Reduction of Transport Expenditure in Forensics

 8th November 2024

By Gqwetha Malinga, Head of Security & QI Coach and William Diaz, Improvement Advisor 

The Forensics Directorate is comprised of 16 wards with almost 200 patients with mental illness, learning disability and/or autism, providing specialist outreach support and supervision to community patients with complex needs working alongside the criminal justice system. These wards are spread across 2 secure units – John Howard Centre and Wolfson House.  

One of ELFT’s strategic objectives is Improved Value. The Forensics Directorate aims to support this through focusing on financial viability as one of our priority areas and the rising cost of patient transport is a relevant issue identified by the team. NHS England reported that £460 million is spent on non-emergency patient transport a year. The Forensics Directorate alone spent over half a million pounds for all transport–related costs last year.  The team has decided to use quality improvement to address this. The transport project team started in January 2023 with a small team of motivated individuals who were supported to understand and apply the QI methodologies. Team members include Nana Obeng (Clinical Nurse Specialist), Bekezela Ndiweni (Clinical Nurse Manager), Abu Imam (Security Nurse Assistant), Horeb Makabukidi (Security Nurse Assistant), Mayuri Parmer (Head of Administration & QI Coach), Gqwetha Malinga (Head of Security & QI Coach) and William Diaz (Improvement Advisor). The team believes that any penny saved goes a long way, as much as every penny counts especially at the current financial climate in the NHS. QI tools and methodologies were used including the fishbone diagram as seen in Figure 1, which was useful in helping the team explore and understand the problem. 

Figure 1. Fishbone diagram about the rise of transport costs

The aim of the project is to reduce transport costs by 10 percent by December 2024. A driver diagram was created to form the basis for the project with the identification of change ideas the team believe will help them achieve their aim, as seen in Figure 2.  

Figure 2. Driver diagram with change ideas being tested in the project 

In July 2023, the team decided to test the use of a checklist (PDSA 1) to address the lack of system for reporting and recording damages to the vehicle.  This was found to have contributed to significant service disruption when the van is out of action for repair. The checklist serves as a prompt to ensure both the Duty Senior Nurse and the driver perform all the necessary checks before and after using the van and escalate any issues to the operational services team. An e-mail reminder was sent to clinical practice leads, modern matrons, clinical nurse managers and reception staff members in September 2023 to ensure teams are aware about this new checklist.  

The team then took a step further by focusing on a change idea aimed at improving working relationships with ‘PTUK’, which is our external contractor providing transport services for our high-risk service users. We found that there were significant numbers of safety incidents between our service users and the contractors. A quarterly review meeting (PDSA 2) was established which includes the Directorate’s Head of Security, Lead Nurses and PTUK Link. Having a regular review ensures that we provide a safe and high-quality service that is aligned with our organisational values particularly with We Care and We Respect. 

Furthermore, the team introduced the use of video conferencing or court video links (PDSA 3) to attend court hearings as opposed to traveling to various locations. This change idea was introduced in May 2024 and mainly tested in Shoreditch Ward. We chose this ward due to ease of access as the ward Clinical Manager is also part of the project team. We have tested the use of court online links for hearings which facilitated 2 court trials virtually from start to finish.  

We believe that these change ideas have so far contributed to 68% reduction in the total transport costs this year with a monthly saving of £47,496.40, which equates to a potential annual saving of £569,956.80 if the figures remain at the same level until the end of 2024. See Figure 3 below.

Figure 3. Total monthly transport costs in the directorate in I Chart 

So, what next? The team is fired up from the amazing results that we have seen so far, so we will be scaling up the use of video links or conferencing facilities for all court cases with Stratford Ward. If Shoreditch Ward can do it successfully, surely other wards can do it too! The team will present the data to the Directorate Management Team, QI forum, and other spaces to share learnings as well. The team is enthusiastic to see how this will work out in other wards in Forensics!