1. SAVING COSTS IN TRANSPORT FOR DIALYSIS PATIENTS September 2010 Sr Maggie Farrell, Senior Sister Mrs Jacqueline Tansley, Senior Dialysis Renographer Dr Patrick Harnett, Consultant Physician Southend Hospital Renal Unit

2. INTRODUCTION Haemodialysis patients are required to attend the renal unit frequently and regularly for dialysis treatment These patients are often dependent on hospital transport to enable them to attend for their treatment The introduction of new practices on The Renal Unit at Southend University Hospital has improved the service as well as significantly reducing transport costs

3. PROBLEM Cause of patient complaint Long waiting times for patients Patient addresses over wide area Uncoordinated journeys Pressure on hospital transport services Increasing transport costs

4. METHODOLOGY Mobility status reassessed for all patients on ambulance transport Geographic data was collected and mapped Data was analysed and patients were regrouped into closest postcode areas Individual patients spoken to re changes

5. METHODOLOGY cont Letter sent to patients informing them of proposed changes Systematic approach used to coordinate patients days and treatment times Close liaison with Transport Providers –eg meetings were arranged with the Ambulance service and volunteer drivers Revised transport schedules produced

7. RESULTS Number of patients requiring transport reduced from 51% to 34% 12 patients came off ambulance transport Number of journeys reduced by approx 33% Patient waiting times significantly reduced

8. RESULTS cont Patient complaints reduced Transport costs reduced Overall Service improvement

9. ANNUAL FIGURES Before ChangesAfter Changes No. on hospital transport6644 Taxi journeys300-350 approx0 Costs Saving £6,000 £0 £6000 Volunteer drivers journeys3,000 approx1,536 Costs Saving £13,350 (£4.45 per journey) £6,830 £6520 Hospital Car Transport Journeys11,500 approx6,300 Costs Saving £86,250 (£7.50 per journey) £47,250 £39,000 Ambulance (£8,892 per pt per year)186 Costs Savings Total Saving £160,056£53,352 £106,704 £158,224

10. Number of patients travelling by ambulance per month.

11. CONCLUSION Following a review of our entire transport arrangements, significant improvements were made to all areas relating to the transport experience. Our results showed that by grouping together patients from the same area a reduction in the number of journeys was apparent resulting in significant cost savings. 22 patients came off hospital transport completely The new transport arrangements on-going.

12. RELEVANCE Good transport service plays a vital role in the formation of patient views and attitudes towards dialysis, improving patients’ experience and attendance. Significant cost saving-£158,224 Better and more cost effective transport service developed in line with recent Department of Health recommendations. Enquiries from other Renal Units

13. NHS QIPP evidence website (quality improvement productivity and prevention)

14. NHS QIPP evidence

16. Supporting the Quality, Innovation, Productivity and Prevention (QIPP) agenda What is QIPP? The most important challenge facing the NHS is to deliver a service with quality as its organising principle through a period of significant financial challenge. Quality, Innovation, Productivity and Prevention (QIPP) is the NHS response to this challenge – a response that will be designed and delivered locally. How do you access NHS Evidence? Go to www.evidence.nhs.uk. You can also download a version for mobile phones so you can search for information on the go.www.evidence.nhs.uk How does NHS Evidence support the Quality, Innovation, Productivity and Prevention (QIPP) agenda? NHS Evidence brings you evidence- based success stories. The QIPP collection showcases practical examples of how NHS organisations are improving quality whilst making efficiency savings. The collection will provoke ideas and discussions about how staff locally and nationally can deliver ‘more for less’. Small change, big differenc e Will the case studies overleaf inspire you to make a difference? Reasons to get involved: The NHS must not lose its focus on quality because of the economic challenges it faces Addressing inefficiencies to benefit patient care is the responsibility of all in the NHS Trusts will become known as local, regional and national beacons of best practice There is an urgent imperative to introduce better ways of doing things Reasons to get involved: The NHS must not lose its focus on quality because of the economic challenges it faces Addressing inefficiencies to benefit patient care is the responsibility of all in the NHS Trusts will become known as local, regional and national beacons of best practice There is an urgent imperative to introduce better ways of doing things Share your success NHS Evidence needs your help to build a comprehensive QIPP collection of best practice so we are calling on all NHS organisations and all NHS Trusts to contribute examples of best practice to the QIPP collection. Got something to smile about? If you’ve been involved in a successful QIPP initiative, why not share it with your NHS colleagues? Visit the NHS Evidence website to find out how.

17. Beacons of best practice ” East Berkshire Community Hospital End of Life Care Project Rolled out in just 6 weeks, the pilot project helped 20 staff from St Mark’s and Upton Community Hospitals to broaden their expertise during 1-week secondments to Thames Hospicecare. Step 2. Collaborative mentoring Secondees worked with hospice team, tracking progress against core competencies. Staff identified changes needed in community hospital Step 3. Improving community practice Nurses learned the importance of small touches. New practices include sending condolence cards with bereavement service information DuringAfter Step 1. Identifying objectives Project leaders identified individuals’ knowledge gaps (such as managing symptoms, holistic assessment and advanced care planning) Before Rosemary Martin, End of Life Service Manager Berkshire East Community Health Services “ Utilising community hospitals is a cost-effective option for end of life care. After our secondment project, staff feel much more confident in delivering this. I would strongly encourage other organisations to submit their own examples for the QIPP collection, so that we can all learn from each other. ” Southend Hospital NHS Trust has slashed its bill for dialysis transport services by almost 60% after tailoring transport to users’ individual needs. Users’ home addresses were mapped into closest postcode districts and treatment times were adjusted. Mobility of people using ambulance transport was reassessed. Total annual dialysis transport costs were reduced from £277,000 to £113,732. The most significant saving was in ambulance costs, which were reduced from £160,056 to £53,352 after reassessing eligibility. An average PCT would save around £164,000 in the first year so considerable savings could be made nationwide. drop in dialysis transport costs Case studies

18. NHS Kidney care

20. National Cost savings. a saving in excess of £25.5M for the NHS in England

23. Happiness with transport

25. Proportion on hospital public or private transport

27. Distance travelled to dialysis

28. RECOMMENDATIONS Strict control, monitoring and regular updating of transport arrangements Regular patient assessment by physiotherapists Regular meetings with volunteer drivers and the ambulance service

29. Vote for Southend Established cost savings Improvement in quality Transferable process “Beacon of best practice”

30. Vote for Southend Sustained effect on quality and cost Improvement on good practice

31. Vote for Southend Possible large scale national savings £25,500,000+ We will talk about it again.

32. FIN