High impact actions to improve non-emergency patient transport in
Leicester, Leicestershire and Rutland
Background
This report summarises the insights and high impact actions that emerge from analysis of
the feedback from people who use non-emergency transport (n=43), their family carers and
escorts (n=11), drivers (n=18) and frontline NHS (n=16) and Arriva/PTS (n=5) staff. These
insights are designed to offer positive challenge and help commissioners, providers and
frontline staff in Leicester, Leicestershire and Rutland reflect on how the services they are
currently offering are impacting on people’s lives and their ability to keep well.
The focus commissioning question for this work was:
‘What needs to happen so that patients in Leicester, Leicestershire and Rutland who are
eligible experience effective, safe, appropriate and timely non-emergency transport
services?’
The full set of people and family carer/escort insights can be found in Appendix one to this
report. The full set of driver and frontline staff insight can be found in Appendix two.
What is working well?

Relationship between people and the driving crew
‘Good – no quibble with any of the drivers, we get on well together – feel like mates’
‘Makes you feel better, happy to have a conversation, eases length of time of the journey’
‘Same driver every time. He knows me’
‘Generally good. I know patients, family and history’
Both people and drivers report having good relationships with each other. Drivers are
viewed as friendly, polite and respectful by people who use transport. They feel they are
able to chat with them and build relationships, which improves their journey experience as
it makes them feel relaxed. Having continuity of driver and being a regular user of the
service compounds this. Drivers also find it easiest to build good relationships with regular
users of the service, who are often the renal patients, as they see them often:
‘Regular renal patients, drivers get a fairly close relationship as take them 3 times a week’
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
Help and support from the driving crew
‘Brilliant – come to the front door to collect me and see me back to the front door when I
get home’
‘They always help me to the car and hold the door’
‘Helped in the ambulance, got wheelchair out, make sure he doesn’t fall’
People and family carers/escorts tell us that the help and support they receive from the
driving crew when getting to their appointment is something that is working well. They
particularly appreciate being collected from, and dropped off to, their front door, as well as
being helped in and out of the vehicle. Some people and frontline staff mention that taxi
drivers, as opposed to Arriva drivers, are not as helpful.
Frontline staff also acknowledge the help and support given by drivers:
‘They [drivers] are caring and supportive of patients’
‘Drivers are helpful and friendly’

Driving safely and securely
‘All good drivers – never feel unsafe’
‘Drivers are very reliable – always very good drivers’
‘Not driving too fast. Fastened in properly’
‘Strapped in, safe, cautious, careful driving’
People who use transport and their family carers/ escorts say they appreciate the people in
the transport crew being good drivers, as this makes them feel safe and find their journey
stress free. Family carers and escorts particularly mention the reassurance of knowing their
loved one is strapped in securely.

Hospital booking transport
‘It is already booked by the staff here, usually before you go on dialysis’
‘Hospital booking for me [works well]’
People say that having their transport arranged and booked for them by hospital staff is
something that is working well. If they are regular users of the service because they have
regular appointments, such as for dialysis, they find having their transport booked
automatically useful.
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Frontline staff say they find it useful when transport is booked at least 48 hours in advance,
as this helps them with planning:
‘In community hospital transfers, all journeys are pre-planned in with at least 24 hours
notice’

On time transport
‘They always come on time’
‘Always on time, a good hour at least’
People and family carers/escorts have mixed experiences of the timing and punctuality of
transport, however many report that their transport is on time and is therefore working well
for them because they make their appointments.

The discharge lounge
‘When finished at clinic dropped to discharge lounge. They look after us’
Some people say waiting in the discharge lounge is something that is working well for them,
as they feel well looked after by the staff there. However some family carers and escorts
feel there needs to be more refreshments available in the discharge lounge, particularly
when they are facing long waits.
Discharge lounges are also something that is working well for drivers, as it means patients
that need picking up are all in one place, which saves the driver having to find the right clinic
or ward to collect them from, which in turn prevents delays:
‘At the LRI the discharge lounge works well as we pick up patients from one place’
‘Discharge lounge works well. Patients all in one place’

Notifying drivers when patient is ready for collection
‘Outpatients call to say they are ready for collection, this works really well’
When it happens, drivers say it works well when outpatients, wards or clinics call to let them
know the patient is ready to be collected, as this prevents them arriving too early when the
patient is not ready and reduces the time the patient has to wait. Some frontline staff also
say they find this works well:
‘Staff at the clinic call to let us know when the patient is ready’
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What can we improve?
The community of people who are eligible for patient transport is often very unwell and
living with complex care needs and poor mobility. They are vulnerable and may be prone to
stress and anxiety exacerbating their health issues. A proportion will be frequent users of
the patient transport service. Long waits are impacting on both their physical and emotional
wellbeing and wasting resources beyond the transport service.
The current transport service is impacting on everyone – staff, carers (paid and unpaid) and
on drivers themselves. There is a lot of time wasted within the system.
Many of the improvements that need to be made require better planning, logistics and new
thinking rather than extra resources. The metrics that matter currently are also getting in
the way of quality improvement, with too much focus on numbers and speed and not
enough focus on quality of information and care.
This means improving the non-urgent patient transport service will potentially have a whole
system impact, and improve the lives of those who use, interact with and deliver the
service.
The following 10 high impact actions are designed to inform internal discussions at
commissioner level and with providers about planned procurement process and tender
design.
They also provide rich seams of further inquiry with front line teams. Focusing Trust quality
improvement resource on this issue will also reap rewards (see High Impact Action 6).
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This infographic summarises the recommended 10 high impact actions. The rest of this
report provides detailed insight and context that describes the current behaviours and
experiences that support each recommended action:
1. Make sure everyone knows what is going on
Communication with patients and NHS staff
People and family carers want to know what is going on.
Recognising that only those who can complain are heard, many of the complaints about the
service stem back to people not knowing what is going on:
‘It can be really frustrating as only the patients who have family members call to complain.
Because they complain, we know to take action. However, the poor 90 year old lad who has
no relatives for example doesn’t complain and is an unheard voice’
Although many do not book their transport directly, some of those that do tell us that
getting through on the phone is difficult - especially during the day:
‘More people on the phone booking system so get answered. This service is very bad at the
moment’
‘I have been doing it [booking] a long time. Have problems getting through. Rang for half an
hour in morning and half an hour in afternoon – no satisfaction’
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‘I am angry - the expensive phone bills. It takes a long time to answer. It was difficult to
cancel as husband got taken in to hospital’
NHS staff have fewer problems booking transport and say it is simple and routine for them;
although some say it takes time and is confusing. However they still waste time waiting for
their calls to be answered:
‘Phones to be answered in appropriate time frame’
‘To be able to get through quicker to transport services’
‘Out of hours the calls are not answered. It can take time. I have other things to do’
They mainly say it is easy to change bookings, which is in contrast to what patients tell us,
with people and carers not always getting the call back and confirmations they are
expecting:
‘Say they will confirm but they don’t call back’
However, some staff do experience problems:
‘It is difficult to change last minute or cancelled clinic journey if clinic is changed’
Patients also want to know when things go wrong e.g. cancellations. Currently they may get
no information:
‘Arriva cancelled the pick up today but did not inform us. I only found out when I rang up and
it had not arrived. I was half an hour late for my appointment’
However, most importantly, people want to understand the reason for delays and WHY they
are waiting. Getting no explanation is their greatest source frustration and causes stress and
anxiety:
‘It’s just waiting. I don’t know why we are waiting’
‘Delays. I never get the reason why. They could update me’
‘It is stressful not knowing what is going on’
‘We get anxious when they are not on time – let us know’
‘Make it more efficient – keep in contact with people and inform them of what’s happening
e.g. delays’
‘A phone call is good. Tell us how long we will be waiting for the return journey if it is
delayed’
Some NHS staff recognise this and say they seek to keep patients in the loop. They also see
this as an area of improvement:
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‘Inform and explain. Check on system to make them ready. Keep checking in system. Keep
telling patient. Keep them up to date’
‘Patients informed of arrival time so they can go get a drink or food. Being sat in here drives
them mad. Need proper control’
‘Be honest about wait time’
People also want to know who is collecting them, and to be reassured that the hospital
knows that they are waiting for transport:
‘They are disorganised. I do not know who is taking me home’
‘The hospital thought we made our own way home, so I have been waiting for over 2 hours
to go home. I feel stressed…’
Staff recognise this need for reassurance:
‘I reassure them that I won’t forget them and make them laugh. This relieves stress. I even
have shawls in my office for if patients are waiting a long time and are cold. I find caring for
the patients when unaccompanied very rewarding. I get attached to patients’
Ideally, people want to know from the driver when the transport will arrive so they can plan
and be ready for pick up without feeling trapped in one place waiting for the driver to
arrive:
‘Patients informed of arrival time so they can go get a drink or food. Being sat in here drives
them mad. Need proper control’
‘I want to know exactly when pick up is (give or take 1 hour)’
‘Ring to say you are 10 mins away so if I need to go to the toilet I know I have time’
Drivers recognise that people need to be kept updated:
‘Keep people informed. People appreciate contact’
Staff also identify the need for patients to understand more about the service and its
limitations:
‘Better information to patients. Educate patients on why and what patient transport is’
This includes eligibility criteria. Staff observe patients ‘playing the system’:
‘Some people who don’t get the service with one call take will call again and give answers
which result in the transport being allocated’
‘… a patient phoned to go to the sys clinic, said he was visually impaired, provided with an
escort and ambulance. The nurse at the clinic called to ask why the patient had been
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provided with an ambulance and escort. When told because he was visually impaired, the
nurse confirmed the patient was not visually impaired’
When it comes to companion eligibility, people also want to know where they stand. Carers
currently feel upset, angry, and stressed when they are told they cannot travel. They would
like to feel more understanding about ineligibility. People say they would also like to better
understand the reasons why their loved one is ineligible to accompany them.
Drivers tell us that saying no to family carers takes time and is difficult. They feel awful
helpless and guilty. They should not be the ones having these conversations with
companions.
Communication with drivers
Drivers say poor communication and lack of information is getting in the way of them doing
their best work.
They too have issues with getting in contact with control, which wastes their time and
causes delays:
‘Better communication – not waiting 15 minutes for control to answer the phone’
‘But if you need to talk to control, it can take a while to contact them. We need a hotline for
quick responses’
However, even more fundamental is the poor quality of the information they get about
patients and pick-up and drop-off points. This is unreliable and inaccurate in relation to:



The place (home address and location in hospital e.g. which clinic and where it is)
The mobility requirements of the patient e.g. type of wheelchair or vehicle they
need; if they need a stretcher, whether the house has steps etc
Other requirements e.g. infection control.
This leaves drivers feeling frustrated and annoyed, and makes their work more challenging
because it means they are unprepared. This often leads to delays.
The phone information they get on the day can be wrong:
‘Inaccurate information – which clinic? It wastes time, pushing the patient around the
hospital to find the right clinic’
‘I feel unprepared for the day. A phone call with a couple of words on the patient and the
journey (is all I get)…’
‘Information is not accurate… it is frustrating - especially as I am quite new in the job and
don’t know the hospital well’
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‘We don’t always get the right locations. Details on phone can be completely wrong. It is
frustrating for me’
Electronic record systems are also inaccurate and poorly maintained:
‘Often information about the patient hasn’t been updated… when the wrong information is
given, it causes delays’
‘It is not always correct information mobility wise’
‘Sometimes it’s very frustrating. Information you get can be too much or not enough. I don’t
know if the mobility is right. Old notes get taken off and information can conflict’
‘We rely on the journey notes which are not always up to date. Information at all stages is
vital. Sometimes it’s just small (important) details that can be left out e.g. book a wheelchair,
but it does not state ‘a wide wheelchair’… another time we turned up for a standard transfer
and needed to gown and glove up as the patient was infectious’
‘Most of the time the notes are not up to date’
NHS staff are also aware of this problem and its consequences:
‘Make sure the correct vehicle requirements are made for each patients for their in journey
and their journey back home – sometimes have to wait for hours’
‘This is the most important aspect – to have the correct information about the patient and
their mobility and capabilities’
They see the planning process as being at fault; not only in relation to information provided,
but also how it is used by planners:
‘They need to let planners know about the logistics of the actual journey’
‘…planners say they don’t have time to read notes and check who is a priority’
They do also recognise their role in getting this right:
‘Inpatients knows what’s going on, do they have home care package. Know nothing about
outpatients, need to know more about them if outpatients be looked after in discharge
lounge. Need to know about carers to pass on to crew’
Drivers highlight the impact on patients:
‘The wrong information is given therefore the wrong vehicle is sent. Having the wrong
address leads to delays. We have to remember patients have been waiting months for this
appointment and if it’s wrong, and they have to wait they lose more faith, and will get ill’
They feel that call handlers are not asking the right questions and that patients do not
always know what to tell them, so do not volunteer the right detail:
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‘We need to look at how the call centre takes information. 90% of the time the patient does
not know what the driver needs to bring. The call handler can’t be bothered to take the right
information and that cascades to poor service
‘…usually the patient has sent the information in an incorrect way’
Drivers want greater staff understanding and improved information-management systems:
‘Keeping patient information updated’
‘Staff understanding of the importance of giving the correct information’
‘We need to get more information in that message. The patient booking, should have a card
so can fill out with the GP and go through it on the phone. Then it won’t be wrong’
Asking the right questions to elicit the right level of detail is key and a training need for call
handlers:
‘It needs to be right at the booking stage.… e.g. for a stretcher case, are there steps? can we
get in and out of the house? does the clinic know? We need really detailed information’
‘We need to ask the right questions at the time of booking’
Drivers may feel that they have already shared how to improve things with their bosses, but
they do not feel there has been a response:
‘…We are given the opportunity to say what we need and think, but these things never
materialise’
An improved call handler data collection pro-forma, co-designed by drivers and call handlers
that nudges the right information being collected could sort out many of these issues.
Patients want drivers to have better information too:
‘Clear information for the crew… the pick-up didn’t give crew the right information about
wheelchair. It was frustrating, I sat in ambulance for 2 hours and it’s not the comfiest’
Calling ahead
Whilst drivers see solutions mainly lying in call handlers asking better questions and them
getting better quality, more detailed information passed to them, patients mainly see the
solution lying in closer liaison between drivers and NHS staff:
‘Better communication between renal unit reception and PTS control so they are on time
more often’
‘I would like to see transport always on time and more communication between ward and
transport’
Drivers agree that calling ahead to the driver – where it happens – is working really well:
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‘Calling ahead works well. It would make a better experience for everyone’
‘Outpatients call to say they are ready for collection, this works really well’
‘Some wards call to say the patient is ready for pick up – this works well’
‘Outpatients clinics let the PTS know when patients are ready, so no delay in starting the
journey home’
Calling ahead should happen systematically as standard hospital practice as it would save
time and stress for drivers, NHS staff, patients and their escorts alike.
Patients would also like drivers to call ahead to them directly:
‘Ring to say you are 10 mins away so if I need to go to the toilet I know I have time’
It may be possible to automate all this:
‘It would help if there was an automated system e.g. by text, to say your driver’s estimated
time of arrival, so the patient was ready’
Given the time and therefore money (not to mention the emotional labour staff do caring
for and worrying about waiting patients) that NHS organisations are spending on this
process as it stands currently, investing in a dedicated mobile phone that drivers can call for
updates may be a very sound investment.
This is predicated on drivers having good quality phones also, which some said they did not
have.
Traffic delays
Drivers would like information about traffic issues:
‘…tell us if there is a fault on the road and we can go another way. Control don’t know, they need
to look at traffic news and tell us – we can then be prepared and go another way’
2. Avoid early morning appointments for people who need patient transport
This work reveals that the NHS is not recognising nor understanding the impact of early
morning appointments on people who are eligible for transport, nor the reality of the
journey that patients often make to be on time.
Patients who get non-urgent transport are often very unwell with significant mobility issues.
Early morning appointments mean them and their carers getting up and two hours in
advance of pick-up. For instance, if the person needs to be at the hospital for 10 o’clock, it
means being ready and waiting for 7 o’clock at the latest. This is often very challenging for
them and their carers (see High Impact Action 3):
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‘I understand why you do it, but it’s an awfully long time to be ready for 2 hours
before. That’s okay if appointment is during the day. When any appointment is at 9 I
have to be ready at 7. And so I have to be up at least a couple of hours before
because my disability slows me down a lot. So I have to be up at 5am. It’s not too
bad at the moment but if my health deteriorated it would be a problem’
‘I have to be ready 3 hours before appointment. For an 8.30am appointment, I was
asked to be ready from 6.30am and they arrived at 8.20am’
It would be a true hallmark of person centred care for clinic managers to recognise this and
book people in for the later appointment slots and minimise the early morning
appointments for those eligible for transport. This small change would make life easier for
everyone and avoid delays and patient exhaustion and stress that impacts on wellbeing.
Drivers suggest this could also reduce delays as they would avoid the rush hour traffic:
‘Don’t offer patients appointments before 10am. Then we don’t have to face traffic at peak
times…”
This message about early morning clinics is something ELC has heard in other parts of the
country in relation to organisation of stroke clinics (because people are often not good in
the morning) and outpatient care for those with multiple long term health issues – for the
same reasons as described here. Timing of outpatient appointments is a really big care
design issue affecting those with complex care needs in particular, and it should be easy to
address.
In this work, clinic staff tell us they find it hard to be responsive to patients, but this is an
improvement that it is really worthwhile achieving for this community.
3. Reduce time slot for pick up slots
This is an improvement challenge that is completely invisible to NHS staff. They do not
mention it at all. It is one of the biggest issues for patients. Whilst it impacts on drivers –
especially when they have to wait, they also are not aware of the impact on patients.
The current two hour pick up slot is having a significant impact on peoples’ lives and whole
system costs. People want it to change, with a shorter pick up time frame and a call ahead
10-30 minutes before seen as a better system:
‘I want to be given less time scale. I have to be ready 2 hours before appointment’
‘To know within half an hour when to expect transport to arrive’
‘Ring to say 10 mins away so if I need to go to the toilet I know I have time’
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The impacts of the current system are both financial and personal.
There is a financial impact because paid escorts have to be there to get the person ready
and then wait 2 hours, which they are paid for:
‘I need to know when they are coming so my escort doesn’t have to be there 2 hours before –
she could be with me in 5 minutes’
‘There is no flexibility… The patient can be waiting hours along with a staff patient escort…’
It also places additional burdens and stress on already overloaded family carers. If they
work, they need time off, which also has an economic cost:
‘Having to be ready 2 hours before. It’s stressful for me to be there 2 hours before. I am
wasting my time’
They also find it very difficult to get their loved one ready – especially for early morning
appointments (see High Impact Action 2); and feel rushed and frustrated:
‘The appointment is 10.20am. I have to dress pressure sore, have medication before dressing.
I have to wake up at 5am. It is very hard and I am rushed. Have to be ready 2 hours before
appointment’
The uncertainty about when the driver will arrive means that peoples’ lives are effectively
on hold as they are trapped for 2 hours, which is stressful:
‘I need to eat before they come. I have to wait for the driver…It might be in the
middle of lunch. They can’t wait for me to finish’
The driver can arrive very early or at the last minute. It is unpredictable:
‘The first time they came 2 hours too early. I was so rushed. I still had my slippers on’
“I get ready in the morning for 7.30am. They don’t come until 9.30….’
‘I am always ready 3 hours before they arrive – I have never been late once.
Sometimes they are early and sometimes late’
‘They always come within the time they say they do. But that’s in the 2 hour
window, it’s a bit annoying sometimes’
Carers and people feel angry and stressed when drivers are late for pick up at home. People
worry about missing vital treatments. Being late concerns them:
‘They cut it fine. I want to get to my appointment – I need this cancer treatment’
‘I have been late for hospital appointment as ambulance late. I felt concerned’
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Being late is also a worry for carers who don’t want their loved ones to miss appointments,
and recognise the impact of being late on their loved one:
‘It was on time. I was satisfied that he would then be there for the appointment’
‘The longer you wait, the more anxious we get that we will be late for the appointment’
‘I am angry for mum when the crew is late. Waiting hours means she feels more pain’
If they end up waiting the full two hours, worry and frustration about being late is
compounded:
‘You need to get up at least 2 hours early. Then you are sitting waiting as they cut it fine’
Carers panic and worry if they leave the driver waiting because the person is not ready:
‘It’s difficult to get ready. I can’t do it quickly. I feel panicky if they are waiting. I panic when
the crew arrive and I have to get things’
‘As they were waiting for care home staff to take patient to the toilet, Arriva had to wait 20
minutes. We just got here on time’
‘Sometimes if I am in the middle of dressing (my loved one), they will say they can wait for a
bit, but you feel bad and awkward’
Waiting also makes drivers angry because it delays them. This is more often a particular
problem in care homes:
‘I am annoyed when [patient] is not ready. It impacts on the day’
‘It can be hard because if they are not ready, it causes delays. It has a knock on effect. I feel
annoyed when this happens’
Hospital staff dealing with the aftermath of the journey say they find it stressful,
challenging, difficult and demanding.
Patients being late impacts on their work:
‘…Often if the transport is too late for the appointment, the doctors get annoyed with us’
‘Patients are late, this puts stress on staff’
‘Sometimes it can be a long delay and the appointment has to be cancelled. Sometimes I ring
the patient up and apologise. I am prepared although this situation can be stressful and
challenging as it happens quite a lot’
No one is winning from this arrangement and finding a better way is worth the time and
effort. Calling ahead is definitely part of the solution, and something that drivers should be
given autonomy to manage. Reducing the pick-up time slot or giving an estimated time
within 30 minutes would be a huge relief.
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4. Focus on improving the journey home
Whilst there are significant challenges around getting to the hospital, getting home is even
worse. The waiting involved impacts significantly on everyone’s health, wellbeing and on
their lives and working lives.
People feel stressed and terrible. Carers describe feeling stressed and struggling. Both say it
is chaos and disorganised. Most people are accepting and understand, but nevertheless it
leaves them exhausted, feeling neglected, stressed, worried and frustrated. Carers feel the
same; though they are less understanding and feel more exhausted.
Waiting is inconvenient:
‘We know we are going home. We just hate the long wait’
‘You can be sat in discharge lounge for an hour. I don’t mind too much as busy, but some
days I just want to go home’
Waiting impacts on mental wellbeing:
‘It is stressful. You want to get home. You are just sitting here waiting’
‘It definitely impacts on your day and how you are feeling if you are delayed or have to wait
around for ages’
‘Last time it was 5 hours. We came to the discharge lounge at 1pm, left at 6pm and got
home at 7pm. The patient was mad’
‘I like to be punctual. Sitting around is not doing me any good. I should be picked up within 1
hour’
People worry they have been forgotten about:
‘It is very concerning when drivers have forgotten to pick me up, especially when I have been
ready for hours. In the past I have sometimes waited 2-3 hours for a pick up’
Waiting also impacts on physical health:
‘We have been waiting since 11.15. It’s now 13.40. The patient is getting uncomfortable. It’s
not very nice’
‘Nobody wants to wait 6 hours. Terrible. It makes you feel ill. It makes it hard for me and
affects my health. Just to wait is hard’
Getting home late means people miss out on paid for care:
‘Paid carers miss their call as he gets back too late. From 8am to 10pm is a long day…
transport was running late. When I called, they confirmed this and said they would let us
know. The hospital said the transport people had cancelled the appointment. I’ve made
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official complaints but in 6 months, nothing has happened. He was waiting from afternoon
until 9pm’
‘Come on time. My carer is waiting for me at home. If I am late, the carer goes’
Paid escorts have a financial cost:
‘There is no flexibility… The patient can be waiting hours along with a staff patient escort…’
Delays also lead to costs in other parts of the system; especially when the patient gets ill as
a result:
‘The hospital thought we made our own way home, so I have been waiting for over 2 hours
to go home. I feel stressed. The patient is diabetic. The doctor will need to come out later’
It also impacts on NHS staff wellbeing. They tell us that watching people wait is stressful and
a challenge. Some feel a strong sense of injustice:
‘Poorly people in wheelchairs should not be sat in there for 2 hours. There is no staff to put
them in a chair. Clinic staff just leave them’
‘I feel for them. They wait 4-6 hours. Some are regular patients - both outpatient and
inpatient. It is not fair on them. This is not proper clinic and nearly full’
‘I feel sorry for patients. Waiting for 3 hours is not good…’
‘Stop elderly patients having to wait for a long time. I find this stressful and upsetting’
‘People forget that mental health patients often need more explanation and tender loving
care. Some patients have dementia. They don’t understand the reason for delays and long
waits. This makes me feel disappointed as they have a lack of understanding and we are not
empathetic to their needs’
‘When dialysis patients are very tired and want to go home and delay puts stress on patient
and staff’
Currently they feel concerned, frustrated and helpless. Transport engenders emotional
labour and takes up their time. This has a significant cost for the hospital and care system.
Waiting wastes family carers’ and paid escort’s time, which has a whole system cost if the
person is being paid to wait e.g. home care worker or care home worker:
‘I don’t like hanging around. I realise that they can’t always be on time, but hard to wait.
They could coordinate better, even drivers say so’
Drivers also feel bad:
‘I am frustrated and embarrassed. When people say they have been waiting 3 hours, you
think why?’
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‘It is annoying. We don’t want to be late for the patient’
They describe emotional labour and tell us it impacts on their wellbeing too. They feel
upset, frustrated, blamed and judged and that they have no control. They also find it
difficult and annoying.
Some people resort to ordering a private hire taxi; although they recognise this is unsafe for
their loved one:
‘We have to order a taxi due to late transport, which is unsafe. We are getting home very
late...’
People would like to see better communication between hospital and driver, with the
hospital calling ahead as standard practice and the patient would like a 10-minute warning:
‘Better communication between renal unit reception and PTS control so they are on time
more often’
‘To know within half an hour when to expect transport to arrive’
‘Ring to say 10 mins away so if I need to go to the toilet I know I have time’
Staff suggest a dedicated transport service and volunteers might help:
‘Dedicated transport team for general hospital patients’
‘Volunteers to come and help, especially with older patients’
Making the wait better
People like the discharge lounge as a place to wait:
‘Staff in the discharge lounge are lovely, but sitting in a wheelchair for hours is just not on. 5hour hospital appointments! I don’t like it. I’m stuck in my wheelchair. I have to keep asking
staff, ‘have I been allocated?’
‘When I am finished at clinic, I am dropped to discharge lounge. They look after us. I have to
tell them we are here’
Drivers like pick-ups from the discharge lounge because it is a central place and makes
efficient use of their time (see High Impact Change 5).
Patients and staff would like people to be able to get refreshments there:
‘A vending machine in the discharge lounge would be good. If we were informed, we
would get food to eat’
‘Make sure there are refreshments in the discharge lounge’
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‘Tea/coffee machine in discharge lounge for patients. Patients should bring own
food, it’s a hospital not a charity’
Knowing an estimated pick up time would make this easier too:
‘Patients to be informed of arrival time so they can go get a drink or food. Being sat in here
drives them mad. We need proper control’
NHS staff improve the experience of waiting by being kind, caring and helpful – listening and
responding; checking the person has all their medicines and that someone is at home to
look after them:
‘I reassure them that I won’t forget them and make them laugh. This relieves stress. I even
have shawls in my office for if patients are waiting a long time and are cold. I find caring for
the patients when unaccompanied very rewarding. I get attached to patients’
‘I make tea, talk to patients, and do all I can to make their wait shorter’
A drink and a biscuit go a long way to improve the experience of waiting:
‘A lady came round with a tea trolley, that was really nice. I felt very cared for. Took time to
ask how I like my tea, felt very looked after
‘They are brilliant, very helpful. As soon as we came last time, we got a cup of tea’
‘To be offered a sandwich or tea, that would be nice’
Some carers report concerns about their loved one being left alone by NHS staff when they
are vulnerable:
‘He comes off the machine and is left alone next to the lounge. He could die like this. He
always has high fever and is shivering. Staff should make sure he is covered, and is not where
the draft is. They should check he’s OK; should check transport is coming’
‘Talk to you more and not just dump you. Don’t tell you what you need to do’
‘Sometimes they question my professional knowledge and opinion in terms of patient’s
physical health’
‘[Relationship] could be better. No one understands each other’s problems’
‘All wards to aim for discharges to be ready to travel by 4pm so elderly are at destination at a
reasonable time’
However, rather than focusing on making the wait more pleasant, hospitals’ priority should
be to work with the transport system to improve systems that enable calling ahead and a
single pick up point (see High Impact Action 5) to improve this part of the journey.
Doing this is likely to have a significant impact on whole system costs and on transport
service quality. It will also improve the quality of NHS staff and drivers’ working lives.
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5. Make it easier to get people in to the hospital building
A largely invisible issue to NHS teams and the management of the transport service provider
is the time drivers are currently wasting at hospitals, dropping people off and picking them
up. This is an area for potential significant improvement that could make drivers’ lives much
less stressful and free up their time to catch up on delays.
Because of lack wheelchairs at the hospital, drivers struggle and take a long time getting
people to where they need to be in the hospital:
‘We get the patient there on time and spend 20 minutes finding a wheelchair… the distance
to clinic is very far’
‘It is time consuming if you have to find a wheelchair… you need to find a chair and the clinic
don’t have one’
‘Our wheelchairs are small so we need wheelchairs at the hospital. We can never find one. It
is a big bug bear at the LRI. You think you are asking for the world’
‘No wheelchairs are available. This impacts on (transport) delays’
‘Sometimes it can be an issue when you can’t find a wheelchair. Some hospitals don’t have
them’
‘Condition of the car park can impact on access. New multi-storey at the LRI has made a big
difference; we can now get in and out’
If people have special needs, NHS staff sometimes recognise this issue too:
‘It can be messy. If you need to get a patient in for an operation at 8am and they need
specialist equipment e.g. a bariatric stretcher, you can’t guarantee it will be available in time
for the 8 am arrival. Even with stretchers there seems to be a shortage of equipment’
Difficulties parking exacerbate the drivers’ challenge:
‘Better parking at discharge lounge in operation’
These delays around getting the patient into the hospital concern drivers. They want access
to wheelchairs to change:
‘Wheelchairs to be available at LRI’
‘More wheelchairs at hospitals. They need to be in one place’
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‘More wheelchairs at destination. Currently we can’t transport a patient’s wheelchair unless
they are sitting in it. The patient still needs a wheelchair at the hospital’
This is a relatively simple logistics issue that hospitals can easily work on with the transport
provider to solve. For instance, involving hospital volunteers in developing a service to meet
and greet drivers and people who arrive in patient transport with a wheelchair might be a
simple solution.
It would further reduce the impact of lack of parking if there was one central meet and
greet point. Drivers say having one central pick up and drop off point really helps:
‘At the LRI the discharge lounge works well as we pick up patients from one place’
‘Discharge lounges or one place for patients to wait and be picked up from clinic LRI and
Glenfield, not available at LGH’
‘It works well when a hospital has a discharge lounge or an ambulance desk – one point of
contact means a quick turn around and reduces delays’
‘Discharge lounge works well. Patients all in one place’
Drivers see a central drop off point as an important thing that will help improve their ability
to do a good job:
‘Have one central place to pick up patients from – we go into one place rather than running
all around the hospital to collect patients – this would save time and prevent delays’
Connecting drivers by phone with volunteers charged with smoothing the journey and
having wheelchairs ready at a set arrival point would create vast time savings and a better
experience of all.
A similar system may also be needed when patients are picked up; although that was not
something drivers described as a problem in their feedback; probably because people wait
in wheelchairs.
The new provider should be encouraged to work with hospitals to set up this kind of ‘meet
and greet’ arrangement and support training of volunteers. It is likely that wheelchairs can
be found within the current system. Drivers and volunteers being able to contact each other
by phone will be important too.
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6. Work with hospitals and care homes to minimise delays at pick up
The improvement agenda with hospitals:
Improving relationships
NHS staff say they have good relationships with transport crews and know them:
‘We know their traits and speak to them on individual level. Training and build relationships’
‘They have been doing job a long time. We work alongside them, being friendly. They do
things for me they might not do in other areas’
They mainly find them flexible and polite.
Some staff feel relationships could improve:
‘Sometimes they question my professional knowledge and opinion in terms of patient’s
physical health’
‘[Relationship] could be better. No one understands each other’s problems’
The insights created by this work can be used to develop training and quality improvement
briefings that can help improve relationships further, which is a key success factor in
improving both staff and drivers’ working lives as well as the lives of patients and their loved
ones whom they jointly support.
Booking in advance
‘Discharges being booked as early as possible, but it can be difficult for hospital staff e.g.
hospital rounds, medicines to take out. This means that as the patients are ready later in the
day, more of our transport is already allocated and this can cause problems’
An area for improvement from both staff and drivers’ perspective is making sure that
transport is booked as far in advance as possible. For their part, NHS staff say they find
deciding when to book transport a challenge, confusing and frustrating.
This is due to confusing eligibility criteria:
‘It can be confusing [booking], you have criteria to meet’
Staff not understanding why and what information is needed:
‘They input a lot of stuff that isn’t relevant. [Booking] should be swifter. Between 9-11am,
staff have to book transfers for patients as Arriva is not on the desk until 11am’
‘Sometimes you are just kept hanging on the phone. If only the caller had all the correct
information at the time of the call, it would be much better. This really delays the booking.
Sometimes when booking discharge, the staff get confused. They will tell us the time when
the patient will be ready e.g. 12 hours. We will ask them to ring and confirm as the 12 hours
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is an estimate when pre-booking. Often staff don’t ring as in their minds, they have booked
the transport and it should have arrived at 12 hours. These problems are around process’
‘When hospitals are booking transport it may be difficult. When the hospitals are booking
transport, they don’t always have the information we need…Hospitals can be very busy. This
means it takes more time and can delay for example a patient being discharged. For example
we need to know the patients mobility capabilities and sometimes the caller won’t have that
information. They will go and find out and that adds a time delay’
Difficulties reaching the call taker:
‘Too many phone numbers [for booking], not clear in the communication, difficult to get
through, especially in evening’
Arriva staff observe that often arrangements to order transport for discharge is made last
minute. They perceive it could be planned better:
‘Transport for discharge planning is booked on the day. It should be booked 24 hours before.
LRI is a knee jerk reaction, has a knock on effect’
More forward planning for potential next day discharges and weekend discharges and
patients referred to rehabilitation’
‘Over the weekend, people can ring for an appointment. First thing on Monday morning, we
can have 30-40 last minute patients we have to accommodate. It is a very big problem’
‘Change the knee jerk planning at the Royal. Discharge planning of all transport should be
booked in the morning even if not leaving until afternoon’
There is also a possible problem with ‘auto allocation’. It is unclear if this is an NHS or Arriva
system:
‘Auto allocation for outpatients sometimes misses patients’
NHS staff recognise that agency staff contribute to this:
‘We need to manage agency staff better. They book in what they want and don’t do it
properly – so it has an effect on everything else’
NHS staff informing drivers when the person is likely to be ready really helps:
‘If transport could be booked once the patients are on the machine, I believe the transport
system on the unit will work better’
‘When a patient’s treatment is started the predicted finish time automatically be transferred
to the transport service’
Arriva staff would like to see standards and ‘cut offs’:
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‘Patients don’t realise we are open 24/7. We ask patients to book 48 hours in advance, not
including weekends. This allows time for planning. We still take the [later] bookings but this
can cause delays for the patient. We should have a cut off point for taking the bookings so
that transport can be booked and planned appropriately to avoid disappointment for the
patient’
‘All wards to aim for discharges to be ready to travel by 4pm so elderly are at destination at a
reasonable time’
‘We do have late bookings, but most should be planned in 48 hours before. We have people
calling in a much smaller time period. It needs to be stricter on the deadline. The late booking
criteria needs to be adhered to by both patients and hospital staff’
‘We need to cap how many bookings are booked and planned for in a day. The system allows
as many bookings without a maximum. We need to cap bookings for each day’
Getting the patient ready to leave
NHS staff feel organised and prepared around getting people ready to leave the hospital or
clinic. Hospitals invest in dedicated staff and resources to this work:
‘I get them into the chair etc. elderly escort. I help them to get to the vehicle. I carry out all
the circles activities e.g. organise, support and prepare the patient at times’
‘We allocate a member of staff to get the patient completely ready – up, dressed, food and
drink before ambulance staff is due to arrive’
‘We have more staff deployed to help move patients’
‘Having pharmacy technician in DC lounge’
Staff recognise it can be challenging when they are short staffed:
‘When we are short staffed, it is difficult with patients needs’
However, this picture of smooth operation is in contrast to what patients say. They tell us
that preparing for leaving is disorganised and chaotic.
Some patients or their escorts could be helping make sure that this process runs more
smoothly – if they were involved and knew what needed to happen:
‘Patients need a clear understanding of all that needs to be in place before the ambulance
can take them home’
‘Patients think that once they doctor says they go home, they can go immediately. It is not
made clear to the patients that they can only go home once they have medications, dressing
etc… then when the ambulance arrives they see a delayed service’
Whilst they recognise NHS staff’s challenge:
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‘Discharges being booked as early as possible, but it can be difficult for hospital staff e.g.
hospital rounds, medicines to take out. This means that as the patients are ready later in the
day, more of our transport is already allocated and this can cause problems’
Some transport staff based in the hospital and drivers observe the same chaos:
‘Being organised. I don’t make (allocate) the patient (as) ‘ready for transport’ until they are
ready, have their home meds, letters etc. I go up to the wards and if they aren’t ready, it ends
up wasting time. There can be 2 or 3 patients already in the vehicle’
‘Patients are never ready because the wards are so busy. This impacts on other patients
because maybe they are in the ambulance or waiting on another ward/ discharge lounge not
being ready’
‘Patients are not made ready by nurses on some wards – especially on Renal’
Discharge Medication
‘A few issues when we pick up from hospital – nurses will have them ready, but they won’t
have their medicines’
Delays in people getting discharge medication is clearly a specific bottleneck in the system.
This is recognised as an issue all over the country. The feedback indicates that one hospital
is looking to address this by having a pharmacy technician in the discharge lounge. It would
be useful to find out more about how this is working as a possible source of best practice. It
would also be worth looking at other solutions around discharge medication, which are
developing in other areas e.g. community dispensing of discharge medication.
Call back
‘Better communication between drivers and nursing staff and transport co-ordinator’
Because inevitably things change, drivers and staff talking directly to each other is important
(see High Impact action 4). This would create the flexibility the system needs to be more
efficient.
This is especially the case with haemodialysis because transport is all pre-booked:
‘All transport in the HD unit is pre-booked in and out. If patients come in on time for HD
session, then going home isn’t a problem. If they are late, it can affect their going home time’
Improvement agenda with care homes:
This work also highlights issues with delays in care homes; although the reasons are less
clear from this feedback. Including an exploration of this in LLR’s work with care homes will
shed more light on the challenge. It is likely that calling ahead will be a big part of the
solution:
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‘Routine – especially in care homes. We are on a tight schedule. Any delay has a knock on
effect. For example, a lady with an electric wheelchair. It was rainy so carers didn’t get the
wheelchair out of the garage. Little things still cause a delay’
‘It’s not the right thing for us to go. We have to wait. Nursing homes are the most
disorganised”
7. Improve transport logistics and planning
These insights suggest that there is much that Arriva can do to improve the logistics of its
planning process.
Key improvements include:
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Making it easier for people to call and book (including NHS staff and drivers who are
wasting time waiting for call to be answered)
Improve the quality of information collected when the transport is booked. This can
be done by drivers and call handlers working together to co-design a pro-forma that
covers all the information the driver needs. NHS staff and families who direct book
should have a copy and explanation so they have all the right information to hand
Use the information collected thoughtfully and to prioritise patients
Making sure the driver knows where they are going and has all the information they
need
Finding a way to warn drivers when there are traffic delays
Giving drivers phones and permission to ring the patient to let them know how far
away they are
Giving drivers permission to liaise direct with clinics and wards so that they can
adjust their timetable and work flexibly
Giving drivers permission to deal with delays flexibly and with autonomy, with a
focus on minimising delays for the patient – especially on the journey home
Making sure it maximises opportunities for people to share cars who live near to
each other to build social networks and community.
Currently these things are not happening.
For instance, planners do not use the information they have:
‘Need to prioritise when booking. Planners say they don’t have time to read notes and check
who is a priority. Planners can’t plan more than 2 days in advance’
‘Planners to take time to read notes’
‘Spilt service, runs up into categories – renal drivers, EOL patients, mental health – they need
prioritising’
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‘We are delayed before we start if planning is not accurate e.g. appointment at 10am, pick
up for 10am. 1pm appointment – one at LRI, one at LGH at the same time – frustrating’
‘…I realise that they can’t always be on time, but hard to wait. They could coordinate better,
even drivers say so’
‘The planning. There seems to be no planning, systems or process in place with transport’
‘Good planning is essential e.g. driver is due to finish at 6pm but cleric system times the end
time to 7.30pm. The cleric system doesn’t allow accurate journey times – planning puts the
times and journey in’
‘Planning issue. Sometimes people are added late. It could be because other drivers delayed. I
feel frustrated as I don’t like being late’
The right information is not collected:
‘Ask more questions about patient’s disabilities and aliments before booking transport’
This means that drivers cannot do their work and causes delays (See High Impact Action 1).
It also means that eligibility criteria are not applied:
‘Look at all patients on record and check their eligibility and notify them to tell them we are
going to change – at the moment we have to book in ineligible patients because
management say book them in because we get bad press otherwise’
‘From a management point of view, we take a lot of people who don’t require our transport.
This is avoidable if the right questions are asked and the right answers are given. However,
some people who don’t get the service with one call taker will call again and give answers
which result in the transport being allocated. Patients who can take a taxi or get there
normally are using our service inappropriately. This is frustrating and avoidable as we have
some patients who need our transport waiting and experiencing delays’
‘If someone hasn’t travelled before, they can tell us what they want. There are no checks so
many (ineligible) people are using the service now e.g. a patient phoned to go to the ‘sys’
clinic. He said he was visually impaired, and was provided with an escort and ambulance. The
nurse at the clinic called to ask why the patient had been provided with an ambulance and
escort? When she was told, because he was visually impaired, the nurse confirmed the
patient was not visually impaired’
The system is missing opportunities to connect people and improve logistics:
‘Have better planning so that people travelling in same direction can share transport’
‘Co-ordinate journeys better for that people can car share’
‘Ideally avoid multiple pick-ups which can cause delays’
‘Look at having certain vehicles in certain areas’
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Some people feel this needs more driver resource:
‘More driving resources would mean people are not waiting for such long periods, especially
at peak times e.g. renal patients in the evening along with other discharges. They know we
have renal as a priority. This means discharges are left waiting’
‘More resources. I am embarrassed to work for Arriva because they have cancelled
appointments on the day because of no resources’
But as this work demonstrates, drivers are waiting a lot of time and this needs to be
addressed. There is also the possibility raised of volunteer drivers doing some work.
There is a big message that things improve when drivers have some autonomy in decision
making and can create flexible responses:
‘More flexibility to the system’
‘Liaison desks and the freedom to come to the desk and see what we can pick up – this is in
place at LRI and Glenfield but not LGH – good for patients and drivers’
This will be easy when the relationship between drivers and others is of high trust, which it
may not be currently (see High Impact Action 10) and when the culture of the organization
is focused fully on delivering a great services for patients; something contract, outcome
measure and KPI design needs to reinforce.
8. Ensure subcontracted taxis maintain standards of care, empathy and support
Even though they may be more often on time, subcontracted taxi drivers do not provide
such a helpful experience. Patients and escorts observe this:
‘Sometimes you are rushed. Arriva drivers are good to wait but taxis are not’
‘The NHS Arriva staff are quite helpful. They help me to the car and walk with me to the clinic,
but if they employ a private taxi, then the taxi drivers do not as a rule help you to and from the
cars. Some might if you ask them, but their responsibility ends when they drop you off. If I’m
feeling a bit unsteady, it’s a bit harder. I’m wary of falling. That is a problem. You don’t get the
same sort of help’
‘More understanding and help from the taxi drivers – they are sometimes very unwilling to help
you in the way you need’
‘I would like all transport staff to be helpful, caring and considerate. Taxi drivers not always
good’
‘I would like all drivers to see me to my door – this is not always the case’
NHS staff and Drivers also recognize this:
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‘Taxi drivers being more helpful to poorly patients. They just sit in the car’
‘Arriva drivers are more caring than taxi drivers’
Standard should be maintained. Where the transport provider sub-contracts with taxi
drivers, they should sign up to helping and supporting people in the same way the drivers
who work for the contractor do.
9. Recognise the therapeutic value of driver-patient relationships
This is a value and opportunity that is currently unrecognised.
Drivers and patients enjoy close relationships and often drivers are spending significant
periods of time with patients – much longer than health professionals do:
‘I would like to think I have a good relationship. I see patients 3 times a week so build up
good relationship’
‘Regular renal patients, drivers get fairly close relationships as take 3 times a week’
‘You get to know them and assess the situation to see if they want to talk or not. Happy
atmosphere on board’
Whilst some detach and do not get involved:
‘I keep them at arm’s length. I don’t get involved; I detach from patient’
‘We don’t have that much contact’
Many drivers feel very empathetic, connected with and supportive of patients; especially
regulars:
‘When control says just leave due to the patient Ward 15 and 16 at the LRI… if it’s a really
important appointment, it’s difficult to leave the patient. This is stressful. It differs from day
to day, don’t always feel supported by control. We know and understand the impact on
patients’
‘Drivers want to do the job as best they can’
‘Drivers are good, caring and passionate’
‘Drivers are good with patients’
‘Control says you can only wait 10 minutes, but if it’s an old lady who’s not ready, you can’t
just leave after 10 minutes’
Patients often report good relationships with drivers, which bring wellbeing benefits and
social connection:
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‘Good. I have no quibble with any of the drivers. We get on well together. They feel like
mates’
‘They chatted to me on the way. It makes me feel relaxed; it takes stress out of it’
‘It makes you feel better. I am happy to have a conversation, and eases length of time of the
journey’
‘Sometimes it is quite enjoyable. I had an instance where he picked me up on his way to drop
off a lady in Rugby. The driver said it was a lovely day and did I want to go for a drive? If I
hadn’t wanted to or not been ready, he would have picked me up on the way – it was really
nice’
‘They always come to my door and knock. They always help me to the car and hold the door.
Sometimes we have a laugh’
Carers really appreciate the support from drivers, which means they no longer struggle
alone. It experienced as a kind of respite and something that makes their life much easier:
‘They took over everything, which was great – and talked to me’
‘They helped in the ambulance; got the wheelchair out, made sure (loved one) doesn’t fall’
Continuity of driver adds value, especially for those who use the service a lot:
‘The driver is always good. It is always the same driver’
‘It’s the same driver every time. He knows me’
Drivers also ease the burden on family carers, which is greatly appreciated:
‘Convenient – we couldn’t manage without it – we would be lost without it. It would be so
difficult – we’d have to ask a friend; that’s a bit much’
‘Saves me driving, takes away pressure of struggling to pick up from house and take back,
get wheelchair etc.’
This feedback signals that being a patient transport driver is a vocation as well as a job. This
aligns with the difference people notice between Arriva drivers and taxi drivers (see High
Impact Action 9).
Drivers may be doing significant emotional labour because they often connect with patients
on a human level. Being a driver is also a high stress occupation. They frequently report in
their emotional mapping that they feel under strain, frustrated, stressed, helpless and not in
control. This is a red light and signals the need to safeguard their emotional wellbeing. They
also see pay as an issue, which signals they feel undervalued.
Drivers tell us that they feel confident, capable and helpful and find supporting people with
special needs rewarding. Drivers can make the journey a therapeutic, enjoyable, fun
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experience. With more training and support, they could provide an early warning system to
identify issues the patient may not be sharing with others – and reinforce important health
messages to their passengers. Giving them a greater sense of contribution and purpose
through an enhanced role may help mitigate their stress and improve their emotional
wellbeing.
Drivers also suggest there is an opportunity for the service to:
‘Bring back voluntary drivers’
Enhancing their role may attract volunteers seeking to make a difference to peoples’ lives.
10. Reward quality and not just quantity in the patient transport contract
It is evident from this work that the balance of contract management is focused on cost,
quantity and numbers – not on delivering a great caring experience for patients and on
getting it right first time. This is leading to perverse incentives and unhelpful behaviours.
Some people believe that Arriva is not interested in patients:
‘Better patient care – Arriva do not have patient care in mind’
‘Arriva staff can’t be expected to be on administration and help patients’
However insights into drivers’ experiences show that caring for patients is an integral part of
their work. Seeking a provider who demonstrates that this is part of their culture will help
shift the focus towards quality. This could be an evaluation criteria in the ITT and providers
can be given these insights to help them design a responsive service specification.
Within the current set up, specific behaviour are getting in the way of quality.
The first relates to how call handlers behave and are incentivised:
‘Quality of the call should be the priority – getting the right information to inform the service
needed. However, the 3.5 minute call is measured as how many calls each day. That’s the
target. It shouldn’t be target driven. This would mean that good, high quality information
was gained on all equipment, right assistance or not, car or ambulance. We get it right first
time’
‘Call takers have call settings – object to call settings – it’s not about quantity it is about
quality’
‘To make team morale about quality not prizes and targets’
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To improve quality, planners behaviour also needs to change and be more person centred
(see High Impact Action 8). Reading notes so they understand the patient whose transport
they are allocating needs to be seen as a core activity. Incentives should also align:
‘We need to prioritise when booking. Planners say they don’t have time to read notes and
check who is a priority. Planners can’t plan more than 2 days in advance’
‘Planners to take time to read notes’
There is also a need for a focus on team building.
Drivers clearly feel that managers are a long way away from the service:
‘They take into account arrival and departure time only. They need to give us the time to off
load the patients and deal with all the other issues and then get back to the vehicle. I can’t
do any more. I work at 100%’
‘I don’t think control understand how long it really takes to pick up a group of patients. They
have unbelievable expectations’
‘Even when I have a day when everything is running on time, control puts extra patients in.
This puts pressure on and means I don’t always have time to complete the paperwork’
‘Everyone singing off the same page – currently drivers on one page and control on the
other’
‘Get managers out on the road so they can see what it is like’
We do not have feedback from managers and call handlers so we cannot triangulate their
perspectives here. This is a gap in these insights that the provider could be asked to fill.
Based on what drivers have told us, getting managers, planners and call handlers ‘back to
the floor’ on a regular basis is likely to enrich their understanding of the contribution they
personally make and how the service changes lives. Getting them to do 6 monthly stints as
drivers might be illuminating. This is the kind of approach that could be highly valued in the
tender process.
The provider and commissioner focusing together on delivering some of the other high
impact actions described in this report will also help reinforce the quality agenda.
There is evidence that application of eligibility criteria is difficult in practice:
‘Criteria for patient to get transport should be more stringent’
‘Ideally patients using our service would be those who really need it – to achieve this the
criteria would need to be changed’
‘Eligibility criteria is very weak. People don’t have a medical reason, but can get through. Put
more pressure on – frustrating. Takes up resources. Criteria is very open ended’
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The reasons for this needs to be explored further.
Whilst people feel vehicles are safe, there is evidence and feedback from all parties that the
vehicles in use are sometimes old, uncomfortable and ambulances in particular are cold:
‘I need a car rather than ambulance as I feel cold in ambulance’
Recognising this and putting small changes in place, e.g. supplying blankets, could make a
big difference to some peoples’ comfort.
There is also evidence that the KPIs being used are not working well. Commissioners need to
review the KPIs they have set in contracts to see if those are driving the wrong behaviours:
‘Change the 15 minute pick up. We hit one target but miss the other two’
‘Problems with KPIs – it isn’t realistic’
‘The amount of patients we have on a daily basis is more than we are contracted to do’
‘No grey areas in the contract specification – it needs to be accurate’
These insights can be used to shape outcomes based KPIs.
This work also suggests that the service may not have a patient feedback system in place:
‘Record patient feedback and pass it on to staff or drivers’
Whether or not it has one already, this work should be used to shape a patient feedback
tool and outcome measures that more closely reflect what matters to patients. What
matters to drivers should also be something that is measured and seen as an important
outcome, given the impact of their work on their wellbeing.
This is work that can inform the design of the contract and service specification and be
highly valued in evaluation criteria.
Prepared by:
Georgina Craig and Rachel Sandford, The ELC Programme
Email: [email protected]
Tel: 07879 480005
Email: [email protected]
Tel: 07902 396339
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