Kernow Clinical Commissioning Group2
NHS / Health Body
Action Planned
NHS Kernow will be working with current providers to extend their current contracts, as the procurement process was not successful. The CCG will finalise future commissioning arrangements for one universal non-emergency patient transport service. (AI summary)
View full response
Dear Mr Cox Thank you for your regulation 28 report to prevent future deaths pertaining to Mr William George Irvin Watson: In your report you identify a number of concerns and the action to be taken by NHS Kernow as commissioners of high dependency and non-emergency transport services. The matters of concern relating to emergency ambulance transport will be addressed by Dorset CCG in a separate response_ The matters of concern you raised to be addressed by NHS Kernow and our response to them are as follows: High Dependency Transport You heard that the only provider of this service in Cornwall was Lifestar. You were also informed that on occasion when Lifestar has no available resource it is necessary to contact providers from out of county You heard evidence that there was a definite gap in service and wished to learn if this was accepted by NHS Kernow. Currently NHS Kernow purchases high dependency transport on a non-contract basis therefore each transport is booked/lpurchased based on the needs of each person: This is arranged through the Centralised Booking Service based at Royal Cornwall Hospitals NHS Trust (RCHT), commissioned by NHS Kernow to ensure that all non-emergency patient transport is booked to suit the individual health care needs. Chair; 01726 627800 Chief Officer kccg contactus@nhs net 'WW _ kernowccg nhs uk Head office: Inhskernow Sedgemoor Centre Road, St Austell; Cornwall, PL25 5AS have Priory
There is more than one provider of this service_ The predominant providers of high dependency transport are Lifestar Medical and First Care Ambulances. Lifestar are based in Cornwall, First Care is based in Exeter and provides a service across the South West also provide services to Northern Eastern and Western Devon Clinical Commissioning Group. High dependency transport is non-emergency and therefore planned; if extra capacity is required above and beyond the capacity of the two providers mentioned above then provision may be purchased another provider out of county in order to meet that need_ NHS Kernow therefore is not aware of any gap in commissioned service Non-Emergency Transfers You were told at the inquest that the service commissioned by NHS Kernow was provided by E-zec You were further advised that its performance targets were to collect 95% of people within one hour and for short notice bookings, 50% were collected within one hour and 95% within two hours. You were also informed that these targets were not being met You have also raised the concern that people who required this form of transfer were kept waiting beyond acceptable performance standards deteriorate and potentially have their life at risk_ E-zec Medical Services is commissioned by NHS Kernow to provide non-emergency patient transport (NEPTs). This covers transport for a range of needs including outpatient appointments, transfers of care and discharges. NEPTs would only transfer someone in a very stable condition; for example a person transferred from an acute to a community hospital or their normal place of residence_ We would not wish people to wait beyond the performance standards for many reasons. With a de-escalation of care or the movement of an individual from an area of high health care need to lowerlno health care need, any deterioration in condition would be addressed, i.e. would be waiting in the safest place and assessed_ In the case of Mr Watson we would not expect E-zec Medical Services as our provider of non- emergency patient transport to convey a high dependency person as are not commissioned to provide that service and would not have a clinically appropriate vehicle or staffing resource and, as result, it would not be safe to do sO. We would also not expect a person to be transferred from specialist centre (Derriford) to another acute hospital unless the person was fit and safe to be transported, as this is a de- escalation of care. A delay in the high dependency transport arriving for the journey would not cause harm to the person as they would be in the most appropriate environment to meet their health care needs and able to access high quality care immediately if needed. If it was an escalation of care and the person's condition was deteriorating then we would expect the person to be transferred in an emergency ambulance by the South West Ambulance Service Trust (SWAST): Page 2 They from may put they they
For clarity the performance target refers to the window of collection from their agreed pick up time, not from the time of booking_ This is for a standard booking: Enough time should be given by the hospital booking the transport to allow the transport provider to time to plan the journey: This should be done as soon as possible, preferably the day before it is required, Wherever possible the performance requirements within the E-Zec Medical services contract for standard bookings are: 50% of service users to be collected at their agreed dischargelready time up to 30 minutes after their identified ready time 90% of service users to be collected at their agreed dischargelready time up to 45 minutes after their identified ready time 95% service users to be collected at their agreed dischargelready time up to 60 minutes after their identified ready time Our provider is currently performing at the following levels: 56% year to date average against the 30 minute target of 50% 73% year to date average against the 45 minute target of 90% (improved from 66% average in previous year) 86% year to date average against the 60 minute target of 95% (improved 74% average in previous year E-zec Medical Services has made significant improvements over the last 12 months and is currently on target to meet their trajectory of improvement in order to meet the required standards NHS Kernow continues to work with the provider and the health system to ensure demand and capacity is manged in order to achieve these standards. Short Notice Bookings At the time of this case the performance measure for short notice bookings was 95% of journeys to be collected within two hours of booking: These targets since been amended to meet the needs of the service and are currently: 50% within two hours (provider currently achieving year to date average 55%) 70% within three hours (provider currently achieving year to date average 75%) 85% within four hours (provider currently achieving year to date average 87%) NHS Kernow is currently reviewing the definition of a short notice booking to ensure that it meets the needs of people_ Page 3 from have
Procurement The inquest was advised that a new service provider would be taking on the business from April 2019. Of great concern to you was the revelation made at inquest that there are currently no compliant bids. would be pleased to learn what steps the commissioners propose to in place to remedy the difficulties that exist currently and the foreseeable risk that will arise from April. NHS Kernow was undertaking a procurement exercise at the time of the inquest which was open to many potential bidders including incumbent providers The procurement was closed on June 2018 The procurement was subject to EU regulations and at the time of the inquest on 20th June 2018 no information had been released relating to the outcome_ The procurement process was not successful in securing the universal non-emergency patient transport service we were trying to achieve so in order to mitigate future risk NHS Kernow been working with our current providers who have agreed, in principle, to an extension of their current contracts. This will ensure that the current service that people receive will not be disrupted _ The re-procurement is viewed by NHS Kernow as a potential opportunity to improve service provision and we are committed to achieving this. During this extension the CCG will finalise their future commissioning arrangements for one universal non-emergency patient transport service with the continued aim of meeting the needs of the population of Cornwall and the Isles of Scilly. Over the coming months NHS Kernow will be working with current and potential providers , stakeholders and the public in order to understand why the procurement exercise was unsuccessful and how we can improve going forward. hope this action provides you with some comfort: Please do not hesitate to contact me if you require anything further in relation to this case_
There is more than one provider of this service_ The predominant providers of high dependency transport are Lifestar Medical and First Care Ambulances. Lifestar are based in Cornwall, First Care is based in Exeter and provides a service across the South West also provide services to Northern Eastern and Western Devon Clinical Commissioning Group. High dependency transport is non-emergency and therefore planned; if extra capacity is required above and beyond the capacity of the two providers mentioned above then provision may be purchased another provider out of county in order to meet that need_ NHS Kernow therefore is not aware of any gap in commissioned service Non-Emergency Transfers You were told at the inquest that the service commissioned by NHS Kernow was provided by E-zec You were further advised that its performance targets were to collect 95% of people within one hour and for short notice bookings, 50% were collected within one hour and 95% within two hours. You were also informed that these targets were not being met You have also raised the concern that people who required this form of transfer were kept waiting beyond acceptable performance standards deteriorate and potentially have their life at risk_ E-zec Medical Services is commissioned by NHS Kernow to provide non-emergency patient transport (NEPTs). This covers transport for a range of needs including outpatient appointments, transfers of care and discharges. NEPTs would only transfer someone in a very stable condition; for example a person transferred from an acute to a community hospital or their normal place of residence_ We would not wish people to wait beyond the performance standards for many reasons. With a de-escalation of care or the movement of an individual from an area of high health care need to lowerlno health care need, any deterioration in condition would be addressed, i.e. would be waiting in the safest place and assessed_ In the case of Mr Watson we would not expect E-zec Medical Services as our provider of non- emergency patient transport to convey a high dependency person as are not commissioned to provide that service and would not have a clinically appropriate vehicle or staffing resource and, as result, it would not be safe to do sO. We would also not expect a person to be transferred from specialist centre (Derriford) to another acute hospital unless the person was fit and safe to be transported, as this is a de- escalation of care. A delay in the high dependency transport arriving for the journey would not cause harm to the person as they would be in the most appropriate environment to meet their health care needs and able to access high quality care immediately if needed. If it was an escalation of care and the person's condition was deteriorating then we would expect the person to be transferred in an emergency ambulance by the South West Ambulance Service Trust (SWAST): Page 2 They from may put they they
For clarity the performance target refers to the window of collection from their agreed pick up time, not from the time of booking_ This is for a standard booking: Enough time should be given by the hospital booking the transport to allow the transport provider to time to plan the journey: This should be done as soon as possible, preferably the day before it is required, Wherever possible the performance requirements within the E-Zec Medical services contract for standard bookings are: 50% of service users to be collected at their agreed dischargelready time up to 30 minutes after their identified ready time 90% of service users to be collected at their agreed dischargelready time up to 45 minutes after their identified ready time 95% service users to be collected at their agreed dischargelready time up to 60 minutes after their identified ready time Our provider is currently performing at the following levels: 56% year to date average against the 30 minute target of 50% 73% year to date average against the 45 minute target of 90% (improved from 66% average in previous year) 86% year to date average against the 60 minute target of 95% (improved 74% average in previous year E-zec Medical Services has made significant improvements over the last 12 months and is currently on target to meet their trajectory of improvement in order to meet the required standards NHS Kernow continues to work with the provider and the health system to ensure demand and capacity is manged in order to achieve these standards. Short Notice Bookings At the time of this case the performance measure for short notice bookings was 95% of journeys to be collected within two hours of booking: These targets since been amended to meet the needs of the service and are currently: 50% within two hours (provider currently achieving year to date average 55%) 70% within three hours (provider currently achieving year to date average 75%) 85% within four hours (provider currently achieving year to date average 87%) NHS Kernow is currently reviewing the definition of a short notice booking to ensure that it meets the needs of people_ Page 3 from have
Procurement The inquest was advised that a new service provider would be taking on the business from April 2019. Of great concern to you was the revelation made at inquest that there are currently no compliant bids. would be pleased to learn what steps the commissioners propose to in place to remedy the difficulties that exist currently and the foreseeable risk that will arise from April. NHS Kernow was undertaking a procurement exercise at the time of the inquest which was open to many potential bidders including incumbent providers The procurement was closed on June 2018 The procurement was subject to EU regulations and at the time of the inquest on 20th June 2018 no information had been released relating to the outcome_ The procurement process was not successful in securing the universal non-emergency patient transport service we were trying to achieve so in order to mitigate future risk NHS Kernow been working with our current providers who have agreed, in principle, to an extension of their current contracts. This will ensure that the current service that people receive will not be disrupted _ The re-procurement is viewed by NHS Kernow as a potential opportunity to improve service provision and we are committed to achieving this. During this extension the CCG will finalise their future commissioning arrangements for one universal non-emergency patient transport service with the continued aim of meeting the needs of the population of Cornwall and the Isles of Scilly. Over the coming months NHS Kernow will be working with current and potential providers , stakeholders and the public in order to understand why the procurement exercise was unsuccessful and how we can improve going forward. hope this action provides you with some comfort: Please do not hesitate to contact me if you require anything further in relation to this case_