As West Cornwall Healthwatch, we have had major concerns about patient access to services for a very long time. We continue to campaign to bring appointments and treatment closer to home, reducing the amount of travelling required.

Where services need to be more centralised, we call for more help for those patients travelling to them. The considerable cost of transport can be a particular struggle for the elderly, those on low incomes, those with cancer or on renal dialysis, etc.

We have been waiting for months to find out which company will be awarded the "Non-Emergency Patient Transport Service" for Cornwall from April 2019, and have recently learned that all those tendering for the contract have withdrawn. This uncertainty is unsettling, and highlights the failed system of outsourcing NHS services which has sadly been undermining our NHS for some years. Since 2013, the proliferation of private companies across the country providing patient transport services has been, on balance, detrimental for the NHS and for patients.

Some of the service provided by private companies has been substandard, verging on scandalous, and staff have reported shortcomings. We may hope that the move towards STPs could herald the end of divisive competition and privatization. We know that there is a drive to 'join up' various services to benefit patients and make the whole system more sustainable. Yet outsourcing services conflicts with joining up and integrating services. A better model would be where a major NHS organization holds the overall contract as a 'lead provider' or 'system integrator'.

For transport this should be the ambulance service. Separating patient transport from ambulance services has always been flawed. Fragmentation of service provision, with weak commissioning, has been recognized in core ambulance services. So we question the wisdom of putting Patient Transport Services out to competitive tender, managed by contracting. We need a fully integrated transport service. Our Health and Social Care leaders need to think again about the role of ambulance services in a more joined up care system, using the same resources for urgent, emergency care and transport services.

So we urge our local commissioners — Kernow Clinical Commissioning Group - to talk again to our Ambulance Service (SWAST) about taking patient transport back. Any private providers would then contract with the ambulance service and not directly with commissioners. This would provide greater clarity, accountability and governance as well as simplicity. Regulation would be easier, with the opportunity to develop a single contract, streamlining Key Performance Indicators and service model.

Organizations like ambulance services are far better at holding contractors to account than less experienced Clinical Commissioning Groups and would directly manage any contract failures. Meanwhile, we encourage readers to share their experiences with us: click here to get in touch.

Contributed by Marna Blundy and Kath Maguire