Harnessing modelling to assess long-term NEPTS procurement needs
Andrew Pooley, Managing Director, ERS Medical
In the face of a second wave of the pandemic and the coming winter, it has never been more important to have appropriate measures in place and capacity secured across health and social care. Non-Emergency Patient Transport is no exception.
At this point, we are faced with the challenge of ensuring that patients requiring ongoing care are able to reach appointments safely, ramping back up non-urgent elective care, while responding to periods of fluctuation where rapid discharge is required in response to the second wave of the virus.
NHS England and NHS Improvement recently released its updated guidance on requirements and funding for patient transport services (PTS). While COVID-19 measures remain in place, patient transport is very much a part of the process as the NHS resets to business as usual. Much of this planning is concerned with capacity and cost and ensuring that measures are in place to cover both.
The guidance states:
“It is vital that commissioners and providers work together to identify how to address any capacity challenges. This will require a good understanding of the potential PTS demand, taking into account the number of elective care services resuming locally, the need for social distancing in vehicles… and requirements for transporting those who are ‘clinically extremely vulnerable’, among other factors.”
From 1 October onwards, any additional costs arising from the updated guidance will need to be met within system funding envelopes. Again, commissioners and providers are urged to work together to ensure that local contractual and payment arrangements reflect the needs from this point forward.
Earlier this year, knowing that we would need clarity on how the pandemic would impact the need for additional services, we developed a model that allows us to more reliably forecast procurement needs for patient transport based on key variables that have emerged since the onset of the pandemic. Through this we’re able to provide the evidence to support ongoing and upcoming decision making across NHS England and Improvement, CCGs, CSUs, and hospital trusts. It also means we’re able to show the impact of differing levels of capacity and new considerations that must be made.
Knowing that a key problem for commissioners in the early stages of procurement is understanding and benchmarking their potential resource requirements, we have turned this into a free online tool through which commissioners and procurement managers can easily and clearly understand their procurement needs.
By using data from multiple contracts and hundreds of thousands of journeys each year, we can identify trends that predict indicative resource requirements with just a few simple inputs such as population size, geography, and service type. We have cross-referenced this model back to our existing contracts to check the efficacy and are confident in the results.
We also know that the effects of COVID-19 will be with us for some time and have allowed within the model for a comparison between pre-COVID-19 and COVID-19-impacted resource requirements.
In developing our COVID-19 model, we looked at the following variables:
- Time taken to accommodate additional infection prevention and control (IPC) measures
- Changes in efficiency due to shielding and COVID-19-postive patients needing to travel alone
- Changes in efficiency due to social distancing requirements in vehicles
The model can generate bespoke recommendations for CCGs and trusts according to their current and projected activity levels. Based on current COVID-19 assumptions, we found that the combined impact of these variables is an efficiency loss of 23%. More importantly, we can also determine the necessary resources required to mitigate the loss incurred by each variable and work with commissioners and procurement leads to ensure they are getting the best value from their contracts.
Using our tool, we’ve also been able to look at the wider impacts of these measures. For example, in England, there are approximately 9.75 million NEPTS journeys per year, 2.3m of which are for hospital discharge or transfer under “normal” circumstances. Patients who qualify for NEPTS have no other method of transport after discharge, which means that where NEPTS services are unavailable, they have to remain in hospital until appropriate transport is available.
We know that COVID-19 measures reduce capacity by ~23% therefore based on these assumptions around 535,000 journeys over a year risk being lost. Hypothetically, if those patients were unable to complete their travel following discharge, they are left with no other option than at least another night in hospital. Accounting for the average cost of just one excess bed day, this would equate to a cost to the NHS of £185m over a year. This highlights the importance of maintaining sufficient resources to manage demand.
Ahead of winter, and in anticipation of pressures on the NHS it will be important to ensure that people who do not need to be spending additional nights in hospital are not doing so, both to ensure bed availability for COVID-19 patients and to reduce risks of infection among those who do not have the virus. With England in its second lockdown and facing increasing infections, it’s critical that the NHS is prepared for the challenge of ensuring a safe and efficient discharge process and ensuring appropriate transport resources are in place is a critical element in this.
Health and social care have never been more dynamic, which is why we have to be focussed on evidence-based decision-making. Moving forward, it will be more critical than ever to ensure that resources are maximised and allocated as efficiently as possible. NHS organisations must invest in patient transport now to mitigate against significant and avoidable costs to the NHS. We urge CCGs and hospital trust contract managers to involve NEPTS providers in planning for the next phases of procurement. Resources such as modelling will inform smart and efficient decision making. As we once again face increasing rates of infections, we must do everything we can to keep patients, and the health and care systems in their entirety, safely moving forward.