This bus is saving the NHS time and money, improving quality of care and improving the mental wellbeing of isolated people

Pressures on the NHS are greater than they have ever been: demand for health care is increasing as the population ages, and budgets are tight. Disabled, isolated people are unable travel to appointments at their GP surgeries and GP’s don’t have time to visit them at home or if they do, can’t provide as a good a service as at the surgery.

Contact: Tim West
tim@fablebureau.com
+44 (0)20 3941 2400
http://www.fablebureau.com

The solution:
Ealing Community Transport (ECT) is a charity which delivers accessible & affordable community transport. ECT identified that for lonely and isolated individuals, access to transport is one of the biggest barriers to regular engagement with health care. ECT developed a new service, together with Ealing Clinical Commissioning Group, to help people travel to appointments at their GP surgeries who wouldn’t otherwise be able to do so. By enabling disabled, isolated and lonely people to remain independent and mobile, ECT also supported community participation and engagement. 

Following a successful two-year pilot, Ealing Clinical Commissioning Group commissioned ECT to provide community transport services to enable older and disabled residents to attend GP appointments. This service was named PlusBus for Health (PBH) and started in April 2017. PBH is a door-to-door, wheelchair-accessible transport service that helps patients travel between their homes and GP surgeries. The service is available to older or disabled patients in the London Borough of Ealing who: – cannot safely get to their GP practice because of mobility or other health issues; and – have limited transport support from friends and family. PBH aims to reduce home visits and missed appointments, while improving the wellbeing of patients by offering them an opportunity to leave their homes and meet and socialise with others. The service is free for GPs and patients to use.

Evidence of impact (in the words of ECT):
In the financial year 2017/18, PBH transported 821 patients to 3,390 appointments. Whilst much anecdotal evidence exists on the positive social impact of PBH, it was important for us to estimate the resulting social value and cost savings for Ealing Clinical Commissioning Group and the NHS. As such, we conducted a thorough impact evaluation on a sample of 92 patients across the six GP surgeries identified as the highest users of the PBH service. 
> In December 2018, we published our findings in a report which concluded that: 
• PBH benefits the loneliest and most isolated older people in the community; 
• Patients attend more surgery appointments after they start using PBH; 
• PBH improves the quality of health care that these patients receive; 
• PBH reduces the rate of missed appointments; 
• PBH reduces the amount of home visits; 
• PBH has a positive impact on wellbeing. 
In total, the research estimates that the cost savings and benefits generated by PBH in the areas outlined above delivered a ‘social value’ worth £354K in the financial year 2017/18. Every £1 spent on PBH during 2017/18 generated a social value of £1.22 (the ‘Social Return on Investment ratio’ in 2017/18 was calculated to be 1.22).

Read the PlusBus for Health Impact Evaluation here: http://ectcharity.co.uk/files_uploads/PlusBus_for_Health_Impact_Evaluation_2018.pdf

More information about PBH can be found in our ‘Special Focus’ publication here: http://ectcharity.co.uk/files_uploads/ECT_Plusbus_for_Health_Special_Focus_Autumn_2018.pdf

Case studies:

Passenger Mollie Evett
Mollie is 84 years old, lives alone and has difficulty walking. She uses PBH to get to and from her GP surgery.
“I know I couldn’t get on a public bus now. And I can’t get into a car, it would take me forever. I had a bad accident two years ago and I broke my hip and damaged my right leg. My knees are going too. I’m always on crutches, even in the house. Three years ago I lost my husband to Alzheimer’s, so I live alone. But this Friday I’m going to Iceland and I’ve got an appointment too at the doctor for a check-up. ECT are fantastic; I can’t live without them. I used to see the green buses around Ealing, but I never knew what they were for. But my doctor sorted it out for me. I use PlusBus for Health to go to different appointments at the surgery, and now I use PlusBus to go to the supermarket as well. When I get off the minibus I go straight to my neighbour’s house for a cup of tea. Trying to get from my front door to their front door is difficult, but when I’m getting off the minibus I’m halfway to their door already. The drivers are lovely, we get to know them and have chats with them. Atif – he’s my regular driver – he’s got used to me and we have a joke. That sort of fun keeps you going.”

GP Practice Manager Furiha Chaudry 
The PlusBus for Health service is fantastic. It helps us to run a more robust service as a practice and we’ve had good feedback from patients too. Previously, we had high numbers of patients being visited at home for warfarin monitoring, so our nurses were making around 24 home visits a month. It would take one nurse a whole day to see 12 patients. We can now see those 12 patients in a two hour clinic because they are brought to the surgery by PlusBus for Health. Lots of patients were seen at home by the GP because of their mobility difficulties. PlusBus for Health has helped us to reduce these visits by over 50% so our GPs aren’t always rushing to complete multiple home visits. We’ve now made time for clinical meetings during the middle of the working day instead of early in the morning or late afternoon. Instead of having 10 home visits a day, we now have up to 10 a week. We know which of our patients need extra care, so now they get brought to the surgery by PlusBus for Health. We can give them the last appointment of the morning, so they aren’t hurried and they can have some extra time with the GP if they need it. The patients tell us that it’s nice for them to have a social outing and they like having the opportunity to talk to people. One elderly lady who isn’t very mobile told our staff that she was fearful of living alone and being excluded from society, but now she says PlusBus for Health has changed her life. It has helped her deal with loneliness because she sees and interacts with people when she gets out of the house. We have 10 receptionists and they’re all very comfortable liaising with the PlusBus for Health administration team to book the patients’ trips. We’re proud to be the number one user of PlusBus for Health!”

GP Dr Kamini Gautam 
“I am part of a team looking after roughly 30 to 40 high-needs patients at a local care home. One of the biggest challenges we face with these patients is to provide good quality, regular and comfortable care for them. To accommodate their comfort and safety, my partner and I initially started visiting the care home on a weekly basis, holding a lengthy clinic in their quiet room. However, it transpired that we did not have access to some of the most important parts of clinical equipment at this facility, such as an ECG machine, weighing machine or even an examination couch. Neither did we have nursing support. We approached ECT, and they very kindly agreed to run a trial whereby they would bring a group of the care home residents to our surgery. We arranged it so that this was at a time when we could spend up to half an hour with each patient, with no other patients present, to account for their comfort and avoid undue distress from a packed waiting room. We have found this to have a most pleasing outcome and care has improved significantly – for instance, timely weight measurements have enabled us to calculate appropriate MUST scorings [a scoring system to assess for significant malnutrition]. In addition, access to ECGs has enabled a higher quality care which in turn, contributes to crucial management and the all-important care planning. This has been an excellent model of care and we are very grateful for ECT’s input and assistance.”

Lessons for society:
“PBH has shown local government, as well as our society, how transport can be part of the solution to lowering expenses – PBH not only saves the health service money and time, it helps people receive better quality care and manage their health more effectively. We have always championed the advantage of people travelling together with others, as opposed to travelling alone. Our evaluation of the social impact of PBH has shown that community transport increases social interactions and improves the physical and mental wellbeing of isolated people. Our work shows society that community transport is far more than just getting people from A to B. In fact, many of our PBH passengers tell us that using this service has given them newfound confidence. Our aim is that this will spur them to use our other door-to-door community transport services to venture out on trips to other places. We hope that surgery staff will encourage these patients to do this – in other words, social prescribing.”

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