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2 June 2009: New research highlights unacceptable transport service for some kidney patients receiving haemodialysis treatment

The first major survey into kidney patient transport across England, Wales and Northern Ireland has found that a significant number of patients receive an unacceptable level of service.

Kidney patients travelling to hospital for life-saving treatment receive a more punctual service from private and public transport than they do from hospital-provided transport, according to the National Kidney Care Audit Patient Transport Survey.

Commissioned and funded by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit and Patient Outcomes Programme, the survey was carried out by The NHS Information Centre.

The survey asked all of the 19, 000 patients who have treatment in dialysis units (haemodialysis) about their views on patient transport, which can have a major impact on quality of life.

Nearly two thirds (nearly 12,000) of all haemodialysis patients, who typically have three or four hours of dialysis treatment three times a week, completed the survey. Patient responses were returned from 98 per cent of renal units.

The survey concluded that just over 61 per cent of patients said the service met their needs.

A large minority reported long waits and journey times when using hospital-provided transport. In all three countries, patients took less time to get to their dialysis unit and waited less time to start their journey home after treatment if they used public or private transport, rather than hospital-provided transport

Performance was measured against the standard that patients should not wait for longer than 30 minutes for their transport to arrive.

Of those patients who completed the survey in England:

• Of those who used hospital-provided transport, 73.9 per cent of the 6374 patients were picked up from home within 30 minutes of their allocated pick-up time.
• 74.6 per cent of the 3488 patients who used public or private transport had a travel time of 30 minutes or less to get to treatment, compared to 59.0 per cent of the 6374 patients who used hospital-provided transport.
• 83.7 per cent of the 3637 patients who used public or private transport waited 30 minutes or less to start their journey home from treatment, compared to 62.2 per cent of the 6344 patients who used hospital-provided transport.

Of those patients who completed the survey in Wales:

• Of those who used hospital-provided transport, 75.3 per cent of the 429 patients were picked up from home within 30 minutes of their allocated pick-up time.
• 80.6 per cent of the 139 patients who used public or private transport had a travel time of 30 minutes or less to get to treatment, compared to 55.0 per cent of the 429 patients who used hospital-provided transport.
• 86.4 per cent of the 176 patients who used public or private transport waited 30 minutes or less to start their journey home from treatment, compared to 64.7 per cent of the 399 patients who used hospital-provided transport.

Of those patients who completed the survey in Northern Ireland:

• Of those who used hospital-provided transport, 87.5 per cent of the 391patients were picked up from home within 30 minutes of their allocated pick-up time.
• 74.2 per cent of the 182 patients who used public or private transport had a travel time of 30 minutes or less to get to treatment, compared to 48.6 per cent of the 391 patients who used hospital-provided transport.
• 91.6 per cent of the 215 patients who used public or private transport waited 30 minutes or less to start their journey home from treatment, compared to 75.3 per cent of the 369 patients who used hospital-provided transport.

The views of managers from all 247 dialysis units were also invited and responses were received from 212 dialysis units surveyed, a response rate of 85.8 per cent.

The survey was also extended to commissioners who were asked to report for each renal centre they commissioned for. There was a 90.8 per cent response rate from commissioners.

The survey responses of dialysis unit managers and renal care commissioners suggest several possible causes of transport problems, such as:

Only around one third of units have clear criteria of eligibility for hospital transport. A similar number had charging criteria for patients and the management of service level agreements with transport providers.

Only around half of managers reported having a system in place to monitor the quality of transport for which they are responsible.

A feeling among unit staff that they are powerless to influence the provision of transport for their patients.

Among its recommendations, the audit said there should be clear and transparent commissioning arrangements for kidney patient transport, and that patients should be involved in the commissioning and monitoring process. It recommends no patient should have to pay for transport to and from treatment, and transport should be an important factor in deciding the location of new dialysis units.

Dr Donal O'Donoghue, National Clinical Director for Kidney Care said: "For people with kidney disease who receive haemodialysis treatment in hospitals or satellite units, transport to and from their dialysis is a major quality of life issue. When the journey times are short, staff are friendly and service is reliable, the experience of care is considerably enhanced."

"The challenge now that transport problems are visible is for every kidney team to make improvements in this aspect of care a priority. Patient transport services, acute trusts and other providers of dialysis, commissioners and kidney patient associations all have responsibilities and need to work together."

Robin Burgess, Chief Executive of the Healthcare Quality Improvement Partnership, said: "This is an issue that can be solved. Trust managers need to work with commissioners to ensure that transport for kidney care meets the standards set. The clinical value of well-organised transfer is clear - the challenge is one of management and organisation to deliver. This audit highlights that urgent attention should be paid to hospital transport improvements for the benefit of patients and to the quality of care"

For more information, or to view the full report, click here.

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