DHL PTS Ponders End

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes

We rated responsive as good. We assessed five quality statements. We found that overall, the collection of people was timely, however return journeys were not always on time and sometimes people had to wait long periods to be collected and returned home. We found leaders were unclear on what patient documentation was retained and found some had been stored inappropriately. However, the service had effective systems to manage complaints and had actively sought and listened to peoples’ views. The service had given training on neurodivergent conditions to support people being transported.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Person-centred Care during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People told us that inward journey times were good, but outward collection times were not consistent and sometimes late by several hours. People from renal units told us they were often collected with other patients and although finished treatment at the same time were sometimes transported home at different times by different vehicles which meant they had been delayed whilst others had been transported home. Some people said they had not always been contacted regarding delays or cancellations.

Staff told us that the main theme for complaints are delays, eligibility for transport and the limit of escorts permitted to accompany people. Leaders told us they had developed improvement strategies on performance i.e. plans to subcontract where appropriate to a taxi service for inward journeys. They told us that some Trust Key Performance Indicators (KPI) at 100% were unachievable. Managers told us the service subcontracted around 50% of journeys that required specialist support. They said some journeys had to be cancelled and were rebooked because information was not provided at the initial assessment and staff were unable to transport people safely or according to their needs.

Staff at Trust venues told us sometimes people had waited several hours to be collected, which had impacted on peoples discharge from the trusts’ care and availability of bed space for other people. They told us frequently groups of people had been brought for appointments and were ready for collection at the same time but are transported home by different vehicles at different times. They told us DHL staff being based at the Trust site had helped to manage issues with peoples’ journeys, however in their absence it could sometimes take a long time to contact control by phone. They said sometimes people had been delayed following their appointment and the service had cancelled the journey which meant it had to be rebooked.

The service had systems in place to assess, plan and manage people's journeys. There were procedures to contact people before their journeys to advise them of arrival times and or delays and also trust staff when transport was cancelled or delayed and should be documented on an electronic system. There were protocols that set out circumstances when journeys could be cancelled or aborted. DHL supervisors were based at some Trust venues during office hours Monday to Friday who were responsible for managing issues with peoples' journeys, represented the service at Trust meetings and perform hand hygiene audits of road staff that had transported people to appointments.

We were assured that overall the service transported people to appointments in a timely way, however we were not assured that people transported home, particularly from non-dialysis appointments were as punctual. The service measured delays on inward and outward journeys. On average over a 12 month period outward journeys (transport home from appointments) 3% of dialysis patients and 11% of non-dialysis patients experienced delays. Over that same period inward journeys (transport from home to appointments) showed 3% of dialysis patients and 5% of non-dialysis patients experienced delays. However, data showed an increase of journey volume and overall delays had decreased.

Some people said the service did not always tell them when they would be late which caused them distress.

Staff told us they are provided with communication cards which people could use to indicate how they felt. They said they had also used an electronic translation application on their own phones. Leaders told us the service did not use a telephone language line and had provided staff with picture cards to communicate with people and their diverse workforce who could provide translation if required.

A leader responsible for General Data Protection Regulations (GDPR) told us that no patient safety records were held on site and electronic records were managed centrally. Some managers told us there was no nominated Caldicott Guardian, but the GDPR lead would cover that role. This meant that peoples’ personal data might not have been stored legally, ethically, appropriately and confidentially.

We were not assured that peoples’ communication needs were met. The service used a card that showed images for people with communication difficulties to highlight how they felt. There was no formal interpretation or translation service provided for people being transported and staff told us they used their personal electronic devices to translate for people being transported.

GDPR for computer-based information is managed centrally by the parent company with access limited to relevant staff. The lead for GDPR told us no documents were stored at the site, however other managers told us confidential paperwork was stored securely in line with GDPR and Caldicott principles. We saw some confidential patient, staff and vehicle paper records in the storeroom which were not compliant with GDPR guidelines in that they were not stored securely or kept confidential. The service had trained 98% of road staff in GDPR and Caldicott principles.

Trust representatives said they were positive about the service performance and that the service had improved overall. Partners said the service actively encouraged feedback and concerns which were recorded and reviewed by governance leads and relevant action and learning had been taken.

Leaders told us that complaints come from different sources, from Trusts, people transported and people who represent them. Complaints are assigned to an investigator who on completion provided feedback to the relevant team lead, complainant and the Trust.

Staff said main themes for complaints are delays, assessments and limitation of people that can accompany people being transported. They said they try to resolve complaints directly but if unable complaints were passed to supervisors.

The service held monthly meetings with the Trusts and regular patient forum groups to receive direct feedback on their performance. DHL staff were based at Trust venues and managed issues, attended Trust meetings and acted as a conduit between the service and the Trust. The service aimed to deal with complaints within 28 days. All complaints should be investigated, outcomes and learning passed to the department lead for action and outcome communicated to the complainant.

The service has feedback posters in Trust venues and patient transport vehicles on how to provide feedback and feedback cards were available for people being transported.

Inspectors saw posters in vehicles with QR codes so people could provide feedback on the service. We have seen outcomes of complaints which had acknowledged the concerns raised and responded with lessons learned and action that had been taken as a result. The service provided data that showed they had received 843 complaints between October 2023 and September 2024 of which 428 were about people being collected late.

People told us the service ensured that people are cared for and that staff are person centred. They told us that without this service they would not be able to attend appointments and they could arrange journeys when they needed them. A person told us "Staff are making sure that my husband is taken care of when I’m not up to it, because I’ve got no one else to do it".

Staff said the type of transport allocated to journeys was based on people’s initial assessment and patient transport history. If necessary, staff would contact people or trusts to clarify needs to ensure peoples journeys were safe. Leaders told us they had started training staff in neurodivergent conditions to help staff understand and facilitate communication needs.

The service had an effective system for people and people who represented them to book patient transport directly and when the service had been busy, callers could request a call back. On assessment, staff ask a series of pre generated questions that assess eligibility and needs. If the assessment showed the person was eligible for transport this information with any previous patient history would be reviewed by a planner and a journey organised. Trust staff could book transport on peoples’ behalf. The system generated questions that assessed people’s need, eligibility and type of vehicle that would be most appropriate. The service held regular patient group meetings to gain feedback, however no minutes, actions or outcomes were provided.

Trust Staff said sometimes people who needed transportation that had required the use of a stretcher experienced longer delays. They said sometimes people are unwell after treatment and transport can be delayed or cancelled which meant staff had to wait with people until they had been collected, or people had been moved to different departments to await collection. However, people said the service recognised and managed their needs effectively when they had been transported to appointments.

Staff told us sometimes they are assigned to journeys where they did not have equipment that met people’s specific needs, that they had to request further support from other crews and this had led to delays. Staff and leaders said sometimes journeys booked directly by trusts did not contain accurate information and this sometimes led to delays by allocating vehicles that were not equipped to transport people safely. Staff told us to improve people's journeys further training should be delivered to trusts that booked journeys on electronic systems but themes had not yet been established to tailor the training that would be required.

Journeys were planned to meet the needs of people and transport to appointments was arranged to meet their individual needs. People could access transportation when they needed to and in a way that worked for them. However, we did see examples of some people with greater needs were subject to delays on return journeys. Staff received training on equality, diversity and human rights, dementia, unconscious bias, autism and learning disabilities, however at 60% this was below the service level of 95%.

We were assured by using the assessment process the service was able to suitably assess peoples’ needs and requirements either directly by telephone or booked on their behalf by Trust staff. Generally, people could access transportation when they needed to and in a way that worked for them. However, we did see examples of some people with greater needs were subject to delays on return journeys.