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Healthwatch North Tyneside Parkside House Elton Street East Wallsend Tyne and Wear NE28 8QU Contact: Phone 0191 263 5321 info@healthwatchnorthtyneside.co.uk www.healthwatchnorthtyneside.co.uk

10 August 2015 Dear Maurya Cushlow Patient Transport Service (PTS) eligibility I am writing on behalf of Healthwatch North Tyneside (HWNT) as part of a broader initiative across North East local Healthwatch with regards to their collective concerns about the introduction of PTS eligibility criteria in October 2014.

We are aware that the eligibility criteria were set nationally with eligible patients described in Eligibility Criteria for Patient Transport Services (Department of Health, 23 August 2007) as those:

• Where the medical condition of the patient is such that they would require the skills or support of PTS staff on or after the journey or where it would be detrimental to the patient’s condition or recovery if they were to travel by other means.

• Where the patient’s medical condition impacts on their mobility to such an extent that they would be unable to access healthcare or it would be detrimental to the patient’s condition or recovery to travel by other means.

• Recognised as a parent or guardian where children are being conveyed.

North East local Healthwatch do not object to the criteria, however feel that clinical commissioning groups failed to engage appropriately with patients, the public and local organisations prior to the introduction of more stringent application of the criteria.

There was limited prior information shared, particularly with members of the public and where information was shared this was done with only a week before the criteria was implemented.

We believe that this failure to engage with the public resulted in confusion and anxiety amongst those who were trying to book transport.

We are also aware that a number of amendments have been made to the questions that determine whether or not a patient is eligible for PTS. North East local Healthwatch feel that had adequate engagement taken place prior to implementation, any issues could have been identified earlier, thus mitigating anxiety and confusion.

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As you know the lack of a statutory requirement to formally consult on an issue should not be viewed as a reason not to engage; engagement is both valuable and essential prior to any form of service change or improvement.

I would be grateful if you could provide us with details of the engagement approach that the CCG has taken to the implementation of the new criteria and any future plans to engage with people to review the impact of their implementation.

We are keen to ensure that the eligibility criteria is being applied appropriately across the North East. To enable us to do so we are gathering performance data from all North East CCGs. Therefore I would like to request that North Tyneside CCG provide the following information:

Since the implementation of the criteria in October 2014, the number of patients:

1. Who have been refused patient transport on eligibility grounds 2. Who have contacted PALS following refusal on eligibility grounds 3. Who have appealed the eligibility decision 4. Who have had their appeal upheld 5. The monthly ‘Did Not Attend’ rates for outpatient appointments for October

to December 2013 and for the same period in 2014.

This letter is written by HWNT to you as a ‘responsible person’ as set out in the NHS Bodies and Local Authorities Regulations 2012 (Part 6, S.44). As such you are required to acknowledge receipt to HWNT; and provide a written explanation of any action which you intend to take in respect of the report or recommendations or an explanation of why you do not intend to take any action in respect of that report or recommendation within 20 working days of receipt of this letter. 1

We would be happy to meet to further discuss the requests that we have made above in support of your response.

I would like to thank you for your assistance in this matter.

Yours sincerely Peter Kenrick Chair, Healthwatch North Tyneside Signed on behalf of: Bev Bookless Cynthia Atkin Chair Healthwatch Newcastle Chair, Healthwatch Northumberland Liz McAllister Judith Mashiter Chair, Healthwatch Darlington Chair, Healthwatch County Durham Dr Ian Holtby Paul Cuskin Chair, Healthwatch Redcar and Cleveland Chair, Healthwatch South Tyneside 1 For more details of the relevant legislation please visit the following web page: http://www.legislation.gov.uk/uksi/2012/3094/regulation/44/made

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Tony Beckwith Jane Tilly Chair, Healthwatch Stockton on Tees Chair, Healthwatch Hartlepool Paul Crawshaw Sharon Stuart Chair, Healthwatch Middlesborough Chair, Healthwatch Gateshead

3 September 2015 Peter Kenrick Healthwatch North Tyneside Parkside House Elton Street East Wallsend NE28 8QU Dear Peter Patient Transport Service – patient engagement Thank you for your letter dated 10 August regarding patient engagement about the eligibility criteria for the Patient Transport Service (PTS). You referred to the nationally set PTS eligibility criteria. By way of background, recent evidence demonstrated that over 10% of journeys undertaken by PTS are for patients who do not have a medical need for transport. Across the North East health economy this has caused delays and access issues for those patients with a genuine patient transport need, and has cost almost £2m each year. CCGs in the North East therefore decided that the agreed national eligibility criteria should be reinforced when bookings for PTS are made. In North Tyneside, we moved responsibility for assessing patient eligibility and booking the PTS ambulance from GP practices to a central booking service. We believed that this would:

Support the consistent application of the criteria

Provide a clear booking system for patients

Reduce the workload of GP practices in respect of PTS ambulance bookings With the support of our colleagues in the North of England Commissioning Support service, we worked to inform people and organisations about the new booking system. Our communications included:

Email briefing to Patient Forums and Patient Reference Groups for onward cascade

Email briefing to CCG member practices and staff for cascade to patients

Email briefing to dentists, pharmacies and opticians for cascade to patients

Email briefing to NHS Foundation Trusts, ambulance service and other NHS organisations for cascade to staff and patients

Email briefing to community and voluntary sector organisations, charities and networks, service providers, representative organisations of the protected groups eg. older people and Age UK

Email briefing to Healthwatch organisations and advocacy services for cascade

Email briefing to MPs and local authorities for information/cascade

Email briefing to CCG representatives (Governing Bodies and Patient and Public Involvement lay-members)

Email briefing to Patient Advice and Liaison Services for information

12 Hedley Court Orion Business Park

North Shields NE29 7ST

Tel: (0191) 293 1140 Fax: (0191) 293 1181

E-mail: Maurya.cushlow@northtynesideccg.nhs.uk

Publicity materials produced for stakeholders included: a poster, a briefing document, frequently asked questions for staff and patients, local travel information and a HC11 - Help with Health Costs leaflet. We have included a copy of the poster, leaflet and frequently asked questions for patients with this letter. The new booking system was implemented on 8 December 2014 in North Tyneside. In your letter you asked some specific questions which we have addressed below. Q1: How many patients have been refused transport on eligibility grounds since implementation of the criteria? As explained above, the criteria were already in place, but were not consistently applied. We don’t have the details on the number of people who have been refused PTS transport in North Tyneside, but we are working with NECS and the providers to obtain this information and we will forward it to you as soon as we have received it. Q2: What is the number of people who have contacted PALS after being turned down against the PTS eligibility criteria? Table 1, below, gives the figures for North Tyneside.

Table 1 – PALS contacts by month

Month Number of patients

October 2014 7

November 10

December 37

January 2015 60

February 52

March 26

April 28

May 22

Total 242

Enquiries were received in October and November, prior to the implementation of the new booking system. These were from patients who were concerned about their future eligibility. Q3 & Q4: How many people have appealed the PTS eligibility decision and have had their appeal upheld? Table 2 gives the figures for North Tyneside

The information in tables 1 and 2 has been provided to the CCG by the PALS service.

Table 2 – Eligibility appeal decisions

Month Original decision

overturned Original decision

upheld Total

Oct-14 2 1 3

Nov-14 1 0 1

Dec-14 12 8 20

Jan-15 15 14 29

Feb-15 29 13 42

Mar-15 41 22 63

Apr-15 32 19 51

May-15 31 9 40

Q5: What were the monthly DNA rates for outpatient appointments for October – December 2013 and the same period in 2014? The new booking system in North Tyneside didn’t start until December 2014. I have instead provided you with the information for January to March 2014 and the same period in 2015 as this will provide the relevant comparator period. The information is given in table 3, below. The source of the information in table 3 is SUS data, supplied to the CCG by North of England Commissioning Support Services.

Table 3 – Outpatient attendances

January to March 2014 January to March 2015

First Attendances Seen 21,209 21,415

First Attendances DNA 1,553 1,577

Subsequent Attendances Seen 53,383 54,049

Subsequent Attendances DNA 5,093 4,789

We have followed up with practice staff to get their feedback on the new booking system, and this has been overwhelmingly positive. We have received very few queries from some individual patients and have attempted to resolve any issues they have experienced with them and the booking service. I am aware of a query raised by one of our MPs to which we responded and have had no further feedback. However, we are always open to further feedback and would welcome any information that you have received about the North Tyneside PTS Booking service. I hope that you find this information useful, and that it has answered your questions satisfactorily. However, if you have any further questions regarding the Patient Transport Service please don’t hesitate to contact me. Yours sincerely pp Maurya Cushlow Chief Officer cc Dr John Matthews Encl