilities between GAS and CCVS primarily on the basis of expertise, with GAS focussing on booking and scheduling functions and CCVS on management and allocation to volunteers. The following summarises the design chosen:
- All bookings, whether from those with a medical or social need, directed to GAS;
- All volunteer drivers located with CCVS;
- An IT based scheduling tool (KL2) introduced (running alongside existing GAS booking software (PTS 2000));
- Invoicing arrangements introduced for the Hospital Travel Costs scheme, with the agreement of the Department of Health (DoH);
- Base to vehicle communications enhanced through the use of (hands free) mobile phones;
- Common (and enhanced) Quality Standards established;
- Potential links with other door to door services examined (after the event).
The pilot has 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.
The pilot has successfully overcome a number of hurdles both during its design and implementation. Overall these have affected the time it has taken to bring about co-ordination and ultimately prevented it achieving the full extent of co-ordination envisaged for the design model chosen.
However, despite this there are a substantial range of benefits to emerge from the pilot and it is considered that with the modifications that are now in place and proposed it offers a valuable approach to rural transport co-ordination that could usefully be developed and applied elsewhere.