Ambulance privatisation, missed appointments and the cost to Patients as well as the NHS

The Sussex Clinical Commissioning Group’s decision to award a £63.5m 4 year contract to a private company for all non-emergency NHS transport services in Sussex is one which has come under scrutiny and been the subject of criticism since the contract came into force. Coperforma Ltd took over provision of the non-urgent transport service from South East Coast Ambulance Service (SECAmb) on 1 April 2016 and so far have proved to be little other than unreliable.

Patients with cancer have missed oncology appointments, and patients with kidney failure have not been able to receive scheduled sessions of kidney dialysis, with some missing 2 of their 3 treatments in a week after ambulances failed to turn up to collect them. Many outpatients receiving a wide spectrum of treatments/care for various conditions have missed important appointments because ambulances did not arrive to take them to hospital. Some elderly patients have had to wait more than 5 hours for ambulances and been stuck at hospital for long periods of time after their appointments because the transport service has proved so unreliable. Coperforma’s chief executive, has apologised for the failings but has blamed the previous provider for not supplying them with enough information in advance about the patients they would be transporting.

There have been countless publications regarding the cost of missed appointments to the NHS over the years. More than 5.5 million hospital outpatient appointments in England are missed every year, which is 1 in 10 of all slots. A study run by the Institute of Global Health Innovation at Imperial College London and the Department of Health at Barts Health NHS Trust revealed the average cost to the NHS of a missed appointment, known as Did Not Attends (DNAs), is approximately £160 as staff and buildings costs remain unchanged regardless of whether or not patients turn up. In one case staff had to stay until midnight to ensure kidney patients arriving hours after their scheduled start time have received vital dialysis. The Trust has had to pay for taxis and other private vehicle suppliers to take patients home when their transport failed to turn up after appointments.

Missed appointments also have a non-monetary and human cost which leads to patients not getting the care they need, when they need it. When patients miss scheduled medical appointments, continuity and effectiveness of healthcare delivery is reduced, appropriate monitoring of health status lapses, waiting times increase and the cost of health services increases. When appointments are missed treatment and the control of their condition suffers but can also interfere with regular preventive screenings, timely attention to the patient’s health status, and the need for medication modifications. The sad and unfortunate reality is that a missed appointment, through no fault of the patient, will have an impact upon their treatment and can potentially cause injury or contribute to premature death. Although none have been reported in this case, any injury or death which results from missed treatment due to the failure of Coperforma Ltd to transport a patient to hospital will have to be investigated to determine if it was avoidable.

If you think that you have been affected by a failure in passenger transport services or the Ambulance Service, please contact us, we may be able to assist.