“GPs now receive a two-hour response more than 95% of the time, taking patients to hospital earlier in the day. It is all managed through a single point of access and a single booking call. Our ambulance service has delivered significant gains in Red performance across our CCG area since the scheme was introduced through protecting 999 ambulance resource for the patients in most need. Our local A&E department and hospital wards appreciate the significant and positive impact this initiative continues to have on their patient flow.”
John Darley, Head of Urgent Care, Hambleton, Richmond and Whitby CCG
365 Response has developed the Healthcab service to support ambulance trusts as demand grows along the care pathway to track where the patient is at all times until safe transfer to their end stage destination and handover.
The cloud-based logistics smart platform supports front line staff to make bookings for patient transport services. The platform plans, tracks, traces and reports on the movement of people, vehicles and goods.
The smart platform removes calls from the bottom of the stack and diverts them away from the 999 service into a lower but more than adequate skill set to boosts response rates, reducing the length of time staff spend making transport arrangements, cuttings costs and reducing the number of complaints about patient transport.
The technology development has benefited from the support received from SBRI Healthcare, Innovate UK, Eastern AHSN, Health Enterprise East, NHS England and the AHSN Network, who played an instrumental role in bringing this technology to the NHS market.
As a result, the Healthcab service has been supported initially by Yorkshire & Humber AHSN and adopted later across the country by ambulance trusts and CCGs. In particular, Hambleton, Richmond and Whitby Clinical Commissioning Group (CCG) has undertaken more than 3,400 urgent care ambulance transfers, yielding £568,000 direct savings addressing the Carter efficiency review.
It took an ambulance almost half an hour to arrive when the then Labour foreign office minister Derek Fatchett collapsed while socialising in his local Wakefield pub in 1999. The delay occurred despite the nearest A&E unit being just five minutes away. The Labour MP for Leeds Central died that evening, aged just 53. Fatchett’s son Brendan spent almost a year trying to find answers and he demanded to see a copy of the ambulance service report. This revealed that ambulances had been diverted from the area to Bradford to cope with celebrating football fans.
When a patient’s life is at risk, for example from severe respiratory distress or if they are in cardiac arrest, a delay of even a few minutes in receiving clinical treatment can significantly affect the outcome. Brendan Fatchett became so determined to make a difference following the death of his father that he spent years campaigning for better ambulance services. In 2013 he co-founded 365 Response.
Delays in the transfer of care can be caused by a range of challenges within the patient journey. These include workforce capacity and the skills mix and flow between organisations. The Carter efficiency review states that improving work flow could save the NHS £2bn.
Over four months in 2015, NHS Providers’ ‘Right Place, Right Time’ commission captured evidence on good practice in the transfer of care. The long-term trend in delayed transfers of care had been reducing but it is increasing again. There were 145,100 total delayed days in August 2015, up from 137,600 in 2014 (source: NHS England).
365 Response has identified the need to track and audit transport bookings and processes along the care pathway so clinicians know where the patient is at all times until safe transfer to their end stage destination and handover. When the ambulance service is delayed there is an impact on patients, healthcare services, workforce flow and the associated costs.
365 Response has developed the Healthcab app to get the technology ready for adoption by the NHS through SBRI funding from the prototype development to the full business offering. The technology was launched in 2013 and Phase 2 of the project began in 2016.
The smart platform was later supported by the Yorkshire and Humber AHSN, who have brokered contacts and introductions into the local NHS network. Some of the benefits included opportunities to showcase the technology and meet other technology companies.
Through spread of adoption 365 Response business created new products, delivered real value to patients and the NHS, employed local people and generally grown – not just in people but in skills, confidence and delivery.
Impacts / outcomes
Overall benefits and impact outcomes includes patients, financial, NHS providers and others:
- Hambleton, Richmond and Whitby CCG has undertaken more than 3,400 urgent care ambulance transfers at a new mean service cost of £119.71. This has yielded £568,000 direct savings representing a 58% saving on what it would have cost with the traditional 999 ambulance service.
- There are approximately one million urgent patient transfers made from GPs to hospitals each year. Assuming that 25% of these will require frontline ambulance support, there remain 0.75 million calls (patients that can benefit) annually that could be diverted to other providers.
- Earlier attendance at A&E with admission avoidance and fine reduction/STP fund allocation
- Smoothing ambulance arrival times and reducing queuing/turnaround fines for ambulances
- Reducing exit block from A&E by direct booking access to a dedicated mental health transport service. This removes the risk of 12-hour breach and costs for 1-1 nursing/supervision of acutely unwell mental health patients in A&E.
- A reduction in cost per ambulance journey (typically £285 reduced to £100-£120)
- A reduction in the number of patients admitted (consequent on earlier and more focused triage)
- A reduction in the number of patients requiring overnight admission because they attend A&E earlier
- Reduced pressure on paramedics and GPs.
- More self-management of their care transport
- Faster response time (within 2 hours)
- Information via the app on where their provider/driver is at a particular time
- Fewer delays and late arrivals at hospitals
- Shorter waiting time to be taken back home
- Less chance their condition will deteriorate because of transport delays.
Other benefits include:
- New model of care for GP home visits reducing the cost per contact by 39% from £85.86 to £57.72 using the Healthcab platform
- In a partnership with NHS Shared Business Services and Leeds Teaching Hospitals NHS Trust the renal patient community used the technology to transform how they were accessing health care transport.
- The technology has created five full-time jobs and the company has also taken on four young apprentices.
Plans for the future
Over the next five years 365 Response would like to see its Healthcab booking portal being used by at least 30% of UK GP practices, 50% of NHS A&E departments and 80% of mental health trusts. The smart technology provider has plans to become the number one supplier for ambulance computer aided dispatch and flow technologies in urgent care in the UK and across the EU.
Which national clinical or policy priorities does this example address?
365 Response addresses a number of priority areas. The Healthcab booking portal addresses the care and quality gap by delivering a new way of booking, tracking and transporting patients, which is better suited to modern health needs and the fast-paced and ever-changing nature of the NHS.
365 Response addresses the disruption caused by delays to patients, healthcare services, workforce flow and the associated cost, and thus addresses the funding and efficiency gap, helping to make patient transport quicker and easier, and helping to minimise delays – all of which save the NHS money as discussed throughout this case study.
Start and end dates
-The technology was launched in 2013 and Phase 2 of the project began in 2016.
Contact for help and advice
Sarah Fatchett, Founder and Managing Director, 365 Response
T: 01924 264270
Esme Crabree, PR Officer, Yorkshire and Humber AHSN