ERS Medical Midlands

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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

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant patients’ needs were met through good organisation and delivery.

The service assessed patients’ needs and used this information to plan and deliver transport arrangements which reflected individual mobility, communication and support requirements. Staff worked with healthcare providers, commissioners and partner organisations to support access to healthcare services and continuity of care.

The service had established systems to coordinate patient transport and respond to changing needs. Leaders worked with healthcare partners to manage demand, support patient flow and identify solutions to operational pressures. The service used patient feedback, complaints, performance information and engagement with partners to inform service improvement activity.

Patients were generally able to access services that met their needs. However, patient and stakeholder feedback, along with performance information identified ongoing challenges with delays and transport reliability. Leaders recognised these issues and had made changes to booking processes, workforce capacity and communication arrangements to improve performance.

The service listened to feedback and took action to improve the experience of patients using the service. Leaders monitored complaints, patient experience and operational performance and worked with commissioners and system partners to support improvement.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

We scored the service as 3. The evidence showed a good standard. The service made sure patients were at the centre of their care and treatment choices, and they decided, in partnership with patients, how to respond to any relevant changes in people’s needs. 

Staff placed patients at the centre of their care and adapted the support they provided to meet individual needs. Staff consistently described treating patients as individuals. They took time to understand their preferences, communication needs and mobility requirements. Staff used information obtained before transfer to provide care that reflected patients' circumstances and preferences. 

Staff gave examples of adapting their approach for patients living with dementia, sensory impairments or patients with a learning disability. This included providing verbal reassurance to patients with visual impairments and adapting their communication for patients with hearing difficulties. They also made reasonable adjustments where appropriate, such as reducing noise and distractions during transport. Staff worked with carers to understand how best to support individuals during transport. 

The service supported patients who experienced communication barriers. Leaders told us staff had access to interpretation services and communication flashcards to support patients whose first language was not English or who required alternative methods of communication. Escort arrangements and enhanced risk assessments were available for patients with more complex needs.  

Staff demonstrated an awareness of changing patient needs and acted when concerns arose. Staff escalated concerns when patients appeared unwell and arranged alternative transport where a planned journey was no longer suitable. They would also returned patients to clinical teams when they were not fit for discharge. 

We scored the service as 3. The evidence showed a good standard. The service made sure patients were at the centre of their care and treatment choices, and they decided, in partnership with patients, how to respond to any relevant changes in people’s needs. 

Staff placed patients at the centre of their care and adapted the support they provided to meet individual needs. Staff consistently described treating patients as individuals. They took time to understand their preferences, communication needs and mobility requirements. Staff used information obtained before transfer to provide care that reflected people's circumstances and preferences. 

Staff gave examples of adapting their approach for patients living with dementia, sensory impairments or patients with a learning disability. This included providing verbal reassurance to patients with visual impairments and adapting their communication for patients with hearing difficulties. They also made reasonable adjustments where appropriate, such as reducing noise and distractions during transport. Staff worked with carers to understand how best to support individuals during transport. 

The service supported patients who experienced communication barriers. Leaders told us staff had access to interpretation services and communication flashcards to support patients whose first language was not English or who required alternative methods of communication. Escort arrangements and enhanced risk assessments were available for patients with more complex needs.  

Staff demonstrated an awareness of changing patient needs and acted when concerns arose. Staff escalated concerns when patients appeared unwell and arranged alternative transport where a planned journey was no longer suitable. They would also returned patients to clinical teams when they were not fit for discharge. 

We scored the service as 3. The evidence showed a good standard. The service mostly supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. However, some patients reported not receiving essential information or updates.  

The service had arrangements in place to ensure people could access information in formats that met their individual needs.  

There service had an accessible standard of information policy. The policy outlined support for people who may experience challenges when communicating with the service.  Leaders told us staff had access to interpretating services for people whose first language was not English. Staff could also use communication flashcards to support people with communication difficulties. 

Staff demonstrated an understanding of the need to adapt communication to meet individual needs. Staff described providing verbal reassurance and clear explanations for people with visual impairments, adapting communication for people with hearing difficulties and working with carers and family members to help ensure people understood information about their journey and care.  

However, feedback from some patients who used the service indicated communication was not always effective. Some patients told us they did not always receive proactive updates when journeys were delayed and instead had to contact the service themselves to obtain information. Leaders acknowledged that communication regarding delays remained an area for improvement and told us operational pressures could affect the consistency of updates provided to patients. 

We scored the service as 2. The evidence showed some shortfalls. The service did not always make it easy for patients to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve patients in decisions about their care or tell them what had changed as a result. 

Patients did not always feel listened to or involved. Some patients told us they had not been asked for feedback about the service. Others felt complaints they had previously raised had not resulted in meaningful or lasting improvements. Several patients described recurring issues despite having raised concerns previously.  

Communication with patients was not always effective. Patients described having to contact the service themselves to obtain updates regarding delays and reported they were not always informed when transport was running late or had been cancelled. Some patients said they had not received updates regarding complaints they had submitted and were unclear about the progress or outcome of investigations.  

The service’s own complaint analysis identified communication and information sharing as recurring complaint themes. Investigations repeatedly identified missed opportunities to update patients proactively, provide timely explanations for delays and maintain clear communication throughout the patient's journey. This highlighted the need to improve communication with patients and strengthen the recording of contact and updates provided.  

The service had processes in place to collect feedback, manage complaints and investigate concerns. Patients could provide feedback through surveys and complaints processes, and staff understood how to escalate concerns raised by patients and carers. The service had a complaints, stakeholder concerns and compliments policy which set out how concerns should be acknowledged, investigated and responded to. Complaints were reviewed through governance processes and monitored for themes and trends.  

Leaders described regular engagement with patients, and partner organisations, including renal services, commissioners and healthcare providers. Feedback and concerns raised through these routes were discussed through governance and performance meetings to help make service improvements. Despite these arrangements, patients did not always experience the benefits of them in practice. 

We scored the service as 3. The evidence showed a good standard. The service made sure that patients could access the care, support and treatment they needed when they needed it. 

The service had arrangements in place to help ensure people could access transport services according to their needs. Patients and carers or loved ones could access the service using telephone and online booking systems. Leaders told us the service had also introduced training for hospital staff to support the use of online booking processes and improve access to transport services.   

Staff understood the importance of making reasonable adjustments for patients with additional needs. The service provided access to interpretation services, communication cards and escort arrangements where required. Enhanced risk assessments could also be completed for patients with more complex physical, mobility or communication needs.  

The service had an equality, diversity and inclusion policy which promoted fair access, equality of opportunity and reasonable adjustments for patients with protected characteristics. The policy recognised the need to support patients with visible and non-visible disabilities and provided guidance for staff in how to treat patients with dignity and respect.  

Staff and leaders described adapting services to meet individual needs. This included supporting patients with sensory impairments, language barriers, learning disabilities, dementia and complex mobility requirements. The service also reviewed eligibility and transport decisions when additional information became available. This ensured patients had transport that was appropriate to their assessed needs.  

Leaders demonstrated an understanding of local demand and the needs of specific patient groups, including dialysis patients, bariatric patients and people requiring specialist transport arrangements. The service worked with commissioners and healthcare providers to review demand, identify capacity pressures and support access to transport services across the system. 

Alternative formats, translation support and communication services were available to help people access transport services and healthcare appointments.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about patients who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. 

 The service demonstrated an understanding of the needs of patients who may experience poorer outcomes. Leaders and staff described the additional support available for patients living with dementia, learning disabilities, sensory impairments, communication needs and complex mobility requirements. Staff worked with patients, carers and healthcare professionals to understand individual needs and adapt support where required.  

Leaders were aware of the challenges experienced by some patient groups, including renal patients and patients requiring specialist transport arrangements. The service maintained regular engagement with healthcare partners and renal services to discuss patient experience, transport performance and emerging concerns. Leaders told us they held a monthly renal transport working group with renal units, which patients were welcome to attend. The service also had dedicated points of contact for renal patients, including a renal coordinator and patient transport liaison officers. Patients could also provide feedback through surveys, feedback boxes located within renal units, direct correspondence and the complaints process. This helped the service understand the impact of delays and transport pressures on these groups and identify opportunities for improvement.  

The service routinely monitored trends in cancelled and aborted journeys. Leaders analysed the common causes of aborted journeys. These included patients making their own travel arrangements. They also included patients being unavailable for collection. Some aborted journeys occurred because patients were too unwell to travel. The provider shared this information with acute trusts. Information was also shared with dialysis units and other healthcare partners. This helped identify opportunities for improvement. It also helped reduce avoidable delays and wasted journeys. Governance meeting minutes showed regular discussion of these themes. Records also showed actions taken to improve booking practices and improve patient readiness for transport. 

The service had an equality, diversity and inclusion policy which promoted equality of opportunity, reasonable adjustments and support for patients with protected characteristics and disabilities.