Renal Transport Project Wales

Dialysis Transport…the beginning In Wales, Renal Networks established March 2008; Original remit – Renal Replacement Therapy

including Vascular Access; Active decision to pursue Dialysis Transport – integral

part of UHD treatment Commissioning responsibility not with RRT

commissioner – disjointed.

Assessment Previous commissioning roles meant that the RNM’s

were aware of issues; Discussed with Welsh Kidney Patients Association Joint survey WKPA and WAST in early part of 2008

Outcome presented at National Annual WKPA conference and for Minister for Health & Social Services

WKPA / WAST Survey Massive variation between three regions but all

generally poor Satisfaction highest with patients on longest journeys

(the ones relying on taxi’s i.e. dedicated in al but name)

Started formal engagement between renal networks and WAST

Slow fuse between November 2008 and March 2009…

Project Start SWRN and SE Region of WAST – good working

relationships, similar approach and style… Momentum No democracy as being caught up in politics,

personalities, etc ‘Machiavellian approach’ – prepared environment,

champions, etc

Briefed Minister on option to tackle the challenge head on and a project to establish a dedicated dialysis transport service

The project Needed dedicated resource to undertake project Wanted a focus on patients rather than money,

resources Strong character required as WAST has leadership

issues locally and nationally Not sure on all the specifics but had cunning plan… Recruited Kate May

Political / Organisational Context Massive Ministerial interest in renal: double-edged

sword but adds momentum and remit in difficult environment

Structural consolidation with larger NHS organisations, mergers, and joining of primary and secondary care – no more purchaser / provider split (sort of)

Establishment of Welsh Renal Managed Clinical Network – budgetary control / Performance Management – “Specialist Commissioner”

WAST & NETWORK Its getting better

(ish)… WAST not used to dealing with creatures like network

with such focus, cohesiveness and patient / Ministerial support

Very uncomfortable at times particularly with bigger review of PTS services in Wales

Project Vision Dedicated transport service that will be patient

focused and timely. Transport will become part of the care plan for

patients receiving unit based haemodialysis Transport will be planned collaboratively with the

ambulance service, the patient and the renal unit staff to minimise delays

Patients will travel in comfortable, appropriate vehicles

Improve patient experience

Renal Standards 30:30:30 75% of patients should access their renal dialysis unit

within 30 minutes travelling time of their home 85% of patients should arrive on the dialysis unit no

earlier than 30 minutes before their dialysis start time. 85% of patients should leave the hospital no later than 30

minutes after their dialysis completion time.

Cheshire and Merseyside NHS Trust 2006

Building Key Relationships Patients WKPA Renal Unit Managers WAST Project board has representation of each of these

groups Collaborative accountability for performance

standards of the service

Exploring the options Standardise ‘Ready Times’ Geographically zoning patients Phasing appointment times Visit to existing successful services: Glasgow and Lanarkshire West Ambulance Services

Oct 2009 Yorkshire Ambulance Services – Feb 2010

Patient InvolvementQuarterly NewslettersDedicated email addressDedicated Free post addressComment cardsPatient forum events

Patient Forums 13 units in Wales Every unit visited over two days to engage with all

patients am/pm for each day. Discussion about newsletter, project plans, feedback

and questions Patient comments re current service and key points

for change. Great value placed on having the same driver

each time, pick up times, prompt pick up following treatment

Vehicle Options More suitable vehicles needed Selection of vehicles shortlisted by Fleet

department as suitable according to brief Vehicle options including potential adaption

presented to patients at five units. Two days at each unit.

Scoring sheets to offer feedback on comfort, access, space, interior layout etc

Vehicle Scoring

Individual Transport Plans Recruited dedicated renal planning staff Transport plans include:i Transport Pack - to collate patient details and

comments. Patient and unit representative to sign off details

t Transport Mask- a saved plan that is most appropriate according to the transport pack, meeting renal standards and is repeated every journey.

Patient and unit staff to agree mask

Benefits of an Individual Transport Plan

Patients involved directly Patient focused Quality focused against renal standards Same journey each time Dedicated driver or team of drivers Continuity that patients desire in terms of pick up

times, routes and fellow passengers Information sharing Improved patient experience Identifies areas where reinvestment required

A contactable Service: Dedicated Renal Unit telephone line operational since

June 2009. Prioritised queuing, operational from 6am until 7pm to

assist resolving issues daily

Dedicated Renal Patient Telephone Line operational since January 2010

Operational 6am until 8am to provide contact to resolve issues when units are not yet open

Renal Transport Coordinators National team of staff providing point of contact for renal

patient and staff Work a shift pattern to offer telephone line cover primary

hours that units are open Assist in resolving transport issues on the day Available for patient queries and concerns Reducing delays by updating drivers ready times etc Transport packs and masks Complaints and performance monitoring Is developmental Permanent posts advertised currently to replace

temporary team

Service Pilot St Woolos

Subsidiary unit with appropriate cross section of patients

Offers an opportunity to explore the benefits and associated cost of a dedicated service as a gold standard

Transport planned to meet 30:30:30 Dedicated drivers working most appropriate shift

pattern Test drive of proposed new vehicles

Performance PilotAlltwen

Newly opened subsidiary unit with a small number of patients

Allows the opportunity to explore performance monitoring options and reporting

Transport planned to meet 30:30:30 Trialling of several methods of collating

performance data

Patient Experience Patient satisfaction questionnaires pre and post pilot Questions offered on timeliness of service on specific

recent time period Questions offered relating to quality of life, using

questions from a recognised quality of life assessment tool.

Patient forums before and after service implementation

Next Step... Permanent appointment of Renal Transport Coordinator

team Feb 2010 Pilots underway 2010 Post pilot evaluation 2010 Analysis of costing and patient experience National roll out of dedicated service based on pilot

results

Regional Action Plans Individual Transport Plans

Any Questions?