MSL Response to the London Assembly's LAS Review

MSL is pleased to submit a response to the review of the London Ambulance Service (LAS), conducted in 2011 by the London Assembly’s Health and Public Services Committee. The review looked at the challenges facing the London Ambulance Service and considered what role the Mayor should take in helping the LAS deliver healthcare services for Londoners. As London’s largest provider of non-emergency patient transport services, taking thousands of patients a day to their healthcare appointments in the capital, MSL is effectively London’s second ambulance service and we welcome the opportunity to engage with the London Assembly to share our experience and contribute to improving London’s patient transport services.

Door-to-Door Transport

The NHS Patient Transport Service, funded by the local NHS for patients with a medical need for transport, is only one type of door-to-door service available for mobility-impaired Londoners and the LAS has a very small portion of the market share, so we were pleased to read that door-to-door transport services were also considered in the scope of the review. The review referenced a report published by the London Assembly Transport Committee in 2010 specifically on door-to-door transport and indicates that there have not been any significant improvements on the recommendations made in that report which included better integration between services and harmonising eligibility criteria.

The review states that LAS is a key partner in improving the door-to-door transport services for mobility impaired people provided by Transport for London and that the failure of the door-to-door service creates additional demand for LAS’ services. Though NHS patient transport is only a portion of the total door-to-door transport service, the people who use the different services are broadly the same demographic and there are opportunities to improve the service overall and realise efficiency savings by looking at the services as a whole.

Any efforts to improve the quality of door-to-door transport services in the capital must take advantage of the knowledge and experience of the private companies who provide the majority of the service.

Unplanned Non Emergency Patient Transport

When a person calls 999 and doesn’t require an emergency ambulance, but does need medical transportation, the LAS often books private hire vehicles, uses an independent sector ambulance or ties up an NHS emergency ambulance  for non life threatening journeys to take the patient to hospital or another medical facility. In 2010/11 the LAS booked 1,200 private hire journeys and conveyed 193,000 Category C calls (not serious or life threatening) and they expect those numbers to increase. There is a significant cost variation in the journeys and there is huge potential for savings if the appropriate vehicle and staff could be dispatched, freeing up emergency resources. It could have a significant cost savings (the LAS spends an average £225 on each incident attended by an ambulance crew, Dial-a-Ride spends approximately £24 per journey and Taxicard £10.50)  and resources impact, while at the same time improving the patient experience.

There must be questions raised about the suitability of private hire vehicles and the assurances that ad hoc private companies are able to give when dealing with vulnerable people. There is a grey line between emergency patients and those that require medical services and the level of care and assurance required. For example, what happens if a patient is sent to hospital in a regular taxicab and medical emergency occurs? Will the driver have the necessary basic skills and knowledge to help the patient? Surely a duty of care must lie with the LAS to ensure that the patient’s outsourced journey is carried out by someone with a minimum of first aid training.

Mayoral Recommendations

The review’s recommendation for door-to-door services is that as Chair of Transport for London the Mayor invites the LAS to participate in the project board for integrating door-to-door transport services in London. MSL would be supportive of such a project and would expect to be considered as a full participant alongside LAS and other private companies and charities on the project board, given the size of our patient transport operation in London.