ProvidingTransport inPartnership

A guide for health agencies and local authorities

1

Contents

North West Regional Centre of Excellence (NWCE)

National Patient Transport Modernisation Group (NPTMG)

Acknowledgements

Definitions

Ministerial foreword by Paul Clark MP and Ben Bradshaw MP

Foreword by Neil Scales, Chair, National Transport Efficiency Projects Steering Group

Introduction

Summary Strategic recommendations

Chapter 1 – Changing transport requirements

Chapter 2 – What is transport integration?

Chapter 3 – Transport integration for the local authority

Chapter 4 – Passenger transport integration across the public sector

Chapter 5 – Partnership fundamentals

Chapter 6 – The opportunity for brokerage

Chapter 7 – Eligibility

Chapter 8 – Engaging the third sector - community transport providers

Chapter 9 – Outsourcing

Chapter 10 – The Role of IT

Chapter 11 – Practicalities of setting up an integrated brokerage operation

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Appendix A: County transport – Co-ordinated working in partnership with the NHS. Case study in Cheshire

Appendix B: Transport integration pilot - Wigtownshire, Scotland

Appendix C: Perth & Kinross Partnership - Transport With Care

Appendix D: Case study on Social Needs Transport Review – Greater Manchester

Appendix E: Case study on Provision of Renal Unit Transport in Sunderland - Nexus

Appendix F: Case study on MoveEasy - Southend University Hospital NHS Foundation Trust

Appendix G: Norfolk Integrated Transport Model

Appendix H: Hertfordshire Integrated Transport Model

Appendix I: Devon Transport Model

Appendix J: Peterborough Transport Model

Appendix K: Scottish Ambulance Partnership; Patient Transport Service –Transport with Care

Annexes1 Members of the Joint Local Authority/NHS working party

2 Abbreviations Used

Appendices – reference models and case studies

North West Regional Centre of Excellence(NWCE)Regional Centres of Excellence were establishedin 2004 by Communities and Local Governmentto advise and assist local authorities in thedelivery of efficiency savings in pursuance of theagenda defined by Sir Peter Gershon. The NorthWest Centre of Excellence, in addition to itsregional role, also took a national lead onpassenger transport efficiency issues. This projectwas part of a wider programme that examinedthe ways in which public sector organisationsplan, process and operate passenger transportservices in such a way as to be efficient andpromote accessibility and social inclusion.

The Regional Centres of Excellence have sincebeen incorporated into the RegionalImprovement and Efficiency Partnerships.

National Patient Transport ModernisationGroup (NPTMG)This project has extended beyond the role oflocal authorities and includes NHS agencies in the procurement and operation of non-emergency patient transport. Initially, through the NPTMG, a number of primary care, acuteand ambulance trusts have been engaged andrepresentatives of these have joined with localauthority transport professionals to form aworking party led by the NWCE transportprogramme director. This group has examinedthe opportunities for partnership and integrationin the provision of patient, client, education andgeneral passenger transport.

AcknowledgementsNPTMG has continued to take a close interest inthis project and has received reports andcomment of developing drafts on a regular basis.We are indebted to the group, its chairman, AlanLake, and its secretary Bill Plumb for theirconstructive help and support.

The input from members of the working group(listed at annex A) and the individuals from anumber of local authorities, health agencies andtransport operation organisations who haveprovided help and advice is acknowledged withgrateful appreciation.

Particular thanks go to Carl Sutcliffe of theDepartment for Transport, Keith Halstead andBrian Shawdale of the Community TransportAssociation and Greer Nicholson, CommissioningManager, Transport and Concessionary Travel,London Borough of Newham.

Garth GoddardProject Director (Transport) North West Centre of Excellence(Retired November 2007)

Doug BennettAdult Integrated Transport ManagerNorfolk County Council

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PassengersVarious names are used for the members of thepublic who make use of transport provided bylocal authorities or NHS agencies. The followingterms are used in this document:

Patient: User of NHS ambulance, contract orvoluntary transport services to gain access tohealth facilities.

Client: User of local authority fleet, contractor voluntary transport for access to social careor for special education needs purposes.

Statutory student: Any young person entitledto free or supported transport to gain accessto their place of education.

When not referring specifically to one of theabove the word ‘passenger’ is used in a genericsense.

Third sectorThis term encompasses both of the two types oforganisations below:

Community transport: the name generallygiven to a voluntary sector organisation, oftena registered charity or similar, that has a mainaim of addressing social issues includingdisability, social exclusion, rural isolation,education, community cohesion or socialwelfare. Such an organisation will begoverned by a management committee ofvolunteers and may or may not use theservices of volunteers in service delivery. Allservice delivery directly from a charity will beunder a unique set of legal rules includingSection 19 permits (1985 Transport Act).However, some of these organisations havetrading arms that exist to support the maincharity and operate for a profit under thesame rules as any other commercial transportprovider.

Social enterprises: the term that relates to anemerging sector of organisations that wish totrade in a particular way to become self-sustaining, creating jobs and benefiting thelocal economy as well as being a provider ofservices to local authorities and the like. Aboard of directors, that could be paid, willgovern the organisation. Social enterprisesgenerally operate to the same standards ascommercial companies.

Definitions

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Providing a health service that is of high qualityand responsive to the needs of the patient liesat the heart of the Government's vision of amodern NHS. Ensuring that people can accessthose services when they need them is centralto this aim.

Improving access to health care, particularly forthose from disadvantaged groups and areas, cancontribute to better health by helping to ensurethat appointments are not missed and thatmedical help is sought at an early opportunity.Difficulties associated with transport tohealthcare - whether that be poor publictransport links or issues with the provision of non-emergency healthcare transport – areamong the key factors that prevent people from accessing healthcare.

Multi-agency working can lead to more effectiveuser-focussed transport services. This documentprovides some case studies of where healthorganisations and local authorities have workedwell together across a range of health, transport,education and social care services.

A joint approach can help to ensure that betterand more appropriate use is made of non-emergency transport services, communitytransport and of the public transport network.This can bring benefits to the public by providinga clearer and well-organised service that ensuresthat they are offered the most appropriatetransport service that best meets their individualneeds. Partnership working can also bringefficiency savings for health trusts and localauthorities in the delivery of these services, bymaking better use of staff, informationtechnology and vehicle resources.

We encourage you to look at this document andto learn from the experiences of thoseorganisations that have made changes to theway they provide transport services for peopleaccessing healthcare.

The Hon Paul Clark MPParliamentary Under Secretary of State for TransportDepartment for Transport

Ministerial foreword

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The Hon Ben Bradshaw MPMinister of State for Health ServicesDepartment of Health

The vision of National Transport EfficiencyProjects is to establish dynamic and cohesivenetwork of transport specialists andorganisations.

By establishing a collective of the best minds inthis field and building on our strong connectionswe can continue to explore new ways of working. Key to this is gathering information and advice,listening and learning from world leadingexamples of best practice and initiating jointprojects or working relationships between thevarious sectors involved in transport.

Through our collaborative work withstakeholders, we are aiming to identify a numberof new initiatives that can help local authoritiesachieve real efficiency savings. But this is not justabout the bottom line.

It is about improving access betweencommunities and healthcare and making adefining difference to those people where accessto transport is a barrier to greater opportunityand the support they need.

We have shaped this document to help providelocal authorities and NHS agencies with theadvice they need to fully integrate transport forpatients and clients within their organisations. These case studies are based on real experiencesand are indicative of some of the improved waysorganisations are working.

Neil Scales OBEChairNational Transport Efficiency Projects SteeringGroup

National Transport Efficiency Projects

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Introduction

This document provides advice to localauthorities and NHS agencies on the benefitsof integrating the organisation andprocurement of transport provided for patientsand clients across various sectors.

It complements and develops the advice providedby the Department of Health Inequalities Unit inits ‘Guidance on Accessibility Planning’ ofSeptember 2004 which can be found at:www.dft.gov.uk/pgr/regional/ltp/accessibility/guidance/departmentofhealthg uidanceon3632The advice in this document extends to thecreation and operation of partnerships andbrokerage arrangements encompassing in-housefleet, commercial sector and third(voluntary/community) sector operations.

This document is, first and foremost intended asa manual for transport practitioners and offersdirect advice, supported by case studies andmodels which are included in appendices.

The working party set up for this project has builton existing joint initiatives and pilot schemes. Ithas identified a range of cross-cutting, integratedtransport partnerships – some initiated by health,some by local authority, and a nationalinitiative in Scotland, all looking at best use oftransport resources and all developing to asimilar timescale.

It is clear that a variety of approaches andsolutions are already being tested. This guideattempts to identify good practice and issues thathave been identified to date and to build ongood ideas and develop new ones.

It is not intended to be prescriptive.

The lessons learned can be applied to suit localcircumstances. Nonetheless, it is clear that thereare a number of general principles set out in thisreport that, if applied, will achieve significant anduniversal improvements in efficiency.

Public sector organisations that support socialand health provision with transport services havebroadly similar options in procuring suchtransport. In-house fleet operations for socialcare and non-emergency ambulance provisionemploy similarly equipped vehicles with similarlytrained operatives. In commissioning commercialsector transport, there are synergies inprocurement mechanisms and contractconditions. There is considerable merit incombining this process with the objective ofreducing costs by:

1) establishing what transport services need to be provided and who is best placed (based on cost and/or quality criteria) to provideservice to meet this need;

2) standardising procurement procedures;3) integrating operations and the allocation of passengers to available services.

The advice is set out in chapters 1 – 11. Whilethis document is intended to be a practicalmanual, three key strategic recommendationshave emerged. These are set out at the end ofthis summary.

During the course of this work it has beenrecognised that many health service locationshave been planned - in terms of both locationand site design - with little regard to the ease, oreven the possibility, of access by patients withoutaccess to a car. At the same time, it is recognisedthat some major hospital sites have beendesigned with effective opportunities for busaccess and/or are operated within the context ofwell-developed, sustainable travel plans.

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Summary

There are a number of key areas ofhealth/social care non-emergency transportprovision where costs can be reduced through ajoint approach by commissioning bodies. Moreefficient use of vehicles and staff will achievethis and also bring benefits of a better serviceto clients and patients.

Effective, cross-cutting partnerships, reflecting theincreasingly close working of front-line childservices, adult care services and health services,offer the opportunity for an integrated approachto the provision of transport. Thus, partners canassess jointly the transport services that need to be provided and through standardisingprocurement procedures, the best way to meet this need.

IntegrationThe integrated organisation of local authorityand NHS transport provision of non-emergencytransport services offers efficiency for a numberof reasons; the overlap in clients; the differencesin times of peak demands; the similarity in needsin terms of vehicle design and escort provision;the present tendency for many low-need users tobe provided with high cost ambulance servicetransport. Ad hoc co-operation can addressspecific demands by sharing resources to reducepeak pressures on individual partners’ fleetvehicles. An absence of integration betweentrusts and local transport authorities in mostareas has resulted in:

A) Additional unnecessary costs due to:• duplication of resources• inefficiencies in procurement and planning

• many patients using higher specification/more expensive transport than they need

B) A poor service to the public with little planning to optimise access for those whohave difficulty travelling to their health care.

BrokerageA mature integration partnership can result in atransport brokerage with a joint operational unitfor planning passenger trips through a commoncall centre. This centre would likely usesophisticated scheduling software to assignpassengers to the most cost-effective transportoperator available, as well as take into accountany special needs of individuals.

An effective brokerage can also provide transportservice information to the public in a simple andeffective form. In this way, transport provision forall purposes, and involving any provider, can bechannelled through the single point of contact.

EligibilityFor an integrated approach by local authoritiesand NHS agencies it is desirable to havecommon eligibility criteria wherever possible toavoid confusion on the part of passengers. At thevery least, if commissioning bodies are to applyseparate eligibility criteria, it is essential that theyare clearly defined and understood.

Whatever the eligibility rules arising fromstatutory responsibilities, the local authority andhealth trust must think beyond this indetermining what transport should be provided inthe light of national policies on accessibility andinclusion. Where practical, a passenger ineligiblefor free or supported transport should still beoffered a transport alternative for the requestedtrip, with notification of the charge that will belevied.

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Third SectorThe third sector can play a significant role inlocal authority and health sector transportprovision. Indeed, it often provides a safety netfor people who would otherwise have no meansof access to a health appointment. A small levelof support for core costs can result in asubstantial return in relation to provision oftransport for individual needs across a wide area.

Whilst it must be recognised that smaller,community transport organisations, providingvaluable local services, may well not want toexpand into partnership in integration projects,there is considerable potential for growth of thethird sector role in partnerships and brokerage.Where the third sector is operating through atrading arm or as a social enterprise, it can play arole alongside, and competing with, commercialorganisations. Third sector operation can begood at meeting the requirements of high qualityservices with high levels of passenger care.However, the third sector organisation mustrecognise its obligation to conform to theprinciples and practicalities of the particularbrokerage scheme in which it is participating.This includes a willingness to accept the possibleloss of a degree of independence in that it will bepassing its scheduling function and initialpassenger contact role to the brokerage callcentre.

OutsourcingPrivate sector operation of transport services inthe local authority sector is characterised bycontract operation on the basis of an individualroute or small groups of routes. The NHSagencies have tended to outsource individualtrips to taxi or community sector operationswhere ambulance operation is not available.

A brokerage system implies a single, operationsmanagement unit which can be market-tested ona continuing basis.

Block outsourcing of ambulance serviceseffectively means the privatisation of bothmanagement and operation of services througha single region/sub-regionwide contract forplanning, management and operation of

services. Comprehensive outsourcing can makethe process of partnership working and brokeragemore challenging and potentially impacts onintegrating transport services.

The terms of the contracts with private sectorproviders should require the contractor to beprepared to enter into local authority partnershipsto enable joint provision. Even so, there may becommercial imperatives which limit the extent towhich private sector providers are willing to workin partnership.

ITIT systems are essential for efficient managementof client/patient and journey data, foradministration, particularly in respect of financialprocedures, and for scheduling of vehicles andassigning passengers to them. Schedulingsoftware is usually the key to transport brokerage.The chosen scheduling systems should link to theclient database and the business administrationsystems operated by the main partners.

There is a strong message here for softwaresupply companies. They must understand theneed for a good interface between schedulingand other support systems. It would be beneficialfor the various commercial players to developinterfaces between the various systems in use sothat they can ‘talk to each other’.

Partnership PracticalitiesNHS trusts and local transport authorities are tobe encouraged to work together to achievesignificant improvements to access to health andsocial care. Holistic planning and transportprovision can provide the basis for improving theprovision of local transport in the wider context ofsocial well-being, inclusion and accessibility, as acomplement to conventional local bus servicesand as a substitute for them where they nolonger provide a cost-effective solution. As well asoffering financial savings, the efficiencies ofbrokerage also support transport sustainability inan environmental context.

Jointly operated transport brokerage will involveissues around potential harmonisation of workingconditions, staff relocation and coordination ofsupport systems.

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The brokerage should apply common standardsin the approach to passenger needs assessmentso that individual passengers are allocated tovehicles that can meet their specificrequirements. Given the vulnerability of manyclients, patients and school children, it is essentialto ensure enhanced level CRB checking for allfront line staff in the brokerage.

If the partnership and brokerage are to be areality, any difficulties around legal, contractualand financial relationship must be resolved. Itwould be wrong, however, to assume that thereare significant barriers in these areas. Mostpartners are, generally, found to be working tothe same standards and guidelines, and requiredchanges to procedures can be reasonablystraightforward.

Effective and early consultation and goodcommunication with staff, providers and users willplay a critical part throughout the developmentand implementation of a transport integrationproject by:

• Creating a solid and stable partnershipframework with wide support in thecommunity.

• Helping to understand the reason for change• giving an opportunity to have input into thechange process.

• Resolving specific problems to facilitateacceptance of change.

• Achieving positive media coverage and support.

• Regularly reporting progress of the project.

Tables S1 and S2 summarise the potential inputsand outputs identified in the project. These areaddressed in more detail in the main documentand are illustrated by case studies, which appearin the appendices.

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Table S1

11

Commissioner/Procurer/Planner

Clarity and consistency in application of client eligibility.• Providing a ‘single point of access’ through a central information and booking servicevia telephone and web to inform people and professionals of transport options and entitlements.

• Piloting innovative ways of working, sharing experience and good practice and maximise use ofavailable funding streams.

• Effective use of funds for transport commissioning through joint cost efficiencies and optimum in-house fleet/contractor balance.

• Collectively understand the real cost of transport for effective management of future spend.• Stronger procurement position within partnership arrangement.• Better service planning and packaging of external contracts.• More focussed professional staff.• Greater flexibility.• Working together to ensure that access to care exists for all.• Quality, appropriate transport for users at appropriate cost.

Provider

• Improved key interfaces between public transport, community transport in-house fleet transportand non-emergency based ambulance services.

• Processes – modernising / simplifying / improving / standardising (including effective use of one or linked I.T. systems).

• Maximise the use of existing transport resources to meet passenger needs..• More available resource- effective and economical use of public funded transport resources• Joint utilisation of expertise and professionalism in delivery of transport amongst partnerorganisations.

• Shared use of expensive resources, coping with peak flows.• Better in-house vehicle fleet utilisation.• More efficient staff and transport resource utilisation.

User

• Maintain and assist client independence by greater range and provision of transport options(right vehicle to meet transport need).

• Improved accessibility and social inclusion.• Single point of access for information and booking.• Seamless client booking process for transport provision.• Quality vehicles for transporting users, with the opportunity for standardisation (eg accessible taxis, low floor minibuses).

• Trained professional staff.• Transport availability and quality improvement will reduce accident rates.• Improving public access to information on all transport options to their care.

Environmental

• Reduction in emissions through improved utilisation of transport resources for completing.journeys i.e. higher vehicle occupancies and reduced “dead” mileage.

• Reduction in private car trips and hence congestion where group transport is now available.

Table S2

Practical opportunities from effectivepartnership

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Action Areas

Policy and Organisation

• Common objectives.• Shared best practice.• Consistent standards.• Continuous improvement.• Shared ownership on access issues – LA/NHS.• Enhanced service quality– more for same or less. • Wider markets – service expansion.• Meeting budget reductions.• Release resources to front line.• Gershon (Efficiency savings).• Adapt to changing patterns of Health/Social Care. • Patient Choice.• Meeting individual client needs, widening transport choice.• Ability for clients to access care at all levels.• Waiting lists – discharge delays reduced .• Engaging third (community) sector.

Operations

• Services delivered by transport professionals.• Joint commissioning / procurement. • Joint Call Centres / journey planning - single point of contact.• Modernisation of business processes best use of IT.• Eliminate duplications / shared journeys.• Seamless service.• Timeliness/punctuality.• Greater coverage.• Improved access.• Use market position to drive up contracted quality.• Emergency preparedness.

Resource Utilisation

• Maximised resource utilisation - lower cost per passenger. • Shared vehicle resources to optimise loading and maximise‘wheel turn’.

• Access to more providers.• Greater leverage in supply market.• Commercial and third (community) sector choices.• Unified database/vehicles/resources.• Reduction in Did Not Attends (DNAs).• Focussed care skills and consistent training.

Improve Impact Areas

Qualityof

Service

SocialInclusion

CostEffectiveness

(Gershon)

Strategic recommendations

Three, key, strategic recommendations haveemerged from this work.

1) Local Authorities and NHS Agencies

Should recognise the benefits, especially in termsof financial savings, of an integrated approach topassenger transport planning procurement andprovision, and should establish partnerships tofacilitate this approach.

2) Government Departments

Should recognise that this is a cross-sector issueto be addressed at a local level, but whichrequires a joint view at government level. The respective government departments should actively encourage and support localauthority/NHS agency partnerships, with pump-priming funding where necessary.

3) Commercial and Third Sector

Providers should recognise the need for brokerageschemes. In particular,suppliers of the essential ITsoftware should ensure that their products caninterface with partnership arrangements and withother, relevant, public authority support systems.

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Chapter 1

Changing transportrequirementsThe nature of demand for transport to meethealth, education and social care requirementsis changing. On the one hand, hospital basedhealth facilities are becoming concentrated inlarger units, while supportive facilities forhealth and social care are becoming moredispersed into smaller, community-based units.Also greater opportunity for choice is availablein care and education provision.

This has fundamental implications for patient,client and student access, especially as front-linedelivery of education/child services, adult careservices and health services are, increasingly,working towards closer integration. In thiscontext, the integration of transport servicesproviding access to these front-line services isbecoming more essential. In addition,government policies on social inclusion andaccessibility require extensions of the generalpublic transport network.

All these factors have major implications for theway in which the whole range of passengertransport networks operate. The greater and moredispersed demand requires broader, more flexibleoperational networks, and diversification of themix of vehicles to be used in terms of size anduser and provider characteristics.

This is an important issue for transport providers,whether commercial operators in the privatesector, community or voluntary organisations inthe third sector or direct fleet operators or in thepublic sector.

In addressing diversification and dispersal ofdemand in an efficient way, partnershipdevelopment and integrated transport operationoffer major opportunities.

Patients without car access are as important asthose with them but, unless this is recognised andaddressed, poor access to health services byorganised passenger transport will continue toresult in a two-tier health system. While healthtrusts, understandably, wish to concentrate theirefforts and funding into advancements in clinicalcare, poor access means that while those patientswho have access can enjoy improving clinicalcare, others without access frequently may notenjoy even basic levels of health care, let aloneany advancements. This can only be addressedby placing a high priority on improving transport,to improve efficiency and to ensure access for allthrough an integrated approach.

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Chapter 2

What is transportintegration?Transport integration, in very basic terms, can be defined as:‘A mechanism where departments of anorganisation or various organisations jointlyplan and deliver transport, sharing resources(vehicles/drivers/staff) and procurementprocedures to optimise their use to meet servicedemand, and enhance the delivery of transportto appropriate users.’

For transport users, integrated transport is aboutthe availability of a co-ordinated transport serviceacross transport modes and operators thatprovides a seamless journey, minimising theimpact of interchange and providing clearinformation on when, where and how the servicemay be used. This is particularly important forusers in areas of rural isolation and socialexclusion where flexibility in transport optionsbrings considerable potential for benefit in areasof thin demand.

There are various approaches to integration,usually dependent on the need and geographicarea served by the participating organisations.Beyond sharing the planning and management ofservice provision by in-house vehicles, a maturemodel of integration would include:

• Co-ordinated commissioning and/orprocurement of services both within anorganisation and externally with otherorganisations where such an approachcan bring efficiencies and synergies.

• Effective performance management withreliable data on trends and quality.

• Horizontal integration with engagement withpassenger needs and trends, and a supply-focussed approach to the market.

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Chapter 3

Transportintegration for the localauthorityAn initial approach to transport integrationwith local authorities is to ensure that theorganisation of publicly supported transportservices is undertaken by a single,professionally staffed transport unit. The areasto be drawn together involve the provision ofsupported local transport services and schooland social care transport.

This has been achieved by a number of localauthorities and the benefits and methodology ofthis approach has been set out in the NWCE’spublication - Integrated Transport Units(http://www.nwce.gov.uk/project.php?id=34).

There are seven key areas where efficiencybenefits can be realised in moving to anorganisational model based on an IntegratedTransport Units (ITU) from one where differentpassenger transport services are planned,organised and procured separately. These are:

• More focussed professional staff.• More efficient utilisation of staff and equipment.

• Better service planning.• Best value in procurement of external contracts.

• Better in-house vehicle fleet utilisation.• Greater flexibility.• Consistency in the development and applicationof policy on service quality and eligibilitycriteria, and in legal compliance.

The before and after model structures for ITUsare set out in Diagrams 1 and 2.

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Diagram 1: Typical passenger transport service delivery without an ITU

Diagram 2: Typical passenger transport service delivery with an ITU

From ‘Integrated Transport Units’ NWCE, September 2006

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The purpose behind the approach taken in thisdocument is to build on the Integrated TransportUnit model covered in Chapter 3 where thestructural change within the local transportauthority has created the environment in which tomodernise processes and promote a phaseddevelopment of integrated operation.

This might then be expected to lead to a positionof organisational maturity when wider integration with other bodies emerges as a next development.(Diagram 3).

The aim is to achieve a new level of efficiencythrough the integrated organisation of localauthority and NHS transport provision ofnon-emergency transport. This opportunity ispresented by:

• Both the overlap in clients and the differencesin times of peak demands between the socialcare, school, health and local transport sectors.

• The similarity between social care and SENclient and NHS patient needs in terms ofvehicle design and escort provision.

There is an added incentive for the health sectortransport providers to participate in this approachof extended integration, stemming from thepresent tendency for many low-need users to beprovided with high-cost ambulance servicetransport.

To address this issue it may be helpful to considera hierarchy of access for those patients whowould be eligible for NHS funded transport totravel to and from hospital, as illustrated inDiagram 4. When thinking about cost, anassessment of the appropriate transport to beprovided should start at the bottom of thediagram and work up (Current prioritisation cantake the opposite approach!). Effectivecommissioning will ensure that all those who cantravel by other means will do so, reducingdemand on PTS/VACS to the actual level that itshould be. Clearly, however, service quality alsocomes into account in effective matching oftransport to patient need and it is important toassign trips to vehicle against a picture of theoverall deployment and down-time of particularvehicles throughout the day.

Chapter 4

Passenger transportintegration across the public sector

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Diagram 3: Integrated Transport Scheduling Unit Generic Lifecycle

Understand “truetransport cost”

Fragmented

Emergingeffiency gains

Co-ordinating Manual Systems

Complex ITsupport required

Introduction of IT

Mature, well established & integrated systems

Co-ordinated brokerage

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Diagram 4. The Need Continuum

An integrated approach opens up a wholespectrum of transport alternatives, ranging fromlarge buses, minibuses and taxis to voluntary carschemes which can be encompassed inintegration projects.

Equally, there is a variety of approaches - from adhoc co-operation addressing specific demands tofull transport brokerage with unified call centresallocating individual trips to the most cost-effective and appropriate transport from thechoices available.

In defining schemes it will be important to aim forwhat is practically achievable with a clearunderstanding of where limitations should bedrawn.

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To begin with, progress is helped by theidentification of quick wins.Quick wins are likelyto be ad hoc arrangements to share resources onspecial activities such as the allocation of patienttransport trips to local authority vehicle downtime,or adding social care or local transport triprequirements to scheduled, non-emergencyambulance journeys. This, in itself, can be amajor step, in reducing peak pressures onresources with considerable savings potential.

Furthermore, quick wins in themselves candemonstrate the possibilities of partnership andthe opportunity to overcome bureaucraticbarriers.

The development beyond this point, shown inDiagram 6, mirrors the development of activity inan integrated local transport authority, asillustrated in Diagram 3.

Diagram 5: Quick Wins

Organisation X Organisation YOpportunity for“Quick Wins”

Overlapping level of skill mix and demand

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The overriding requirement for further stages ofintegration beyond fleet usage is to include anintegrated approach to passenger interface,network planning and transport procurement,

including services contracted in from commercialcontractors, and community transportpartnerships (see Chapter 8).

Diagram 6: Overview of Joint Scheduling Lifecycle

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Chapter 5

PartnershipfundamentalsWhile integration of transport delivery will bethe ultimate result, an essential requirement inthe initial stage involves forming a solid andstable partnership to bring about cultural andorganisational change. Without this, it mayprove difficult to achieve successful operationalintegration.

This is a clear common starting point, whicheverof the various approaches and models are to beadopted to implement an integrated transportservice. The nature of the partnership shouldencompass the following:

• Clearly identified partners, particularly thosewho will have key influences on project success.

• Clear understanding of the aims and objectivesof the project. It is important that these arecontinually reviewed, agreed and fullydocumented with partners throughout theproject development lifecycle.

• Patience in bringing some partners fully onboard, particularly in the early stages of theproject and addressing initial barriers - culturaland procedural.

• Ensuring all partners have an effective voice sothat the partnership is not overwhelmed by theviews of the largest partner.

• Ensuring partners are flexible to change. Thiswill be important as there will inevitably be aneed to change/streamline areas such asprocesses, procedures, working practices andcosts.

• Provision of effective measures of success. This will assist in providing confidence to thepartners to continue long-term support.

• Close relationships required with local transportproviders who may feel threatened byintegration.

• Good public support for the project throughextensive communication.

The partnership will then need to formulate keycriteria that will define the outputs to besought. Examples are shown in Table 1.Following such criteria will help to provide clarityat the start of the project on:

• What needs to be achieved.• What needs to be done to achieve it and by whom.

• Likely timescales.• Stumbling blocks.• Likely outcomes for success.

Any partnership needs to recognise that transportintegration is ultimately about benefiting peoplein the community.

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CRITERIA

Efficiency gains.

Ease of implementation.

Service access.

Passenger experience.

Social inclusion.

Management control.

Impact on staff.

Policy acceptability.

Sustainability.

DESCRIPTIONS

Expected to produce real, quantifiable financial benefits.

Integration must deal effectively with some complexchange and its organisational impact.

Effectiveness and user-friendliness of the bookingprocess.

Impact in terms of the vehicle environment, the timespent travelling and waiting for individual journeys.

Whether and how the Social Inclusion Agenda issupported.

Availability of management information andeffectiveness of the interface with financial and othersystems.

Improved health, well-being and productivity throughchanges in working arrangements.

Alignment with local and national policy.

How likely the option is to attract sustained support from partners and the level of risk involved.

Table 1Examples of possible outputs

Chapter 6

The opportunity for brokerageMaturity in the integration partnership offersthe opportunity to operate a transportbrokerage. In the brokerage mode, the partneragencies effectively set up a joint operationalunit for planning potential passenger trips. Triprequests are processed through a common callcentre, usually using sophisticated schedulingsoftware to assign passengers to the most cost-effective transport operator and takinginto account any special needs of individuals.

Individual service providers will provide theiroperational characteristics and availability such astypes of vehicles, level of care assistance that canbe provided and times of operation. These will befed into the passenger allocation system asopportunities, but also constraints, which will betaken into account in matching individualpassengers to available transport.

The brokerage model has been applied by alimited number of local authority/ health sectorpartnerships. Notably, there is the Norfolk CountyCouncil and East Anglia Ambulance Trust pilotscheme, originally funded by the Department forTransport under the Rural Bus TransportChallenge Programme. This is set out as a casestudy in Appendix G.

Brokerage provides the opportunity to stepbeyond provision for patients, clients and studentseligible for free or supported transport to ensure,for example, that any patient is able to travel totheir health care or any individual has reasonabletransport access to a range of activities. Thisaccords with government policies on inclusionand accessibility.

For this to work, it is essential to have clearpassenger eligibility criteria and payment regimes.This is discussed further in Chapter 7.

An effective brokerage can also provide transportservice information to the public in a simple andeffective form. This should include bus services,community transport options and non-emergencypatient transport incorporating appropriateeligibility criteria. In this way, transport provisionfor all purposes and involving any provider can bechannelled through the single point of contact -the call centre - for simplicity of public use.

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Chapter 7

EligibilityFor social care, local authorities are required toprovide transport where there is a critical orsubstantial need for a client to gain access tocare facilities. With regard to schoolchildren,the duty to provide free transport to school incertain circumstances is defined in theEducation and Inspections Act (2006). Primarycare trusts (PCTs) are responsible for thecommissioning of non-emergency patienttransport at a level that is necessary to meet allreasonable requirements for the service userswithin their area. This was extended to includetravel for medical procedures that werenormally undertaken within a hospitalenvironment and are now available within acommunity setting (White Paper - Our Health,Our Care, Our Say: a new direction forcommunity services).

Within local authority social care and NHS non-emergency transport, eligibility for free orsupported transport has come more into focus,mainly because of financial pressures. Indeed theDepartment of Health published further guidanceon eligibility in September 2007. The guidance,‘Eligibility Criteria for Patient Transport Services’can be found at:www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyandGuidance/DH_078373If an integrated approach to transport provision isto be taken by local authorities and NHSagencies, then it is desirable to have commoneligibility criteria wherever possible. Markedlydifferent criteria for similar client types for joiningpurposes will lead to confusion on the part ofpassengers. Potentially, responsibility for tripscould be shuffled between agencies, causingfurther confusion to clients and possible animositybetween supplier agencies, straining thepartnership and leading to the breakdown of theintegrated operation.

At the very least, if service providers are to applyseparate eligibility criteria, it is essential that theyare clearly defined and understood by call centreoperatives, so that clear advice can be given inresponse to client enquiries.

Failure to meet eligibility criteria does notnecessarily mean that a trip will not be made. Apassenger ineligible for free or supportedtransport should still be offered a transportalternative for the requested trip with notificationof the charge that will be levied. Clearly this maybe fairly modest in respect of social car schemeprovision, but may be high if a commercial taxi isto be used. If the passenger holds aconcessionary fare pass, it is important toestablish clearly whether this applies to thetransport to be provided.

Where a charge is to be levied, the operatorclearly must conform to the licensingarrangements needed to permit fares to becharged. Both the arrangements for charging(pre-paid or on-vehicle) and the mechanisms forinvoicing for work done by participating operatorswill again have to be properly thought through.

What should be clear is that, whatever the basiceligibility rule arising from an authority or trust’sstatutory responsibilities, the local authority mustthink beyond this in determining what transportshould be provided in the light of national policieson accessibility and inclusion. While a chargemay be appropriate, the system may be failing ifthe charge is so high as to prevent the individualin question gaining the access he or she needs.

Chapter 8

Engaging the thirdsector - communitytransport providersThe third sector covers transport providedthrough voluntary, community and socialenterprise. Fundamentally, it is operated on a‘not-for-profit basis’ and is likely to involvesome voluntary input. Volunteer trustees willgovern all charitable community transportorganisations.

It is important to recognise that the third sector, orcommunity transport, consists of a wide spectrumof different approaches (Diagram 7) ranging fromsmall, voluntary organisations in deep rural areasfocusing on limited but vital services, to largesocial enterprise organisations which areexpanding activities to compete with thecommercial sector for local authority contracts.

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LocalisedSmall – scaleMainly volunteersLocal authority initiated & supportedFocused outputsInformalNot expanding

Wide Variety of Models in Between

FormalisedProfessional staffSelf sufficient managementCompeting in commercialmarketsContractual arrangementsExpansionist (in size & geography)

Characteristics

Mainly ruralClearly defined client groupLocal transportHospital car schemes

Spread Strengths and

Experience AcrossSpectrum

Mainly in larger townsand conurbationsExpanding into wider clientopportunitiesSome bidding for local buscontracts

Applications

Diagram 7. The C.T. Spectrum for local authorities

Thus Community Transport, already in manyareas, plays a significant role in local authorityand health sector transport provision (Indeed, itoften provides a safety net for people who wouldotherwise have no means of access to a healthappointment). A small level of support for corecosts can result in a substantial return in relationto provision of transport for individual needsacross a wide area. However it must berecognised that smaller community transportorganisations, providing valuable local services,may not want to expand into partnership inintegration projects.

The reasons for gaps in coverage in thecommunity transport network need to beevaluated to establish whether it can be mademore widely available.

In doing this, it must be recognised that avoluntary community transport organisation isobliged to operate within the transport legislationand has to make sure that it does not chargebelow the true cost of providing the service. Ifsuch organisations did so, they would be guilty ofusing charitable assets to provide public services.This could endanger their charitable status withthe Charity Commission. If they charge too muchfor the service they would be outside the legalconstraints of the permit legislation and likely toattract the attention of the Traffic Commissionerand the Vehicle and Operator Services Agency(VOSA) which could result in prosecution.Therefore, any price that a community transportorganisation offers for a particular service has tobe the true actual cost. With the advent ofinitiatives such as ‘full cost recovery’ these costsare now being identified more precisely. Theconcept of competing with other operators does,therefore, not normally apply.

Nevertheless, there is considerable potential forgrowth of the third sector role in partnerships andbrokerage, especially where it is operatingthrough a trading arm or as a social enterprise,when it can play a role alongside, and competingwith, commercial organisations. Third sectoroperation can be good at meeting therequirements of high quality services with highlevels of passenger care, and local authorities,through their accessibility strategies, should workto build increased capacity in the third sector

The Local Government White Paper (November2006) indicates the importance governmentattaches to the third sector in local authorityactivity. Transport is seen as a key activity andGovernment allocates funding where appropriateto build on the social enterprise approach whichhas been successful in developing large, highlyprofessional organisations, mainly in some of themetropolitan areas. The objective of this fundingis to see the growth of a selected number of ruralinitiatives on the social enterprise model, whichcan also mentor smaller, rural communitytransport schemes and help them to becomemore business orientated.

More recently, the Local Transport Act 2008 hasintroduced flexibilities to the regulatory regimegoverning community transport. For local servicesfor the general public (provided under “section22” permits), drivers will now be allowed to bepaid and vehicles of more than 16 seats will beable to be used on those services. In relation toservices for particular educational and otherbodies (provided under “section 19” permits),vehicles of fewer than 9 seats will be able to beused (in addition to the larger vehicles that couldbe used before) and the permit issuing system isbeing simplified. These changes became effectivefrom 6 April 2009. Details on the Act andsupporting guidance can be found at www.dft.gov.uk/localtransportact

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This should be of considerable benefit tobrokerages in encouraging the third sector to playa role alongside, and perhaps competing with,commercial organisations by meeting therequirements of high quality services with highlevels of passenger care. Positive measures shouldbe taken to include this sector during thetransport procurement process, recognising thatthese operators will fare best with an approach totendering that rates care and quality at least atthe same level as price in the evaluation.

The third sector organisation must recognise itsobligation to conform to the principles andpracticalities of the particular brokerage schemein which it is participating. This includes awillingness to accept the possible loss of a degreeof independence in that it will be passing itsscheduling and initial passenger contact to thebrokerage call centre.

Specifically in the context of voluntary input, theCommunity Transport Association reminds us thatcommunity transport organisations areindependent bodies that may or may not beinterested in this form of passenger brokerage.However, the value of having the communitytransport sector involved in such a schemeincludes:

• Providing a framework for volunteering.• Provision of publicly funded transport without a profit element.

• Use of well trained staff.• Supporting an organisation dedicated to social change.

• Generalist vehicle design avoiding social stigmas.

• Opportunity to engage with public transport provision.

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Chapter 9

OutsourcingPrivate sector organisation of transport servicesin the local authority sector is a long-standingfeature of provision and is, generally,characterised by contract operation on anindividual route or on a small groups of routesbasis. The contract is based on clearspecification of service and assignment ofclients/passengers on a route-by-route basis.For most authorities some inhouse provision isretained by fleet operation - in the main forsocial care and school services. In a few cases,the transport management function - in wholeor part - has been outsourced with varyingdegrees of success in that most outsourcedtransport units have been returned to directlocal authority operation.

The NHS agencies have tended to outsourceindividual trips to taxi or community sectoroperators where ambulance operation is notavailable or appropriate. In most areas, a highnumber of journeys for the NHS are provided bythe same companies that provide services to thelocal authority, suggesting that the two sectorscan be competing for the same transportresources which may be pushing procurementcosts up.

Local authority/health sector partnerships inprocurement provide an opportunity to addressthis and, clearly, a brokerage system implies asingle operations management unit which can bemarket-tested on a continuing basis.

Block outsourcing of ambulance serviceseffectively means the privatisation of bothmanagement and operation of services through a single region/sub-regionwide contract forplanning, management and operation of services.

The NHS is rapidly outsourcing its passengertransport services, largely where the NHSAmbulance Service has not been successful whenthe service is put out to tender. Recently, therehas been a move away from single trust tendersto consortium or hub tenders.

Contracts, up until now, have been designed toprovide for this comprehensive outsourcing buthave not lent themselves to effective partnershipworking and brokerage. This is a serious obstacleto the achievement of the type of cost efficienciesenvisaged in this document.

If local authority/health sector transportintegration is to be developed in this context, it will be necessary for the health transportprocurement agencies and the Department of Health to ensure that the terms of theoutsourcing contract enable this. The terms of the contract with the private sector providermust require the contractor to be prepared to enter into local authority partnerships to enable joint provision, through the operation of transport brokerage.

There may be commercial imperatives which limitthe extent to which private sector providers arewilling to work in partnership with local authoritiesand/or operate in the way that some ambulancetrusts do by outsourcing specific functions to localauthority fleet operations. However, if the privatesector provider is comfortable in a contractoriented towards partnership, a cost effectivebalance of the complementary strengths of in–house and outsourced provision could focuspositively on the service to passengers.

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Chapter 10

The role of ITAmbulance trusts and local transportauthorities generally make use of IT systems to manage client/patient and journey dataadministration, particularly in respect offinancial procedures, and, increasingly, toschedule vehicles and assign passengers tovehicles. Ad hoc work to share local transportauthorities’ and NHS vehicle resources is likelyto make use of the providers’ software to somedegree to manage passengers.

Transport brokerage, on a small scale, does notnecessarily require specific scheduling software.However, manual assignment of trips and vehiclescheduling becomes inefficient beyond dealingwith small numbers and may inhibit growth.

Scheduling software is usually the key tobrokerage on a partnership basis and, where onepartner comes to the table with schedulingtechnology, it would make sense that this isexpanded to provide a basis for brokerageoperation.

An issue emerges where more than one partner,for example the ambulance service and the localtransport authority, both have pre-existingscheduling systems. Can the systems talk to eachother so that their operation can be integrated?This may be technically possible but, in practicalterms, it is likely to be more cost-effective toselect one system for common use, especially asthis is likely to be supporting a single integratedcall centre.

More significant, perhaps in terms of IT systemsinterfacing, is the value of linking the chosenscheduling systems to client database andbusiness administration systems operated by themain partners.

There is a strong message here for softwaresupply companies to understand the need for agood interface between scheduling and othersupport systems, particularly those used by NHSand local authority transport agencies. Somesuppliers already offer suites of software thatcover scheduling, contract administration andmanagement which is to be welcomed. However,recognising that individual partners may well becommitted to different systems it would bebeneficial for the various commercial players todevelop interfaces between the various systems inuse so that they can talk to each other.

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Chapter 11

Practicalities of setting up an integratedbrokerageoperationThe establishment of a jointly operatedtransport brokerage will involve potential issuesaround harmonisation of working conditions,staff relocation and coordination of supportsystems.

Staffing issues are likely to need to be addressedin the relocation of the call centre and the travelinvolved with staff from partner organisationsmoving to a single joint unit. There is also likelyto be employee concern on the matter of paydifferentials between the drivers and escorts of fleet vehicles, ambulances, voluntary carschemes and commercial operators.Harmonisation is unlikely to be practicable in thiscase and it will be necessary to maintain a policybased on pay settlements being an internalresponsibility for the individual transport providerorganisations.

Front-line staff training should also be organisedto a consistent standard across the providerspectrum. In the case of local authority clientsand health sector patients, training for definedlevels of support to the passengers is important.

For all passenger transport it should berecognised that the drivers, escorts and callcentre staff are the principal points of contactwith the partners as commissioning agencies forthe vast majority of passengers. Generalcustomer interface training is, therefore,important.

Given the vulnerability of many clients, patientsand schoolchildren, it is essential to ensureenhanced level CRB checking for all front-linestaff in the brokerage. Furthermore all staffshould be aware of the confidentiality ofinformation held in client databases.

The brokerage should apply common standardsin the approach to passenger needs assessment.This does not mean that all vehicles should beequally equipped, although it might beconsidered good practice to work towardsuniform high standards but that the level ofindividual, or company, vehicle accessibilityshould be ascertained and input to the brokeragedatabase and a professional standard ofpassenger assessment should be applied asrequired. This information will ensure thatindividual passengers are allocated to vehiclesthat can meet their specific needs.

If the partnership and brokerage are to be areality any difficulties around legal, contractualand financial relationships must be resolved. Itwould be wrong, however, to assume that thereare significant barriers in these areas that needto be overcome. Most partners are generallyfound to be working to the same standards andguidelines and changes to procedures can bereasonably straightforward.

Effective and early consultation and goodcommunication with staff, providers and users willplay a critical part throughout the developmentand implementation of a transport integrationproject by:

• creating a solid and stable partnershipframework with wide support in the community.

• helping understand the reason for change.• giving an opportunity to have input into thechange process.

• resolving specific problems to facilitateacceptance of change.

• achieving positive media coverage and support regularly reporting progress of the integration.

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Appendices

Reference Models and Case StudiesNationally, there are a number of organisations undertaking transport integration. The following case studies and models provide a broad representation of that activity and give anindication of the wide spectrum of approaches that can be considered in achieving an integratedtransport service.

Appendix A:

County Transport -Co-ordinatedworking inpartnership with the NHSCase Study in Cheshire

BackgroundCheshire County Council Transport Co-ordination Service (TCS) has been, since2002, working in partnership with the NHS toutilise social care / Special Education Needs(SEN) fleet vehicle downtime for suitable NHStransport requests.

This introduced local authority operation intonon-emergency patient transport which had beenmainly provided through service level agreementsbetween NHS acute trusts and the AmbulanceService. Significant pressure on the existingambulance resources had been developingbecause of both an increase in the proportion ofthose patients travelling in their own wheelchairsand an increase in transport requests for renaldialysis patients.

The ServiceAt the start of the arrangement the healthservice client satisfied itself that the Cheshire CCfleet reach required standards of vehicle qualityand equipment, with operatives properly checkedthrough CRB processes and trained in clientinteraction and handling. The agreed financialformula initially reimburses the council atmarginal rates so that costs to the health sectorare broadly equivalent to direct ambulanceoperating costs.

TCS worked with North West Ambulance Service(NWAS), enabling the county fleet of accessiblevehicles to be used during their downtime toassist in times of difficulty in meeting peakdemands. For example, if excessive demand onambulances was resulting from delays at clinics,TCS would be asked to transport less-mobilepatients home following completion of theirappointments. This was achieved by TCSproviding ‘blocks’ of vehicle time and also byresponding at short notice, where possible, to

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specific requests, often for quite long journeysinto eastern Cheshire from specialist clinics atManchester hospitals. This, therefore, avoidedhigh-value, taxi alternatives.

The next stage identified that transport for renaldialysis and oncology patients, due to its regularnature and defined times for arrival andcollection, could be readily undertaken by TCS on behalf of NWAS. Starting with a two vehicleoperation, this has resulted in regular resourcesbeing provided with the benefits of expanding the daily vehicle utilisation of county fleet vehicles and fitting particularly well aroundspecial education needs runs.

TCS has also provided vehicles direct to theambulance liaison officer at Leighton Hospital inCrewe on the basis that vehicles would reportdirectly to the hospital on completion of morningruns (around 11am) and carry out dischargejourneys during their normal downtime.

BenefitsThis is a developing partnership, with theTCS/NWAS relationship moving in the directionof co-location of resources. TCS passenger fleetvehicles have been using Crewe AmbulanceStation as an operating base. As this has provedto be successful it is leading to a formalisedagreement in which the sale of land released isfunding site and facilities improvement works forthe benefit of all staff.

Location of the TCS area supervisor on thepremises is adding the culture of joint workinghere and the success is prompting theexploration of further opportunities elsewhere aspart of a strategic review of operational locations.

Lessons LearnedThe Cheshire examples demonstrate the value ofa step-by-step approach enabling the supplyingpartner to demonstrate its ability to deliver,initially on a small scale. This is a confidence-builder that encourages the development of asounder partnership, leading to wider joint-working and co-locations and bringing furtherefficiency savings.

Appendix B:

TransportIntegration pilot -Wigtownshire,ScotlandBackgroundNHS Dumfries and Galloway, the ScottishAmbulance Service, Dumfries & GallowayCouncil, SWES TRANS and the Dumfries andGalloway Accessible Transport Forum haveworked closely with the Scottish Executive’s JointImprovement Team (JIT) to explore the potentialfor shared booking and management of clientand patient journeys within the Dumfries andGalloway area.

The JIT has worked with partner organisations topromote collaborative working in relation topatient and client transport. A wide variety ofbodies carry patients and clients to manydifferent destinations. National work hasdemonstrated significant potential opportunity tostrengthen the quality and efficiency of presentarrangements and to deliver cost improvementthrough the adoption of common booking andscheduling systems.

The JIT is now working with partners in Dumfriesand Galloway to investigate the potential forpathfinder shared booking and schedulingscheme at local level – in this case theWigtownshire area.

The ServiceAs a pathfinder area Wigtownshire offers anumber of advantages:• It is geographically well-defined.• It has a high proportion of older adults in its population.

• It is rural in nature and therefore demonstratesmany existing challenges to effective transportprovision. Parts of it sit within the ScottishExecutive definitions as ‘remote rural’.

• Distances and travel times to care and otherservices can be long (over 2 hours).

- For older people particularly, accessing‘local’ social care day services oropportunities can involve a fairly lengthyjourney depending on where they live within the area.

- For many patients a long journey may beneeded to access hospital care in Stranraer,Dumfries or Dumfries & Galloway.

- For family and friends visiting patientsjourneys can be similarly extended.

• It has a number of statutory and community-based transport providers with effective workingrelationships already engaged in a range oftransport projects.

• With a population of around 20,000 it is small enough to be manageable but big enough to be a valid pathfinder, particularly for rural areas.

The area also includes the ferry port of Stranraer,which includes a ward with a high deprivationscore. Earnings across Dumfries & Galloway areamong the lowest in Scotland and in the west ofthe region there are fewer car owners, less - people have access to computers and there is agreater apparent reliance on public transport.

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A Project Team works in partnership with the JITand appointed consultants to providerecommendations on the delivery of the service based on:

• Assessment through review of systems,documentation and personal contact thefeasibility of establishing a common bookingsystem for all or most client and patientjourneys and for all or most carriers providingsuch services.

• Assessment on the number of journeys thatmight be handled through such a system.

• Review of clerical and IT-based systemssupporting existing separate transport services.

• Identifying the practical implications,opportunities and risks for such systems of moving to a common booking system.

• Identifying client and service benefits frompathfinder implementation.

• Recommendation of common booking system,if feasible, that should be adopted.

• Planning the work needed to design,implement and assure the operational integrityof a common booking system.

• Setting out a project timetable, resource plan,estimated costs and statement of value for money.

Support for Community TravelSome journeys by clients may be moreappropriately taken by public or private transportthan by statutory or voluntary providers. Theproject team will therefore seek to include in theproject two further areas of work whichcomplement the main study and which should progress at the same time. They are:

• Mapping of all available journeys using publictransport and development to provide betterpublic transport information.

• Implementation of a Liftshare website forpeople needing access to hospital (as patients,carers or visitors) to assist them to plan andenable their own journey. This would bepredominantly for private car sharing but otherforms of transport can be included.

The scoping study will include an assessment ofthe feasibility, practical, operational and resourceimplications of fully functional implementation inDumfries & Galloway and recommend how thesematters should be addressed within thepathfinder area.

Benefits and Lessons LearnedThe benefits and lessons of both Scottish projectsare dealt with on page 37.

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Appendix C:

Perth & KinrossPartnership -Transport WithCare BackgroundThe Perth & Kinross Partnership is made up of the following organisations:

• Scottish Ambulance Service (East Central Division, non-emergency service).

• NHS Tayside (Perth & Kinross locality).• Perth & Kinross Council (Public Transport Unit).• Perth & Kinross Community Transport Group(representing the CT sector).

There is a real desire within the partnership todevelop greater integration between transportproviders working in the public and voluntarysector as it is realised that there are potentialoperational efficiencies that could be achievedthrough greater collaboration and joint working.

Local operational evidence, backed in part by theevidence gathered during the Transport WithCare data analysis exercise, has concluded thatthere is duplication of transport provisionbetween the various partners and that withgreater shared planning and co-ordination. This duplication could be minimised, freeing upvehicle and staff resources, reducing journeytimes and improving passenger experiences.

The partnership has identified that the greatestoverlap is between the provision of transport tosocial day care services provided by Perth &Kinross Council and medical day care servicesprovided by NHS Tayside. It is not unusual foreach organisations’ vehicles to follow each otherout on a morning to collect their clients from thesame villages and return them to the same venuewhere they receive either medical or social dayservices (in separate wings of the same building).

The ServiceThe Perth & Kinross Partnership considers twospecific proposals:

Proposal 1 – Integrated Delivery: Local Pilots

In certain locations in Perth & Kinross such asCrieff and Aberfeldy, non-emergency serviceambulance crews and vehicles that are currentlyallocated to servicing the transport needs of dayhospital patients are targeted for greatercollaboration. An equivalent number of councilowned or council funded vehicles (including taxisand private minibuses) could, potentially, befactored into the mix, plus a small number ofNHS owned vehicles that can help contribute tothe collaborative process by providing a furthertransport resource for patients.

All of the public sector transport operationsidentified above are complemented by thetransport resources provided by the Perth &Kinross community transport sector (mostlyvolunteer drivers). The intention will be that thethree public sector operations (i.e. ScottishAmbulance Service, Perth & Kinross Council andNHS Tayside) will come together and adopt asingle system approach with a co-ordinating leadagency supported by all partnership members.

The management of volunteer drivers who arenotionally attached to the three public sectorpartners within the Perth & Kinross partnershipwill be reviewed during this process. It is theintention that within Perth & Kinross, theseresources will be pooled with joint conditions ofservice being adopted. This area of work fits wellwith the second main Proposal 2 of thepartnership.

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Proposal 2 – Community Transport: CommunityCar Association

The public sector transport providers seek toengage with the community transport sector butthere are some legitimate concerns about theoperational standards adopted by some of theless formal local providers. While there areexamples of good practice and co-operative working in some areas, across the whole of Perthand Kinross, there is a wide range of differentpractices and governance arrangements.

Perth & Kinross Community Transport Group willwork with community and hospital car schemesto develop a Community Car Association that willallow schemes to retain their independence whiletaking advantage of joint working and sharedgood practice. The main focus of the work will beon:

• Driver standards – training requirement, age limits, Disclosure Scotland, licensing.

• Vehicle standards – vehicle quality, insurance,MOT checks.

• Insurance – public liability, motor insurance,risk management.

• Training – first aid, moving and handling• Adopting common mileage reimbursementrates.

The Perth & Kinross Partnership will work with theCommunity Transport Group to develop andsupport the Community Car Association, identifyand negotiate a basis for joint working anddevelop a common set of standards that are bothappropriate to the community transport sectorand also provide the local authority, NHS andScottish Ambulance Service with the assurancesthey require.

This work will help to raise the profile of thecommunity transport sector in Perth & Kinrossand bring about a greater understanding andacknowledgement, by the statutory partners, ofthe community transport sector’s contribution totransport provision in their respectivecommunities.

BenefitsThis project is still in its infancy. A successful pilothas been run in Blairgowrie which has assisted inidentifying some key outcomes and potentialbenefits that can be realised from transportintegration. Just as important to the successfuldelivery of both projects is the preparation workthat has been undertaken to formalise a properlystructured partnership with key stakeholders andidentification of the key issues and barriers thatneed to be addressed.

The benefits sought include:• Increased well-being of people.• Addressing rural isolation/social exclusion.• Partnership approach to project delivery.• Utilisation of expertise provided through thepartnership arrangement.

• Transport efficiencies through combinedcommon approach to planning and utilisingresources to undertake client journeys.

Lessons LearnedAt the preliminary stage the lessons learned fromthese two Scottish case studies are:• There are barriers to greater collaborativeworking in both practice and culture.

• Service providers, for example, drivers,ambulance crew and day hospital/unitmanagers, need to have a clear understandingof the process behind the collaborative workingand what partnership is striving to achieve.

• The lead agencies clearly acknowledge thatthey will encounter concerns and obstacles,such as different arrival/departure times, themixing of client groups and the specific needsof passengers, as to why the goals they arehoping to achieve cannot be made to work and realise that these issues will take time,commitment and sensitive handling to resolve.

The key lessons are:• The need to engage all key stakeholders in aformal partnership structure.

• Clearly define what needs to be achieved, how and when.

• Benchmarking to learn from others.

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Appendix D:

Case Study onSocial NeedsTransport Review –GreaterManchesterBackgroundFollowing a Best Value Review, completed in2004, Greater Manchester Passenger TransportExecutive agreed to establish an IntegratedSocial Needs Transport (ISNT) service that wouldimprove the use of vehicles operated by anumber of agencies to meet identified andunmet client needs. This attracted the interest ofthe Audit Commission because of theopportunities to improve service quality andrealise efficiencies in the costs associated withthe provision of transport to meet diverse needs.

The framework of the ISNT service is based on:• the use of computer-based booking andscheduling system.

• the establishment of a shared cost model• streamlined contact/access for users andpotential users of transport services.

• collaboration around processes such asprocurement and shared support costs.

• the dissemination of good practice.

The ServiceWithin Greater Manchester, the experience of implementing a variety of initiatives, all atdifferent stages, illustrates the extent to whichefforts are being made to collectively implementa more integrated approach to transportprovision.

Service 1A joint financial investment arrangementbetween Ashton, Leigh, and Wigan Primary CareTrust and Greater Manchester PassengerTransport Executive has given significant fundingto a community transport service that providestransport links to new health facilities for arecognised deprivation area that is not directlyserved by conventional public transport.

Service 2The requirement for health to deliver specialisthealth intervention treatment led to a pilotinitiative with Stockport PCT, who wanted to offera concentrated number of client assessments andfittings of digital hearing aids, supported bytransport services where necessary. By offeringclinic appointments during the middle of the day,Stockport PCT could utilise the spare capacity ofSolutions SK (a Stockport MBC owned, arms-length, accessible fleet, operating company) toprovide transport support, scheduled to suit thetransport available, and reduce the risks of non-attendance.

Service 3Transport initiatives are being explored with healthservice staff in Bolton and Rochdale, particularlyfor people who need to attend falls clinics. Theseclasses will provide a potential opportunity wherefuture travel training and individual journeyplanning can be discussed which will supportgreater independence among those whoselifestyle changes may include reduced car usageas a driver.

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BenefitsThe development of collaborative initiativesbetween transport operators and health agencies,to deliver services that work, is clearly recognisedas an important goal. Reconciling the prioritiesof different partners, capturing the value ofcollaborative work, and agreeing how transportcosts can be funded makes the delivery of thisgoal difficult.

At a strategic level, further discussions with theAssociation of Greater Manchester’s primary caretrusts will continue. These will include thepossibility of establishing a joint health andtransport fund that can be accessed by healthprofessionals who have identified specifictransport needs for the services they areproviding. The purpose of the funding would be toensure that transport barriers in relation to healthcare are reduced, that transport supportmeasures are properly evaluated and that thewider benefits to individuals and agencies arecaptured.

Lessons LearnedThe requests from primary care trusts and healthtrusts to provide transport services to supporthealth functions has established a strongevidence base of the existence of continuing gapswhich needs to be rectified.

Work linked to the delivery of transport services tosupport effective health care has emerged as akey area of concern, in line with policy objectivesaround social inclusion, accessibility, and the useof alternatives to the private car. This was givengreater emphasis because of the significantchanges in health care provision that resulted innew transport demands or a requirement torespond to changing patterns of movement.

39

Appendix E:

Case Study on Provision of Renal UnitTransport in Sunderland -NexusBackgroundNexus (Tyne and Wear Passenger TransportExecutive) has funded and procured transportservices for those with mobility difficulties foraround 20 years under the brand name CareService. This, until recently, was in the form of aconventional ‘dial-a-ride’ service using minibuseswith ramp access for wheelchairs through therear doors. Customers booked the servicethrough the Nexus Call Centre and Trapezesoftware was used to schedule vehicles.

The ServiceAn opportunity arose to pilot a scheme with theRoyal Hospital Sunderland to provide transportservices to and from their renal unit, for patientsrequiring regular dialysis. The extra volume ofjourneys required two additional vehicles butotherwise the service used the existing vehiclefleet, call centre facility and IT software used byCare Service for planning and completion ofclient journeys.

The renal unit was only charged for the time thatthe vehicles were employed on work to and fromthe hospital. This arrangement allowed optimaluse of existing fleet vehicles’ renal unit trips,largely fitting in around the peak demandsfor traditional Care Service journeys. The twoadditional vehicles provided extra capacity for theCare Service operation during peak periods.

In 2006, Nexus replaced its Care Serviceoperation with a new taxi-based operationbranded as TaxiLink. This was broadly similar tothe previous Care Service, the main differencesbeing the implementation of tighter membershipcriteria and reduced operational area providing amore focused transport operation.

The results from the initial pilot scheme provedsatisfactory to both Nexus and the renal unit Itwas agreed that Nexus would tender andmanage, on their behalf, a four vehicle contractusing taxis to provide the patient transport.Essentially this was similar to the Nexus TaxiLinkcontract but designed specifically to meet renalunit requirements. As part of the revisedarrangements, Nexus provided a one-stop shopfacility for the renal unit and its patients with adedicated supervisor at the call centre that tookjourney details, scheduled and planned these tovehicles ‘real time’.

In early 2007 the Royal Hospital was obliged togo out to tender for the operation, in line with itsstanding orders, and its procurement sectionissued a tender for patient transport for its renalunit. The scope of the contract was larger,including a satellite facility in Durham City andthere were significant additional requirementsaround driver training and health and safety. Thecontract required vehicle scheduling andmanagement services. Critically, however, itrequired a single price for the management andoperation of the service.

40

Nexus, not being an operator, would have had tosub-contract the operations. This was felt toprovide an unacceptable legal and financialliability and, in any case, there was insufficienttime for Nexus to arrange a tender for the sub-contracted elements. Reluctantly, therefore,Nexus advised that it was unable to submit atender.

As a result of Nexus not being in a position totender for this contract, the proven synergies thathad resulted from the extended pilotarrangements were lost. Nexus had difficulty inreplacing the ‘lost’ 300 journeys with the resultthat refusals on TaxiLink increased. The renalunit did not immediately award a contract and,pro tem, negotiated its own temporaryarrangement with the same taxi company tocontinue the previous operation.

Key benefits of the Nexus/renal unit contractThe significant feature of the contract, was thatNexus would use any down time of renal unitvehicles to supplement its TaxiLink operation,paying the renal unit for hours used at an agreedhourly rate. This had two benefits:

i) The overall cost to the renal unit was reducedand Nexus was able to provide additionaljourneys for its TaxiLink operation.

ii) The dedicated supervisor provided a high level of service and, by making use of thedown-time of the four renal unit taxis, was able to schedule around 300 additionaljourneys a week to supplement the 2,400 or so journeys operated by Nexus’ owncontract for 12 vehicles. These were,significantly, at the time of peak demandbetween 0930 and 1200 and 1400 to1600.

Lessons learnedIf a partnership approach had been applied, afull understanding of the actual requirements ofthe transport contract could have been identifiedto provide the opportunity for Nexus to structuretheir business to at least be in a position tocompetitively tender for this work and continuerealisation of existing and future benefits.

41

42

Appendix F:

Case study on MoveEasy -SouthendUniversity HospitalNHS FoundationTrustBackgroundAs part of the travel plan measures of theSouthend University Hospital NHS Trust,Southend Hospital instigated a network of localtravel plan coordinators The group adopted thelocal council’s MoveEasy title and branding towork in collaboration with the council and otherbusiness in the area.

Aims of the MoveEasy Network:i. To encourage the use of sustainable travel.ii. To enable an informed travel choice.iii. To increase accessibility to the area.iv. To work in partnership with local transportproviders.

MoveEasy Network’s Objectives:i. Identify, implement and encourage best travelplanning practice.

ii. Identification of transport related problemsand issues for businesses and organisationsthat have accessibility, congestion and costimplications.

iii. Where possible, and suitable, hold jointinitiatives to view the impact on the localroads and our individual locations.

iv. Jointly market travel plan measures toencourage a change in the travel behaviour ofstaff, visitors and customers.

v. To work together as a business communityraising awareness of travel plan issues aidingbusinesses to meet their travel planningtargets.

vi. Offer guidance and recommendations toSouthend Borough Council, local transportoperators and other bodies onoutcomes ofMoveEasy initiatives and projects.

vii. Make the Network accessible to all businesses in the area.

The ServiceThe MoveEasy Network is open to travel plannersfrom local businesses and establishments and isregularly attended by local councillors andrepresentatives from local transport companies.

The travel plan encourages a sustainableapproach to transport. A key function is to makethe hospital accessible to everyone whilstproviding alternative options to single caroccupancy and promote sustainable, greenoptions of travel. Southend University HospitalNHS Foundation Trust actively promotes its travelplan to all staff, patients and visitors.

BenefitsThe MoveEasy Network now forms part of theSouthend Borough Council’s Smarter ChoicesStrategy, a daughter document to the LocalTransport Plan. The MoveEasy Network bringstogether all of the council’s ‘soft’ transport policymeasures which seek to give better informationand opportunities, aimed at helping people tochoose to reduce their car use while enhancingthe attractiveness of alternatives.

43

Appendix G:

Norfolk Integrated Transport Model

Gre

at

Yarm

outh

Nor

wic

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unst

anto

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Thet

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tingd

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ough

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44

Appendix G:

Norfolk Integrated Transport ModelC

omm

issi

onin

g &

Man

agem

ent

Boa

rd

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l Cen

tre

Elig

ibili

ty s

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ning

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Model

45

Project OriginationThe Project originated from discussions heldbetween the Health Improvement Programmepartnership group and Integrated TransportSteering Group ( 2000-2002) based aroundbetter utilisation of vehicles to meet passengerneeds, particularly in areas of rural isolation /social exclusion. Funding was obtained from theDepartment for Transport (DfT) to run a 3 yearpilot scheme on creating an integrated transportmodel covering health, social and well being,utilising existing transport resources only.

Key Policy Links• Audit Commission report “Going Places.”.• Social Exclusion Report “Making theConnections.”

• Country Side Agency “Benefits of Transport toHealthcare in Rural Areas.

• Norfolk County Council Best Value.

The Project commenced in October 2002,working closely with multiple organisations andtransport providers from the public, voluntary andprivate sector to integrate operations providing amore efficient, effective and inclusive service tothose members of the public eligible to accessthe service.

Key Aims and Objectives• Streamlined booking and journey service forpassengers by providing one central bookingcentre and one contact number.

• Booking arrangements for paying passengers.• Increased flexibility of driver/vehicle resource tomeet passenger needs by introducing a centralpool of drivers from the voluntary andorganisational sectors.

• Standardised passenger charges and driverpayments.

• Streamlined processes, procedures and fundingarrangements.

• Pooled Partnership funding providingsustainability for the service and sustainablePartnership working.

• Provide a recognised model supported byquality reference data that can be used forfuture implementation nationally.

• Direct referral for Health/Social Servicespassengers eligible for free transport

• Fully understand the benefits anddisadvantages of integration.

Project Geographic Population Statistics

Parishes Population

11 10,001+

9 6,001-10,000

19 3,001-6,000

29 2,001-3,000

60 1,001-2,000

116 501-1,000

295 1-500

The Partnership completes some 800,000 clienttrips annually county wide, providing a range oftransport services for people eligible to use them.Typical examples of the services available are:

• Health related journeys including hospitalappointments, hospital visiting and othermedical related appointments (eg. doctor,dentist, optician, physiotherapy).

• Day care and Respite Care.• Preventative health care.• Social activities, voluntary care.• Essential Shopping.• Other activity aiding the well being of the public.

Service deliveryPhase One: 2002 – 2004. Concentrated aroundthe market town of Dereham - 27 parishes with apopulation of approximately 37,000. Whilstlocally the service proved successful, the size ofthe area identified clear limitations inenabling all key transport partners to fully engagein integration.Phase Two: 2004 – 2007. Geographic areaincreased covering the whole of South Norfolkand Breckland - 232 parishes with anapproximate population of 230,000.Increase provided opportunity to engage all keytransport providers and fully progress transportintegration.

46

Phase Three: 2007- onwards. Build on PhaseTwo to provide integrated transport servicescounty wide covering health, social and wellbeingclient journeys– 539 parishes with population of941,000.

Key Achievementspotential benefits of transport integration and willactively delivery this by focussing on the followingkey project outcomes:

• Approved working model.• Increased geographic area of project.• Improved eligibility criteria for Health/SocialServices and well being.

• Single point of access for Health & SocialServices by direct referrals.

• Standardisation of key processes.• Increased resource providing greater flexibilityfor passengers.

• Effective use of funds for transportcommissioning.

• Implementation of one I.T. system (Cleric)amongst key partners.

• Capture of efficiency and effectiveness throughstandardised Key Performance Indicators.

• Framework for Partnership CommissioningBody.

• Implementation of transport pilot schemes.

Summary and ConclusionWith constant changes to client needs thatrequire transport support, the close workingrelationship between commissioner and transportprovider is critical in enabling a proactiveapproach to organising transport, particularly in amulti-partnership service. Whilst the project hasmade great strides, there is still a significantamount of work to be done to fully address theissues involved in working within such arelationship, identifying how, when and wheretransport integration can be successfully applied.

Key areas to be fully addressed are:

• Ensuring there is sufficient provision oftransport for people suffering from ruralisolation/social exclusion by increasing theflexibility of existing vehicle/driver resource.

• Expansion of the project county wide to fullydemonstrate the benefits of transportintegration.

• Removal of barriers (cultural / procedural /organisational / financial) with existing/newpartners as project expands.

• Sustainable funding.• Standardised transport charges and paymentmethods (i.e. tokens/card) to:- remove barriers on collection of money by drivers.- allow flexible and wider choice of transport and removal of issues around paying/non-paying passengers.

• Joint management arrangementsfor transport commissioning and funding.

• ‘Real time’ journey information to transport providers.

• Establishing quality data for measuring success.

Savings2004-2007: £1,250 - Phase 1 pilotPilot change and consolidation period2007/2008: Envisaged savings of £100k2008 onwards: Envisaged savings £230k per

annum

47

Appendix H:

Hertfordshire Integrated Transport Model

Model

PROVISION

IN-HOUSE

CONTRACT

MANAGEMENT

SEPARATE

INTEGRATED

LIAISON

CO-ORDINATED

POLICY BUDGETS

SEPARATE

CO-ORDINATED

CORPORATE

POOLED

SEPARATE

The Hertfordshire model focusses on three key processes for the provision of transport. The modelprovides the ability for an organisation(s) to link into the transport chain at any given part of theprocess. The above highlights a potential linkage between organisations providing transport bothseparately and through a co-ordinated approach.

hospitalurban areamotorwayprimary roaddistrict boundary

Project OriginationThe partnership developed in 2001 as a result ofthe County Council and North Herts & StevenagePrimary Care Trust meeting to discuss if and howthey could work to address common issuesof access, especially around health facilities.

Key Aims and ObjectivesThe initial aim of the Hertfordshire IntegratedTransport Partnership was:

‘to research the feasibility of single transportservice in order to improve access toappropriate travel for the residents ofHertfordshire’

In 2002 a partnership steering group wasestablished, consisting of senior representativesof NHS trusts, Voluntary Sector agencies, 10District and Borough Councils and the CountyCouncil.

Partners agreed a work program that committed the organisations to:

1. a) Undertake internal transport policy reviewswithin education, looked-after children,elderly, physical disability, learningdisability and healthcare services. Each partner reviewed transport policy,commissioning, processes andprocurement.

b) Reviews would use a common frameworkand be shared across organisations toidentify opportunities for joint working andlong term efficiencies and sustainability.

2. Develop projects

Service Delivery

Travellink Call CentreSingle point of access providing residents andprofessionals with information on transportoptions and entitlements. This has developed totake and screen all requests for non-emergencypatient transport from residents served by East &North Herts GP surgeries.

Use of Call Centre covering West Herts. Interestfrom other organisations in using this facility (i.e.West Essex PCT).

Health shuttle

1) Lister Hospital

Door to door, accessible transport, using 5 vehicles covering Stevenage, North Herts and South Bedfordshire.

2) Broxbourne

Door to door, accessible transport for residents ofBroxbourne who have to travel to Chase Farm,QEII and Lister Hospitals.

Hertfordshire Integrated Transport Partnership

48

49

Key AchievementsThe work to date has resulted in:

• reviews of partners transport policy,commissioning, procurement and processes

• introduced the Travellink call centre, web pagesand NHS Travellink Centre

• launched the Health Shuttle• procured transport routing and bookingsoftware

• delivered savings of £450,000 in the cost of home to school transport contracts

• identified savings £500,000 within health anda further £175,000 saving on renal transport

• evidence of simplified management and better quality transport within Children Schools and Families

• attracted investment of £222,000 todevelop/further develop joint working that will integrate and co-ordinate transport inHertfordshire.

SummaryThe core aims and objectives remain veryrelevant to both national and local policyframeworks and the partnership hasdelivered considerable outputs, providing animportant cooperative framework that is a keyexample of good practice of nationalsignificance.

The partnership has also delivered importantprojects such as the Health Shuttle and NHSTravellink, including a review of HertfordshireIntegrated Transport partnership in 2006 donewith external consultants

ConclusionThe challenging objective of the originalpartnership process was to develop a progressiveprocess creating the pre-conditions fordeveloping full transport integration. A review willtake place to establish how best to implementthis with future partnerships.

The reorganisation of health agencies, change ofnon emergency PTS provider and financialchallenges faced by PCTs and NHS trusts will addto the difficulty of ensuring longterm and sustainable transport integration.

50

Appendix I:

Devon Transport Model

51

Model A.

Loca

l Tra

nspo

rtA

utho

rity

Tran

spor

tU

nit

Soci

al C

are/

Hea

lthTr

ansp

ort

Brok

erag

e

In H

ouse

tra

nspo

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mm

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onin

g an

djo

urne

y pl

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ng

Join

t co

mm

issi

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g an

d pl

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ng t

hrou

ghBr

oker

age

Cen

tre

Hom

e to

Scho

olSp

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Scho

olM

ains

trea

mTr

ansp

ort

Publ

icTr

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ort

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al C

are

(Soc

ial

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ices

)Tr

ansp

ort

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lth P

TS

Tran

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omm

unity

Tran

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cal m

odel

whe

re c

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the

typ

e of

ser

vice

, clie

nt n

eed

and

vehi

cle

spec

ific

atio

n / r

equi

rem

ent.

52

Model B.

Soci

al C

are

(Soc

ial

Serv

ices

)Tr

ansp

ort

Hom

e-to

-Sc

hool

Spec

ial N

eeds

Tran

spor

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ome

toSc

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Mai

nstr

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blic

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spor

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Com

mun

ityTr

ansp

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Join

t ve

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arin

g be

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nLo

cal t

rans

port

aut

horit

y an

dH

ealth

tra

nspo

rtC

lose

r N

etw

ork

Plan

ning

One

Sto

p Sh

op

Hea

lth P

TS

Tran

spor

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Whe

re s

ocia

l car

e (s

ocia

l ser

vice

s) tra

nspo

rt h

as b

een

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ed w

ith

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-sch

ool s

peci

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tra

nspo

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e D

evon

mod

el). In

this

mod

el the

syn

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es a

re b

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real

ised

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egul

ar s

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l car

e tr

ansp

ort an

d re

gula

r sp

ecia

l nee

ds e

duca

tion

tra

nspo

rt.

53

Devon CountyCouncilTransport Co-ordinationService:OrganisationFunctions & VolumesThis example gives a clear idea on how anorganisation can be broken down into key serviceareas and structured so that both its mainstreamtransport functions can be fulfilled as well asidentifying potential areas where an integratedapproach to transport provision can be applied,either internally or externally with otherorganisations / partners.

Specialist Transport• SEN school transport.• SEN FE transport.• Social Services transport.• Reviews.• Network planning.• Contracts/ tenders. • Service integration including with otheragencies e.g. Health Trusts.

• Adult Social Services transport £1.73m• 1000 regular passengers transported/ day - £1.1m/ yr.

• 1700 “One-off” bookings - £0.65m/ yr.

Mainstream School Transport• School transport.• FE transport.• Reviews.• Network/ tenders.• School meals transport Service integration.• Transport: £20m budget.• 22,000 pupils transported/ day.• Post 16 & other ticket contributions £0.5m.

Public Transport• SWPTI Traveline.• Network planning.• Schedules/ timetables.• Concessionary fares & education tickets.• Monitoring service performance/ data analysis.

• Contracts/ tenders.• Publicity & information.• Local Transport Plan implementationConsultation.

• £5.0m bus service support/ yr.• 4.5m passengers carried/ yr.• 220 local bus contracts.• 6 area timetable books covering all Devon.• 130,000 Devon wide concessionary faresscheme pass holders (Devon manages schemeon behalf of 8 District Councils) & 2000 SeniorRail Cards issued.

• 3 Rural Bus Challenge projects.• 11 Fare Car schemes.

54

Community Transport• Community/ rural transport & capacity building.

• Devon Rural Transport Partnership.• Partnership external bids & grants.• Community planning/ DSP /LSP links.• Health Transport Partnership (Includes 2 x Devon Rural Transport Partnership posts).

• Community transport schemes support£290,000.

• 4 Local transport partnerships. • 16 Ring & Ride schemes.• 15 Community Car schemes.• 6 Community Bus schemes.• 5 Shopmobility schemes.• 3 Wheels to Work projects.

Business Development• Improvement planning & development.• Project co-ordination.• Support systems.• QA/ performance indicators.• Monitoring TCS services.• Market research/ surveys.• New service formats & RBC joint initiatives/ bids.

• LTP input/ delivery & other DCC strategies.• Communications/ PR.• Performance Management Plan.• Performance indicators & annual customer survey.

• Leading SW Counties Transport Benchmarking Group.

• QA & audit process.• 250k timetables & booklets published/ yr.• Contractors’ forums.• GIS/ E-govt development.• Smartcard scheme & development.• Best Value Action Plan delivery & integration.

Compliance & Fleet

Compliance:• Fleet management.• Fleet management.• Vehicle procurement.• Safety.• Driver vetting.• Driver standards.• Coach hire & removals.• 1330 school contracts.• 150 Social Services contracts.• 4300 drivers issued ID badges.• 200 drivers trained in carrying wheelchairs/ yr.

Fleet Management:• 500 road going vehicles including 100accessible minibuses, 60 minibuses, 33 accessible cars.

• Annual vehicle replacement programme£1.2m.

55

Appendix J:

Peterborough Transport Model

56

Model 2 – Central Transport Commissioning

Health Education

Social Services Leisure

- single point of access- commissioning- planning and policy- communication- benchmarking

GP/receptionist advises patientof transport booking line

Trained assessment staff ascertaintransport needs of patients

If appropriate a patient transportassessment for medical purposes is made

Outcome of Assessment

Eligible Not Eligible

Transport provider informed of request

Patient informed of other public andcommunity transport options available

xStep 1

xStep 2

xStep 3

Model 1 – Transport booking for Health care

57

PeterboroughIntegratedTransportPartnershipProject Origination:Peterborough City Council works in partnership withPeterborough Primary Care Trust and other localpartners on improving the co-ordination of traveland transport access across health, social care,education and leisure services.

Key Aims and Objectives:• To improve patient transport services, byupdating eligibility criteria and issuing theguidance on commissioning transport.

• To improve the advice and information availableto patients, by allowing patients to choose thetime and place of healthcare appointments anddeveloping options for a one-stop shop ofappointment and transport booking.

• To promote accessibility considerations indecisions on healthcare infrastructure.

Partnership Review and Recommendations:A review of existing transport arrangementsundertaken by the local authority, NHS trusts andcommunity transport operators identified thefollowing recommendations:

1) Implement non-emergency patient transportservices primary and secondary healthcare

2) Endorse and fund the development of atransport booking system to process.

3) Patient Transport Services (PTS) requests forprimary and secondary healthcare as part of aone stop shop for transport.

4) Procure improved planning tools and IT systemsthat are centrally available to plan journeys.

5) To include a transport element in the costing ofnew services across health, education and socialservices.

6) Improve and expand community transportoptions that are available in Peterborough andwider environs.

7) Establishment of a travel plan for all newservices including health, education and socialservices.

8) Improve information that is consistent andtailored across all health and community sites.

9) To develop a travel training programme forparticular groups with specialist needs.

Service Delivery:Travel options have a customer-focussed emphasison choice, accessibility and value for money.Service delivery has been assisted by using thefollowing key steps:

1) Establishment of a robust project managementprocess and clear stages to integration thatincorporate customer needs.

2) Promotion of clear criteria and procedure fortransport for medical and social reasons rolledout to all GP Practices and hospitals inPeterborough.

3) Support and advice offered to clinical staff inassessing patients travel options.

4) Reduction in inappropriate use of patienttransport and a reduction in aborted journeys(less than 1%) through improvedcommunication.

5) Co-ordinated marketing campaign - over10,000 copies of transport to healthcarebooklet sent out to local health and communitycentres to ensure staff and patients are awareof travel options.

6) Travel training programme established forlearning disabilities / mental health clientsregarding concessionary fares and similarschemes. Tailored marketing materialaccompanies the scheme.

7) Smarter and joined up commissioning ofpatient transport services has enabledimproved services within existing financialenvelope.

8) Increased support and business for communitytransport operators - over 50 drivers have beenissued with permits to help them access thelocal hospitals more easily.

58

9 Establishment of new local bus servicesserving local hospitals - bus services now runbetween the city centre and the majorhospitals every 10 minutes.

10 Health impact review of the 2nd LocalTransport Plan carried out in conjunction withPeterborough PCT Public Health.

11 Representation on the Hospital Travel PlanGroup by PCC and PCT representatives toimprove access for staff, patients and visitors

12 Joint review work with regional and nationalcommittees on patient transport, the hospitaltravel costs scheme and integrated transportunits.

Key Service Outcomes:The recommendations from the agreed servicemodel are now being implemented and thefollowing outcomes have been delivered:

• Effective co-ordination of transport resourcesfor patients accessing healthcare services.

• Developing a whole system approach tolooking at both a medical and social need for transport.

• Improved key interfaces between publictransport,community transport and non-emergency based ambulance services.

Summary and Conclusion:Transport integration remains a high priority onboth the local authority's and local health trust'sefficiency plans and has been given the supportand backing of chief executives and localmembers. However the original jointly employedCoordinating Officer departed to another job in2006 and has not been replaced. As a resultsome of the momentum of the initiative has beenlost. Nonetheless the intention remains tocontinue the effort to maximise appropriate traveloptions for patients and visitors accessing healthservices, particularly those in vulnerable groups.

59

Appendix K :

Scottish Ambulance Partnership:Patient Transport Service – Transport with Care

Project background:

The Vision:

Key Objectives:

The Scottish Ambulance partnership is, at the time of this document going to print, in the early stages of implementing an integrated transport service.This partnership aims to deliver better use of current resources by improving co-ordination across the key providers of Social Transport – Health, the Ambulance Service, Local Authority and Voluntary Sector Providers.The Transport with Care Programme aims to increase the quality, range and volume of transport for those with medical or social needs.Effective and efficient transport is an essential component in the provision of effective Health and Social Care Service Delivery and is crucial in terms of access to services.

The Vision of the Transport with Care Project is to establish Integrated Transport Solutions across Scotland including co-ordinated booking services, which provide Social Care and Health Services users who require transport with a fit for purpose, reliable and effective transport to and from the point of service delivery.

To optimise the use of current transport resources held across the local authorities, health boards,ambulance and community transport sectors to deliver economic and environmental benefits:1) Tailored to the needs of patients and patient centred.2) Easy to access and equitably provided.3) A high quality service: caring, courteous, punctual, reliable and efficient, with appropriately skilled,equipped and trained staff.4) Based on National Minimum Standards, but delivered through local solutions.5) Flexible and responsive to local needs.6) Rewarding for the staff who work in it.7) Delivered in partnership with other agencies.8) Underpinning the Emergency Ambulance Service and the wider NHS.

Implementing the Strategy for the Developmentof the Patient Transport Service

High level actions:• Educate and involve stakeholders in the new vision and the new service delivery processes.• Develop different tiers of PTS staff with various skill levels to meet the different requirements of the services and to provide a career path for PTS staff.• Extend the hours of working, where required, to meet NHS hospital appointment times and to help reduce bed-blocking and facilitate early discharges.

Review staff terms and conditions of service.

Continued on next page

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Patient Transport Service – Transport with Care (Continued)

Service CategorisationService Type 1 – NHS Priority Clinical Conditions Cancer, Coronary Heart Disease, Mental Illness, RenalService Type 2 – Patients Attending for Remedial/Invasive Treatments (e.g. Diabetes, Endoscopy)Service Type 3 – Routine/Rehabilitative (eg. Day Hospital, Physiotherapy)The core of the categorisation system would be a matching of patient need to an appropriate service response. There are three ‘drivers’ which would determine the category of the patient and the type of service provided:1) The Clinic being attended2) The basis of the transport need – medical, social or geographic3) The mobility of the patient

• Improved user access through adopting single number booking services and other appropriate centralised communication channels by integrated I.T. Systems within and across the Partnerships.• Improved Quality of Service through creation of co-ordinated use of all transport resources to increase capacity and user responsiveness.• Improved service users experience through improved access, explicit standards, clear eligibility criteria and reduced journey times.• Increased activity from existing resources through effective co-ordination and planning

Expected Key Outcomes:

Quality Standards:1) Punctuality for appointment • Punctuality for "pick-up" (post appointment). • Travel time to/from appointment - urban/rural/sparse health boards (categorisation = different quality standards).2) To provide easy, reliable and consistent access to transport with care service for users/carers.3) To improve the quality of journeys in respect of time and comfort for passengers.4) To build strong, effective and enduring partnerships across the transport providers to support continued efficiency gained through greater integration of service delivery, service infrastructure and procurement arrangements.5) To build improved service development sensitivities through effective and continuous user/carer engagement with service providers and commissioners.

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Annex 1

Members of the joint localauthority/NHS working party whichformulated this advice document

Ron Beckett

Doug Bennett

Lena Boghossian

Chris Busst

Judy Carne

Julie Cox

Roger D’Elia

Garth Goddard

Chris Hanley

Andy Hickson

John Hodgkins

Jane Jackson

James McCafferty

John McVey

Stuart Murray

Dave Neilan

Tony O'Connor

Jason Roberts

Bruce Thompson

Richard Turley

Graham Wray

London Councils

Norfolk County Council

HPC Birmingham

West Midlands Ambulance Service

Lewisham Borough Council

South West London NHS

Hertfordshire Partnership NHS Foundation Trust

North West Centre of Excellence

Peterborough City Council

North West Ambulance Service

Buckinghamshire County Council

Heatherwood & Wexham Park NHS Trust

Scottish Ambulance Service

Poole Borough Council

GMPTE

Hertfordshire County Council

London Councils

Merseytravel

Devon County Council

Cheshire County Council

HPC Birmingham

Annex 2

Abbreviations

CT(A) – Community Transport (Association) –covers voluntary, community and social enterprise organisations collectively referred to as “The Third Sector”

IT – Information Technology

ITU – Integrated Transport Unit

JIT – Joint Improvement Team (Scottish Executive)

LA – Local Authority

LTA – Local Transport Authority as per The Transport Act (2000) S.108(4)

NHS – National Health Service

NPTMG – National Patient Transport Modernisation Group

NWAS – North West Ambulance Service

NWCE – North West Centre of Excellence

PCT – Primary Care Trust

PTS – Patient Transport Service

PVR - Peak Vehicle Requirement

SEN – Special Educational Needs

TCS – Transport Co-ordination Service ( Cheshire CC)

VACS – Voluntary Ambulance Car Scheme

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