Free transport reduces ‘was not brought’ rates for children at Midlands trust

Group of women and a child standing outside a sign that says 'Welcome to main outpatients'Children living in areas of high deprivation have benefitted from a pilot programme that offers free transport to hospital appointments.

The eight-week pilot was conducted by Birmingham Women’s and Children’s Hospitals NHS Foundation Trust (BWC). It saw a reduction in the number of children who were not brought (WNB) to appointments and freed up appointments for children on waiting lists.

Caring for women, children and families from Birmingham, the West Midlands and beyond, BWC provides inpatient and community services across a range of specialties. Each year, more than 641,000 patients visit the trust; 30.7% of whom live in the most deprived local areas.

A short research project found that the average cost for a family to attend medical appointments is over £35. This can create barriers to accessing services, particularly for those experiencing financial hardship.  Every year over 30,000 appointments are missed at BWC costing the trust around £3.6million. To learn more, and understand barriers to access, the trust took part in a pilot targeting families living in the most deprived areas.

Families of children with appointments scheduled within the next fourteen days were telephoned to confirm they were aware of the appointment and its purpose. People were also asked about any challenges that may prevent them attending. The trust created standard discussion points to support administration staff making the calls and a tailored transport support offer was developed. This included free parking at the hospital site, public transport tickets, and taxi services if needed.

The pilot was staffed thanks to over-time hours by existing administration staff, with some support from the staff bank. It was also supported by the trust’s interpreter team, to ensure the offer was accessible to all.

Over the course of the pilot nearly 4,500 children and families were identified as eligible for support. Two thirds were randomly selected to take part in the pilot and over 1,900 families were successfully contacted within three attempts. Ninety percent accepted a travel offer; the most popular of which was assistance with car parking costs.

The trust was able to facilitate access for those who would have struggled to attend and reallocate over 140 appointments. Staff also started to develop better relationships with the people they were contacting, helping to build trust and increase engagement with their local community.

The pilot was funded from money available to the trust as a paediatric accelerator site and realised significant cost savings due to the reduction in the number of missed appointments.

Ally Davies, Assistant Director of Quality Improvement, said:

“At BWC our mission is to provide outstanding care and treatment and be at the forefront of what is possible. The national NHS England Core20PLUS5 approach to reducing healthcare inequalities for children and young people identifies deprivation as a key factor for healthcare inequalities. We are delighted by the positive difference this fantastic initiative is making.

“Despite this being a very short pilot, it was fantastic to see that the WNB rate for families who were contacted was almost half that of families living in the most deprived areas who were not spoken to.

“One of the biggest challenges we faced in the pilot was staffing, which was reliant on over-time. Making use of bank staffing helped us to overcome this.

“We were incredibly fortunate to have been supported by Sheffield Children’s NHS Foundation Trust who were testing something similar at the same time. As such we have been able to share and spread learning to iterate our work as we go.

“The best advice we can give other trusts’ is to develop a strong conversation guide. This will help them to explore and understand the barriers people are experiencing. Establishing key performance indicators also informed our approach and helped us effectively use our limited resources. A robust standard operating procedure with transport companies also meant there was a clear support offer which was easy to access and use.

“A second phase of the pilot started in November 2022 and will run until the end of March 2023. Artificial intelligence data  is helping us to identify high-risk patients and guide future conversations with families. We have now offered free transport to a further 2400 families and are seeing sustained improvement. We hope to embed this within the children’s service with a view to extending this across our women’s and mental health services.”

National guidance is available to support providers and systems reduce Did Not Attends (DNAs) and WNBs, recognising the important role this plays in supporting elective recovery and improving patient experience. Many of the actions set out in the guidance support patients to take control over their own care and help to reduce health inequalities.