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Non-emergency NHS funded patient transport policy

This policy provides a framework for local decision making when assessing the eligibility of patients for non-emergency NHS funded patient transport in line with national guidance and current legislation. It provides a basis for ensuring equitable access to non-emergency NHS funded patient transport to eligible patients in Cornwall and the Isles of Scilly.

Policy purpose

To standardise access to non-emergency NHS funded patient transport across Cornwall and Isles of Scilly for patients with a medical or financial need for transport to and from a premises providing non-emergency NHS healthcare, and between NHS healthcare providers (commissioned by the NHS to deliver NHS funded care and treatment). To achieve this, the eligibility criteria outlined in this document has been standardised and will apply to all patients registered with an NHS Kernow GP practice.

It will ensure delivery of a sustainable patient transport service, which is fit for future as it has been developed in association with patients, clinicians and partners. The geographical challenges, that Cornwall and the Isles of Scilly experience, require a robust transport service as it plays a key role in ensuring improvement of the health of patients and provides reassurance to family members. Stakeholder consultations have provided valuable local insight and supported already identified challenges.

Scope

This will cover non-emergency NHS funded patient transport for patients travelling to receive healthcare at all NHS and independent service providers contracted to the NHS.

This policy does not apply to emergency transport such as 999 ambulances, air ambulance, helicopter search and rescue and mental health transport.

Policy statement

NHS Kernow Clinical Commissioning Group’s (NHS Kernow) policy is to fund non-emergency NHS funded patient transport where there is a statutory obligation to do so and make no discretionary payments other than those detailed within this policy document. These obligations are described in:

  1. Eligibility criteria for patient transport services (PTS)
  2. Healthcare travel costs scheme – instructions and guidance for the NHS (2010)
  3. The NHS (travel expenses and remission of charges) Regulations 2003

NHS Kernow will provide access to non-emergency NHS funded patient transport for patients registered with and NHS Kernow GP practice or who are usually resident in Cornwall and the Isles of Scilly who:

  • meet the nationally defined criteria on health grounds (described in the eligibility criteria for patient transport services
  • meet the nationally defined criteria on financial grounds (described in healthcare travel costs scheme and NHS (travel expenses and remission of charges) Regulations 2003)
  • meet the locally defined criteria for frequent travellers
  • are usually resident on the Isles of Scilly (described in healthcare travel costs scheme and NHS (travel expenses and remission of charges) Regulations 2003).

NHS Kernow will provide access to non-emergency NHS funded patient transport for escorts of those patients identified above who meet the nationally and locally defined criteria for escorts.

Patients should be assessed every time they request NHS funded patient transport as their condition may have changed

Introduction

Patients travelling to receive NHS non-emergency healthcare are normally expected to make their own way using their own transport or the range of public, community or voluntary transport available locally. However, patients may be eligible for assistance on the grounds of either health need or financial need.

NHS funded patient transport for health need

NHS funded patient transport services are available to patients who are unable to travel on private or public transport due to a health need. This service mainly helps patients who are accessing healthcare services, being transferred between healthcare services or being returned to their place of residence having received healthcare services. The healthcare must be NHS funded in order to be eligible for non-emergency patient transport. NHS funded patient transport services are available free of charge to eligible patients.

NHS funded patient transport for financial need

Patients that do not have a health need but are on a low income, or in receipt of certain benefits, may be able to claim a refund of reasonable travel costs under the healthcare travel costs scheme if they are referred to hospital or other NHS premises for NHS specialist treatment or diagnostic tests. Patients are expected to use the cheapest suitable mode of transport for their circumstances.

Both patients and escorts or carers will be assessed against eligibility criteria defined nationally by the Department of Health guidance and supported by NHS England guidance.

The purpose of these eligibility criteria is to provide a fair and equitable service to patients accessing NHS funded patient transport. It is also to ensure that this resource is provided to those who have a specific medical or financial need that means that they require transportation to access healthcare services or return home.

NHS funded patient transport

If you live on the Isles of Scilly please refer to the separate section below.

NHS Kernow’s policy is to fund in line with national statutory guidance with no discretionary payments other than those detailed within this policy document.

Eligibility (extracted from national guidance)

A patient’s eligibility for NHS funded patient transport services will be assessed against the following nationally defined clinical eligibility criteria as a medication condition that:

  • requires the skills or support of patient transport staff, on or after the journey, to the extent that it would be detrimental to their condition or
    recovery if they were to travel by any other means
  • impacts on their mobility, to such an extent that they would be unable to access healthcare, and it would be detrimental to the patient’s condition or recovery to travel by any other means

Patients should be assessed every time they request NHS funded patient transport as their condition may have changed.

A patient’s eligibility for non-emergency NHS funded patient transport and provision of escorts should be determined by either a healthcare professional or by the centralised booking service at Royal Cornwall Hospitals NHS Trust who are both:

  • clinically supervised and/or working within locally agreed protocols or guidelines
  • employed by the NHS or working under contract for the NHS

Exclusions

NHS funded patient transport eligibility does not extend to include:

  • patients who are usually able, for the purpose of daily living, to travel in a private car (for example a relative, friends or neighbour’s car) or on public transport (for example a bus, train, volunteer car service or taxi)
  • patients travelling for private treatment funded by themselves
  • transport for social need (for example because a patient does not have their own car)
  • transport to primary care services for example GP or dentist
  • patients requiring an urgent or 999 response
  • visitors to patients in hospital

However, you may be entitled to NHS funded patient transport if you have a temporary medical need (for example, your leg is in plaster).

Escort criteria for NHS funded patient transport (extracted from national guidance)

Only healthcare professionals will normally be carried as patient escorts on NHS funded patient transport vehicles. Family members and friends may be authorised to travel in exceptional circumstances if they are able to provide the necessary skills or services that the patient requires on the journey that cannot be supplied by the transport staff.

A patient can travel with an escort if 1 of the following applies:

  • medical condition is such that he/she requires constant supervision for safety (the escort must be able to meet the medical need and it should be
    established whether a healthcare professional would not be the preferred option)
  • has mental health problems that prevents them travelling alone
  • is under 16 years of age
  • has significant communication difficulties, including learning difficulties, impaired sight or is hard of hearing (where a patient has communication difficulties the escort should be able to provide a positive benefit in ensuring the patient can understand anything being said to them by the ambulance crew; for example, through the use of sign language where the patient is hard of hearing)

NHS Kernow local criteria

Patients attending a 20-week pregnancy scan will be entitled to funded escort travel. If this entitlement is unused it cannot be saved for a later appointment.

Patients attending a 2-week wait appointment, where the initial diagnosis will be discussed will be entitled to funded escort travel for emotional support. If this entitlement is unused it cannot be saved for a later appointment.

Only 1 relative escort will be permitted for children under 16 years and for adults who require constant attention and/or need an advocate during their hospital visit.

Where a request is made for a patient to travel with a friend or relative as an escort the decision to approve the request will be made by the centralised booking service having sought appropriate clinical guidance.

How to book NHS funded patient transport

To receive NHS funded patient transport, patients must telephone the centralised booking service at Royal Cornwall Hospitals NHS Trust on 01872 252211. The team will check eligibility against the nationally defined criteria and book any appropriate transport.

Healthcare travel costs scheme

NHS Kernow policy is to fund in line with national statutory guidance with no discretionary payments other than those detailed within this policy document.

Eligibility (extracted from national guidance)

The healthcare travel costs scheme is aimed at patients that have a financial need for assistance with their travel costs to access health services which are not primary medical or primary dental care services, for which the patient has been referred by a doctor or dentist.

To qualify for help under the Healthcare Travel Costs Scheme, patients must meet 3 conditions:

  • At the time of their appointment the patient, or their partner (including civil partners) must be in receipt of 1 of the qualifying allowances or benefits listed:
    • income support
    • income based Jobseekers allowance
    • pension credit guarantee credit
    • income-based ESA
    • named on an NHS tax exemption certificate
    • on a low income and named on certificate HC2 or HC3
  • The patient must have a referral from a health care professional for a specialist or to a hospital for further NHS funded treatment or tests.
  • The patient’s appointment must be on a separate visit to when the referral was made.

Exclusions (extracted from national guidance)

The healthcare travel costs scheme does not apply in the following circumstances:

  • patients who attend an establishment to receive primary medical or primary dental services
  • transport of patients with a medical need for ambulance transport
  • patients being transferred between treatment centres
  • patients who discharge themselves from hospital at their own request
  • self-referral patients (who have not been referred by a doctor or dentist)
  • visitors to patients in hospital
  • patients travelling for private treatment funded by themselves
  • overnight stay costs

Patients receiving non-primary care services on the same visit and in the same premises as those occupied by the doctor or dentist who during that visit has referred them for that care in the course of providing primary medical or primary dental services. In these cases the patient has not made an additional journey outside of the journey undertaken to attend their primary care appointment and therefore reimbursement through healthcare travel costs scheme is not appropriate.

Patients entitled to assistance through healthcare travel costs scheme are only eligible to claim the cost of their travel to the emergency department if the reason for their attendance is in relation to a pre-existing condition for which they are under the care of a consultant. Where patients attend the emergency department for any other reason they would not be eligible for assistance through healthcare travel costs scheme for help with their travel costs.

Reimbursement of escort costs for healthcare travel costs scheme (extracted from national guidance)

Where deemed medically necessary by the patient’s referring consultant, GP or another health care professional involved in the patient’s care, the travelling expenses of an escort (or escorts) may also be claimed as part of the patient’s travel expenses. Additionally, in cases where a child under 16 attends an appointment the travel costs of a parent or guardian escorting the child to its appointment may be paid.

Such payments are made on the basis of the patient’s eligibility for the scheme irrespective of the escort’s eligibility. The actual travel costs should be assessed on the same basis as those of the patient.

Eligibility for provision of escorts should be determined by either a healthcare professional of by the centralised booking service at Royal Cornwall Hospitals NHS Trust who are:

  • clinically supervised and/or working within locally agreed protocols or guidelines
  • employed by the NHS or working under contract for the NHS
  • must be agreed in advance of the journey

Payments are made on the basis of the patient’s eligibility for the scheme irrespective of the escort’s eligibility. The actual travel costs should be assessed on the same basis as those of the patient and assessed in the same way as all other healthcare travel costs scheme claims.

Only 1 relative escort will be permitted for children under 16 years and for adults who require constant attention and/or need an advocate during their hospital visit.

NHS Kernow local criteria

Outside of the statutory requirements of the healthcare travel costs scheme, NHS Kernow has identified 2 areas where, subject to strict eligibility criteria, the provision of an escort may be approved in order to provide emotional support for a patient either attending a:

  • 20 week pregnancy scan
  • 2 week wait appointment, where an initial diagnosis will be discussed

If this entitlement is unused it cannot be saved for a later appointment.

Types of transport (extracted from national guidance)

Patients should use the most cost effective means of transport, which in most cases will be public transport. When assessing how reasonable the means of transport is the following will be taken into consideration:

  • the distance that the patient has to travel
  • how long the journey has taken to complete
  • whether the patient has to make this journey frequently
  • availability, suitability and accessibility of public transport
  • medical condition of the patient
  • age of the patient

The use of a taxi is only to be considered if no other alternative is available, taking into account the patient’s circumstances.

Travel expenses for treatment abroad (extracted from national guidance)

Patients travelling abroad for NHS funded treatment may make healthcare travel costs scheme claim for travel costs incurred in travelling to a port (including an airport, ferry port or international train station) in Great Britain from which an international journey begins.

The costs of travel from the port to the place of treatment fall within NHS foreign travel expenses and cannot be claimed through the healthcare travel costs scheme.

NHS foreign travel expenses are travel expenses which a patient necessarily incurs in travelling abroad from a port in Great Britain in order to receive services arranged by the NHS. A patient will only be entitled to the payment of NHS foreign travel expenses where the health service body, which has made the arrangements for services to be provided overseas, agrees the mode and cost of travel and the necessity or otherwise for a companion before the costs are incurred.

To claim payment or repayment of NHS foreign travel expenses the patient must apply in writing to the health service body which arranged the services within 3 months of the expenses being incurred, unless otherwise agreed with the health services body.

How to claim travel expenses

Patients can claim travel expenses from a nominated cashier’s office, these are usually located in the hospital or clinic that provided the patient’s treatment. To claim a reimbursement, patients must present their travel receipts, appointment letter or card and proof of qualifying benefits.

Nominated cashiers offices are responsible for assessing healthcare travel costs scheme claims and making payments direct to patients.

Where a hospital or clinic does not have a nominated cashier’s office, patients can complete an HC5(T) form and post it to the address on the form. Postal claims can be made up to 3 months after travel expenses are incurred.

Mileage rates will be set at the advisory fuel rates specified by Her Majesty’s Revenue and Customs (HMRC) for company cares as a proxy for the cost of fuel at the time of travel.

Isles of Scilly NHS funded patient transport

NHS Kernow’s policy is to fund in line with national statutory guidance with no discretionary payments other than those detailed within this policy document.

Special arrangements are in place for residents of the Isles of Scilly who only have to pay £5 towards the cost of NHS funded patient transport to the mainland. Travel to the mainland can be either boat or air transport. Air transport will only be available to Land’s End airport.

Residents of the off islands are entitled to the off island element when travelling to the mainland for NHS funded treatment. Patients will be issued with a reference number for the off island element of their travel when they call the centralised booking service at Royal Cornwall Hospitals NHS Trust on 01872 252211.

Patients travelling to the mainland and back in the same day will be entitled to the reimbursement of either a scheduled boat fare or a special boat fare dependent on the time of their travel. Claims for this should be sent:

For the attention of the patient transport team
NHS Kernow Clinical Commissioning Group
Room 210, Cornwall Council offices, 39 Penwinnick Road, St Austell PL25 5DR

Eligibility (extracted from national guidance)

For Isles of Scilly residents to qualify for NHS funded patient transport to the mainland patients must meet 3 conditions:

  1. At the time of their appointment the patient must be usually resident (not temporary resident) on the Isles of Scilly
  2. The patient must have a referral from a health care professional for a specialist or to a hospital for further NHS funded treatment or tests
  3. The patient’s appointment must be on a separate visit to when the referral was made.

Exclusions (extracted from national guidance)

Isles of Scilly NHS funded patient transport does not apply in the following circumstances:

  • patients who attend an establishment to receive primary medical or primary dental services
  • patients who discharge themselves from hospital at their own request
  • self-referral patients (who have not been referred by a doctor or dentist)
  • visitors to patients in hospital
  • patients travelling for private treatment funded by themselves
  • overnight stay costs

Funding of Isles of Scilly travel is subject to the same exclusions as outlined in the healthcare travel costs scheme section.

Escort criteria

If it has been deemed medically necessary for an escort to accompany a patient, the escort must travel with the patient. The escort should escort the patient for the outbound and inbound journeys. Escort transport must be booked at the same time as the patients transport.

Only 1 relative escort will be permitted for children under 16 years and for adults who require constant attention and/or need an advocate during their hospital visit.

Where the nationally or locally defined criteria for escorts are met, the NHS will pay for the cost of an escort to travel to the mainland, minus a £5 contribution from the patient. The need for an escort must be agreed in advance of the journey.

Eligibility for provision of escorts should be determined by either a healthcare professional of by the centralised booking service at Royal Cornwall Hospitals NHS Trust who are:

  • clinically supervised and/or working within locally agreed protocols or guidelines
  • employed by the NHS or working under contract for the NHS
  • must be agreed in advance of the journey

National criteria (extracted from national guidance)

A patient can travel with an escort if 1 of the following applies if the patient:

  • medical condition is such that he/she requires constant supervision for safety (the escort must be able to meet the medical need and it should be established whether a healthcare professional would not be the preferred option)
  • has mental health problems that prevents them travelling alone
  • is under 16 years of age
  • has significant communication difficulties, including learning difficulties, impaired sight or is hard of hearing (where a patient has communication difficulties the escort should be able to provide a positive benefit in ensuring the patient can understand anything being said to them by travel operator’s staff; for example, through the use of sign language where the patient is hard of hearing)

NHS Kernow local criteria

Outside of the statutory requirements of the healthcare travel costs scheme, NHS Kernow have identified 2 areas where the provision of an escort may be approved in order to provide emotional support for a patient either attending a:

  • 20 week pregnancy scan
  • 2 week wait appointment, where an initial diagnosis will be discussed

If this entitlement is unused it cannot be saved for a later appointment.

Return travel

Patients attending for NHS funded services not requiring an inpatient stay must book their return travel at the same time as their outbound travel.

Patients travelling with an escort are required to complete their return journey within 72 hours of their outbound journey. Please note that the 72-hour calculation does not include Sundays as flights and sailings do not operate.

Where a patient cannot book their return travel due to being an inpatient with an unknown discharge date, they, or their representative, should telephone the centralised booking service at Royal Cornwall Hospitals NHS Trust on 01872 252211 as soon as the discharge date is known.

How to book Isles of Scilly NHS Funded Patient Transport

To receive NHS funded patient transport to the mainland, patients must telephone the centralised booking service at Royal Cornwall Hospitals NHS Trust on 01872 252211 to arrange air or sea transport.

Adverse weather conditions

If a patient (and escort where applicable)is not able to undertake the inbound leg (mainland to Isles of Scilly) of their NHS funded patient transport Journey, due to weather conditions, accommodation costs on the mainland are not paid. Local arrangements have been put in place with Volunteer Cornwall for assistance with transport and accommodation should any vulnerable patient get stranded on the mainland. Volunteer Cornwall can be contacted for this purpose via the centralised booking service at Royal Cornwall Hospitals NHS Trust on 01872 252211. The costs for these services will be borne by the patient.

Cancellation or amendment of travel bookings

Cancellation:

  • by travel operator – weather or technical
  • or amendment by provider of NHS services
  • or amendment by patient

Patients may request to amend or cancel travel bookings provided that all conditions detailed in eligibility and escort criteria and are maintained. Where a cancellation or amendment is required as a result of adverse weather or technical issues with the transport provider or changes to appointment dates or times by an NHS organisation, there will be no cost to the patient.

In all other situations where cancellations or amendments are made at the patient’s request, the patient will be liable for all costs associated with the change or cancellation that are charged to the NHS by the transport provider.

Frequent travellers

Outside of the statutory requirements, NHS Kernow has identified frequent travellers as an area where access to a NHS funded car service will be provided for those individuals who do not meet the nationally defined medical or financial eligibility criteria, subject to the strict eligibility criteria detailed below.

Frequent travellers are defined as those patients who are required to attend hospital at least:

  • 3 times a week for a sustained course of treatment lasting a minimum of 6 weeks
  • 6 times a month for a sustained course of treatment lasting a minimum of 3 months

Discretionary payments

NHS Kernow’s policy is to fund in line with national statutory guidance with no discretionary payments other than those detailed within this policy.

This policy does not allow for discretionary payments that fall outside of the criteria detailed above for transport or accommodation costs.

Community transport services within Cornwall

Where a patient is not eligible for NHS funded patient transport there are a number of community transport services within Cornwall that can be accessed. The costs for these services will be borne by the patient.

Public transport

Information and resources relating to bus services and train services across Cornwall are available from Cornwall Council.

Appeals process

If a patient is unhappy with a decision to refuse non-emergency patient transport or reimbursement of travel costs or with the manner in which the policy has been applied to their individual circumstances, they should appeal to the centralised booking service at Royal Cornwall Hospitals NHS Trust where it will be reviewed by a senior manager.

If the patient is unhappy with the outcome of the appeal, they can complain formally using the NHS complaints procedures. The centralised booking service has local arrangements and procedures for investigating complaints which conform to NHS complaints procedures.

The Independent Complaints Advocacy Service (ICAS) provides support to people in England wishing to complain about the treatment or care they received under the NHS. The ICAS delivers a free and professional support service to clients wishing to pursue a complaint about the NHS.

Review

This policy will be reviewed in 2 years or sooner should any national guidance, legislation or statutes change. Date ratified 24 April 2018.

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