DHL PTS Ponders End

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We rated effective as good. We assessed five quality statements. Staff effectively assessed peoples’ transportation and suitability needs and co-ordinated transport to and from health venues. Staff had received sufficient training to care for people being transported and there were effectives systems in place to monitor driving standards, vehicle locations and arrival times. The service managed complaints effectively and worked with partners to support people. However, the service did not have a deteriorating patient policy, staff could not easily access policies, staff were inconsistent on how to recognise a deteriorating patient and action they would take.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some people told us arranging transport wasn’t straight forward and the phone lines were always busy. Some people told us they preferred when they could book transport more than a week in advance but liked that they could contact the service at weekends by phone.

Staff told us some bookings made by Trust staff did not always contain enough information which meant recontacting the Trust staff who were not always available. They said further training was required for some Trust staff, but there was only one trainer available to do this and no themes had been identified. Some bookings were allocated to the wrong type of vehicle which could cause delays or cancellations.

The service had effective systems to assess eligibility and book patient transport by phone. When the service was busy callers could request a call back. A planner used an electronic system and liaised with colleagues to amend fleet requirements based on the user’s need and patient history. The service planned journeys in advance and leaders reviewed past performance based on specific incidents and at a weekly meeting. Trust staff that had been trained could book transport for people electronically directly. Systems were in place that ensured do not attempt cardiopulmonary resuscitation (DNACPR) and special notes were accessible to staff on electronic systems. Where this information was not documented the service could access this information electronically.

We saw call takers book transport using a pre-formatted system which was thorough and followed a logical process. This process identified peoples’ needs and identified which transport was most appropriate. We saw staff worked collaboratively with colleagues through assessment, co-ordination and despatch of journeys.

People said the service cared for them according to their needs that they felt supported. One person said "I don’t know how to manage without them to be quite honest, the service has always had a good reputation by my book and I’ve also told my friends who used to Service as well, that they have no bad words to say".

Staff said training was sufficient for their role and received training regularly. Leaders said training had been provided face to face but had looked at electronic systems to deliver this more efficiently for some areas.

All staff received mandatory training on joining the service which covered the key skills required for patient transport and further training provided to staff selected to work on HDU vehicles. Refresher training was provided on a rotational basis. The service had systems in place to gather, assess and plan peoples’ journeys to and from health providers based on peoples’ needs. Senior leaders and managers held daily review on performance, incidents and areas of concern or that could impact on service delivery. Peoples’ hydration needs were met in line with current guidance through provision of bottles of water for people being transported and formed part of road staff daily equipment.

We saw staff worked collaboratively with colleagues through assessment, co-ordination and despatch of crews and vehicles to journeys. We saw people transported by staff between venues safely using evidence based good practice and standards. We saw staff clean vehicles according to service policy after a journey and before collection of a new person.

People told us that the service worked with health providers to arrange transport for appointments and that the system worked well. Some people who used the service felt the assessment process was very long, but they understood it was necessary.

Leaders told us they had recognised a division between control and road staff and had arranged cross portfolio working so people could understand each other’s roles and challenges. Both office based and road staff said this had helped them to understand what staff and people needed. Leaders told us the Trusts focussed on inward journeys only, however they did monitor performance on outward journeys and looked to improve punctuality. Road staff told us that Control staff did not always listen to concerns, did not understand their role and prioritised completing jobs over patient safety.

Leaders told us they had recognised a division between control and road staff and had arranged cross portfolio working so people could understand each other’s roles and challenges. Both office based and road staff said this had helped them to understand what staff and people needed.

Leaders told us the Trusts focused on transporting people to Health venues, however the provider also monitored transporting people from health venues back homeand looked to improve punctuality. Road staff told us that Control staff did not always listen to concerns, did not understand their role and prioritised completing jobs over patient safety

The initial assessment process meant staff had access to the information they need to effectively plan people’s journeys and transport them to health providers. We observed the service had effective systems to manage complaints and dealt with them within agreed timescales. We saw DHL staff engagement at a trust bed management meeting to support the Trust, resolve issues and engage with DHL directly.

The service held daily, weekly and monthly meetings with service leads and trust representatives to review bookings, incidents, complaints and compliance with Key Performance Indicators (KPI). Complaints regarding the service were received directly and through Patient Advisory and Liaison Service (PALS). All complaints that come directly to the service and were not resolved were shared with PALS and investigated by the service. The service had managers permanently based at Trust venues, whose role included resolving issues directly with the Trusts and to complete IPC audits. Service leaders held regular meetings with care providers and patients to seek feedback and improve their service model.

People provided no feedback on this category.

Leaders told us they had a “patient incident process” which they felt was the same as a deteriorating patient process. Some staff said they had no knowledge of National Early Warning Score (NEWS2) scores which is used to monitor people at risk of deterioration. Staff told us of an incident involving a deteriorating patient where the service current patient incident process had not been complied with by road staff or control staff.

The service had no clear accessible deteriorating patient policy but used a patient incident process which road staff were unable to access as they have no access to electronic systems. They could only access these processes by requesting a print from a manager at the site

We were not assured that the service always had effective systems or equipment to monitor people, identify a deteriorating patient and the process staff should follow and access to that process. Staff who transported people did not give consistent answers on how to recognise or manage a deteriorating patient. We found some HDU vehicles life support monitoring equipment was incomplete and defibrillator pads were out of date.

People gave us no feedback for this category

Leaders told us to improve performance, attendance times and to support people they have explored and implemented new ways of working. They told us they held regular meetings with partners, patient groups and staff to monitor and improve performance. The service has electronic systems which monitor journeys and driver actions and enables real time action to be taken to support people being transported. The service was always looking at improvement strategies to meet the increasing volume of patient transportation requirements.

The service had systems in place to monitor journeys using electronic systems to support people transported to appointments. The service produced data which had been shared with partners to show compliance with KPIs and formed part of their regular meetings.

The service effectively monitored driving standards, arrival times, cancellation and aborted journeys. We saw performance data which showed that over the course of one year the volume of journeys had increased whilst the percentage of those journeys cancelled or aborted was similar.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.