Part A
NON – EMERGENCY PATIENT TRANSPORT SERVICES SPECIFICATION (GENERIC)
WALKING, WHEELCHAIR, STRETCHER, BARIATRIC & HD/EMT PATIENTS INCLUDING
OUTPATIENTS, DISCHARGES, TRANSFERS &ALL OUT-OF-HOURS PATIENTS, INCLUDING MENTAL HEALTH, FROM & TO THE TRUST
INDEX
1.INTRODUCTION
2.SCOPE OF THE CONTRACT
3.THE SERVICE
4.ORDERING TRANSPORT
5.ABORTED JOURNEYS
6.TRANSPORT TIMING
7.MANAGEMENT BY THE CONTRACTOR
8.CONTRACTOR’S STAFF & SUB CONTRACTORS
9.VEHICLES AND EQUIPMENT
10.QUALITY ASSURANCE
11.DOCUMENTATION AND PROCEDURES
12.STATUTORY AND OTHER REGULATIONS
13.COMMUNICATION
14.CHARGING AND INFORMATION
15.CANCELLED JOURNEYS (CONTRACTOR)
16.QUALITY STANDARDS
17.INVOICE DETAILS REQUIRED
18.MAJOR INCIDENTS
19.ENVIRONMENTAL CONSIDERATIONS
20.PATIENT DIGNITY
21.MEDICAL EXAMINATION
22.INFORMATION MANAGEMENT & TECHNOLOGY (IM&T)
1.INTRODUCTION
In this specification the Trust shall mean the Commissioner and the Contractor shall mean the Service Provider as defined in the Contract Terms and Conditions.
1.1This specification is not exhaustive and will be subject to variation or amendment during the currency of the Agreement.
1.2The Trust is committed to providing a high quality, patient led service. This specification reflects the overall requirements of the Trust for the provision of the Non-emergency Patient Transport Services for patients to be conveyed in vehicles, including secure vehicles for forensic patients.
1.3This specification sets out the basic aims of the Trust for providing patient transportation services. It sets out the basis of the agreement between the Trust as the purchaser and the Contractor as the provider, identifying conditions and obligations applicable to both parties.
1.4The following provides details of the specification.
2.SCOPE OF THE CONTRACT
2.1The Agreement is for the supply of Non-emergency Patient Transportation Services for the Trust, 24 hours per day, 7 days per week, and 365 days per year unless stated as otherwise in the site specific schedules.
2.2The Agreement covers the transportation of non-emergency patients with or without patient’s own wheelchair. The Trust will inform the contractor of the type of wheelchair at the time of booking. The Contractor is required to provide a suitable wheelchair if the patient does not have their own.In exceptional cases, the Trust may supply a wheelchair which the Contractor will be required to transport at no extra charge and return to the Trust once the journey is complete.
2.3The Agreement covers patients requiring transport to (an Inward Journey) or from (an Outward Journey) a Trust facility and from and to other hospitals, health centres, nursing homes, hospices, satellite units and any other location as determined by the Trust and considered by the Trust to be medically unfit to be transported by other means. Some journeys will require the Ambulance crews to wait and return the patient once treatment has been completed, thesetypes of journeys are normally stretcher patients but can be higher acuity patients, these are known as “Wait & Returns”. Home Visits may also require the crews to wait, Home Visits usually have very specific timings that must be adhered to, as they can have other Healthcare or Social Care Professionals involved in the visit.
2.4The majority of patients requiring the Services will be from within the local boundaries, however the services are also required, for outside these boundaries.
2.5The Agreement covers patients required to arrive & departthe facility 24 hours per day, 7 days per week.
2.6The Agreement covers patients who fall within the following mobility types;
2.7Mobility of Patients
The Mobility of patients are defined as follows and compares with the costing and activity data:
- Bariatric – 2 person crew
- Bariatric - 3 Person crew
- Bariatric - 4 Person crew
- Bariatric – More than 4 Person crew
- High Dependency ( EMT through to Paramedic)
- Wheelchair - 1 Person crew
- Wheelchair / 2 Person crew
- Carry Chair / 4 Person crew
- Stretcher
- Walker
- Solo
Bariatric
Definition of Bariatric. A patient who is over 25 stone (150kg) and/or has a BMI >[40], and/or is of a size/shape exceeding the safe working load of standard equipment, and/or has complex needs. The Trust requires the Contractor to undertake a Risk Assessment in respect of all these patients and record it on the patient’s transport notes. For access by Trust staff and the Contractor’s staff as required.
Bariatric 2 Person crew
Bariatric Stretcher 2 Person crew – Patient is within bariatric definition but can be moved using a two Person crew, normally easy home access or to another care facility.
Bariatric Wheelchair 2 Person crew - Patient is within bariatric definition but can be moved by a two Person crew, normally flat or specially modified access to home or another care facility.
Bariatric 3 Person crew
Bariatric Stretcher 3 Person crew – Patient is within bariatric definition but can be moved using a three Person crew, normally easy home access or to another care facility.
Bariatric Wheelchair 3 Person crew - Patient is within bariatric definition but can be moved by a three Person crew, normally flat or specially modified access to home or another care facility.
Bariatric – 4 Person crew
Bariatric Stretcher 4 Person crew – Patient is within bariatric definition but requires 4 Person crew to transfer, normally to home address or another care facility.
Bariatric Wheelchair 4 Person crew - Patient is within bariatric definition but requires 4 Person crew to transfer, normally to home address or another care facility.
Bariatric – greater than 4 person crew
Bariatric 4 + Person crew, Patient is within bariatric definition but requires more than a 4 Person crew to transfer, normally to home address or another care facility, Risk Assessment has confirmed the need for a minimum of 5 person crew and upwards to move the patient safely.
Wheelchair / 2 Person crew
Carry Chair 2 Person crew* – Patient needs lifting and/or carrying but this can be done by a standard two Person crew.
2.7.Wheelchair Cannot Transfer 2 Person crew - Patient is in their own chair and must travel in their chair, by definition if they use the Contractor’s chair they must be able to transfer. Patient needs lifting and/or carrying but this can be done by a standard two Person crew.
Wheelchair / 4 Person crew
Carry Chair 4 Person crew* – Patient needs lifting and/or carrying but because of their size, shape, condition or home environment needs an additional person crew. Not Bariatric.
High Dependency
- All HD journeys will be classified by anauthorised member of Trust staff as requiring this type of transport; this will be in line with Trust requirements. All HD vehicles are fully equipped, have the appropriate trained crews, and will be used for all the above categories. In order to comply with national protocols all patients requiring oxygen at flow rates >4 lpm will be transported using HD vehicles and crews.
- Paediatric HD – As adult HD but will always have medical escort(s) and in addition must be equipped with suitable equipment to meet the requirements of any booking..
- Angio Patients – require the skills of an Ambulance Personnel trained to Advance Life Skills level
- High Acuity Patients - require the skills of an Ambulance Personnel trained to Advance Life Skills level
Wheelchair
Electric & Special Wheelchair* – Patient has own electric or special wheelchair, due to the size and weight of the chair this may mean that a vehicle can only carry one chair, instead of 2 or it cannot be allocated to smaller accessible vehicles.
Large Wheelchair* – As Electric Wheelchair above.
Wheelchair Own Not Transferable* –Patient has their own wheelchair but cannot transfer and needs to be transported in the chair, in either an ambulance or specially modified accessible vehicle, these patients can require single or two Person crew, they can also be bariatric.
Solo
Patient is assessed by an authorised member of Trust staff to travel with no other patients, normally due to infection, end of life or mental health issues.
Stretcher
Stretcher – Patient must travel in a prone position but can transfer to wheelchair or carry chair for access to home address. The Contractor will be required to make arrangements in advance to enable the patient to be transferred to a trolley or bed on arrival at the hospital department or other destination, unless the journey is booked as a “Wait and Return”,
Walker
Walker: Walking patient requiring minimal assistance that may travel by a 4-door car and patients who are required to travel with a folding wheelchair. A people carrier or minibus may be utilised solely with the agreement of the Trust’s’ Authorised Officer(s).
Walker Car Suitable – as per Walker
- Requires Wheelchair can transfer to Ambulance – Patient needs a wheelchair to get from home to vehicle and/or vehicle to department but can transfer to a seat in an ambulance.
- Requires Wheelchair but can transfer to car - Patient needs a wheelchair to get from home to vehicle and/or vehicle to department but has sufficient mobility to transfer to a car.
The Trust requires the Contractor to undertake a Risk Assessment in respect of all patients that may require Lift and Handling and record it on the patient’s transport notes. For access by Trust staff and the Contractor’s staff as required
Under the published guidelines and regulationspatients can only travel in wheelchairs on vehicles if they cannot under any circumstances transfer, if a patient is able to transfer, with minimal assistance, then they must do so. Guidance on the Safe Transportation of Wheelchairs(MDA DB2001(03) June 2001), the Medical Devices Agency.
Patients with Special Requirements
2.8.The work will include the transportation of patients with the following special requirements:
- “Patients with Special Needs”, some patients have special needs ` which must be clearly identified in the “special instruction” (including inter alia bariatric patients and Dignity patients) section of the booking form. This may include patients requiring oxygen, specialist equipment or have IV drips in situ, as per the protocol provided and agreed with the Contractor.
- In some circumstances it may be necessary to allow a member of the patient’s family or a friend to accompany them to their appointment. This decision will normally be made by the Authorised Officer(s) of the Trust authorising the journey and it will be notified to the Contractor at the time of booking, unless the Trust agrees with the Contractor any alternative arrangements. This will require monitoring and including in activity reporting.
Dementia/confused patients may also require members of the family/friends or career to escort them, patients identified with dementia or being confused should always have an escort when travelling for an outpatient / day case appointment.
- A parent or other responsible adult must accompany all patients under the age of 16 years.
- Patients with non-sectioned psychiatric conditions will be conveyed according to their mobility.
- Nurse or social escort will accompany any of the above categories if it is deemed necessary by the Trust. Such escorts will be notified to the Contractor at the time of booking. When a Trust nurse acts as an escort the Contractor may need to return the nurse and any equipment back to the hospital, which should be included within the service cost. Nurse escorts and equipment are to be returned without undue delay.
Secure Vehicle:A secure vehicle containing a lockable cage is required for the transportation of mental health patients (if applicable).
2.9Any patient that is known to be infectious has to be transported in a vehicle with sole use but charged at their mobility rate.Vehicles should have wipeable seats.Vehicles should be thoroughly decontaminated as per the agreed format with the Trust infection control team prior to being put back into use.
3.THE SERVICE
3.1The Contractor shall provide a Service encompassing the following stages:
a.A transport booking service that includes an assessment of the patient medical/ mobility needs and allocates appropriate transport and support (i.e. a patient eligibility assessment service);
b.A transport scheduling service that facilitates a timely and punctual service to avoid problems such as patients being kept waiting, missed appointments and blocked beds;
c.A system to notify the Trust of all booking activity. Please also refer to clause 22.8 and clause 22.20.
d.A system to ensure that patients travel safely and in comfort and that journeys are started and completed on time, with appropriate vehicle and resource;
e.A system to collect and report management information such as activity data, exceptional journeys, qualitative information around standard service, delivery indicators, complaint / compliment monitoring and mandatory data required by Department of Health and for inclusion in ERIC returns.
f. A system that shows the mapped locations of all vehicles utilised on the contract via the web/on-line system.
3.2Patients will typically, but not necessarily, be picked up from their home address. Return transport will be provided by the Contractor to the patient’s home address, other hospital facility, nursing home, or such other address as determined by the Trust. Please also refer to clause 8.9g.
3.3Patient escorts will be transported only when an authorised request is made. Patient escorts will be transported free of charge. Please note that a parent or other responsible adult must accompany all children under the age of 16 years.
3.4The Contractor will be responsible for the safe, timely, and comfortable transport of patients between their place of residence or other such address as determined by the Trust and the Trust facility.
3.5The Contractor will provide the following operational vehicles to transport patients:
a.CAR: A car with a minimum of four doors, suitable for walking patients, with (as appropriate) collapsible wheelchairs. See also clause. 9.13.
NOTE: All cars must be of suitable size to allow easy access for walking but infirm patients.
b.MODIFIED VEHICLE WITH OXYGEN SUPPLY
A medium sized panel van or chassis conversion (e.g. Fiat Ducato Long Wheelbase Maxi) equipped to carry patients requiring to be transported in their own wheelchair, with their own wheelchair but can transfer into a fixed seat or patients travelling without a wheelchair or other aid who require to be carried to or from the ambulance.
Standard equipment will include: a tail lift or suitable ramp, a carry chair, piped oxygen, fixed seats with lap and diagonal seat belts, tracking and approved safety clamps to secure patients travelling in wheelchairs and seat belts and fasteners to be applied to all patients travelling in their own wheelchairs. An impact protection system must be in place in all vehicles.
c.VEHICLE WITH STRETCHER & OXYGEN SUPPLY
As above, but also to include an approved stretcher to be fitted and secured down one side of the cabin of the ambulance.
In both cases conversions are to comply with Schedule Six of the Road Vehicles (Construction & Use) Regulations 1986and the Road Vehicles (Approval) Regulations 2009 which includes Directive 2007/46/EC, which apply to all vehicles constructed to carry more than eight but not more than 16-seated passengers. This includes the following: 2 fire extinguishers, first aid kit, grab handles, legal lettering for exits, rear scope, and automatic step lights to side and rear steps and exhaust to emit to offside. Spillage kits must be carried on board the vehicle.
d. HDU and/or BARIATRIC AMBULANCE VEHICLES
As above, but also to include an approved stretcher to be fitted and secured down one side of the cabin of the ambulance.
In both cases conversions are to comply with Schedule Six of the Road Vehicles (Construction & Use) Regulations 1986 and the Road Vehicles (Approval) Regulations 2009 which includes Directive 2007/46/EC, which apply to all vehicles constructed to carry more than eight but not more than 16-seated passengers. This includes the following: 2 fire extinguishers, first aid kit, grab handles, legal lettering for exits, rear scope, and automatic step lights to side and rear steps and exhaust to emit to offside. Spillage kits must be carried on board the vehicle with the necessary equipment to move high acuity patients.
3.6The Contractor may arrange for alternative, subcontracted transport to meet the requirements of the Services. Under these circumstances, the Contractor retains full and total responsibility for the provision of the Services to the Contract Standards. Such subcontractors will have been agreed in advance with the Authorised Officer(s) of the Trust in writing. No additional charges will be borne by the Trust.
3.7A Quality Assurance Manager shall be identified by the Contractor whose role will be to monitor the effectiveness of the Patient Transport Services in liaison with the appropriate nominated manager(s) in the Trust. Details of this person and the monitoring to be undertaken are to be provided by the Contractor prior to contract commencement.
3.8The Contractor will ensure that there is an appropriate organisational structure to provide services to the levels specified in this Agreement.
3.9Performance of the contract will be monitored in accordance with clause 10.
3.10The Trust requires all patients within the bands (i.e. Local) to be ready to travel from home 2 hours prior to appointment unless specified otherwise in the site specific schedules. Patients outside the bands (i.e. National) will need to be contacted by the contractor who will advise a time for pick up that will ensure the patient arrives at the facility in good time for their appointment.
4.ORDERING TRANSPORT
4.1The Contractor will provide appropriate staff to manage the contract on a daily basis and to receive a daily workload from the Trust.
4.2All scheduling of vehicle pick-ups and loading will be determined by the Contractor.Incertain circumstances however the Trust may instruct the Contractor to perform a specific journey. In certain circumstances the Trust will require the Contractor to provide forecasted accurate home arrival times for discharged and home visit patients.Home Visits usually have very specific timings that must be adhered to, as they can have other Healthcare or Social Care Professionals involved in the visit meeting the patient at a pre-arranged time.
4.3Booking requests may be accepted only from authorised Trust staff, or from GP Practices, specified by the Trust as updated from time-to-time.
4.4The Contractor will confirm receipt (e.g. booking and estimated arrival time)directly with the departmentwithin 15 minutes of receipt of the booking.