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SCHEDULE 2 – THE SERVICES

A. Service Specifications

Service Specification No. 1

Service Non-Emergency Patient Transport Services (NEPTS)

Commissioner Lead Commissioning Manager, Erewash Clinical Commissioning Group (CCG)

Provider Lead

Period 01/04/2016 to 31/03/19 (With the option to extend for a maximum of 24 months

Date of Review Annual

1. Population Needs

1.1 National/local context and evidence base

Improving access to healthcare and reducing health inequalities are key objectives for the four Derbyshire Clinical Commissioning Groups, and transport to healthcare in a county with many areas that are classified as significantly rural is an important issue. The county contains part of the National Forest, and borders on Greater Manchester to the northwest, West Yorkshire to the north, South Yorkshire to the northeast, Nottinghamshire to the east, Leicestershire to the southeast, Staffordshire to the west and southwest and Cheshire also to the west. Non-Emergency Patient Transport Services (NEPTS) is the non-urgent transportation of patients with a clinical requirement for NHS funded transportation and includes both planned and on demand transportation. Within Derbyshire NEPTS is part of an integrated care programme and covers patient transportation to and from a variety of appointment types and wide ranging locations. To meet the varying clinical needs of the patient the provider will provide fit for purpose vehicle types and levels of care suitable for the patient’s needs. NEPTS will be provided for non-emergency patients in accordance with guidelines set nationally and eligibility criteria. A non-emergency patient is defined as a patient whose medical condition is such that they require the skills or support of appropriately trained NEPTS staff and/or their equipment during their Journey to access planned healthcare appointments.

2. Outcomes

2.1 NHS Outcomes Framework Domains & Indicators

Domain 1 Preventing people from dying prematurely

Domain 2 Enhancing quality of life for people with long-term conditions

Domain 3 Helping people to recover from episodes of ill-health or following injury

Domain 4 Ensuring people have a positive experience of care

Domain 5 Treating and caring for people in safe environment and protecting them from avoidable harm

2.2 Local Defined Outcomes A high quality, safe, flexible service that can meet, grow and respond to the changing needs of the Derbyshire healthcare environment. A service that is patient centric and cost effective and one that continually innovates to deliver value for money.

3. Scope

3.1 Aims and Objectives of Service The Provider is responsible for delivering an appropriate, dignified and safe NEPTS to patients, ensuring all eligible patients are able to travel to and from the community or acute healthcare setting in a timely manner, without

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adverse impact on their medical condition. Non-Emergency Patient Transport Services will be delivered in line with the following aims:-

QUALITY The NEPTS will improve access to healthcare for eligible patients. The Provider will ensure that patients are transported in a legal, safe, friendly, dignified, clean and comfortable environment by appropriately qualified staff; ensuring that Journey times are minimal and arrival and/or departure times are prompt.

FLEXIBLE & RESPONSIVE The NEPTS will be a flexible service that can meet, grow and respond to the changing needs of the Derbyshire healthcare environment. The Provider is expected to be the expert in delivering a fit for purpose service specific to the Derbyshire healthcare setting.

COMMUNICATION & PERFORMANCE The NEPTS Provider will undertake clear regular and effective communication with all Parties and support or feed into strategic planning of individual NHS healthcare providers where appropriate. The Provider will understand its position and minimise its own impact on the quality and financial efficiency of both community and acute healthcare providers. The Provider will improve patient and Stakeholder satisfaction year on year.

VALUE FOR MONEY The NEPTS will be cost effective to Commissioners.

INNOVATION & INFORMATION TECHNOLOGY The NEPTS Provider will use innovation and maximise information technology to drive quality, safety, value for money and improved patient satisfaction.

SUSTAINABILITY The NEPTS Provider will plan and manage patient Journeys to maximise efficiency and minimize their carbon footprint. The Provider will endeavour to provide vehicles that minimise their detrimental impact on the environment.

3.2 Service Description/Care Pathway General Requirements The NEPTS will operate 7 days a week 365 days a year (366 days in a leap year) based on the current activity levels. The core hours of service will be determined by the activity required by the healthcare providers, the clinical need, the patient choice, the geographical location, when not compromised by the preceding consideration, and the session availability. The Provider must work closely with acute and community healthcare settings to align the NEPT with patient attendance patterns The Provider is responsible for all aspects of the NEPTS provision. The Provider is the single point of contact for the community and acute healthcare providers in the provision of NEPTS. If the Provider is unable to meet demand the responsibility for securing the additional transportation required in accordance with this specification, at no additional cost to the Commissioner, is that of the Provider. In the event where the Provider fails to secure additional transportation and the Commissioner is required to arrange it, it will be recharged to the Provider at actual cost plus a 10% administration charge.

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The Provider will operate the service to patients and their escorts whom they have assessed as eligible under either the patient or escort eligibility criteria as described in this specification. The main types of Journeys to be delivered by the Provider include, but are not limited to, the following:-

Acute & Community Day case and inpatient services

Discharges including A&E

NHS funded beds in residential and nursing homes

Transport to and from outpatient and clinic appointments in both acute and community settings

Inter-hospital and inter-facility transfers, including time critical, to both NHS and NHS funded beds in independent sector hospitals

Hospices, End of Life and patients requiring NHS funded intermediate beds

Specialist care service delivered via a community clinic (i.e. podiatry)

Satellite Clinics

Home Visits The Provider is expected to accept that a patient’s place of residence as any address specified at the time of booking. Journeys to and from healthcare settings, in the bordering counties of Greater Manchester to the northwest, West Yorkshire to the north, South Yorkshire to the northeast, Nottinghamshire to the east, Leicestershire to the southeast, Staffordshire to the west and southwest and Cheshire also to the west are not considered Out of Area. This statement applies to healthcare settings that are a reasonable distance from the Derbyshire border, utilising the current activity data as a baseline and guide. The Provider will ensure that patients are transported in a safe, friendly, dignified, clean and comfortable environment taking into consideration their specific personal circumstances and medical needs without discrimination. The NEPTS Provider will be responsible for the repatriation of an eligible patient from an Out of Area community or acute healthcare setting back to their place of residence in Derbyshire, as long as Commissioners have provided prior authorisation for the Journey. Only this Journey type is defined as an Extra Contractual Journey (ECJ) and volume is expected to be low. Transportation Requirements The Provider is expected to allow one small suitcase/bag to be transported per patient. Parents travelling with infants will be limited to a single box of feeding supplies. These allowances are in addition to the patient’s notes and any equipment that is vital to support the patient’s medical condition, mobility and/or in the case of infants and children’s safety during transit (child seats are to be provided by Provider where parent cannot). The number of items deemed vital to support the patients’ medical condition could include but is not limited to:-

Portable Oxygen

Walking frames/Sticks

Wheelchairs

Commodes

Self-Managed Syringe Drivers Assistance dogs will be allowed to travel on vehicles free of charge. In the case of eligible patients discharged from A&E then all belongings will be transported to their place of residents at the Commissioners discretion. The Provider will adhere to all current legislation and guidance when transporting wheelchairs. The Provider will ensure that patients are secured safely, using an appropriate safety belt, for the duration of the Journey except for those covered under DVLA exemptions. The Provider is not responsible for the transportation of any other goods unless they are those stated in this specification and connected directly to the patient. For all patients prior to their first transportation the Provider will carry out a risk assessment of the patient’s mobility, mode of travel required and access/egress from pick up/drop off location.

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The Provider is expected to optimise the number of patients per vehicle at all times without a detrimental effect on travelling times. The Provider will ensure that the appropriate vehicle is dispatched to the patient in accordance with the mobility categories as defined in the table below:-

Mobility Categories

CODE CODE DESCRIPTION CATEGORY DESCRIPTION

C WALKER A patient who can walk and does not require assistance/supervision.

C1 WALKER A patient who can walk but may require minimal assistance/supervision.

WC1 WHEELCHAIR USER A patient who uses a wheelchair and does not require supervision, but may need some assistance from the driver.

WC2 WHEELCHAIR USER A patient who uses a wheelchair and requires supervision and assistance from an attendant.

A1 LIMITED MOBILITY A patient who will be able to walk but may have mobility issues necessitating the need to travel by Ambulance only; the patient may also need the assistance of the driver to or from their place of residence/care setting but does not require supervision during transit

A2 LIMITED MOBILITY Patients who will need the skills of two people to manually assist them into the vehicle or to/from their place of residence/care setting. The patient may also be one that requires supervision during the Journey. A two person lift may be required where the patient needs to be lifted or carried at some care settings in the Journey.

A4 LIMITED MOBILITY A patient who cannot mobilise and requires the assistance of two or more people and may require use of a hoist or stretcher but doesn’t require supervision, these patients may also need to travel in a recumbent or semi recumbent position.

ST LIMITED MOBILITY A patient who cannot mobilise and requires the assistance of two or more people and may require use of a hoist or stretcher and the supervision of an attendant, these patients may also need to travel in a recumbent or semi recumbent position.

The Provider is responsible for the transportation of all eligible patients for all the mobility types listed above. Patients in any of these mobility categories may also fall into the following clinical categories and the Provider remains responsible for the transportation of eligible patients:-

High Dependency which is defined as a patient, who needs to travel in an equipped vehicle, e.g. with piped oxygen, AED, spinal board, scoop stretcher, suction unit, first-aid bag and basic life support equipment. While there may be a qualified nurse or medical escort, the crew should be fully trained in the use of specialized equipment with a skill level of ECA or equivalent FPOS standard.

Bariatric which is defined as a patient whose weight is greater than 25 stone, although weight is not the only consideration and the patients build must also be assessed

The Provider will collect patients from a point in their place of residence that is appropriate for their medical

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condition and/or their mobility, in a clinically appropriate manner, which may include the use of hoists. The Provider will transport the patient to a designated waiting area at the healthcare setting. Where no such waiting area exists the Provider will transport the patient to the correct clinic or ward, and ensure appropriate handover. Under no circumstances should patients be left before the department or premises are open.

The Provider will ensure that when patients are returned they are left securely in their place of residence i.e. either seen to enter premises if mobile or handed over to a carer or responsible person. Under no circumstances should a patient be left without assurances that they are fit to be left appropriate for their medical condition and/or their mobility. The Provider is responsible for returning equipment owned by healthcare facilities which is transported with the patient. The return of this equipment and location for the return will be agreed with the relevant healthcare facility All vehicles used to service this agreement, must be equipped with satellite navigation and two-way radio or mobile telephone. Hands free equipment must be installed in all vehicles. All vehicles used to service this agreement must be equipped with a tracking device or a similar system which enables service monitoring. Any radio or satellite equipment installed on the vehicles must comply with all legislation and national standards and must not interfere with systems and equipment used by healthcare providers. The Provider is responsible for ensuring enough vehicles appropriate for the transportation required are available to deliver the service. All vehicles must be equipped in accordance with:-

The type of vehicle

The level of Staff’s manning the vehicle

The needs of the patients conveyed The following is a suggested equipment list:- LIST 1 - Basic: VCS and single-manned vehicles

Alcohol hand gel

First Aid kit

Disposable wipes

Disposable vomit bowels

Umbrella

Torch LIST 2 - In addition to list 1, for Ambulance/PCV:

Carry chair

Clean Blankets, pillows, towels

Dressing Packs

Incontinence pads

Infection control protective clothing

Infection control spills kit

IV fluid holders (for use by nurse escort accompanying patient)

Portable ramps

Sharp boxes

Safe storage of bio-waste

Sterile gloves

Traceable infection control waste disposal system

Wheelchair clamps and appropriate safety belts

Stretcher with safety straps

Bariatric stretcher with safety straps (only for bariatric vehicle)

Bariatric wheelchair with safety straps (only for bariatric vehicle)

Bariatric equipment for stairs (only for bariatric vehicle)

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Piped Oxygen LIST 3 - In addition to list 1 & 2, Specialist Equipment for High Dependency Vehicle:

Suction Unit with soft catheters

Automatic External Defibrillator (AED)

Scoop Stretcher with straps

Ambulance Bag:

plasters, dressings & bandages

sterile water

bag-valve-mask (BVM) for adult, child & neonate

tape, triangular bandages, safety pins

Oxygen CD cylinders

Oxygen face-masks with piping (maximum up to 28% - 6 litres per minute masks)

Pressure Mattresss and pressure splints All ambulance vehicles used for Stretcher and Wheelchair’s must meet M1 and M2 standards (2007/46/EC as last amended by 385/2009 )along with meeting the standard BS EN 1789:2000 for vehicles carrying stretchers If the Provider is not able to successfully clamp and/or fit a universal headrest to the patient’s wheelchair and the patient is unable to travel in the vehicle seat then the Provider must provide an alternative mode of transport with the commissioner. All vehicles, internally and externally must be clean. Clean is defined as free from dirt, marks, stains or rubbish. The Provider must also ensure that all vehicles and equipment minimise the risk of infection through effective hygiene management. The Provider is responsible for arranging an annual deep clean of all vehicles, however where the need arises, a more frequent schedule should be implemented. All journeys cancelled by healthcare providers or patients prior to the vehicle commencing the Journey (wheels turning), will not be considered chargeable or aborted. Where a patient is not ready to travel within 10 minutes of their booked collection time, either fault of the patient or provider at the patient location, the Provider will obtain permission from their control room to record this as an aborted Journey, and this must documented on the Provider systems for audit purposes. All NEPTS Journeys that are cancelled must be reported to the commissioner where a decision will be made to determine if these are chargeable. The Commissioner must be notified of these in a timely manner and the reason for cancellation provided.

In these circumstances the Provider is expected to proactively manage the situation to ensure the maximum number of Journeys take place. For those remaining Journeys the Provider must inform the Commissioner of the reason and consequences of the service disruption in order to gain agreement. The Provider will be responsible for notifying patients and their healthcare destinations.

An aborted Journey is:-

One that is cancelled once the patient Journey is underway, including pre-patient collection

Where collection of a patient is attempted but they do not travel, where the Provider is not at fault. A calling card should be left in all instances of attempted collection.

The Provider must evidence all aborted Journeys and communicate them, where appropriate, to the receiving healthcare providers at the time of occurrence. Failed Journeys where the failure was in the control of the Provider will not be considered aborted and will not be chargeable to the Commissioner. When an inbound NEPTS Journey does not occur, for whatever reason, it must be communicated to the receiving healthcare setting immediately. Patients are considered to have arrived for appointments, or to have been collected, when they are booked in or out

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of the relevant department by the Providers Staff. For Mental Health or vulnerable patients a signature will be required by the Providers Staff. Booking Requirements The Provider is responsible for assessing the eligibility of patients and escorts at the time of booking, including where a healthcare profession makes the booking NEPTS will be bookable via an online booking facility and a dedicated landline telephone number operating 7 days per week. Those making the ebookings should receive confirmation of the booking and have the ability to review and edit the bookings. Patients, family member, healthcare professionals or care homes on behalf of the patients can l make the bookings The Provider is expected to have a contingency plan in the event that the booking system fails or is unavailable for whatever reason. The booking system should allow for block and/or individual bookings to be made, up to three months in advance and on the day bookings regardless of the Journey type. The booking system must enable the Provider to capture and report key patient data and key Journey data and cost, to support all aspects of service delivery including those defined as Key Performance Indicators (KPIs). The booking system will include a Fast Track Facility for patients; these bookings are urgent and must take priority. The Provider will devise a priority process for Fast Track patients needing urgent transport and agree this with the Commissioner. All bookings are considered confirmed unless the Provider is notified of a change by the patient, a healthcare professional or care home. Workforce Requirements The Provider will ensure that senior management oversees the delivery of NEPTS and is available during the main hours of operation, operating an on call rota outside of these hours. All Staff involved in delivering NEPTS must be trained appropriately and comply with the Road Traffic Act and all other applicable legislation affecting the operation of this service. All Staff involved in delivering this service will abide by the site rules for example speed limits, set on the community and acute healthcare premises as well as their own company protocols. All Staff delivering the NEPTS will understand how their individual actions represent the overarching NHS brand and they will not engage in any activity whilst on duty that will negatively impact this. The Provider must maintain optimum staffing levels to deliver the service. The Staff are responsible for asking whether the patient is carrying all necessary medication and documentation relating to the appointment for which they are receiving NEPTS. The Staff are responsible for providing assistance to the patients irrespective of their mobility category as and when required. The Staff should, where necessary, ask if the patient’s place of residence is secure, all appliances are switched off and the patient has their keys. The Staff should ensure that the patient’s outerwear is appropriate for the weather conditions. The Staff should ensure that patients are not left to negotiate stairs or steps alone or when boarding or disembarking from the vehicle. The Staff should inform the receiving department if the patient becomes unwell during transportation and follow agreed procedures including referral to emergency services. If the patient becomes unwell on the return Journey the

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Staff must inform a relative or the patients GP. The Staff are responsible for appropriately transferring the patient on the vehicle. All Staff will wear a uniform and a photographic identification badge. All Staff engaged by the Provider in a driving capacity will hold a full driving license, which shall be endorsed with no more than 3 penalty points. The Provider will also ensure that these individuals hold a Passenger Carrying Vehicles (PCV) license if applicable. Staff with more than 3 penalty points will be employed on this contract at the discretion of the Commissioner. The Provider is responsible for checking the driving licenses of its Staff and as a minimum this must be carried out annually. The Provider will ensure that Drivers ring on the day prior to arrival at the patient’s place of residence. If any Patient is found in a life-threatening situation the Emergency Ambulance Service must be contacted immediately. For vulnerable patient’s i.e. mental health, dementia, the Provider will ensure that continuity of Staff is maintained. The Provider is responsible for supplying all uniforms and personal protective equipment (PPE) to their staff, this may include PPE that is stipulated by the Commissioner.

The Provider should have a clear non-smoking policy in line with local healthcare non-smoking policies, including offering support to Staff to quit smoking.

The Provider must have a protocol for its Staff to raise concerns and safeguarding issues for the patients it transports to the relevant agency.

Service Management The Provider will promptly inform the Commissioner of any unresolved problems relating to the provision of the NEPTS The Provider will use activity data to drive both the strategic and delivery planning of the NEPTS to ensure that patient appointment times are met and essential treatment provided. The Provider will follow the guidance contained in the NHS Standard Contract 2016/17 in relation to:-

Emergency Preparedness and Resilience Including Major Incidents Business Continuity Plan

Incident Response Plan The Provider will attend monthly service review meetings Key Performance Indicators (KPIs) will be used to measure the success of the service against this specification and are defined in Appendix 1 & 2 (Renal Specific. The Provider will hold a documented complaints procedure including an escalation process and outcomes process which will be subject to agreement with the Commissioner; The complaints process should also align with the NHS Complaints Advocacy Service and Patient Advice and Liaison Service (PALS) to ensure complaints received this way are appropriately addressed. The Provider will have a system to track the progress of complaints and this will be reported on monthly at the service review meetings. The Provider will operate a feedback facility that clearly defines the action taken from feedback received. The Provider will be expected to produce annual reports for publication on NHS choices including but not limited to Quality.

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Special Requirements The Provider will maintain the provision of a control room and a dedicated Emergency Department (ED) crew for Derby Hospitals Foundation Trust which is in addition to the provision of HDU crews. The hours of operation for the ED crew are 24 hrs. The control of this dedicated ED crew remains with the responsibility of the Provider and the operating protocol to be agreed with the Commissioner. The Provider will supply transport liaison desks to co-ordinate and manage the daily allocation and control of resources at healthcare settings agreed with the Commissioner. The Provider will maintain operating hours of the liaison desks to cover clinic timings and discharges. Fast Track patients are identified as high risk, patients needing intermediate beds within the community or deemed unsafe left at home. Patients covered by this Fast Track process include but are not limited to:-

End of Life

Single Point of Access (SPA)

Respite care or Pain Management in Hospices

Time critical Mental Health transport to specialised units In respect of End of Life Patients. These patients and any eligible escort must be transported individually. The Provider will ensure they receive the Do Not Resuscitate (DNR) letter, if appropriate signed by a doctor, at the point of collection prior to transportation. There will be a need to transfer patients to appointments who are high dependency such as tracheostomy patients requiring minimal airway management or patients on Non Invasive Positive Pressure Ventilation (NIPPV) machines for example. The skills needed for this type of transport would be an Emergency Care Assistant or Edexcel First Person on Scenes accredited skill level. A guideline of appropriate patients conveyed to this skill level to be agreed with Commissioners Derbyshire County Council has been successful in their application under the Total Transport Pilot Fund managed by the Department of Transport. Derbyshire County Council has embarked on two pilots in the Bolsover and the High Peak areas. At present the Council has a clear understanding of the transport that it provides within the pilot areas; mainstream and SEN education transport, Adult Care and local bus. These pilots seek opportunities’ to integrate this transport with key transport provided outside of the Council including Wheels to Work, services operated privately by colleges, university campus’ and employers, the commercial bus network, Community Transport and, most significantly, non-emergency transport operated by the NHS who provide approximately 270,000 journeys in Derbyshire per year. The Provider is expected to support the County Council in these and any subsequent pilots and/or shared integrated services that can be achieved to improve efficiencies to all parties. 3.3 Population Covered The Derbyshire population estimate, including Derby City in 2012 was 1,024,100 with a projected increase to 1,051,289 by 2015. The NEPTS will be available to all eligible patients registered with a Derbyshire General Practice (GP) and for those patients not registered with any GP, but whose usual place of residence is within Derbyshire. 3.4 Acceptance and Exclusion Criteria and Thresholds Eligibility Eligibility for the NEPTS will be determined by the Provider in accordance with the following principles:-

The patient is responsible for arranging and funding their own transport to and from healthcare facilities, unless a medical need for transport is required;

The NHS shall be responsible for providing, and funding, transport for patients who require medical transport;

The NHS shall not be required to fund, or provide, transport for patients who do not require clinical support when travelling;

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The Healthcare Travel Costs Scheme addresses affordability by providing financial assistance for patients on a low income;

The NHS shall not be required to provide transport for Social Reasons, or to private patients

Some patient groups who do not require clinical support but do need assistance with transport to be able to access healthcare – such cases shall be considered on an exceptional and individual basis by the Provider, and the Provider shall deliver agreed Journeys as an integral part of this service specification.

Patients eligible for NEPTS Services are those:-

Where the medical condition of the patient is such that they require the skills or support of NEPTS service staff on/after the Journey and/or where it would be detrimental to the patients’ condition or recovery if they were to travel by other means;

Where the patients’ medical condition impacts on their mobility to such an extent that they would be unable to access healthcare and/or it would be detrimental to the patients’ condition or recovery to travel by other means; or

Where the patient currently receives higher rate disability living allowance

Recognised as a parent or guardian where children are being conveyed

For medical reasons, the patient requires a trained escort. Other patients who do not have access to public/private transport shall be assessed on an individual basis by the Provider. These shall include:-

Patients in wheelchairs;

Patients with psychiatric or learning difficulties who are unable to use public transport (NEPTS will only be booked for these patients by the Provider where it is appropriate to the users’ needs, or it is a legal requirement to provide transport);

Patients with a medical condition that would compromise their dignity or would cause public concern if public transport were used:

Patients who cannot walk without continual support; or

Patients who experience side-effects as a result of the treatment they receive Transport shall not be booked by the Provider, or provided, by the NEPTS purely on the basis that the patient:-

Lives a long distance from the hospital/healthcare facility;

Is elderly; or

Is on a limited income NEPTS Staff should be aware of the eligibility criteria for the NEPTS in general and the criteria applicable for individual patients. Feedback must be provided to the Commissioner where there is concern that the eligibility criteria may not have been met for any particular patient. Individual patient eligibility for those with long-term conditions will be subject to an eligibility review every 8 weeks. Escorts The Provider shall permit a maximum of one escort (2 if a nurse and carer are required) to accompany a patient on some Journeys where appropriate, which shall include, but not be limited to those where a patient:-

Is aged under 16 years;

Has a psychiatric or learning difficulty and needs constant supervision on the Journey;

Requires specialist medical staff to provide clinical care on the Journey; or

Is dependent on the help of a relative or carer (e.g. blind, mentally impaired, or elderly with dementia/acute confusion)

The patient requires an escort to communicate with the consultant even if the escort themselves have poor mobility or in a wheelchair

Escorts shall not be conveyed by the NEPTS purely because:-

They are related to the patient;

They are on a ward/unit at the same time as the patient is leaving;

They are on a limited income; or

They suffer from mobility problems

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Escorts will need to arrange their own transport for the return Journey where the patient is admitted to the healthcare facility. Exclusions The following shall be excluded from the NEPTS:-

Patients requiring Emergency Ambulance Services

Patients requiring treatment for injury at the scene of a road accident or other accident;

Patients attending A&E (although patients may be eligible for NEPTS on discharge from A&E or from pre-arranged clinic appointments)

Mental health patients who are assessed as high risk and/or sectioned

Transport for routine appointments at GP Clinics, health centres and dental surgeries provided under NHS contract by General Medical Services / Personal Medical Services / General Dental Services / Personal Dental Services

Prisoner transport

Patients with challenging behaviour, as described in this specification

Paediatric and Neonatal intensive care patients

Non-NHS patients

Patients requiring transport outside of England, Scotland and Wales;

Unaccompanied children under 16 years of age

Patients requiring complex care during a Journey which needs a paramedic trained crew

Intensive Care Transfers

Visitors to hospital

Patients registered to a GP outside of Derbyshire (including those receiving treatment at Derbyshire Healthcare settings)

Patient Behaviour Any patient who has presented at a GP practice with a history of violent or challenging behaviour and has been deemed to pose a threat to that GP practice and its staff will be identified within this category. Such patients who have had their right to local NHS care removed are only entitled to services if denial of treatment would cause lasting harm, or put their lives at risk. There is no obligation to provide NEPTS to attend the home of these patients identified as posing a risk, where there is no immediate clinical need. 3.5 Interdependence with other services/providers The NEPTS will provide clear regular and effective communication with all Parties and support or feed into strategic planning of individual NHS healthcare providers where appropriate. The Provider will understand its position and minimise its own impact on the financial efficiency of both community and acute healthcare providers. The Provider will improve Stakeholder satisfaction year on year. The Provider will work closely with NEPTS providers in neighbouring counties to maximise transport efficiencies The Provider will be expected to work closely with the Emergency Patient Transport Service. In the event of a major incident the Provider will only follow guidance from Commissioners but will be instructed to work closely with the Emergency Services and Healthcare Providers.

4. Applicable Service Standards

4.1 Applicable national standards (eg NICE)

Renal National Service Framework (2004)

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Renal Association Clinical Practice Guidelines for heamodialysis 2007

NICE quality standards for chronic kidney disease in adults issued during March 2010. Disability Discrimination Act 1995

4.2 Applicable standards set out in Guidance and/or issued by a competent body (e.g. Royal Colleges) 4.3 Applicable local standards

5. Applicable quality requirements and CQUIN goals

5.1 Applicable Quality Requirements (See Schedule 4 Parts [A-D])

M1 and M2 standards (2007/46/EC as last amended by 385/2009) The standard BS EN 1789:2000 for vehicles carrying stretchers

Medical Devices Regulations 1994 (SI 1994 No 3017) Guidance on the Safe Transportation of Wheelchairs DB(NI)2001/03 NOVEMBER 2001 NHS Complaints Advocacy Service Patient Advice and Liaison Service (PALS)

5.2 Applicable CQUIN goals (See Schedule 4 Part [E])

5.3 CQUIN goals of 2.5% will apply to this contract and will be agreed with the Commissioner

6. Location of Provider Premises

The Provider’s Premises are located at:

7. Individual Service User Placement

Not Applicable.

8. Renal Patients

General Requirements The importance of an effective transport service is reflected in the Renal National Service Framework (2004). The Renal Association Clinical Practice Guidelines for haemodialysis 2007 recommends that patients who require transport should be collected from home within 30 minutes of the allotted time and be collected to return home within 30 minutes of finishing dialysis. The Provider is expected to adhere to the guideline principles but adjust the timings to take account of the geography of Derbyshire; the patient pick up time from their place of residence will enable them to arrive no earlier than 30 minutes ahead of their appointment time. The Commissioner expects the Provider to provide a Dedicated Renal Service The Provider should adhere to the standards of transport of the NICE quality standards for chronic kidney disease in adults issued during March 2010. Non-emergency renal haemodialysis patients will normally be booked by the renal unit in advance of the day of expected travel; however, short notice bookings may be required. There are currently a number of Renal Units (including satellite units) in Derbyshire or bordering counties and the patient can choose, subject to machine availability, which dialysis unit they attend. The number of units is not fixed

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and is subject to change. Therapy is provided daily, seven days per week (Monday – Sunday); the number of sessions per week and length of appointment times, per session, will vary depending on the treatment. The schedule of individual patients will be determined by Acute healthcare providers in accordance with clinical need, patient choice, geographical location (when not compromised by the first two considerations) and session availability;

Renal haemodialysis patients are defined as Essential Patients. No patients shall attend a renal haemodialysis unit on Christmas Day. The Commissioner anticipates an increase in Dialysis activity over the next 5 years. The Provider will work to the Key Performance Indicators defined in Appendix 2

9. Definitions

Term Definition

AED Automate External Defibrillator

Dedicated Renal Service A service that is provided within the scope of this specification but that has a separate focus on the needs of the Renal Patients

ECA Emergency Care Assistant

End of Life Someone who is specifically being transported to a chosen location with the expectation that s/he will die there in the near future

Essential Patient Someone whose medical treatment must happen when scheduled to ensure their continued quality of life

Fast Track High risk patients needing intermediate beds within the community or deemed unsafe left at home

Fast Track Facility The ability to book a patient as fast track which signifies the booking is urgent and must take priority, where priority is defined as collection within 1 hour of booking

FPOS First Person on Scene

Journey Once the vehicle is in motion on route to collect or pick up to or from a healthcare setting or place of residence

M1 Vehicles designed and constructed for the carriage of passengers and comprising no more than eight seats in addition to the driver's seat.

M2 Vehicles designed and constructed for the carriage of passengers, comprising more than eight seats in addition to the driver's seat, and having a maximum mass not exceeding 5 tonnes

Out of Area All counties beyond all those that neighbour Derbyshire.

Parties Means; clinical commissioning groups (CCGs), acute and community healthcare providers and patients

Provider The organisation responsible for delivering the NEPTS service

Staff All persons working directly for or on behalf of the Provider

Stakeholder An Acute and/or community healthcare provider