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EFFICIENT GOVERNMENT FUND
Stage 1 application - expression of interest
Part 1: Summary Table
Bid number (for EG use) | EGF/1/3/086 |
Lead bidder | Scottish Ambulance Service - Contact:
Mr Pat O'Meara, Non Emergency Service Programme Manager, Telephone 0131 446 2800; 07900 136 841, pomeara@scotamb.co.uk |
Brief description of the aims of the project | This project will seek to find efficiencies in and to improve transport services for health and social services users by integrating the deployment of relevant resources held by the Scottish Ambulance Service, NHS Boards, Local Authorities, and Voluntary sector transport providers. These aims reflect the policy objectives of Community Planning, CHP's, recommendations for improving access in Building a health service: Fit for the Future and Scottish Ministers' developing policies for Transport For Health. |
Clear description of what the EGF money would be used to buy | The Stage 1 funds will be used to undertake detailed feasibility and programme objectives in Partnership areas (as detailed below) and to fund project management costs and initial 'set-up' costs. Funding will used specifically for: Project Management arrangements (for Pilots and Roll Out) Continuing to extend the number of partners across Scotland engaged with this initiative with a view to coverage across the whole country (building on existing enthusiasm from a number of partnerships and using the evidence of improved performance from the pilots) IT changes. A centralised booking and planning system would be needed. The Cleric system, currently used by the SAS ( www.cleric.co.uk), has the necessary capabilities. Booking staff recruitment (limited: to amalgamate and extend current SAS and local authority capability) Support to plan and cost measures to support communications with service providers Staff training (in the use of integrated booking and planning systems) Management Accounting support (integration will require changes to spend profiles and more specific budget reporting) Developing agreed access criteria to transport with care covering medical, social and geographic factors |
Partners to the project likely to commit resources | Scottish Ambulance Service NHS Health Boards Local Authorities Community Transport Providers Joint Improvement Team ( Cosla/ SExec/ NHSiS sponsored team) Note: In principle the project could apply across Scotland. Phase 1 is currently being developed in consultation with the following areas: Tayside Health Board/Perth & Kinross Council Lothian Health Board/East Lothian Council Lanarkshire Health Board/North and South Lanarkshire Councils. Orkney Health Board. voluntary sector transport providers and Orkney Islands local authority. Early expressions of interest have been received from other Partnership areas, including Stirling and Aberdeen. Resources will come from combining transport and support services to create an integrated and unified service. |
Names of other organisations with whom the project has been discussed (to assist the introductions process) | - Relevant divisions of the SE Health Department and Transport Department
- Rural Community Transport Initiative
- Joint Improvement Team
- Association of Directors of Social Work
- Association of Transport Co-ordinating Officers
- COSLA
- Health Boards (via Chief Executives)
- local authorities (via Chief Executives)
|
Evidence that suggested approach has been deployed successfully elsewhere | In Norfolk the ambulance service, primary care trust, county council and voluntary sectors have worked together successfully for the last two years in providing shared transport services and a one stop booking and control system. Similar schemes are also active in Hertfordshire, Worcester & Gloucester, and Devon & Cornwall. In Scotland an integrated transport scheme is in the late planning stages between Orkney Health Board, Orkney Islands Council, voluntary agencies and the Scottish Ambulance Service. It has common objectives with, and will be used to inform, the development of the wider mainland initiative. Within some local authorities significant efficiencies have been gained where Education and Social Work transport have been effectively integrated. Local authority arrangements tend to be paper based but in the instances where there are electronic booking arrangements they tend to use the same solution as, but independently of, the SAS. The Scottish Ambulance Service ( SAS) has used a single electronic booking solution for non emergency transport resources since the 1980s. This system is used regionally in 30 booking offices. For Health Boards, a study in East Lothian by Hedra consulting ( www.hedra.co.uk) demonstrates the potential of interdependency for transport cost savings (especially in cutting taxi demand for moving patients and material samples: this is a key aim of many Health Boards). These improvements could now be built on by fuller integration across the system. |
Are there any restrictions to potential for enlargement of the project (i.e. technology, number of partners etc) | There are no geographical or boundary restrictions in principle: the national reach of the SAS arrangements mean that non co-terminosity of Local Authority and Health Board boundaries should not be an issue. For change management reasons, and in recognition of the different priorities assigned the project in different regions, our intention is to develop the project a few areas at a time across Scotland, in a staged process. Some legal/financial restrictions would need to be accommodated if we were to extend the eligibility criteria for passengers at a later stage beyond those currently entitled to free or concessionary services. Not all participating organisations have powers to charge passengers for the transport services they receive, so that in rural/remote areas any extensions of the service to passengers ineligible for the service on other grounds would depend on legal powers specific to voluntary sector partners or local authorities (eg s20 Local Government in Scotland Act 2003 power to advance wellbeing, which allows cost recovery). |
Benefits projected from the project | The Project aims to get more from existing resources through: i. optimising the use of vehicles and support services currently located in at least 4 different public service sectors and not co-ordinated ii. Programme is 'citizen centred' as its approach is to put customer needs first and plan transport provision from there. Efficiency saving released during the life of the project would be recycled into improving services and extending the client group. iii. improving the quality and range of transport with care services for NHS patients, Local Authority Social Work Clients, NHS staff and materials/substances etc iv. provide local one stop booking services, via a network of local control centres using a common system, v. ensure improved punctuality to clinics, for hospital admissions, to day centres and to other facilities, by improving communications and extending transport control/tracking facilities outwith the SAS utilising existing SAS technology, This will improve punctuality and treatment targets at those sites. vi. providing clear eligibility for access to services that takes account of medical, social and geographical circumstances vii. Cost savings in taxi fares (both in reducing demand and through improved procurement) viii. Savings in employment costs (although improved administration will require additional resources, we would expect this to be more than offset by economies of scale in the front line) ix. The standardisation of mileage rates and service quality standards. x. to enable time efficient sharing of relevant data across services with appropriate consent from users of services (link to single shared assessment) |
Estimated financial projections | Total | 2005/6 | 2006/7 | 2007/8 | 2008/9 |
Overall project cost | £2.15m | 150k | 400 | 800 | 800 |
Estimated projected benefits | £4.95m | | £0.55m | £1.8m | £2.6m |
Is a pilot required - see guidance notes | It is good (and safe) methodology to ensure that any proposed system is workable and to reduce risk to the vulnerable, elderly and ill groups that current providers support. We also want to have confidence in our 'starting points', to set outcomes and to provide a performance measurement framework that will explicitly identify benefits from the project. To this end: We will look to learn from the projects already underway in England. As stated above, a related pilot on the island of Orkney is already in hand and on track to commence in the autumn. This will test the capacity of the proposed system (Cleric) for integrated booking, planning and costing. If successful we will use the remainder of 2005/06 to project plan the next stage (with the 4 regions mentioned), with the assistance of consultants, and get agreement in principle from relevant players in other parts of Scotland through leading presentations, showcases, strategy days and workshops We are looking in Stage 2 (2006/07) to roll out the project across 4 regions By Stage 3 (2007-2009) we would be intending to roll integrated arrangements out across the rest of Scotland |
Additionality: why is EG funding required | Funding is needed to create the extra capacity required in ambulance, Health and Social Care services to ensure the development and introduction of integrated transport systems and the management accounting support which ensures adequate governance arrangements for them. It is also needed to ensure technological support for an extended booking system and transport fleet. Funding is to cover the "transitional" costs. |
Is this project complementary in anyway to other EG work | Yes - especially to the vehicle maintenance and procurement projects. |
Is "stage 2 development funding" requested? | Yes - indicative costs set out in table above. |
Part 2: Narrative bid
No integrated service provision involving all transport service providers in Scotland has yet been attempted. In any one area there are services that are independently operating alongside others. This is not a project to set up a range of new transport services, but to demonstrate the benefits of existing services co-ordinating their efforts into one system. This will involve mixing client groups and journey purposes where necessary. All journey purposes except work will potentially be catered for.
The project complements and supports other initiatives, including, amongst others, the aims of the 'Transport for Health' programme of the Scottish Executive Involving People Team, the Scottish Executive Joint Improvement Team, the 'Transport with Care' programme and the Scottish Ambulance Service EG bid ' EGF/1/1/004' Emergency Services Fleet Collaboration. The programme also links to the Scottish Executive Report by Professor Kerr 'Building a Health Service fit for the Future', particularly in the areas of: Regional Planning Groups, Community Health Partnership's, Managed Clinical Networks, and systematic approaches to caring for the most vulnerable (especially older people). The general principles underlying the bid received general support from cross-public and voluntary participants at the 'Integrated Working Strategy Day' organised by the Scottish Ambulance Service in April 2005.
The bid does not seek funding for additional transport resources. It seeks to extract added value from the resources already operating in Scotland. The bid is for the additional costs involved in project managing their integration and setting up the control systems necessary to deliver a better overall service.
The issues to be tested in the programme include:
- Promoting a 'can do' culture amongst transport providers
- Whether appointments can be matched up with times of transport
- There should be no worsening of the timescales for organising transport
- Complex funding arrangements and 'ownership' of individual schemes
- Diverse range of booking systems in operation by the various transport providers
- Contractual arrangements that currently exist will need to be reviewed to facilitate participation
- Perceived problem of mixing fare paying and non fare paying passengers in the same vehicle
The programme will be gradually phased in, with full consultation at every stage. Phase 1, scheduled to commence this year, will include the following features:
- Setting up a partnership pool of transport provision
- Establishing a central booking centre that is widely advertised to co-ordinate all suitable journeys. The Control Centre will filter the requests to ensure that the most suitable type of transport is booked to meet the passengers/patients/clients' needs.
- A thorough review of what has and has not been achieved will be undertaken between Phases 1 and 2 and any modification or rectification will take place in advance of proceeding with Phase 2 bidding.
The Project will require a significant element of management and for this reason it is intended to appoint from the outset a project manager who will prepare a detailed project plan. The project manager will devote the necessary time to remove the barriers that currently exist for the concept to be implemented. In parallel the manager will address the practical issues of the Control Centre set up, subsequently manage its operation and publicity, monitor and report progress and prepare to expand the scheme.
The Transport for Care Programme will work closely with the Efficient Government Fund team and the project manager to ensure effective monitoring arrangements are in place. Comprehensive information on usage and trends of all providers' services will be undertaken prior to the introduction of the service. Robert Gordon University is currently carrying out such an evaluation of transport provision on Orkney.
A strategic Programme Management Group (in line with Prince 2 methodology) will be established with all the commissioning partners involved ( SAS, COSLA, ADSW, NHSiS, JIT, Community Transport assoc.) The Group will support the Project Manager and oversee the development and implementation of the strategic delivery framework
There are very strong benefits of this proposal;
- It makes better use of existing transport resources by cross-organisational integration
- It has a broad based influential partnership supporting it with enthusiasm.
- It offers innovative solutions promoting partnership working between the public, voluntary, community and private sectors
- It contributes to a number of policy objectives of all the statutory partners
- It is structured in such a way as to be deliverable
- it is a model that is capable of introduction elsewhere
- It optimises transport use thereby having a positive environment impact.
Estimated Detailed Financial Projections
The following table illustrates the costs and projected financial benefits associated with the elements of the bid:
Element | Estimates | Totals | 2005/06 | 2006/07 | 2007/08 | 2008/09 |
|---|
Vehicle costs | Costs | | | | | |
|---|
Benefits | £1,500,000 | | | £500,000 | £1,000,000 |
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Employment Costs | Costs | | | | | |
|---|
Benefits | £3,200,000 | | £500,000 | £1,200,000 | £1,500,000 |
|---|
One number access and control | Costs | £1,850,000 | | £250,000 | £800,000 | £800,000 |
|---|
Benefits | | | | | |
|---|
Savings in Taxi fares | Costs | | | | | |
|---|
Benefits | £250,000 | | £50,000 | £100,000 | £100,000 |
|---|
Consultancy to prepare Stage 2 | Costs | £150,000 | £150,000 | | | |
|---|
Benefits | | | | | |
|---|
Consultancy to implement | Costs | £150,000 | | £150,000 | | |
|---|
Benefits | | | | | |
|---|
Totals | Costs | £2,150,000 | £150,000 | £400,000 | £800,000 | £800,000 |
|---|
Benefits | £4,950,000 | £0 | £550,000 | £1,800,000 | £2,600,000 |
|---|
Vehicle costs
Savings will be generated from reduced duplication of service provision. The annual running cost of an ambulance patient transport vehicle is £18,500 and based on previous experience of operating local authority fleets, running costs of minibuses are generally of a similar magnitude. The SAS currently has 500 such vehicles, and local authority stocks are estimated at 1,500. It is estimated that 54 of such vehicles can be saved between the Service and the larger local authorities.
Employment costs
Savings will be generated from reduced duplication of service provision. The annual staffing cost of the ambulance patient transport service is £19m. The annual staffing costs of local authority social services transport is estimated as £28m. It is expected that 3% savings can be made from amalgamation of administrative arrangements and reduction in duplication of service provision.
One Number Access and Control
The Service has recently upgraded its patient booking and management system. Discussions with several local authorities have indicated that this system has far superior functionality than their present systems and processes. It would be the intention for local authorities to migrate to new systems such as the one used by the SAS or for the SAS to provide booking and management services. The costs are based on SAS providing this latter service to a third of services. Costs will increase as more Local Authorities migrate, but the national reach of the SAS arrangements mean that non co-terminosity of Local Authority and Health Board boundaries should not be an issue.
Taxi fares
Based on discussions with health boards it is estimated that in excess of £3m is spent on taxi fares in the NHS in Scotland. Some of this is spent on non patient transport and the savings are a net estimate
Consultancy to Progress to Stage 2
This would be used for more detailed analysis of the current service provision, future service design and project planning for implementation
Consultancy to implement proposal
This will be used for project management.
Scottish Ambulance Service
July 2005