A - SERVICE SPECIFICATIONS

Service Specification No. NEPTS Service Non-Emergency Patient Transport Services (NEPTS) Commissioner Lead Kate Blackledge, Kernow Clinical Commissioning Group Provider Lead Claire Olohan-Bramley, NSL Ltd Period 1 October 2014 to 30 September 2018 Date of Review NA

1 National/local context and evidence base

The Department of Health defines non-emergency Patient Transport Services (PTS) as the non-urgent, planned, transportation of patients with a medical need for transport to and from a premises providing NHS healthcare and between NHS healthcare providers. This can and should encompass a wide range of vehicle types and levels of care consistent with the patients’ medical needs.

Equitable access to health services is of national concern as highlighted in the priorities set by central Government for the second round of Local Transport Plans (March 2006) and the Darzi review of NHS services, where “equity of access, outcomes, and treatment” were central themes.

The National Service Framework part 1 (NSF) outlines key standards and markers of good practice for rental care. It highlights the importance of good transport for all renal patients and suggests that it plays a vital role in the information of patient views and attitudes towards dialysis. Some of these patients have to dialyse some distance away from their homes and it is important that they are picked up quickly and transported efficiently to their dialysis destination.

Transport to healthcare has also been identified as a priority by local healthcare providers and has been recognised as a strategic policy issue in the Local Area Agreement. Barriers that prevent access to health services for the most vulnerable and therefore contribute to health inequality should be removed.

Access to PTS service for NHS non-emergency patients and their escorts has been defined by the Department of Health (19 September 2007) and the local NHS Kernow Policy (2011). These are Journeys between the patients place of residence and healthcare facilities, and between hospitals. The place of residence is defined as any address specified at the time of booking, e.g. home, nursing home, hospice, hospital or treatment centre. Healthcare Facilities can include NHS and Independent providers but it must be the case that the patient is in receipt of NHS funded treatment at that establishment.

It is recognised that PCTs will no longer exist after 2013 and the new commissioner will be Kernow Clinical Commissioning Group.

This service specification is underpinned by the following documents:

Department of Health – Finance Arrangements for ambulance services Department of Health – Guidance for the commissioning of Ambulance Services Department of Health – Eligibility Criteria for non emergency patient transport

The Provider and Commissioner will agree any future amendments in view of changes to national policy, guidance or survey results.

2 Outcomes

2.1 NHS Outcomes Framework Domains & Indicators

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2.2 Local Defined Outcomes

The provision of a high quality, patient-focused, service that is cost effective, safe and secure, innovative and provides value for money.

Achieves patients access healthcare services where their medical condition would have prevented them from doing so.

Achieves smooth patient flow through healthcare services for good patient experience and efficient use of healthcare services.

3 Scope

3.1 Aims and objectives of service

To deliver the commissioning intentions for Non Emergency Patient Transport service provision:

 Responsive service to eligible patient access and healthcare system need  Resilience and continuity of service provision across rural and urban sites in core and escalation periods  Flexible range of provision that is most appropriate to the range of patient need through supply using a range of vehicles and appropriately competent staff  Provision of accredited local supply chain  Contract operating times to cover full span of need for transport and ‘patient flow’ through hospital care  Local operability, liaison, and interface with key health service providers, transport bookers and patient signpost groups  Streamline service processes and communication with increased efficiency of service provision, meeting Key Performance and Quality Indicators.  Efficient cost reduction to commissioner and provider  Intelligent information, supply and solutions to transport need, provision and demand  Collaborative and pro-active approach to continuous improvement across continually changing and evolving organisational boundaries  Consistent application of eligibility criteria (if Hub procured)

To ensure access to a diverse range of healthcare services in recognition that more services are being delivered closer to a person’s home or as part of their Health Care needs or as a result of patient choice for example:

 Independent/ private sector healthcare through extended choice network providing NHS Treatment  End of Life and Hospice care  Intermediate care step up/down beds  Outpatient clinics in the community  Rehabilitation in the community

In all cases the patients must meet the eligibility criteria and be booked by an authorised booker and each Journey must be given a specific reference number that can act as a purchase order number.

The Provider will be responsible for the sourcing and delivery of safe, timely and comfortable suitable non-emergency medical-tier patient transport services for patients between their place of residence and

the healthcare facility and between healthcare facilities and from the healthcare facility to their place of residence.

The objectives for the service will be:

 Service – A service that is available 24 hours a day 365 days a year (366 on a leap year).  Quality – Patient-centred services delivered in a safe, friendly and effective manner by trained staff in clean, comfortable vehicles with due regard to infection control protocols for the relevant health community. This includes keeping Journey times low and ensuring promptness of arrival and pick-up.  Flexible and Responsive – Services provided must be flexible to respond to changing patient (eg bariatric and dementia) needs as well as organisational needs eg. Specifically regarding new healthcare locations, on-the-day requests, and flexible times for pick-up and delivery including evenings and weekends. Additional flexibilities must be applied in agreement with Commissioners.  Communication, Quality and Performance Information – as specified within this contract  Value for Money – Service must provide efficient and effective Journeys which maximise the best use of resources and provide ongoing improvements in value for money in both management of logistics and supply side.  Innovation and use of Information Technology – Service must be innovative in its approach using best practice to respond to future needs. It needs to make the most effective use of technology for the scheduling of Journeys. The providers will also work with commissioners to achieve improved outcomes for patients and efficiencies i.e. reduced unnecessary admissions and length of stay.  Green – Service must take action to reduce the carbon footprint of patient Journeys wherever possible  Accredited Supply – of NEPTS able to respond to immediate fluctuations and demands

3.2 Service description/care pathway

3.2.1 Definitions

“Activity ” means the movement of patients within the scope of this contract. Activity is measured by reference to (i) number of Bookings and (ii) Patient Mileage.

“Abort” When a vehicle has been allocated and has started moving on the Journey. If the first leg of the Journey is aborted, then the return is cancelled. Aborts are chargeable for mileage covered up until the point at which the vehicle is ‘turned round’. Escorts booked to travel with the aborted patient will not count as chargeable Activity.

“Booking Agent” Authorised nominated named individuals able to book NEPTS through this Agreement.

“Booking” number of bookings is the aggregate of the total number of Journeys plus the total number of Cancellations.

“Cancellation” A booking cancelled before the vehicle has started moving. A cancellation shall be considered Booking Activity but not Mileage Activity.

“Confirmed” A Journey undertaken to be delivered by the Provider.

“Complex Handling Patients” Where a high level of manual handling knowledge and expertise is required and where there are specific issues to address to achieve safe handling and equipment – an example might be a 30 stone stroke patient or a child with complex needs who cannot stand. Requires assessment of risks and a recorded action plan to address these.

“Escorts” An accompanying person who is escorting a patient, where a medical need has been

identified in line with DH Eligibility Criteria

“Eligibility Criteria” A set of decision making principles as set out in the Commissioners’ policy

“Journey” An Individual patient Journey which falls within the scope of this contract.

“Loading Times” The time taken to load a patient from collection point to vehicle (and vice-versa). Consideration must be given at time of booking if the length of time required to load is likely to be extensive – i.e. due to medical conditions or type of equipment required.

“Mileage” the Patient mileage for all Journeys

“On the Day Booking” is a booking made any time after 17.00 hours the day before for a Journey to take place that day

“Operational Review Meeting” This will be a sub-meeting and act as the pre-meet for exception reporting to the main contract performance review meeting.

“Patient Ready” A patient will be deemed ready when they are able to move immediately to a vehicle. Wards must ensure patients have relevant equipment, medicines and luggage – ready to go.

“Provider” The Provider of patient transport services under this contract being NSL Limited (trading as NSL Care Services) registered in England under company number 6033060 whose registered office is at 4th Floor, Westgate House, Westgate, London, W51YY .

“Points of Care” means the points of care (destinations) that may be in place from time to time to which Journeys are made to or from under the terms of this contract.

“Short Notice Booking” is a booking made within two hours of the required Journey time

“SPOC” Single Point of Contact –organisations across Cornwall and Isles of Scilly (RCHT) who provide information, signpost and book transport.

“Static Movements” These are patient movements within the same domicile. All need to be agreed by the Booking Agent.

3.2.2 Service description/care pathway

To provide an NHS funded transport service to those patients registered with a GP in NHS Kernow meeting the Medical Eligibility Criteria as set down by the Department of Health including vulnerable people by reason of mental health or learning disability and children (and their escorts) accessing healthcare provision.

Thetypes of NHS funded services to and from which patients shall be transported under this Agreement are:

 Outpatient type healthcare appointments at any treatment centre (these clinics cover a wide variety of treatments from oncology, where patients can have daily appointments, to surgical procedures and mental health therapeutic programmes, day centres. Not all are on NHS premises.)

 Day case and inpatient admissions and day care

 Accident and Emergency – patients going home after attending A&E and patients who need transferring promptly to community hospitals direct from A&E.

 End-of-Life patients - Due to the nature of the patient’s condition these may need to be fast tracked through the system and can include authorised requests in respect of transfers to nursing homes for admission to intermediate care services or End of Life Choice.

 Patients who require static movement within the same domicile that is who may need to be moved from one part of a home to another part of the same home (usually from upstairs bedroom to a down floor level). A preset time slot where packages of care are being organised or where bed swaps are being organised at a specific time. Further examples of timed responses are for the day hospitals and rehabilitation units, including early supported discharge for stroke patients, where arrival and return times for each session are critical to ensure patients receive maximum benefit from their attendance and home visits where a number of specialist services have been co-ordinated

 Renal patients are the highest priority for essential services in the event of emergency. These attendances are planned and regular, often with a certain number of patients with appointments that take place at the same place at the same time. This is essentially the same as day hospital attendances but will occur for a minimum of three sessions of dialysis per week and a maximum of five. Dialysis usually lasts 4-5 hour a session and afterwards the patient can feel tired and unwell. Sessions generally take place in the morning, afternoons or evening (twilight).

 Transfer patients – patients between NHS facilities

 Long Distance Journeys (including repatriation) – occasionally unpredictable long distance Journey out of county will be required to transfer a patient to another hospital.; such Journeys must be authorised by the Commissioner. The Provider should submit details in advance on how these Journeys will be organised and managed.

 Home Visits - there may be the occasional need for home visits, where the patient (who meets medical eligibility criteria) may be accompanied by a healthcare professional. The Provider may be expected to transport equipment with the passengers. The driver is expected to help carry the equipment to/from the vehicle. Occasionally the driver may be required to wait, returning the healthcare professional and equipment to the Hospital. Home visits are likely to take 1 or 2 hours.

 Discharges (outward trip only) this includes patients transferred to the Isles of Scilly the provider will not be responsible for the cost of flights which shall be borne by the Commissioner or Commissioning Agent.

 Transport to other NHS funded treatment, clinics and care settings, as is required by extended patient choice.

This will include Journeys to NHS funded respite care and Journeys to attend clinics at community based sites with NHS and non-NHS providers.

Subject to the above provisions of paragraph 3.2.2 the service will need to:

 Reflect population trends, such as an ageing population or bariatric patients with complex needs.

 Provide for same-day discharges which would otherwise lead to the need for an extended use of a hospital bed.

 Transport ‘out of hours’. This will necessitate provision of a service 24/7 365 days of the year

to include all statutory and discretionary Bank and Public Holidays.

 Be available to undertake long distance and repatriation work. This will normally be a pre- planned request; however there will be a requirement for on the day requests as well. These are not anticipated to be significant in numbers.

 Be inclusive of adults or children, with complex psychological problems, requiring an escort (as defined in the eligibility criteria).

 Need to have sufficient number of appropriately-equipped vehicles to transport bariatric patients.

 To provide as set out within this contract the Minimum Data Set data collection down to GP practice and healthcare provider level.

 To provide, control and plan all Journeys utilizing the most appropriate and cost-effective transport.

 Services for adults or children, with complex psychological problems, requiring an escort (as defined in the eligibility criteria).

 Ensure staff can demonstrate an understanding of mental illness.

 Authorised requests in respect of transfers to nursing homes for admission to intermediate care services or End of Life Choice

 Booking Agents should be able to book/cancel Journeys up to 17:00 on the working day prior to travel. Similarily patients should have the ability to cancel Journeys. However, there is a requirement for short notice Journeys and the Contractor is expected to accommodate late bookings. An ‘on the day’ booking will be classed as a booking made after 17.00 hours the day before. ‘Short Notice’ bookings will be classed as a booking made within two hours of the Journey time. There will be no cap on, or additional charge for, ‘on the day’ or ‘short notice’ bookings. The CCG will work with the hospitals to reduce on the day bookings to less than 20%. The Provider will support this work by providing relevant data sets to measure progress.

 Have sufficient number of appropriately-equipped vehicles to transport bariatric patients.

 Signpost patients who do not meet medical criteria to voluntary care services or alternative means of transport

 To provide collection of data and information as set out within this contract

 Coordinate and manage the Private Sector (to agreed level in the KPIs)

 Respond to urgent (non 999) requests, e.g. suspected DVTs

For delivering a managed NEPTS service for all patients registered with the commissioning organisation and who meet the agreed eligibility criteria for NEPTS (determined using national and local guidance).

Managing the entire NEPTS Journey requirements for patients including all the categories of Journeys specified to the hours and range of patient need described within this specification. This includes those patients defined as bariatric or as having complex manual handling needs or who have a mental health ‘low risk status’.

For providing the Minimum Data Set data collection down to GP practice and healthcare provider level.

3.2.3 Operational Planning and Booking

NHS Kernow is consolidating their Non Emergency Transport Services provision and will require a single point of access hub.

RCHT currently operate a single point of access which offer the following facilities. These facilities would be required if NHS Kernow were to move to a Single Point of Access (Hub) provided by the bidder.

 A Single telephone number for patients/public and healthcare professionals.

 A key interface with hospitals/patients to facilitate bookings and solve any issues regarding bookings.

 Act as liaison between the wards/departments/patient/provider.

 Call centre/telephone lines will be available Monday-Friday 8am-8pm and 10.30am-5pm Saturday-Sunday.

 Triage calls to ensure they meet eligibility criteria, providing information on other forms of transport to non-eligible patients.

 Patients not meeting eligibility criteria will be sing posted to public transport, voluntary car schemes or made aware of Healthcare Travel Cost Scheme.

 Help desk function for enquiries

 Monitor and uphold the 15 minute wait policy.

In addition:

All bookings will be made as far ahead of the required Journey date as possible and accepted up to 6 weeks in advance of the Journey date.

The Provider will have data migration support from the existing booking/record systems to ensure a seamless transfer of Journey scheduling to the new provider system. The new system will be designed to allow for migration of data to future systems, should this become necessary. This should include the ability to prove the data migration process via test or trial loads.

The Provider’s system must have the ability to handle electronic transfer and the import of an electronic data file of transport bookings, for example from a Commissioning Agent’s information system.

The Provider will receive bookings by electronic transfer of data or telephone from the Commissioning Agents or the Helpdesk/Booking Office/SPOCs via an agreed data system approved by the Commissioner.

The electronic booking system will have all the details necessary to schedule the patient Journey and any additional information to provide to the relevant crew. The provider must also identify at the time of booking who to contact in case of patient not at patient pick up point.

The Provider’s system must be able to input details if received by telephone or in paper format. The Provider must use systems that can input data in the most effective way through ‘Postcode look-ups’,

codes for GP practices linked to Primary Care Trusts, hospitals and departments, etc.

If the Commissioner or Commissioning Agents make changes to their live electronic booking system, the Provider shall have a test system available to ensure all data changes transfer successfully before the new system is implemented.

The Provider and the Commissioner will agree any systems needed for processing booking information for each tier of service, which includes planned and on-the-day bookings. Data provided for the file export will include all the necessary patient details i.e. name, address, ID, postcode, mobility, time of Journey and all special requirements. The Provider may need to import additional information into the data file so that there is a complete patient record with Key Performance Information included.

The Provider’s system is to ensure the transfer of any special or additional information concerning a patient’s travelling needs is made available to the driver or crew undertaking the Journey.

The Provider’s system is to be able to add additional data such as data on aborts, cancellations and measurement of Key Performance Indicators. The final information needed for performance reports will be agreed along with the agreed date of an established data set with key categories for trend modelling.

The Provider’s system must be able to make post-travel enquiries to enable the investigation of complaints, incidents or potential disciplinary matters.

The Commissioner and Commissioning Agents will endeavour to ensure that requests for transport are made with as much notice in advance of the day of travel as possible. Although a number of short notice and on day of bookings will occur.

The Provider is responsible for determining all scheduling of vehicle pick-ups and loading to meet appointment times to ensure achievement of the Key Performance Indicators. This includes operational delivery times and maximising patients in vehicle.

The Provider will provide safe and secure storage and handover of all paper and electronic records.

The Provider will provide sufficient staff with the appropriate skill levels to undertake the contract on a daily basis.

The Provider to have an alternative back-up system if there is a fault with any of the equipment needed to carry out the contract. This will be clearly stated as part of the Business Continuity Plan.

The Provider is expected to not to have aborted Journeys and minimise cancelled Journeys. There will be an agreed system with the Commissioner, e.g. use of automated systems or personal phone calls, SMS reminders of booked Journeys etc.

The Provider is to make available a dedicated phone number and will be expected to answer telephone calls in the agreed time limit as specified in the Key Performance Indicators.

The Commissioner and Commissioning Agents shall have the right to full access to the Provider’s computer information. Any other interface between the Helpdesk/Booking Office and the Provider will be formally agreed.

3.2.4 Cancelled and Abortive Journeys

Abortive Journeys by provider should never happen and may incur a financial penalty (as set out in the KPI schedule), these Journeys should be exception reported and will form part of KPIs.

Journeys which are cancelled by patients or Booking Agents before the vehicle has commenced the Journey will not form part of the chargeable contract Activity for mileage. The charge associated with the booking fee will still be incurred.

Journeys may be aborted for reasons outside the control of the Provider. This will form part of the Mileage and Booking Activity if the Journey could not be or is not required to be reallocated. The Provider will only record Mileage covered by the vehicle before the Journey is aborted in the Activity. Escorts booked to travel with the aborted patient will not count as chargeable Activity.

Where, to assist with Journey planning and use of resource, the Commissioner notifies the Provider of on-the-day delays to a patient Journey (for example, due to a clinic overrun) this will not be treated as a Cancellation or new booking and as such, and will not be considered additional Activity.

For reporting purposes, as part of the minimum data set, the Provider will provide the reason for the patient Journey not taking place or being delayed as set out below:

 Booking errors from healthcare professional – including details on type of error

 No reply or unable to locate

 Patient not ready in reasonable time

 Wrong address

 Patient deceased

 Hospital or GP cancelled

 Patient cancelled

 No appointment

 Too ill to travel

 Refused to travel

 Patient made own way to appointment

 Wrong mobility

 Extreme adverse weather

 Other, with a description to be provided

In connection with the above, the Provider’s Staff will:

 Make every reasonable effort to confirm that the patient is not at home, waiting up to five minutes for a response to doorbell/ knocker/ visual enquiries/ telephone call

 Make immediate contact with their office facilities to check the address of the patient, and

take every action to remedy this fault prior to aborting the Journey

 Post a card through the letterbox stating that a call was made.

The Provider will proactively work with the Commissioner and CAs on ways to reduce aborted Journeys.

It is expected that only in exceptional circumstances shall the Provider cancel Journeys for reasons within their control. The Provider must notify the affected Commissioning Agents in advance if there is a need to cancel any Journey and must undertake to inform any patients concerned of the cancellation.

3.2.5 Communication with Commissioner, Commissioning Agent, Health Staff and Patients

The Commissioner expects the Provider’s staff to have a proactive, friendly, solution-focussed style of communication. A key objective is to have high-quality communication processes to discuss flexible and innovative approaches.

The Provider will gain patient feedback after 3 months in the first year and then on an agreed basis but a minimum of annually. The questionnaire will be agreed with the Commissioner.

The Provider will gain staff and Commissioning Agent feedback on an annual basis. The questionnaire will be agreed with the Commissioner.

From time to time, the Commissioner or Commissioning Agents may have a requirement for patients to receive leaflets/ questionnaires. The Provider’s staff will assist in this and, where necessary, carry and distribute such leaflets/questionnaires.

The Provider will be proactive in changing procedures in response to requests from the Commissioner or Commissioning Agents and following staff feedback, patient feedback through surveys, complaints and the Patient Advisory and Liaison Services (PALS).

The Provider will ensure the Commissioner is made aware of any actions that could impact on service delivery or generate adverse publicity.

No charges will be made by the Provider for any of the above Activities.

3.2.6 Incidents & Complaints Processes

In conjunction with Service Condition 33 Incidents Requiring Reporting and Service Condition 17 Complaints the Provider will:

· Ensure day to day operational issues are flagged via an agreed process which will be determined prior to contract commencement. The process should include an escalation process to the Commissioner to deal with issues that cannot be resolved locally.

· Have in place policies that adequately demonstrate the processes and reporting mechanisms for all incidents including hazards, risks, adverse incidents, accidents, near misses and serious incidents. Policies will be reviewed, and if necessary amended, by the Provider and Commissioner prior to contract commencement.

· Ensure any serious incident that results in harm is reported by the Provider to the Commissioner within a maximum of 24 hours of the occurrence. The Commissioner will then report the incident via the Strategic Executive Information System (STEIS). In the event of a serious incident that results in

harm, a detailed investigation will take place and the Provider will follow the guidance provided by the Commissioner for the type of investigation required, and will produce an investigation report within an agreed timeframe, in accordance with national guidelines for Serious Incidents Requiring Investigation.

· The Provider will have in place a policy describing the process for managing complaints from patients, carers, relatives or members of the public. The policy will be reviewed, and if necessary amended, by the Provider and Commissioner prior to contract commencement.

· The Provider shall inform the Commissioner or Commissioning Agents within 24 hours of any complaint raised by a patient, by the patient’s escort or any other person concerning the Provider’s vehicles, staff or any other matter relating to a patient’s Journey. All patient complaints will be investigated by the Provider. However, any complainant has the right to complain to their respective NHS organisation.

3.2.7 Performance, Management Information and Audit

The set of Key Performance Indicators is attached at Schedule 4 Part C Local Quality Requirements, the frequency of reporting is attached at Schedule 6 Part B Reporting Requirements. A report format for the KPIs will be agreed between the Provider and the Commissioner, which will include a standard Red /Amber/ Green rating to assess whether the contract is being met together with profiling of data.

A selection of agreed performance information will be published on the Provider’s/Commissioner’s website.

The Provider will be responsible for ensuring the provision of all data in the KPIs.

The following exceptions to KPI’s will be allowed:

In relation to any Journeys the Provider will be granted relief from the KPI’s as a direct or indirect result of:

Weather- extreme weather conditions that cause delay e.g. snow or flooding

Traffic – major unplanned disruption to local road networks. This does not include scheduled road works that the provider should be aware of, or heavy traffic due to planned events such as the Royal Cornwall Show or Boardmasters.

Patient not ready at home – when a crew has to wait more than 15 minutes. The Journey will be aborted and rebooked but will impact the patient’s arrival time.

Patient not ready at point of care – patient is delayed at the point of care for drugs, paperwork or another reason. The majority of these Journeys will be aborted and rebooked and will not be an exception. An exception will only be granted where it is not efficient for the crew to move straight to another job and must wait e.g. if the point of care is in a remote location.

Delay due to hold-up on previous Journey – where the crew has been delayed on the previous job and it has had a knock on effect to the next Journey.

Booking Error by User – when the booking gent incorrectly enters details of the Journey e.g. incorrect point of care, home address or mobility. The patient still makes the Journey but is delayed.

Priority given to another patient – This will be at the request of a healthcare provider. A risk assessment must first be undertaken by the transport provider and the healthcare provider to identify other patients affected. Only patients with the same healthcare provider can have their Journeys

moved. The cohort of patients that can be prioritised must be agreed by the Commissioner.

KPI’s will be reported with the above Journeys excluded. The provider must provide a separate monthly report listing each Journey excluded with reason that can be linked back to the MDS by the commissioner for validation.

On the day bookings in excess of 30% - When ‘on the day’ bookings exceed 30% of total Activity on that day, penalties will be suspended for all Journeys that take place on that day that were booked on that day. Penalties will still be applicable to all pre-planned Journeys that take place on that day ‘On the day’ Activity is any Journey booked after 5pm the previous day.

KPI will be reported with all ‘on the day’ Journeys included, even when the 30% threshold is breached. An ‘on the day’ report must also be provided with the monthly KPI reports showing the percentage of ‘on the day’ bookings for each day of the reporting period and listing all Journeys booked on the day for those days within the reporting period where the 30% threshold is breached.

The monthly Activity report will be agreed with the Provider in order to validate any data queries and for the Provider to recharge other CCGs as and when necessary

The Provider must be able to show full, reconcilable data for every patient Journey, this is to include as a minimum the following fields:

CCG GP GP PCT From PCT To PCT From Hospital From Clinic Name From Post Code To Hospital To Clinic Name To Post Code Appointment Time Return Time Arrive Pickup In Depart Pickup In Arrive Destination In Arrive Pickup Out Depart Pickup Out Arrive Destination Out Ready Time Late Inward Reason Late Outward Reason Status In Status Out Mobility Inward Mobility Out Relative Escort in

Relative Escort out Medical Escort in Medical Escort out Type Booking Type Mileage Contract Code ECJ Marker Call Sign In Call Sign Out Booked Date Patient Number Eligibility Questions

The Provider will, as a minimum data set, supply Activity reports and key quality performance reports on a monthly and annual basis. Monthly reports will show a year to date as well as monthly Activity and quality performance for the year in question and the annual report will show the final Activity and quality performance outturn for the finance year.

All reports will show actual Activity by patient mobility, Journey category, mileage and cost against indicative Activity plan and expected full year outturn. The Activity to be shown as a number and a percentage.

An end-of-year report will be provided, summarising all Activity and information from the Key Performance Indicators, any trends and any other agreed information requested by the Commissioner.

The Provider must allow the Commissioner’s internal and external nominated auditors access to documents relating to the provision of the Services for the purposes of audit. These would include, but are not restricted to, Activity/invoicing arrangements, employees’ training records, vehicle servicing and equipment calibration certificates, etc.

3.2.8 Review of Contract/Performance Management

The contract will be managed using a number of processes. These will include a monthly Contract Review meeting, chaired by the Commissioner and Quality lead and to which all Commissioning Agents will be invited to raise issues.

Local operational / pre meet for Contract Review meetings will be held, on a monthly basis prior to the date of the monthly contract meetings with Commissioner and Commissioning Agents present.

The Provider is required to send senior operational, finance and quality representatives to these meetings. These representatives will be given delegated powers to make the appropriate decisions.

The Commissioner will lead on issues relating to the contract, with other Commissioning Agents involved, as and when required.

There are four levels at which the Commissioner, Commissioning Agents and Provider will communicate in the course of this Contract:

· Enquiries and operational issues on an ad hoc basis

· Operational/pre meet for Contract Review Meeting

· Contract and Performance Review Meeting

· Emergency/Urgent Meeting

For ad hoc enquiries, the Provider will respond by email within five working days unless agreed otherwise.

The Commissioner, Commissioning Agents Representatives and Quality Lead will agree a Terms of Reference for the Contract Performance Review and the Operational Review Meetings (which acts as a commissioner pre-meet for the main Contract Review Meeting) to take account of all contract terms and conditions including reporting requirements. The Terms of Reference will include a schedule of dates for the year. Minutes for both meetings will be recorded by the Commissioner or Commissioning Agents during the Meeting and then issued as a record. The Provider will respond to all action points within five working days, or as agreed.

3.2.9 Contract Performance Review Meetings

These will held monthly and at such other times as agreed between the parties and include a review of:

· Performance and standards of service against Key Performance Indicators and associated incentives/deductions.

· Activity against demand profile and charging on a monthly, year to date and full year out turn position.

· Continuous improvement measures.

· Compliments and complaints.

· Demand management plan.

· Quality and Performance Report [including incidents and investigations]

· CQUIN

· Exception reporting from Operational Review Meeting

There will be an annual contract review meeting to review performance, Indicative Activity Plan and contract requirements including CQUIN.

3.2.10 Operational Review Meeting –these will be held monthly and act as the pre-meet for exception reporting to the main contract performance review meeting

These will include a review as set out in template provided including eg:

· Operational issues raised by staff making bookings and communicating with the Provider.

· Clinical issues relating to the training of staff, vehicle equipment and advice given to healthcare professionals making the booking.

· Performance and Activity including the Financial performance of the contract.

· Proposed developments or changes to services.

· Any other issues or concerns.

3.2.11 Emergency/Urgent Meetings

Shall be held within half a day of an emergency, or as soon as reasonably possible. The Provider will respond to all action points generally within two working days, or as agreed.

The Provider may also be required to produce reports for or attend meetings with other scrutiny organisations (such as Local Health Watch) or Local Authority Committees.

No charge shall be made by the Provider for attendance at any meetings.

If the contract performance standards are not met, remedial actions as stated in the contract apply procedures are described in the Contract.

3.2.12 Provider’s Management Structures

The Provider will ensure that there is an appropriate organisational structure to provide services to the levels specified in this Contract.

The Provider shall supply an organisational structure identifying lines of accountability and key functions of staff.

The Provider shall nominate at a minimum the following:

· Designated NEPTS contract Manager and deputies. The key functions should be agreed with the Commissioner.

· Designated Contract/Quality Assurance Manager.

· Designated Clinical Lead – this is to assist with making decisions on the type of vehicle/crew needed according to the medical/mobility needs of the patient.

· Designated Caldicott Guardian – this is a senior member of the organisation who carries the responsibility for the appropriate use and protection of patient data.

· Designated day-to-day local Operational Managers who can be contacted by health staff making bookings, or for general enquiries. Outside core hours, an on-call representative needs to be available. There may be a need at the start of the contract to have designated staff at each of the major hospital sites.

· Designated senior control room operators or supervisors.

Contact details of the designated staff will be made available, i.e. names, titles, email addresses and telephone numbers.

If any of the Commissioner or Provider designated managers are away, nominated deputising contacts will be notified.

The Provider is expected to be proactive to ensure the organisation is a good place to work. This includes setting internal Key Performance Indicators and encouraging staff feedback through formal and informal processes.

3.2.13 Information and Governance

The Provider must have use of information technology to ensure systems are used that maximise:

· cost effectiveness

· scheduling of booking to reduce carbon footprint

· performance management systems to provide the Commissioner with information to meet the Key Performance Indicators and contract data

· electronic systems to support the Commissioner’s and Commissioning Agents booking procedure

· information to the patients and professionals who use the service.

The Provider will be responsible for:

· Secure storage of information eg encrypted hardware

· Provide secure backup system

· The provision and management of IM&T hardware and software. Systems should be fast broadband networking services compatible with the NHS.

· Appropriate information management and governance systems and processes to safeguard patient information and compliance with confidentiality and Data Protection laws/regulations and Confidentiality Codes of Practice (such as DOH code). This will need to be supported by appropriate training for all staff. All information must be secure in any form or media, e.g. paper or electronic copy. Any exchange of personal/sensitive data must be via an encrypted memory stick unless an alternative method is agreed.

· Ensuring full detailed information is available for performance management. This should include an audit trial of each patient Journey and any other information required for the prevention of fraud or investigation of any complaints.

· Data migration support from existing booking/record systems to a new provider system to ensure a seamless transfer if and when required.

All staff must respect the confidentiality of any information relating to the Commissioner or Commissioning Agents, its staff or its patients.

The Provider will be responsible for the secure storage of all paper records. At the end of the contract, these will be transferred to the Commissioner.

The Provider or its staff must not disclose to any person other than a person authorised in writing by the Commissioner or nominated Purchasing organisations working on behalf of the Commissioner, any information acquired by them in connection with the provision of the Services which concerns:

· The Commissioner and Commissioning Agents, its staff or procedures

· The identity of any patient at any of the Commissioner’s or Commissioning Agents hospitals or other establishments

· The Medical condition of, or the treatment received by, any patient.

Under Contract Terms and Conditions the Provider is required to nominate a Caldicott Guardian - this is a senior member of the organisation who carries the responsibility for the appropriate use and protection of patient data.

3.2.14 Monthly Management Information

Under Contract, Core Legal Clauses and Definitions, ”Information Requirements” and “Data Protection, Freedom Of Information and Transparency”, the Provider shall submit to each Commissioning Agent data set and information reports.

The minimum data set should be received by the 15th of each month on Activity in the previous calendar month.

The Provider shall only submit the above Information by either secure online access or email in a format that can be downloaded into excel. If a secure internet connection cannot be established then the data set is to be sent, by recorded delivery, on an encrypted memory stick. The cost of the memory sticks and postage is to be met by the Provider. Once received by the Commissioning Agent a phone call will be made to a number specified by the Provider to confirm receipt and to obtain the access password to the data. The password must be at least 7 digits long and contain at least 1 capital letter with a combination of alpha, numeric characters and must not relate to the date of the data e.g. January2010.

3.2.15 Parking and Services

Parking will be provided for the dropping off and collection of patients at the main Hospital sites within the area. On-site facilities are not available for overnight or long term parking.

The sites will make known to the Provider what facilities are available at their site; eg parking for long periods, rest places, refreshments for Provider’s staff.

All parking is solely at the Provider’s own risk.

The Commissioner, Commissioning Agents and other NHS organisations will not be providing linen unless in an emergency sanctioned by the NHS Organisation’s nominated person.

3.2.16 Activity Levels and Demand Management

This paragraph is subject to clause 3.2.

An Indicative Activity Plan is attached at Schedule 2 part B.

The majority of the workload will be planned, but the workload for short-notice / same-day requests will fluctuate from day to day.

The Provider should be aware that there will be significant daily and seasonal peaks and troughs in demand.

The Provider will assist the Commissioner and Commissioning Agents in actively managing demand. This will include providing systematic feedback on patients who, it is thought, may not be eligible to NHS funded transport, discussing modifications to existing procedures, and piloting new or innovative schemes.

Activity levels for this contract cannot be guaranteed.

3.2.17 Patient Mobility and Escorts

Mobility categories of patients are shown below. This information will be indicated on the booking request to the Provider

Name Description

Vehicle 1 Patients who require an ambulance but do not require the assistance of two persons’ whilst on board.

Vehicle 2 Patients who require two persons’ assistance to board or alight from the vehicle, or to be lifted in a chair.

Wheelchair 1 Patients who need to travel in their own wheelchair for the Journey, but do not need the assistance of two persons’ to board and alight from the vehicle.

Wheelchair 2 Patients who need to travel in their own wheelchair for the Journey, with two persons’ assistance to board and alight from the vehicle.

Electric wheelchair 2 Patients who need to travel in their own electric wheelchair for the Journey, with two persons’ assistance to board and alight from the vehicle.

Stretcher (ST) Patients who need to lie down for at least part of the Journey, with the assistance of two persons’ required.

Escort Not chargeable

For all categories patients with additional needs will be clearly identified at the time of requesting.

3.2.18 Clinical requirements of the patient

Patients may have a number of clinical requirements of varying levels of complexity. These include patient who may have specialised equipment supporting their condition (for example oxygen or syringe drivers), which crews will be advised about prior to the Journey.

3.2.19 Interventions, etc.

· In line with the original assessment and booking details, the Provider is expected to convey the Patient to the appropriate destination using appropriate levels of support. Patients who require higher levels of care should be referred back to the Booking Agent to ensure the correct details are recorded for any future Journey requests.

· Where no response is obtained at the address, the Provider will have procedures in place to ensure that the Patient is contacted and the commissioning service at the relevant destination is informed.

· If any patient is found in a life-threatening situation or circumstances that gives grave concern for the safety and well-being of that patient the Provider shall immediately contact the appropriate Emergency Authority and the Provider’s controller.

3.2.20 Mental Health & Complex Manual Handling Patients

Due to the nature of patients’ conditions, Mental Health patients may need extra assistance such as escorting to and from their residence and to their drop off and collection from their destination at day Activities or clinics.

Some Mental Health patients may need to be escorted by a responsible adult/carer or NHS

professional OR require 2 manned crews as the patient may be special needs, vulnerable through their illness and/or require observation during their Journey. The Booking Agent will advise at the point of booking.

Notification of patient ready times – The Provider will contact the patient/carer and advise them of collection time from their pick up location. This is to be no more than 2 hours in advance of their Activity/appointment time – unless agreed with the patient and the Commissioner. Any complications that occur following advance notification must be relayed to the Commissioner as soon as possible.

3.2.21 Complex Manual Handling Patients

For patients where there is a high level of manual handling knowledge and expertise required and where there are specific issues to address to achieve safe handling of equipment and/or the support of extra personnel. An example might be a 30 stone stroke patient or a child with complex needs who cannot stand.

A patient’s weight should not be construed as a pre-determinant of ‘complex manual handling’. Many patients are able to mobilise with limited assistance and therefore will fall outside of this grouping.

To qualify for a premium payment, the ‘complex handling patient’ must be pre-authorised either by the Commissioning Agent or CCG. The Provider will need to be able to evidence an assessment of risks and a record action plan in addressing these patients.

The following risks will also need to be considered by the Provider to ensure that patients are conveyed appropriately and in a timely manner. These include:

· If the patient has been treated for, or is currently experiencing symptoms of, an infectious disease such as noro virus, MRSA, C Diff or Swine Flu.

· Whether the patient’s weight and mobility needs require specialist/bariatric equipment and/or the support of extra personnel.

· Whether there are any access issues at either the pick-up or destination which require a full risk assessment due to patient’s mobility. This includes steps and narrow corridors.

· If any patient is found in a life-threatening situation or circumstances that gives grave concern for the safety and well-being of that patient the Provider shall immediately contact the appropriate Emergency Authority and the Provider’s controller.

· Whether the patient is considered at risk of cardiac or respiratory arrest during the Journey and whether a Do Not Resuscitate (DNR) position has been confirmed for the Journey.

3.2.22 Other Special Requirements

Gender of crew:

Request for a male or female crew member

Escorts:

A parent or other responsible adult must accompany all children under the age of 18 years. Patient escorts will be transported only when an authorised request is made at the time of booking, and this includes escorts for end-of-life patients. The definition of who is eligible as an escort is included in the PTS eligibility criteria but may also be determined at the discretion of the Provider to a patient’s escort where there are particular skills and/or support needed, for example, this might be appropriate for

those accompanying a person with physical or mental incapacities, vulnerable adults or children, or to act as a translator.

Escorts are not subject to Journey charging.

Where, a Journey for an escort will only be one way ie for an admission - the escort is responsible for their own return transport.

3.2.23 Transportation and Care of Patients/Escorts

NEPTS is only for patient transport and a single piece of patient luggage/personal belongings. However transporting patient equipment should be accommodated when safe to do so.

The Commissioner and Commissioning Agent will:

· Inform the patient to be ready 60 minutes prior to their scheduled pick-up. Standard information will be contained in the patient PTS information sheet and hospital letter.

· The Provider will operate an agreed system for: confirming accurate transport pick-up times with patients; notifying the patients of any changes and how patients can contact the Provider.

· The Provider will set up a ‘call back’ service to patients to confirm whether they still require the transport as requested. This should be done the working day prior to travel at the latest. (Currently carried out by SPOC by RCHT)

The Provider shall ensure that staff will:

· Carry out necessary medical procedures in accordance with the training they have received.

· Transport patients to home/healthcare facilities as requested at the time of requesting or when subsequently amended.

· Treat patients in a courteous manner which pays due regard to their medical condition, age, personal modesty and circumstances, without discrimination on grounds of gender, race, religion or disability.

· Make sure that patients are comfortable during their Journey and that the vehicle is kept at a comfortable temperature and is well ventilated.

· When a two person crew is used to convey patients that one member of the crew remains seated in the rear of the vehicle with the patient(s) when the vehicle is in motion.

· Provide assistance as required to patients (with or without the use of aids) to undertake the Journey. Assistance may be required at both the patient’s residence and at the health department.

· Check the patients carry medication, any necessary medical equipment, appointment card, doctor’s letter, any assessment documents or personalised care plans, etc.

· Check, as and when necessary, that household appliances have been switched off, premises locked and that the patients have their keys.

· Make sure that all patients are secured safely using seat or stretcher safety belts unless covered by DVLA exemptions.

· Carry patients’ equipment and belongings, ensuring they are secured safely, e.g. wheelchair, walking frame, medical notes and personal possessions. (Patients will be informed that they should

only travel on PTS transport with one bag under 15kg in weight, no larger than a small suitcase.)

· Ensure that any documents that contain personal or sensitive information are secured whist in the vehicle and not left in public view or able to be accessed by anyone not authorised to view them.

· Ensure patients are not left unattended while negotiating steps or stairs, or when boarding or alighting from the vehicle – when necessary, assisting the patient.

· Inform the relevant department if the patient becomes unwell during the Journey. This will follow agreed procedures which include referral to the 999 emergency services.

· Return all equipment to the designated location if the equipment has left the site, as agreed with the healthcare facility.

· Ensure the patient arrives at the correct department and report their arrival to the department reception or designated healthcare professional.

· Ensure that when the patient is picked up from the healthcare facility, the Provider’s staff liaise with healthcare staff on who to transfer and how to transfer the patient from the bed or chair to the stretcher or wheelchair.

· Prior to leaving with a discharge or transfer patient, report the departure to a healthcare professional in the department.

· If any patient is found in a life-threatening situation, the 999 Emergency Ambulance Service must be contacted immediately – using the 999 telephone system, also advising the Provider’s controller at the earliest opportunity.

· In the event of any delay, e.g. vehicle breakdown, the Provider’s crew will inform their controller as soon as possible to allow the Provider’s control staff to inform the receiving healthcare site or residence at the earliest opportunity. Alternative arrangements for the transportation of the patient(s) will be made at no additional charge.

· Some patients may need to be escorted as agreed at the point of booking . The Provider is responsible for the transport of the escort where they have been authorised.

· In the case of a doctor or nurse escort, the Provider may be required to return the doctor or nurse to the requesting Commissioning Agent after delivering the patient to the receiving Hospital. This will notified at the time of requesting.

· The number of passengers to be carried is dependent on driver qualification and vehicle licence/specification.

· Provide individual sealed bottled water on all vehicles. For long Journeys over 50 miles, the hospital will provide other refreshments for the patient/escorts if required but not the ambulance crew.

· Provider’s staff are not permitted to carry their friends/relatives or fare-paying passengers or any other unauthorised passenger (for the sake of clarity any additional volunteer escort can only be by authorised agreement with the authorised booker).

· The provider is responsible for transport of an escort who is acting as interpreter when agreed and arranged for by the commissioner or commissioning agent

· Will allow assistance dogs to travel when conveying their owners as patients on vehicles.

All the standards apply to escorts as well as patients

3.2.24 Change of Destination

Patients must not be taken to a destination other than that specified on the booking request or as subsequently amended unless it is authorised by Commissioners/ Commissioning Agents designated point of contact.

3.2.25 Delivery Points

It is a principle within this contract that every reasonable attempt is made to collect/deliver patients to and from the agreed points at the agreed time. Within NHS Facilities, patients shall be delivered to the designated Ward/Department and collected from the same unless a discharge lounge system is in place or alternative destination is specified.

3.2.26 Location of Office Base and Vehicles

The Provider should endeavour to have vehicles based within the geographic area covered to ensure a timely dispatch of vehicles and liaison with local healthcare providers.

The Provider is required to have an office from which it will manage the service. The Commissioner will not be providing the office base.

The Provider will provide garaging, maintenance, cleaning and consumables for all vehicles.

The Provider will provide as many office bases, garages, shower, rest and changing areas and facilities for their staff as are required to service the contract. These are expected to be Disability Discrimination Act compliant and to be of a good standard in line with being a good employer.

3.2.27 Sub-contracting

The Provider is actively encouraged to use as Material Sub-Contractors any local transport provider that has previously been accredited as a PTS provider for the transportation of registered patients –as a minimum 30% of total mileage and all Journey categories. Responsibility for on-going accreditation will rest with the Provider – subject continued CQC registration. Any sub-contracting is to be agreed with the Commissioner.

The standards set within this contract are applicable to any agreed sub-contractor.

3.2.28 General Policies

The Commissioner reserves the right to inspect the Provider’s premises/vehicles/records and policies at any time.

The Provider must comply with all current legislation, relevant Commissioner policies and guidance as stated under the Terms and Conditions of the Contract.

The Provider is required to be accredited with The Care Quality Commission.

3.2.29 Emergency Planning / Major Incidents / Internal Incidents

The Provider must supply the Commissioner with a copy of their emergency planning procedures and will be required to update as necessary. Plans must be compatible with the Commissioner’s Major Incident/Emergency Response Plan, a copy of which will be available to the Provider And in accordance with the requirements of the NHS General Conditions, Schedule 2 Part D Commissioner requested and Essential Services, shows the proposed list of critical services in the event of emergency

planning or business continuity plans.

The Provider will be expected to be involved in the preparations for emergency preparedness advice, co-ordination and emergency planning for the areas covered by this contract.

The Provider must liaise with the relevant CCG Emergency Planning Adviser.

In the event of a large-scale disaster or extreme emergency, the Provider will co-ordinate and deploy all necessary PTS crews and vehicles to assist the 999 Emergency Services as requested, with the minimum of delay.

For emergencies that involve fuel shortages, it is expected that the Provider will be able to become a designated user in the case of disruption to fuel supplies.

For internal incidents an escalation protocol will need to be agreed to ensure rapid movement of patients to free up the hospital.

3.2.30 Business Continuity

The Provider will submit a business continuity plan which should be aligned to the standards in BS25999. It would be expected that the Provider would have an agreed year-on-year action plan of how they will be fuller compliant with BS25999 within 5 years.

The plan will provide details in relation to events which affect normal business, e.g. severe weather, industrial action and vehicle breakdown or road traffic accident. The Provider shall decide on the need to postpone services with the safety of patients in mind and shall notify the relevant Commissioning Agent of the reason and consequences of the disruption to services. This will not form part of any chargeable Activity, no Journey will be charged or aborted but will be rescheduled.

The Provider should have systems in place to administer both the seasonal flu vaccinations annually and other vaccinations such as pandemic flu, and to ensure a high take-up with all staff.

For internal incidents an escalation protocol will need to be agreed to ensure rapid movement of patients to free up the hospital.

The Provider must advise the relevant Commissioning Agent immediately if they are unable to transport a patient due to a failure in their ability to provide the Services. In such circumstances the Provider must make alternative arrangements for the transportation of the patient, at no additional charge to the Commissioner.

3.2.31 Indemnity and Insurance

The Provider shall be liable for and shall indemnify the Commissioner and the Secretary of State for Health against any liability, loss, damage costs, expenses, claims or proceedings whatsoever arising under any statute, contract or at common law in respect of any:

· Loss of or damage to property (whether real or personal). NB: 'Real property' means any immovable property for example land, structures, integrated equipment. ‘Personal property’ includes any movable property and can include any personal possessions and movable objects.

· Injury to any person, including injury resulting in death.

· Direct financial loss as a result of non-performance of the contract.

The Provider shall insure at their own cost and maintain appropriate insurance policies to a minimum level per incident for Public Liability of £5 million, Employer’s Liability of £10 million, Professional

Indemnity of £2 million, and Clinical Negligence Liability of £10 million.

As and when requested by the Commissioner, the Provider shall produce the insurance policies maintained in accordance with this condition and the premium receipts.

If the Provider defaults in insuring to the required levels, the Commissioner will consider this as a serious breach of contract which if not rectified immediately will lead to termination of contract. The Commissioner shall also recover from the Provider any costs, expenses, claims or losses arising from the failure of the Provider to indemnify the Commissioner and the Secretary of State for Health against such liabilities.

3.2.32 Contract and Fraud

The Provider will have policies and procedures in place to prevent and deter fraud entering their processes. The Commissioner will carry out audits to ensure due processes are in place. This is in line with the Service Conditions.

3.2.33 Geographic Coverage/Boundaries

Activity will predominantly take place in Cornwall and Isles of Scilly as well as in the adjoining counties (Devon, Dorset, North Somerset, Bath & North East Somerset and Bristol); however Patient Choice is likely to increase the range and geographic location of care providers with increasing cross-border and out-of-area provision anywhere in England, Scotland or Wales.

3.2.35 Day/hours of Operation

A service will be required to operate according to the Journey categories as described below 7 days a week 365 days of the year to include all statutory and discretionary Bank Holidays. Whilst most Journeys will be booked in advance there maybe some same day or short notice booking where the 999 service contract Urgent Criteria is not applicable

The required service standards are detailed in the Key Performance Indicators.

Timeliness in picking up and dropping off patients is a crucial element of the service.

The Provider should give due consideration to destination, distance, Journey times, local traffic conditions, etc., to ensure patient punctuality.

If there are delays to pick-ups or arrivals outside the standards of the Key Performance Indicators, every attempt will be made to contact the healthcare facility and patient.

The specified operating hours require the Provider’s staff to be on board their vehicles and on the road to collect patients so they arrive at their appointments on time. Therefore, vehicle checks, cleaning, refuelling, etc., should be carried out outside of these hours.

If the patient or transport is delayed, the Provider must ensure the patient is collected and returned to the agreed destination.

The Provider will be required to be flexible in the planning of return Journeys. This will need to take into consideration the type of clinic being attended, e.g. outpatient clinic requiring diagnostic tests, treatment session (i.e. rehabilitation, radiology, oncology, physiotherapy, etc.) or day hospital attendance (half-day sessions). Commissioning Agents will provide agreed parameters for individual clinics, etc.

Operating times are set out below as 5 Journey categories. To note Short Notice (i.e. two hour

notice) Journeys maybe requested by commissioning agents in certain conditions.

Booked Renal services Out of Hours Discharges Out of Area appointments and Transfers / medical need transport

Times Patients to 07:00 – 23:00 21:00 – 08:00 08:00 – 21:00 Any time by usually arrive agreement by 08:00. with discharging Last pick-up organisation usually 19:00

7 days a week, 7 days a week 7 days a week 7 days a week, Any day by with reduced with reduced agreement Activity Activity with Days Saturdays, Saturdays, discharging Sundays and Sundays and organisation Bank Holidays Bank Holidays

3.3 Population Covered

NHS services for patients (and their escorts as defined within the eligibility criteria) who are registered with a GP in NHS Kernow: Patients from other health communities are the responsibility of their CCG and Journeys undertaken for such patients using local healthcare providers will be invoiced to the responsible CCG. Such Journeys may need approval from the responsible commissioning organisation. Any such Journeys undertaken by the Provider shall be charged to that commissioning organisation.

There will/may also be a requirement to transport some patients who are not GP registered in the geographical area covered – this will primarily be for returning patients who are being discharged from an inpatient stay, and may also include outpatient or day hospital appointments. It should be noted that the South West is a major summer travel destination so patients may need to be transported anywhere in the country. A charge will need to be made to that resident’s CCG to cover the Extra Contractual Journey. It will be for the discharging hospital to have contacted the responsible commissioner as part of the discharge planning to give the lead NEPTS provider contact details.

The Department of Health gives guidance on the type of service provision which is covered. It is about treatment, outpatient appointment or diagnostic services, i.e. procedures that were traditionally solely provided in hospital, but are now available in a hospital (NHS or Private) or community setting.

Patient Choice is likely to increase the range and geographic location of care providers with increasing cross-border and out-of-area provision anywhere in England, Scotland or Wales.

Responsible commissioner rules will apply for patients who live in the geographical area covered by this contract but have no history of being registered with a GP.

3.4 Any acceptance and exclusion criteria and thresholds

3.4.1 Referral criteria & sources

The current national guidance states that the CCG in which a patient is registered (referred to in this

guidance as the “home CCG”) is responsible for funding their NEPTS needs, provided they meet the eligibility criteria set out in the 2008 guidance and any supplementary local criteria. The national guidance states eligible patients for NEPTS are those where:

Eligible patients are those:

 Where the medical condition of the patient is such that they require the skills or support of PTS staff on/after the Journey and/or where it would be detrimental to the patient’s condition or recovery if they were to travel by other means  Where the patient’s medical condition impacts on their mobility to such an extent that they would be unable to access healthcare and/or if would be detrimental to the patient’s condition or recovery to travel by other means  Where a patient is deemed ‘vulnerable’ and at risk by their health condition and cannot access normal transport  Recognised as a parent or guardian where children are being conveyed.

3.4.2 Referral route

Referral can be made by the Authorised Booking Agents.

Repatriation Requests for Cornwall and Isles of Scilly Patients from Out of Area Providers will be via Booking Agents or the Commissioner.

This to be reviewed annually for accuracy and efficiency via the Operating Review Meeting.

3.4.3 Exclusion Criteria

The Journeys will mainly be in or around the South West area but there will be a requirement for transport to anywhere within England, Scotland or Wales.

Patients who need emergency transport. The Emergency Ambulance Service provides call handling and prioritisation of 999 calls from the general public, and other calls and requests from healthcare professionals and other emergency services. There are four types of calls covered by the A&E agreement:

 Emergency calls from members of the public and healthcare professionals.  Urgent requests for ambulance transport from other healthcare professionals defined as being required within 1 to 4 hours.  Inter-hospital transfers of an urgent or emergency nature where the patient is moving to a higher level of care.  Mental health patients who are under the care of any of the Mental Health partnership Trusts who are assessed as high risk (e.g. sectioned patients) and are not suitable for PTS. A risk assessment tool will be agreed for use.

Transport to primary care services provided under the following NHS contract; General Medical Services/Personal Medical Services/General Dental Services/ Personal Dental Services, e.g. routine appointments to GPs/health centres and dental surgeries.

Prisoners – Transport is provided by the prison service.

Paediatric intensive care retrieval.

Neonatal intensive care retrieval (NICU). (This is a two-way Journey to collect a specialist team and transport them to the patient)

Non NHS-funded patients.

Patients assessed to be not eligible for NHS funded transport.

Conveyance of supplies, mail or any other goods unless previously agreed between the Provider and the Commissioner or Commissioning Agent.

Patients who require transport outside England, Scotland and Wales. NB: These Journeys, if and when they occurred, would be agreed on an individual pricing basis.

3.5 Interdependence with other services/providers

The Provider will work proactively and jointly with Commissioning Agents to ensure the adherence to Eligibility Criteria. To underpin this, the Provider will give regular information on potential misuse of the service so that issues can be quickly resolved. Where there is thought to be blatant disregard for the criteria the Provider is empowered to refer the request to the authorised transport co-ordinator within the Commissioning Agency, or if necessary escalate to the Commissioner.

For the avoidance of doubt a table is attached to outline payment responsibilities.

Commissioners will ensure :  all required information is supplied to the Provider on booking request forms  all booking requests over 48 hours to be made by email, or via the online booking system or phone  they notify the Provider of any new sites/site changes at least 12 hours in advance of patient movement  patients will be ready at least 15 minutes before agreed collection time  TTA's are ready at least 15 minutes before agreed collection time  the Provider will be given at least 30 minutes notice if a patient's collection/drop off point is changed  for Wheelchair and stretcher patients, adequate equipment will be provided at the drop off point (within NHS premises), no later than 15 minutes after the required drop off time  all invoice queries are resolved with the Provider within 28 days from the date of the query provided backing is given and as per the providers requirements that meets the Month and Year End requirements

4 Applicable Standards

4.1 Applicable national standards (eg NICE)

NA

4.2 Applicable standards set out in Guidance and/or issued by a competent body (eg Royal Colleges)

NA

4.3 Applicable local standards

4.3.1 Staff The NHS Guidelines for national job profiles for staff are the minimum requirements for staff.

The Provider will use job evaluation, promotional policies and grading of posts to ensure effective delivery and performance of the specification.

The Provider shall ensure that all staff have the necessary qualifications, including driving licence

category, to drive the vehicle, as well as adequate experience and sufficient knowledge to drive the vehicle in a manner conducive to patient safety and comfort.

The Provider shall be responsible for ensuring that all staff employed on this contract are formally trained to national and local recognised qualifications which are acceptable to the Commissioner.

The Provider’s staff shall at all times comply with current legislation with respect to the Road Traffic Act and any other laws applying to the operation of this service.

The Provider will seek agreement for the employment of any individual who has acquired driving licence penalty points in excess of 6 points within the last five years. If it is agreed that employment can take place it would be in a non driving capacity.

All staff and volunteers will have enhanced DBS before commencing employment which will be renewed every three years and whenever they move to a different role following competitive interview or internal regrading. There will be an agreement on action to be taken between the Provider and the Commissioner if a check shows a criminal conviction for a driving or safety related issue. The Commissioner reserves the right to insist on the individual concerned being removed from patient contact or driving duties whichever is deemed, in the view of the Commissioner or Commissioning Agents, to be the most appropriate course of action.

Anyone found to have a criminal conviction or police caution will be dealt with in line with the Rehabilitation of Offenders Act. The Provider will be expected to manage the situation complying with their appropriate policy (s).

The Provider shall have developed policies on employing people with criminal records and have the appropriate references in their recruitment and employment practices. This will also include assessing and managing risk and implementing safeguards.

The Rehabilitation of Offenders Act will apply to all staff employed on this contract.

No additional charge will be made by the Provider for these disclosures.

Where applicable, staff must meet current and all future requirements of the Licensing Authority and The Road Safety Act 2006. Key areas to note are:

 Licences are required to be obtained from the Local Authority for any vehicle that carries eight or less persons with a driver and where commercial benefit is obtained.  An operator's licence. This is granted for up to one year, and places various record-keeping requirements on licence holders.  A vehicle licence. This is granted for up to 12 months (pro rata, depending on when the application is made) after completion of compliance test.  A driver's licence. This is currently granted from one to three years to drivers who can show they are “fit and proper” after satisfactorily completing a medical examination, an enhanced Criminal Record Bureau disclosure, and a topographical Knowledge Test (in addition to the DVLA driving licence).

4.3.2 Training The table below is a suggested list of the training required for differing crew types. It will need to take account of the latest guidance in the NHS job profiles. The final list will be agreed with the Provider at the start of the contract and requirements reviewed annually.

Training – all staff General Induction training to include:  All relevant rules, policies, procedures and standards applicable to the contract, e.g. counter-fraud, data protection, information governance, equality and diversity, safeguarding children and

vulnerable adults, and complaints resolution etc.  Knowledge of local area/healthcare departments.  Use of communication and computerised systems.  Requirements for Health and Safety at Work Act 1974, including other relevant legislation and codes of practice.  Service issues including communication skills, standards of hygiene, dealing with aggression and violence from patients  The care and safety of all patients, including mental health patients and dealing with any other special requirements.  Dementia Care Standards

Specific Induction training to include:  Driving knowledge and skills. To include: economical driving skills to minimise fuel usage and training to minimise risks for vulnerable road users.  Use of vehicle equipment, daily checking/cleaning of vehicles and equipment.  Moving and handling techniques (including equipment, hoists, etc.) including moving and handling of bariatric patients.  First aid – including basic emergency accident management.  Basic Life Support Skills (BLS) to include Adult, Child and Baby.  Infection control procedures, knowledge of transporting patients with communicable diseases.  Oxygen therapy up to 4 litres per minute.

4.3.3 Policies The Provider will ensure (and will be responsible for ensuring any of their sub-contractors’) staff are easily identifiable as working in PTS. This will include a uniform or corporate identity work wear and a legible ID card with the Provider’s organisation and the individual’s name, job title and an up-to-date photograph. The failure by the Provider to supply their staff with an appropriate ID card or the inability of staff to produce one when challenged may result in the refusal to grant access to a building or allow a patient to be handed over into the care of that individual. In either case it will remain the responsibility of the Provider to undertake the original Journey at no extra cost or undue delay.

The Provider will ensure that they have, as a minimum, the following policies which all staff are aware of and adhere to:  Infection Control / Outbreak policies  Safeguarding Children and Vulnerable Adults  Information Governance and Data Protection  Serious Incidents Requiring Investigation and Patient Safety related Incidents  Business Continuity including essential service provision and service resilience during inclement weather  Major Incident  Environmental Sustainability  Health and Safety at Work/Manual Handling  Restraint

The Provider will ensure there is a staff conduct policy which covers inappropriate behaviour, appearance of staff, personal hygiene and customer care.

The Provider will have a standard and comprehensive range of HR policies, e.g. policy for recruitment, performance, appraisal, disciplinary issues, staff grievances and complaints procedure.

Where possible, the Provider will ensure that staff are familiar with the locations to which patients are being delivered, eg outpatients departments.

Provider staff are not permitted to accept any form of gratuity, tip or reward.

The Commissioner requires Provider’s staff to operate a no smoking policy. Drivers should not smoke within the car within half an hour prior to pick up of the Patient.

Provider’s staff shall be subject to the same Road Traffic laws and rules that apply to private motorists, and if a penalty is incurred whilst conveying patients, this is the responsibility of the driver. It will be expected that driving is conducted in a way which minimises the risks to vulnerable road users such as cyclists and pedestrians, with special attention with regard to children. Training can be obtained from accredited local and national organisations and should form part of drivers’ induction training.

As well as patient and general public safety and comfort, driver behaviour also has a significant effect on the amount of fuel used, impacting on both the carbon footprint and fuel cost. The Commissioners require that the Provider shall communicate expectations on efficient driving behaviours during induction training to minimise fuel use.

All staff will need to have a good standard of English in order to clearly communicate with patients and staff. This needs to be in line with current legislation and good practice.

All the above must be regularly reinforced through regular updates.

It is anticipated that car parking personnel (hospital sites only) will allow a reasonable time for the picking up and setting down of patients.

The Provider will ensure that employees immediately notify their supervisor (or deputy) of any communicable disease encountered by the employee, which may affect his or her suitability to undertake their normal duties.

It is suggested that the Provider’s staff are immunised against the following:-  Tuberculosis (TB)  Rubella (German Measles)  Tetanus  Hepatitis B

If the Provider employs a person under this Contract who is not vaccinated against the above and subsequently contracts or passes on the infectious disease, the Commissioners will not accept liability in the matter.

Staff should also be vaccinated against seasonal flu at the provider’s expense. This will form part of the Business Continuity Planning.

The Provider’s staff engaged in or about the provision of the Service shall primarily be under the control and direction of the Provider’s own management; however, whilst on hospital trusts’ premises they shall obey all reasonable instructions given to them by Officers of the Healthcare provider in any matter in which immediate safety or medical needs of any patient, member of staff or public shall be involved.

4.3.4 Staffing and Qualifications/Employment Checks

Training records are to be maintained by the Provider and evidenced to Commissioners upon request.

4.3.5 Vehicle Requirements

In addition to any requirements in the Service Conditions, the Provider will ensure:

Sufficient and suitable dedicated vehicles to fulfil the contract shall be available at all times.

The vehicles will need to meet all relevant UK and European Legislation, Department of Transport

standards, requirements of Licensing Authority and any Codes of Practice.

The Provider will comply with all road Traffic Act Regulations (excluding national and local exemptions given to PTS). The Provider will ensure at all times that vehicles are driven in a manner conducive to patient safety and comfort and abide by all Road Transport Laws/Regulations, the Highway Code and local bylaws.

The Provider will ensure at all times that the vehicles used in the provision of the Services have a current valid MOT certificate and road tax, and maintain appropriate insurance. Vehicles must be insured for passenger liability. Regular checks will be made of MOT and insurance documents.

No more than 20% of ambulance vehicles to be over 6 year or at start of contract, reducing to none by Year 3.

Vehicles must be maintained to the highest possible standards which comply at least with the maintenance standards recommended by the manufacturer of the vehicle, being serviced by appropriate qualified mechanics.

There will need to be multi-purpose vehicles capable of conveying stretcher and wheelchair patients. A variety of car and wheelchair accessible vehicles will also be required to support the main fleet. Not every vehicle needs to be bariatric but the provider needs sufficient number in the fleet to meet bariatric Journeys requests.

The Provider will select the most fuel efficient and lowest emission vehicle that meets the operational requirement for each Journey where a choice is available.

Vehicles used for carrying wheelchair passengers must be fitted with wheelchair locking devices and passenger harness that comply with current legislation for safe travelling, and with a tail lift or suitable alternative.

The vehicle exterior shall be clean and tidy with body panels of a uniform colour. Vehicles provided must be solely used for PTS; the livery will show that the vehicle is a non-emergency Patient Transport Service. The format of this needs to be agreed and comply with NHS Branding as set out in section E core legal clauses – section 61. All vehicles must carry a company identification label clearly displayed on the vehicles.

The vehicle interior shall be of a clean and tidy appearance with no damaged upholstery. The interior should be made of a hard surface material that is easy to clean/wipe.

Cleaning procedures must be undertaken in accordance with the highest standard of infection control and the national standards available from the National Patient Safety Agency.

Space should be available for the storage of wheelchairs or equipment that is required to accompany the patient. Such equipment must be conveyed in a safe and secure manner.

The Provider will check all vehicles for defects on a daily basis and maintain a “vehicle check and defect report”.

The Provider will ensure that notices in vehicles are visible to those with impaired sight.

The Provider will not allow advertising on or in the vehicle unless agreed with the Commissioner.

The Provider will ensure that all ambulances and MPVs have reversing alarms and that a banksman operates when dual crewed and where the patient’s condition allows.

When on NHS property, all drivers should turn off their vehicle engines when parked to either pick up or drop off patients. Vehicles must not be parked in such a manner to cause an obstruction or constitute a

hazard.

Where clear glass windows are fitted in the saloon of the vehicle provision must be made available to obscure the windows when it is necessary to maintain patient privacy and modesty.

Vehicles must be equipped with secure containers for confidential information.

4.3.4 Vehicle Equipment

The minimum internal equipment requirements will be dependent on the vehicle type and crew grade contracted to meet the needs of the patients conveyed. See below for a suggested list of requirements. Additional equipment may be required for patients with additional special requirements [eg Bariatric], which should be stated at the time of making a booking.

BS or equivalent approved child seats must be supplied by the Provider for the conveyance of young children and babies. They shall be properly fitted in accordance with the manufacturer’s instructions and the Provider’s staff shall be responsible for ensuring that the occupant is properly secured.

Seats must be fitted with high backs suitable for the conveyance of elderly/infirm passengers, and must conform in all aspects of British Safety Standards.

The Provider must have equipment able to accurately record the information needed to measure the Key Performance Indicators for Journey times, arrival and collection times, length of time on vehicle, total mileage and other performance measures such as carbon footprint.

The Provider shall arrange a method of ensuring that staff can contact the wards/department /healthcare provider when they are unable to make contact a patient from their home address or place of residence. The minimum communication equipment will include: a phone/ communication system to contact the patient, ward/department and office base, data recording to measure all performance indicators and mapping systems for efficient routing.

The Provider must ensure that all equipment is serviced in accordance with manufacturers’ specifications, taking account of usage and infection control. Equipment used for manual handling must be serviced and checked at six-monthly intervals by a qualified engineer. Medical gases, piping and components must be serviced and checked annually by a qualified engineer.

All vehicle equipment should be checked on a daily/shift basis by the allocated crew – this includes checking stock levels and any necessary cleaning in line with infection control and national standards.

4.3.5 Equipment List

Document Folder Hospital barrier cards (where appropriate) Fuel cards Insurance certificate Manufacturers’ instruction folder No Reply slips PTS patient leaflet PALS leaflet Vehicle equipment checklist Vehicle cleaning checklist Vehicle defects report

General Aids and Consumables Alcohol hand gel First Aid kit Carry chair

Clean blankets, pillows, towels Disposable wipes Disposable vomit bowls/bed pans and urinals Dressing packs Drinking water and disposable cups Fire extinguisher, as detailed in the Public Service Vehicle Specification Folding wheelchair Incontinence pads Interior lighting Infection control protective clothing Infection control spill kits Portable ramps Safe storage of bio-waste Sterile gloves Traceable infection control waste disposal system Torch Umbrella

Safety Equipment Immobilisation aids Safety belts Secure closing cupboard Wheelchair clamps

Specialist Equipment Stretcher with safety straps PAT Slides O2 Suction (hand held for specific patient groups)

4.3.6 Green Issues and Carbon Footprint The Provider will have a green transport and environmental policy to address environmental concerns. The Provider should specify, where possible, that vehicles use current technologies such as low- emission models, hybrid vehicles, electric vehicles, automatic stop/start, speed limiters, lean-burn engines, green-optimised models (such as Ford ECOnetic, etc.) and LPG dual fuel to assist in the reduction of the carbon footprint where they are commercially available and financially viable.

The Provider will have a waste disposal policy which refers to oil, batteries, etc., if the vehicles are serviced “in-house”. If this function is contracted to a third party then the Provider should require evidence that correct procedures are in place. This policy will also covers vehicle disposals.

The Provider will have exemplar policies in place to cover recycling of basic office waste: paper, card, etc., as well as vehicle disposal.

In line with the Government strategy, ‘Securing the Future’, the Provider will be required to report on sustainability development performance including carbon footprint reduction.

4.3.7 Office Equipment

In addition to any requirements in the Service Conditions, the Provider is required to provide all necessary equipment to facilitate delivery of service.

4.3.8 Transfer of and Discharge from Care Obligations The provider shall ensure that the patient arrives at their planned destination and where receiving healthcare services or being discharged to the care of another health or care provider has brought the arrival to their notice and ensured the patient has been acknowledged as having arrived.

4.3.9 Self-care and Patient and Carer Information

Copies of NHS Kernow’s Transport Advice and Information leaflet should be available in all vehicles.

5 Applicable Quality Requirements and CQUIN Goals

5.1 Applicable quality requirements (See Schedule 4 Parts A-D)

5.2 Applicable CQUIN goals (See Schedule 4 Part E)

6 Location of Provider Premises

The Providers premises are to be located at:

Bodmin Base:

NSL Care Services 1C Lucknow Road BODMIN PL31 1EZ Redruth Base:

NSL Care Services Unit 13b Cardrew Industrial Estate REDRUTH TR15 1SS Exeter base – Control Centre

NSL Care Services Unit 16/17 Kestrel Business Park Kestrel Way Sowton EXETER EX2 7JS

Booking centre:

NSL Ltd Shared Service Centre Falcon Business Centre Victoria Street Oldham OL9 0HB

7 Individual Service User Placement

NA

Appendix 1

NEPTS Critical Service Provision: In the event of Emergency Planning or Business Continuity

Critical Service Service Type Provision Level

Paediatric Renal Dialysis Level 1

Adult Renal Dialysis Level 1

Oncology and Haematology Outpatients/ Admissions Level 1

Cardiac Shuttle Level 1

Cardiac Repatriations Level 2

Paediatric Repatriations Level 2

General Inter-hospital Transfers Level 2

General Repatriations Level 2

General Admissions Level 2

General Day Case Level 2

General Discharges Level 2

Out Of Area General Discharges Level 2

Out of Area General Transfers Level 2

Inpatient Outpatient Appointments Level 3

Level 1 Clinically Level 2 Operationally Level 3 Not Critical

For the purposes of this Contract the Services meet the definition of Essential Services