AN MP has slammed the "unaccountable" outsourced patient transport service in Sussex.

Six months after being awarded the contract for non-emergency transport, Coperforma has come under fire from Caroline Lucas MP.

The Brighton Pavilion MP said the company's "unaccountable outsourced model" is failing as she called for drastic changes.

However, The Argus can reveal Coperforma boss Michael Clayton is bidding for other NHS contracts.

Ms Lucas said: “Our patient transport service is in chaos because the unaccountable outsourced model is failing.

“We’re witnessing a battle just to ensure all drivers are paid and this week there have been reports of drivers sent home due to mismanagement and arguments between the private companies involved.”

She added: “When I spoke to the Clinical Commissioning Group about this serious problem – and the risks for patients if these sub-contractors go bust – they told me that one of the problems is identifying responsibility when things go wrong.

“This problem occurs because of the layers of complexity linked to our privatised patient transport service. Simply put: privatisation has made a mess of accountability.”

Katrina Miller, of Sussex Defend The NHS, told The Argus the contract should be taken back in-house.

She said: "They should offer a management and delivery contract, and they should give it back to Secamb and if they need to improve let them spend money on that.”

Unlike elsewhere in the country, provision of non-emergency patient transport in Sussex is split between the service manager, Coperforma, and providers in the form of private ambulance companies.

The model has created difficulties for staff, although patient service has not been disrupted.

But when last month a subcontractor failed to pay its staff, the NHS had to step in to try to resolve the dispute between the sub-contractor and Coperforma and then, finally, to pay the staff itself out of taxpayer money.

Coperforma chief executive Michael Clayton told The Argus the company is now bidding for contracts elsewhere in the country.

He claims multiple contracts would help if there was a sudden need for more resources in the event of, for example, an unplanned flu epidemic or bad winter weather.

COMPLICATED STORY OF COPERFORMA

WHO is Coperforma?

The company website states Coperforma is the country’s “leading provider of patient transport consulting and managed services to the NHS”.

It is responsible for more than 1,500 patient journeys each day but in Sussex it does not own or operate ambulances, it runs a call and data centre which takes bookings and co-ordinates vehicles owned by subcontractors.

Just under two thirds of the Hampshire-based company’s shares are owned by chief executive Michael Clayton and his family but around 40 per cent belongs to Seabourn Limited, an offshore company registered in the Channel Islands.

Chairman John Porter is among the directors listed on Seabourn’s records filed at Guernsey’s equivalent of Companies House.

It is not known what percentage – if any – of Seabourn is owned by Porter, who is the grandson of Tesco founder Sir Jack Cohen.

But any dividends paid from Coperforma to Seabourn and then on to Seabourn’s shareholders would not be subject to UK taxation unless they were resident in the UK. Porter lives in Switzerland.

Who used to do this and when did it change?

Prior to April 1, patient transport for non-emergency care in Sussex was provided by the South East Coast Ambulance Service (Secamb) working in conjunction with the Patient Transport Bureau.

These are both NHS bodies.

The patient transport service has nothing to do with emergency ambulance trips. It is about moving non-emergency patients to and from their hospital appointments.

The service is commissioned by a group of seven Clinical Commissioning Groups (CCGs).

Earlier this year, they put a new contract out to tender which did not allow the same organisation to both manage the transport provision and provide it, thus disqualifying Secamb.

By the final stage of the bidding process Coperforma was the only company willing to take on the £60 million, four-year deal.

How did the changeover go?

April was catastrophic for the company and for the patients who depend on it.

An abysmal handover from Secamb and the Patient Transfer Bureau (PTB) to Coperforma and its subcontractors led to thousands of patients missing their appointments.

Mr Clayton apologised but later blamed the previous incumbent for telling patients to reconfirm appointments on April 1.

He also said dialysis patients had been falsely told that provision would be reduced and that Secamb did not allow Coperforma the opportunity to train staff who would be transferring from one employer to the other until the day of the handover.

Secamb insisted that data protection legislation and the pressure of work had prevented them from doing either.

There have also been allegations of sabotage and an investigation was launched. But to date, the findings have not published.

That there was a cliff-edge handover moment for such a complex service has itself been criticised, with patients at the time asking why the switchover was not handled in a piecemeal manner.

Whatever the causes, the outcomes were shocking.

Drivers told The Argus the situation was further complicated by information missing from instructions sent via the Coperforma smartphone app on which their system is based.

It would give a street address for patients but not a flat number.

Or it would give a postcode for the destination hospital but not tell the drivers which wing or ward to head to.

In some rural parts of the country, it didn’t work at all. One driver at the headquarters of Coperforma subcontractor Thames Ambulances explained said she had to leave their base and walk several hundred yards down the road, hand aloft, in order to have sufficient phone reception for journey instructions to be received by her phone.

How is the service now?

It is not possible to compare like-for-like performance between Secamb and Coperforma because the targets have changed.

For instance, Secamb was targeted to get outpatients to appointments no earlier than 45 minutes before and no later than 15 minutes after.

Their targets for those two measures were 95 and 90 per cent respectively and the 2015/2016 average for their attainments were 94 per cent and 84 per cent.

So that meant 16 out of 100 patients arrived more than 15 minutes late.

Coperforma on the other hand has been targeted to achieve 100 per cent and given a window from 45 minutes before the appointment for renal patients.

For non-renal patients the time window starts at 75 minutes before.

The company recently stated that it is operating at 94 per cent of the performance targets.

It is not clear whether the CCG has any way of independently verifying Coperforma’s performance statistics, which are unquestionably an improvement on service in April, when performance indicators dropped as low as 22 per cent.

David Liley, of Healthwatch Brighton and Hove, said a recent survey of patients showed a 60 per cent satisfaction rate.

He said: “There are still a lot of complaints about timeliness but also about the cleanliness of vehicles and drivers from out of area not knowing the route and wasting time.

“And there are still terrible stories.

“One lady I spoke to, an amputee in a wheelchair in her 70s, had been picked up more than two hours late.

“So she missed her dialysis slot and had to wait for a later one.”

How does Coperforma work?

Coperforma works with subcontractors, mainly private ambulance companies, to transport patients but it provides a software-based system which allocates journeys.

Rather than a specific crew always picking up a certain patient every Tuesday morning, and collecting other patients en route, journeys are distributed based on location and workflow of cars across a network.

The Argus has spoken to dozens of drivers and patients who don’t think this maximises efficiency.

Large vehicles, which under Secamb might have picked up six patients, now criss-cross the county with a single patient on board, taking one booking dozens of miles away from the next.

But Coperforma insists that even though no other NHS contract in the country is run in this way, it is the future.

It is bidding for other contracts.

Coperforma claims to have eight “top tier” subcontractors and five “second tier” or backup firms, which it relies on to provide vehicles and manpower.

Some of the firms used by Coperforma only have a fleet of vehicles numbering in the single digits.

The complexity of the network of providers and subcontractors has contributed to the problems.

In June, one subcontractor – V M Langfords – went into administration.

Its replacement, Docklands Medical Services, has now ceased providing vehicles and has been involved in a long term dispute over non-payment of drivers.

Most recently the CCG has itself had to use taxpayer money to pay tens of thousands of pounds to Docklands staff who after seven weeks with no money were at risk of losing their homes.

The CCG has said it will recoup the money from the contract provider, Coperforma. But in a statement last week, Coperforma insisted the drivers were not its employees and therefore not its responsibility.

Caroline Lucas, MP for Brighton Pavilion, believes that the complexity of the system is the core problem.

She said: “This problem occurs because of the layers of complexity linked to our privatised patient transport service. Simply put: privatisation has made a mess of accountability.”

But the NHS insists the solution is not as simple as returning the contract to nationalised ownership.

A spokeswoman said: “The way public sector contracts work is predicated on working together to make it work, it’s not about punishment.

“But there are contract levers you can deploy and that is what we’re doing. Otherwise all you’re doing is giving money to lawyers.”

An independent review into the handover, published in September, questioned why CCG officials had taken at face value Coperforma’s assurances of readiness, rather than demanding proof.

And a CQC inspection conducted in May is due to be published in November.

Meanwhile, just this week, the GMB union has alleged that one subcontractor, Thames Ambulances, is owed more than £600,000.

And unemployed drivers let go by Docklands, who in the last six months have also lost their jobs with Langfords and before that with the NHS, are still looking for work.

So whether or not Coperforma retain its contract, there are certainly more developments ahead for the tortured and torturous story of patient transport in Sussex.

It used to be so simple.