Agenda item

(To consider a report from Lincolnshire West Clinical Commissioning Group on the Non-Emergency Patient Transport Service in Lincolnshire.  Lincolnshire West Clinical Commissioning Group is the lead commissioner for these services, and Sarah-Jane Mills, the Chief Operating Officer, and Tim Fowler, the Director of Commissioning and Contracting, will be in attendance from the CCG.  In addition, Sue Flintham, North Regional Director, Tracy Hodgkiss, Improvement Director, and Blanche Lentz, Interim Chief Operating Officer from the Thames Ambulance Service Ltd are due to attend and present information to the Committee)

The Chairman welcomed to the meeting, firstly presenters from Thames Ambulance Service Limited (TASL):- Sue Flintham, North Regional Director, Graham Briggs, Director of Corporate Services and Workforce, Blanche Lentz, Acting Chief Operating Officer and Tracy Hodgkiss, Improvement Director and then secondly, the presenters from Lincolnshire West CCG, Sarah-Jane Mills, Chief Operating Officer and Tim Fowler, Director of Commissioning and Contracting.

The Committee had received a report from the Lincolnshire West Clinical Commissioning Group, which formed part of the agenda, which advised of the actions the LWCCG was taking to ensure that TASL were making the necessary improvements in the quality of services being provided to patients.  A subsequent supplementary report from TASL had then been circulated to Committee by email, which advised of the actions TASL were under taking to make the necessary changes to deliver the contract performance, and to improve the patient experience of the service being provided.

In their presentation to the Committee, TASL advised that they had been awarded the NHS contract for delivery of Non-Emergency Patient Transport for the four CCGs following a competitive procurement process.  The five year contract had commenced on 1 July 2017, (with the potential for an extension for a further two years).  Details of the contract were shown on page two of the supplementary report.

The report highlighted that since the 'go live' date there had been issues relating to performance in line with the contract pertaining to journey planning, and significant delays in answering calls, which had resulted in patients not arriving on time, or not being collected in a timely manner on discharge.  The Committee was advised that the service in Lincolnshire had been adversely affected by the distraction of management capacity to support the commencement of patient services in Leicestershire, and that the TASL Executive had agreed not to bid for any further work until performance in current TASL contracts were at a required level.

Following the issue of a formal Contract Performance Notice by the Lincolnshire CCGs on the 17 November 2017, the Committee was advised that in accordance with the contract TASL had submitted a Remedial Action Plan to the LWCCG.  The Committee was advised further that work was ongoing with LWCCG to improve service provision.  A list of the changes to enable TASL to work towards the Remedial Action Plan was shown on page three of the supplementary report.

As well as the changes detailed in the report, the Committee noted that TASL had implemented a new management structure which had commenced in August 2017, which had incorporated a regional devolution process, which would provide more control to the local team.  The Committee was also advised that as a result of ill health, the Chief Executive Officer had recently resigned; and that the process of external recruitment for the post had commenced. 

The Chairman invited members of the Committee to posed questions to TASL. The following issues were raised:-

·         Whether TASL had had experience of the rural nature of Lincolnshire.  The Committee was advised that TASL was aware of the rural nature of Lincolnshire; as they had similar contracts with Essex, Sussex, North and North East Lincolnshire and Hull;

·         Knowledge of the importance of the voluntary sector, by way of the Voluntary Care Scheme.  TASL representatives admitted that they had not handled the changes it had implemented relating to voluntary care scheme very well; and as a result a number of volunteers had withdrawn their services; which had resulted in TASL being unable to deliver the required service.  Some concerns were strongly expressed to the fact that TASL had managed to destroy the Voluntary Car Scheme in Lincolnshire; and leave residents of Lincolnshire with an appalling non-emergency patient transport service;

·         Contract Penalties – The Committee was advised that if the contractor failed to meet the key performance indicators, the contract provided for financial penalties being imposed;

·         Contingency arrangements – A representative from TASL confirmed that TASL was committed to the contract for its full duration; and TASL would working alongside the LWCCG to rectify the situation; The Committee was advised that TASL wanted to make sure that the patient experience in Lincolnshire going forward was a better one;

·         One member enquired as to the cost of missed appointments to the NHS.  Lincolnshire West CCG representatives confirmed that they were working with TASL to help overcome the poor service; and confirmed that the contract did not cover the cost of missed appointment to the NHS;

·         One member enquired as to whether TASL's performance was the same in other areas they covered.  TASL advised that performance in other areas was not an issue.  The factors that attributed to the poor performance was the commencement of the patient services in Leicestershire and Rutland, which had seen an increase in the number of calls taken, more than TASL had anticipated.  The Committee was advised that generally there was a central pool handling all calls across the country except for Essex and Sussex.  Another area that TASL had misjudged was the transaction of activity i.e., availability of vehicles and the correct planning of journeys were also factors as to why patients were late for appointments.  It was reported that call handlers were now being trained in-house; and that calls and performance information was now being collated.  TASL accepted the criticism expressed and agreed that their performance had not been acceptable.  The Committee highlighted that they had no confidence or had received any reassurance that the November KPI's would be any better.  The TASL representative advised the Committee that the start of the New Year would see an ongoing improvement of the service.  The Committee agreed that performance information should be received by the Committee on a monthly basis so that performance could be closely monitored;

·         One member expressed concerns received from users of the service and from voluntary car drivers.  Particular reference was made to the fact that drivers only knew about some of the journeys in a day; and that drivers were expected to bear the cost of the first £500.00 if they were involved in an accident.  TASL representatives advised that drivers now had hand held computers, and they were now able to see the whole day's jobs; which was helping with delays.  The Committee was advised that in relation to insurance claims, if a driver was found to be negligent, the excess amount on the insurance would be their liability;

·         Late payment to staff – TASL confirmed that all staff were paid on time; and that overtime was paid once it had been approved;

·         Some concern was expressed to the KPI information detailed on page 63 of the report.  A question was asked as to whether the CCG was aware of TASL's bad performance; and whether they had been the cheapest in the tendering process.  Representatives from the LWCCG confirmed that the contract had gone through the procurement process, which had been governed by a legal framework. TASL had come through the whole process with a high score.  Confirmation was given, that TASL had been the cheapest in some areas specified in the contract, but not in all areas;

·         The Healthwatch representative advised that Healthwatch had had the opportunity to speak with TASL and had raised the concerns of patients in Lincolnshire.  These included the lack of knowledge regarding the geography of Lincolnshire; eligibility issues; and to the fact that 50% of volunteers had left since TASL had taken over.  The Committee was made aware of the fact that volunteers were not paid mileage from their home to pick up their patients; and that a volunteer would not be accepted, if their car was more than five years old.  The Committee expressed their concerns and reiterated the importance of volunteers in Lincolnshire.  The Committee was advised that TASL was in the process of changing some of the voluntary criteria; and would continue to review it based on information received; and

·         Temporary closure of the Heckington base – The Committee was advised that there had been a review of base locations incorporating vehicle and staff requirements; and that a decision had been made to temporarily close the Heckington base and move staff to other bases.  Staff had now been deployed at Grantham and Boston.  It was highlighted that the aforementioned changes had been made in consultation with staff.  One member suggested that it would be useful for members of the Committee to receive a map showing the location of bases in Lincolnshire.

RESOLVED

It was unanimously agreed:-

1.    That a vote of no confidence be recorded by the Health Scrutiny Committee for Lincolnshire in relation to the non-emergency patient transport service provided by the Thames Ambulance Service Limited.

2.    That performance reports be submitted to the Committee on a monthly basis, with such reports including any available comparative information on the service provided by Thames Ambulance Service Limited in other areas.