Challenge 12.4

What is the problem, and how does it affect the Challenge Sponsor organisation, service users and/or People of Scotland?

We have heard directly from patients and renal healthcare professionals that improvements are urgently required in dialysis transport across NHS Scotland.

Evidence from Kidney Care UK highlights the scale of the issue. Almost two thirds of renal healthcare professionals report concern about transport arrangements for patients travelling to and from in-centre dialysis, while a third of patients report issues with the transport they rely on.

Patients requiring dialysis are often unable to travel independently. Treatment is frequent and predictable, typically three times a week at the same time and location but is also time sensitive. Despite this, transport provision is often not aligned to patient need. Across Scotland, the most common model involves the Scottish Ambulance Service (SAS), alongside third-party providers such as taxis arranged and funded by Health Boards.

Limitations and inconsistency in current arrangements mean dialysis schedules and service delivery are often shaped by transport availability, rather than what works best for patients and clinical services. Coordinating transport also places a significant administrative burden on NHS staff, reducing time available for clinical care. 

For full year 2034-24, the total expenditure on renal transport costs came to over £9.1 million, with majority of expenditure on taxis (47%) and private ambulances (30%). The return showed across the 14 Boards who returned costs, there was 16 different types of transport used, demonstrating the need for a consistent approach. 

The aim is to develop a solution that addresses these inefficiencies, reduces costs, and delivers a more patient focused and sustainable approach to dialysis transport.

How will we know this Challenge has been solved?

We will know the challenge has been solved when patients can safely and consistently access suitable, efficient, sustainable, reliable, person-centred transport to and from dialysis, and when service provision is no longer driven and affected by transport availability. This should be supported by improved patient experience, reduced administrative burden, and greater system efficiency.

​Indicators of success:

• ​Patients report that transport is no longer a barrier, with greater choice, access and ownership

• ​A more consistent approach to transport delivery across Health Boards

• Clinical and administrative staff spend less time coordinating transport, allowing more focus on patient care

• Improved efficiency, with reduced delays and better use of resources, delivering cost efficiencies

• A more sustainable approach to transport that supports net zero ambitions and reduces environmental impact

• ​Reduced waste across the system, including better alignment between transport and service delivery

• Solutions are accessible, easy to use, and suitable for a range of digital literacy levels​

• Patient experience could be measured using the Kidney Patient Reported Experience Measure (PREM) annual national survey, including relevant transport-related feedback.

Who are the end users likely to be?

The primary end users are renal patients across NHS Scotland who rely on transport to attend dialysis. The solution would also support NHS staff within SAS and Territorial Health Boards involved in coordinating and delivering transport.

​While initially focused on renal services, there is clear potential to scale across NHS Scotland to support other patient groups who require regular, planned transport as part of their care pathway.​

Has the Challenge Sponsor attempted to solve this problem before?

Challenge Sponsor (SAS) has explored Uber Assist in the past, too costly and concern about drivers not understanding the patient’s condition and accessibility requirements.

Are there any interdependencies or blockers?

There are several interdependencies that would any successful solution would need to consider:

​System wide working and variation across NHS Boards

​Differences in geography, service models and data recording across Boards make consistent delivery challenging, particularly across rural, island and urban contexts. Boards can also operate in silos, leading to variation and duplication. A more consistent national approach, supported by East/West sub‑national working, will be important, while still requiring local delivery. There may also be opportunities to link with third sector organisations.

​Clinical pathways and patient suitability

​Any solution must align with clinical pathways and be malleable to individual patient needs. For example, alternatives such as home dialysis are not suitable for all patients, so clinical engagement will be essential.

​Digital access and integration

​Solutions must be affordable, easy to use and accessible. There is also an opportunity to align with existing programmes such as the Digital Front Door.

​Data sharing and governance

​Data protection, information governance and ethics approvals will need to be considered, particularly where data is shared across Health Boards.

​Patient choice, engagement and co-design

​Solutions must balance efficiency with maintaining patient choice and managing expectations. They should be developed and tested with patients and staff, to ensure they are practical and accessible.

​Operational complexity

​Opportunities such as improving visibility of capacity across sites could improve efficiency, but would require careful coordination and planning, including considerations such as pre-session blood tests.​

Will a solution need to integrate with any existing systems / equipment?

A solution will need to integrate with existing local IT systems, and while the Challenge will be expected to pilot through NHS Greater Glasgow & Clyde, not all systems are fully interlinked across Health Boards.

​There will also be a need to align with relevant national systems, such as the SRR (Scottish renal registry) and UKRR (UK renal registry), and wider programmes such as the Digital Front Door.

​​Data protection and information governance will be key considerations, particularly where patient information is shared across Boards.​

Is this part of an existing service?

The challenge is focused on renal transport, but solutions should be designed with scalability in mind, with potential to apply to other pathways such as chemotherapy where patients attend regular planned appointments.

Solutions should support patient control while meeting both patient and clinical needs.

Any technologies the Challenge Sponsor wishes to explore or avoid?

There is interest in a patient centred booking system that gives patients greater choice in their appointment times and transport options, including more flexible or real time scheduling approaches. There is particular interest in solutions that can optimise scheduling, routing and capacity in real time across services. 

​Integration with existing systems, including the Scottish Renal Registry, will be important, alongside engagement with the renal clinical community. Solutions should remain simple, reliable and accessible.​​

What is the commercial opportunity beyond a CivTech contract?

There is strong potential to scale beyond an initial CivTech contract, with adoption across additional NHS Scotland Boards following pilots.

​There is also potential to expand across the wider UK, where similar challenges exist, as well as opportunities to work with third sector organisations 

​Internationally, there is potential to apply the solution in other healthcare systems facing challenges around transport for patients with long term conditions.​

Who are the stakeholders?

• Scottish Government Health Finance.

• Scottish Ambulance Service (SAS)

• Pilot Board Sponsor – NHS Greater Glasgow & Clyde , SAS. Potential for NHS Lothian involvement representing East of NHS Scotland.

• Territorial NHS Boards – including rural, island and urban Boards, ensuring solutions are adaptable to different service models and local needs.

• Renal patients, carers and patient representative organisations – ensuring the project is informed by lived experience and delivers patient-centred outcomes.

• Renal clinical teams and service managers – providing insight into operational challenges and opportunities for service improvement.

• Transport providers and third-sector organisations – supporting delivery of patient transport services and identifying opportunities for improved coordination.

• National renal and sustainability programmes – including the Renal Pathways Clinical & Dialysis Programme and National Green Renal Programme, to ensure alignment with related work and strategic objectives.

Who’s in the Challenge Sponsor team?

The Challenge Team will include representatives from Scottish Government Health Finance, Scottish Ambulance Service, and NHS Greater Glasgow & Clyde drawing on both national and local perspectives. Clinical and patient organisation input would be provided through the renal community to support user centred design.

​In-kind support will include access to policy, service users, clinical and operational expertise, engagement with Health Boards and pilot sites, and access to relevant data.​

What is the policy background to the Challenge?

There is growing recognition of pressures facing renal services, including capacity and demand challenges. While important, this challenge is focused on transport as a key enabler of access to care.

Transport is a vital and essential component to attending lifesaving in-centre dialysis treatment. Transport plays a critical role in ensuring patients can access dialysis safely and reliably. Where transport is inefficient, unsuitable, unreliable and lacks flexibility it can affect service delivery, patient experience and overall system performance. This links to wider work on sub national planning, supporting better use of capacity across Scotland.

Scheduled care transport may be provided by Scottish Ambulance Service, private/ community operators commissioned directly by NHS, taxi, privately arranged or NHS arranged or other community transport/ volunteer car services.  Each NHS Board has its own arrangements.  

Where scheduled care transport is inefficient, unsuitable, unreliable and lacks flexibility it can affect healthcare delivery, patient experience and overall system performance. This links to wider work on transport access to healthcare as set out in the Service Renewal framework, and to new opportunities delivered by sub national planning, supporting better use of capacity across Scotland.

AI and digital improvements may provide opportunities for improved scheduling of transport and treatment. 

Improving transport also supports population health by enabling patients to attend treatment, maintain independence and remain in work where possible. Employment rates among people on dialysis are low.

Between 2022 and 2032, Chronic Kidney Disease (CKD) in the UK is projected to result in 81.6 million missed workdays in people diagnosed with CKD, and 11.9 million missed workdays by carers of people with CKD. This has wider economic and social benefits, particularly in areas of deprivation. Kidney failure is up to five times more common in people from minority ethnic groups, highlighting health inequalities and the need for equitable access to treatment, including reliable transport.

There is also a need to move towards a more consistent, coordinated approach across the system, while enabling local delivery.