Agenda item

(To receive a report from Lincolnshire West Clinical Commissioning Group (CCG), which updates the Committee on the Non-Emergency Patient Transport Service. Tim Fowler, Director of Commissioning and Contracting, Lincolnshire West CCG and Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West CCG, will be in attendance for this item)

Pursuant to Minute number 66(3) from the meeting held on 12 December 2018, the Committee gave consideration to a report from the Lincolnshire West Clinical Commissioning Group (CCG), which provided an update concerning the Non-Emergency Patient Transport Service.

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West CCG and Tim Fowler, Director of Commissioning and Contracting, Lincolnshire West CCG.

Attached at Appendix A to the report were details of Activity and Performance against Key Performance Indicators – July 2017 to November 2018 for the Committee to consider.  It was highlighted to the Committee that call handling information had been very low in November, with no month on month improvement and that cancelled journey performance had been worse in November than it had been in October.  It was noted that all other KPIs had shown month on month improvement.

The Committee was advised that Thames Ambulance Service Limited (TASL) had recently put forward a revised trajectory for performance improvement and that this was being considered by the CCG.  It was also highlighted that the CCG was also in discussion with TASL to drive forward quality improvements relating to the on-going programme of CCG quality visits.  It was highlighted further that the Care Quality Commission was expected to publish their final report following their October 2018 inspection visits to TASL sites.

The Committee was reassured that the Lincolnshire West CCG would continue to work to address the concerns raised regarding TASL's continued unacceptable performance.  However, it was currently the view of the CCG that there was an unacceptable level of risk of giving notice to exit the contract and moving to a new provider during the winter.  It was reported that the CCG would update its assessment of risk associated with the TASL contract in light of changing circumstances and new information and in the absence of significant improvement might give notice at a future date.

During discussion, the Committee raised the following points:

·         That the graphs included at Appendix A did not provided meaningful information.  Representatives agreed that some of the KPIs could be more meaningful and that this would be looked at as part of any re-negotiation.  It was agreed that for the next meeting the graphs would be refined and that additional information would be included, for example information on the patient experience.  It was noted that the information on the current KPIs provided was the whole picture, and was in accordance with the contract requirements;

·         Voluntary Car Drivers – It was highlighted that voluntary drivers were vital to the non-emergency transport service.  It was noted that the number of voluntary car driver vacancies were at the same level as when TASL first took over the contract.  It was noted further  that although the situation had recovered, there was no way of quantifying the impact of TASL's earlier decision on voluntary car drivers;

·         Some concern was expressed relating to the due diligence process taken prior to the contract being awarded.  Reassurance was given to the Committee that all elements of the due diligence process had been followed; and what was apparent now was that the company appointed was not able to meet performance requirements, as TASL had not realised the magnitude of the task and the specific challenges of Lincolnshire.  There had been some resource gaps at the start of the contract for example not having enough crewed vehicles.  It was highlighted that TASL bid for the contract at a set value; and that it was up to TASL to put in the required capacity to meet the contract and protect patients in Lincolnshire.  One member highlighted that the cheapest option was not always the best option;

·         Concern was also expressed that it was costing some Trusts money to meet the shortfall created by TASL.  The Committee was advised that the CCG was supporting Trusts to ensure that any outlay was reimbursed;

·         One member enquired whether penalties had been imposed on TASL.  Confirmation was given that penalties had been imposed.  Reassurance was given that the CCG was taking the situation very seriously; and was reviewing the situation on the ground on a daily basis; and that the CCG was having regular conversations with TASL; and was providing them with direction when necessary, as it was not just performance indicators, it was the quality of the service and the patient experience that was important;

·         One member enquired whether there was a contingency plan in place if TASL decided to leave the contract.  The Committee was advised that the CCG would try to avoid that happening; however, if it was to happen conversations had already been had with another provider who would help provide the service.  It was however, the view of the CCG that the TASL workforce was very committed to their work; that frontline line staff had stepped up; and were aiming to provide a good service. It was thought that the way the company was structured was not helping the overall situation; 

·         A question was asked as to what was the tipping point.  The Committee was advised that there was not a tipping point.  Performance would continue to be managed on a day to day basis;

·         Some concern was expressed that the fast track journey target had not been met; and a question was asked as to how many people had been affected by it.  The Committee was advised that transport for any patient was determined by need and the level of support required, and that this was done by the hospital.  Most patients in an end of life situation would go home in an EMAS ambulance and that the whole process would be managed very sensitively.  It was noted that there was an estimated 150 fast track patients a month; and if any patient had to go home immediately, support would always be given;

·         Some members agreed that exiting from the contract now was not the right course of action.  The Healthwatch representative offered assistance to the CCG to help with visits.  The CCG accepted Healthwatch's  offer; and

·         Confirmation was given to the Committee that the CCG did have conversations with neighbouring CCG colleagues on a weekly basis.  It was noted that generally it was a requirement for the CCG to manage its own area, but because of the extent of the areas served by TASL, NHS England had become involved in performance monitoring.

RESOLVED

1.    That the Non-Emergency Patient Transport Service Update report be received and that bi-monthly updates continue to be received from Thames Ambulance Service Limited, with the next update being on 20 February 2019.

2.    That bi-monthly updates be received from the Lincolnshire West CCG at alternate monthly meetings, the next one being on 20 March 2019.

3.    That consideration be given to the CQC report on Thames Ambulance Service as soon as it becomes available.