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2017 NKF Annual Patients’  Transport to hospital-based dialysis units.

            Patients must come first By Neil Walbran, Chief Officer, Healthcare Manchester

            T       hey’re going to have to travel a bit

                    further.’ This was the summary statement
                    made to me back in 2013 regarding
                    the relocation of a Manchester dialysis
                    service and its effect on its patients.
            It doesn’t sound too bad does it?  But with the
            benefit of hindsight, I wish I’d heard alarm bells
            and delved into things further.
            The same alarm bells I hear now when I’m told I
            might be ‘a bit sore’ after a medical procedure.
            I think that as we get older we understand this
            can be a platitude we should treat with some
            As we discussed the planned relocation’s
            transport implications, I was initially reassured by the team overseeing the process that patients would be
            travelling only a manageable distance further and that their treatment and care would not be adversely affected
            as a consequence. Our survey last summer of patients, staff and drivers at the Altrincham Dialysis Unit showed
            that in reality, the time taken up by travel and waiting most certainly does adversely affect the patient experience
            and does have a knock-on effect on their wellbeing. This is reflected in the report we produced: ‘No Time to Wait
            – The effect of service relocation on dialysis patient transport and access’*.

            There is no criticism of the services themselves. The staff at the Altrincham Dialysis Unit and the Patient
            Transport Service received praise for quality of their service delivery from the patients. It’s the system which is
            letting everyone down. Getting ready time, travel to the unit time, waiting time, dialysis time, waiting time, travel
            home time. This all adds up to a major proportion of someone’s day, several times a week. With this knock-on
            effect in mind it is clear that the quality of life for many patients is being reduced.
            As a Healthwatch with limited resources we have to prioritise where we focus attention, and this is often
            difficult considering the huge diversity in local need for a city like Manchester. In this particular case however,
            implementing this investigation wasn’t a difficult decision to make.
            Following our report we’ve met with lead officers from the Hospital Trust and with the Ambulance Service to
            explore ways forward. I’m happy to say there are plans in place which were also presented at a recent event in
            Manchester, and the changes they aim to bring about will go a long way to improving the patient experience. We
            will continue to monitor the outcomes closely.
            It’s been a very useful experience for us all at Healthwatch Manchester with a number of lessons learned:

            •  As this was our first investigation within the Greater Manchester footprint doing cross-boundary work in
               neighbouring Trafford, we did find getting to the patients proved much easier than expected; although people
               were often too tired to talk with us and there were some language barriers.
            •  It also became clear from talking to staff that despite recognising the current system was letting patients
               down they knew the system required an independent assessment - in this case from Healthwatch Manchester
               - to bring about change.

            •  The bridge we managed to create between providers enabled a frank exchange of issues and a range of
               possible solutions.

            We have learned much from this exercise but most importantly that for a dialysis patient the patient experience
            starts before the journey to the dialysis unit. For people who rely on a carer, a dialysis day may start as soon as
            they wake up and for others it begins and ends at the doorstep. Yes, there are efficiency gains to be made for the
            NHS in the relocation/centralisation of some services, but it is clear that the impact on the patient, the person &
            their wellbeing must be central to planning this.

            *If you would like to read the report ‘No time to wait - The effect of service relocation on dialysis patient transport
            and access’ by Healthcare Manchester it is available on the NKF website at
                                                             HELPLINE  0845 601 02 09   Summer  2017   7
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