SFI-PGN-07-04… · SFI-PGN-07-04 – Payment of Patients’ Carers & Relatives Travelling Expenses from Petty Cash V02 Iss 2 – Nov 19 Part of CNTW(O)51-Standard Financial Instructions

Cumbria Northumberland, Tyne and Wear NHS Foundation Trust SFI-PGN-07-04 – Payment of Patients’ Carers & Relatives Travelling Expenses from Petty Cash V02 Iss 2 – Nov 19 Part of CNTW(O)51-Standard Financial Instructions Policy

Standing Financial Instructions Practice Guidance Note Supporting Patients, Carers & Relatives with Travelling including Payment of Expenses from Petty Cash – V02

Date Issued Planned Review PGN No: Issue 1– Oct 2018 Issue 2 – Nov 2019

Oct 2021 SFI-PGN-07-04

Part of CNTW(O)51- Standing Financial Instructions Policy

Author / Designation Ailsa Miller (Content relating to HTCS) – Patients Finance & Cashiers Manager

Responsible Officer / Designation

Dave Rycroft – Deputy Director of Finance

Contents

Section Description Page No. 1 Background 1

2 Introduction 1

3 Hospital Travel Costs Scheme 1

4 Eligibility Criteria 1

5 Carers and Escorts 2

6 Calculating Travel Expenses 2

7 Modes of Transport 2

8 Verifying Claims 3

9 Completion of Patients Travelling expenses paid from Petty Cash Form

3

10 Advance and Retrospective Claims 4

11 Guidelines for facilitating and supporting carer and relative travel to visit inpatients

4

12 Fraud and Corruption 6

Appendices – attached to PGN

Appendix_1 Eligibility Matrix – Benefits providing Automatic Entitlement

Appendix_2 Eligibility Matrix – Other routes providing eligibility to HTCS

Appendix_3 Example of Travelling Expenses Paid from Petty Cash Book

Appendix_4 Easy reference flowchart for Process of Reimbursing Patient’s Travel Expenses

Appendix_5 Framework for determining travel support for Carers / Relatives

Appendix_6 Monitoring Tool

Appendix 7 Patients, Carers & Relatives information leaflet

https://www.ntw.nhs.uk/resource-library/supporting-patients-carers-and-relatives-with-travel-costs/

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1 Cumbria Northumberland, Tyne and Wear NHS Foundation Trust SFI-PGN-07-04 – Payment of Patients’ Carers & Relatives Travelling Expenses from Petty Cash V02 Iss 2 – Nov 19 Part of CNTW(O)51-Standard Financial Instructions Policy

1 Background

This Practice Guidance note (PGN) provides guidance to Cumbria Northumberland Tyne and Wear NHS Foundation Trust (The Trust) staff of the principles, processes and practices to be followed in facilitating and supporting patients and carers/relatives with travel arrangements and expenses.

2 Introduction 2.1 For some patients, carers and relatives travel is in an integral requirement in

order to achieve the outcomes of the patient’s care plan. This can however present difficulties, the journey may be lengthy, complex and costly or there may be poor access to public transport. This can widen health inequalities and potentially have serious consequences for the health of the patient. Therefore, the Trust is committed to supporting patients and carers / relatives travel as part of an overall package of care.

2.2 The term carer refers to someone who, without payment, provides help and

support to a friend, neighbour or relative

3 Hospital Travel Costs Scheme 3.1 The Hospital Travel costs Scheme (HTCS) is a mandatory scheme. The National

Health Service (Travel Expenses and Remission of Charges) Regulations 2003 (the 2003 Regulations) place a legal requirement on NHS Trusts and NHS Foundation Trusts to pay the NHS travel expenses of eligible patients through HTCS. The Regulations also set out the eligibility criteria which are to be applied.

3.2 HTCS is part of the NHS Low Income Scheme, and was set up to provide

financial assistance to those patients who do not have a medical need for ambulance transport, but who require assistance with their travel costs.

3.3 Under the Scheme, patients on low incomes or are in receipt of specific

qualifying benefits or allowances are reimbursed in part or in full costs incurred in travelling to receive certain NHS services, where their journey meets certain criteria.

4 Eligibility Criteria

4.1 The patient must be:

• In receipt of one of the qualifying benefits or allowances and provide evidence of their entitlement as specified in Appendix 1 – Eligibility Matrix - Benefits

• Named on a NHS Low Income Scheme certificate HC2 or HC3 (or in certain cases be a member of the same family as a person named on a NHS Low Income Scheme Certificate) – Appendix 2 – other routes to entitlement

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• You are named on, or entitled to, an NHS tax credit exemption certificate.

4.2 The journey undertaken must be made to receive services under the

National Health Service Act 2006, e.g. a hospital or clinic visit, this does not include a visit to see a GP or a Dentist.

5 Carers and Escorts 5.1 Where deemed medically necessary by the patient’s referring Consultant, GP

or other health care professional involved in the patient’s care, the travelling expenses of an escort may also be claimed as part of the patient’s travelling expenses. Additionally, in cases where a child under 16 attends an appointment the travel costs of a parent or guardian escorting the child to the 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.

6 Calculating Travel Costs Expenses 6.1 The 2003 Regulations stipulate that travel costs should be calculated based on

the cheapest form of transport appropriate to the patient. Trust staff should check that the costs of the patient’s travel are reasonable, taking into account the patient’s personal circumstances. When assessing a patient’s claim the following should be taken into account: • 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 • the availability, suitability and accessibility of public transport • the medical condition of the patient • the age of the patient

7 Modes of Transport

7.1 Staff should encourage the use of public transport, however, sometimes the

use of public transport may pose difficulties in itself, e.g. where public transport is infrequent or where the patient may have to change buses or trains several times to reach the place of treatment. In addition, people may have health problems that make travelling on public transport difficult.

7.2 Where staff consider the use of a private motor vehicle is reasonable, the Trust should pay the full estimated cost of fuel to make the journey. Mileage rates are pre-set by the Trust (current rate is available from Central Cashiers). Car Park receipts should be submitted with the claim if the patient wishes to claim the charge.

7.3 If staff feel that the use of a private vehicle is not reasonable and that the patient could have reasonably been expected to travel by public transport, they should reimburse the lesser of:

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• The estimated cost of fuel actually used • The equivalent public transport cost

7.4 The use of taxis will not be prohibited solely on the grounds of the expense to

the Trust, there may be a valid reason and requests should be reviewed on an individual basis to take into account of the reason for the request and the patient’s personal circumstances. For guidance on the use of Taxis please follow Transport Policy CNTW(O)37 – PGN 04.

8 Verifying Claims 8.1 When considering a claim, staff should ask to see the following:

1. Evidence of the patient’s entitlement to have their NHS travel expenses paid under HTCS – see Appendix 1

2. Evidence that the patient has attended, or plan to attend an appointment at the hospital

3. Proof of travel e.g. bus or train ticket, or details of proposed travel method

4. Car Park receipt if patient has travelled by private car.

9 Completion of Patients Travelling Expenses paid from Petty Cash Form 9.1 Where travel expenses are claimed by a patient, each claim should be recorded

in a Patient’s Travelling Expenses Paid from Petty Cash Book. This is a pre-printed book and has sequentially numbered pages, each page has two copies. Patient’s Travelling Expenses Paid from Petty Cash Books are controlled stationary and only one book should be used at a time. When not in use the book should be stored securely. Books can be accessed from the Central Cashiers Department and if books are lost a replacement will only be issued following an email from the float holder to the Central Cashiers Department.

9.2 Once a patient’s claim has been verified and entitlement has been established

a Patient’s Travelling expenses paid from Petty Cash Form should be completed with the following:

• Patients Name and address • Clinic or Ward • Amount to be paid in both figures and words • Patients National Insurance Number • Patients NHS number • Type of Transport Used • Evidence of Entitlement produced • Entitlement reference number (if the patient holds a valid HC2 or HC3

certificate) 9.3 The patient should be asked to sign the form as a declaration that the

information provided by them is true. 9.4 The patient should then be paid from the petty cash float and the White Copy

of the Patient’s Travelling Expenses paid from Petty Cash Form should be

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attached to the reimbursement documentation for the float as per PGN-07-03 – Petty Cash Sub-Float.

10 Advance and Retrospective Claims 10.1 Where appropriate and reasonable advance payments can be paid to patients,

who may not have access to the monies to travel to their healthcare appointment.

10.2 Where a patient requires an advance for travelling expenses and is collecting

monies from the hospital/unit, the patient’s Consultant will be required to provide a letter or email to the Cashiers/General Office staff or float holder, prior to the patient attending to collect their monies. Only one advance will be issued per visit. Proof of travel must be produced by the patient upon their next appointment and handed to the Cashiers/General Office or float holder.

10.3 Where a patient requires monies to be sent by post, it must be established

whether the patient has a bank account. If so, the Cashiers staff should agree whether the patient requires a cheque or BACs transfer.

10.4 Patients who are unable to obtain their travel expenses when they attend for

treatment, can make a claim up to three months after the date of their treatment using HC5(T) refund claim form. These forms are available from using the either the following link or from local healthcare providers e.g. Health Centres, GP Practices or Dental Surgeries:

https://www.nhs.uk/NHSEngland/Healthcosts/Documents/HC5(T).pdf

10.5 HC5(T) forms are processed by the Prescription Pricing Department and

patients using this option should be made aware that this process may take several weeks.

11 Guidelines for facilitating and supporting carer and relative travel to visit

Inpatients.

11.1 The HTCS does not include carers/relatives travel costs to visit hospital in-patients, however the Trust has recognised this in an integral requirement in order to achieve the outcomes of the service users care plan. If visits cannot be facilitated due to travel difficulties this can widen health inequalities and potentially have serious consequences for the health of the patient. Therefore the Trust is committed to supporting both patient and carer/relative’s travel as part of an overall package of care.

11.2 Where the service user does not identify a carer, the carers may come forward

themselves for advice and support. In such cases it is important to establish that the link between patient and carer exists.

11.3 In some cases family members will not recognise themselves as carers or understand the term carer so, if this is the case, it is important to inform friends and family that the term carer does apply to them.

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11.4 If a patient’s care plan indicates that it would be beneficial for their carer or

relative to visit them and /or facilitate leave, the Trust should support this to happen. This should always be considered on admission to a hospital ward and within the 72 hour review. The ward manager will work with patient and main carers to agree the benefits of ward attendance by the broader family

members. It would not be expected that broader family members would be offered transport solutions unless it was clearly identified that this would have significant benefits to the service users

11.5 The travel needs of carers should be explored with carers as part of the ‘Getting to Know You’ process within 72 hours of an inpatient admission. In doing so, ward managers and named nurses should be mindful of the individual needs and requirements of carers/relatives.

11.6 Travel solutions (see below) should always be offered to carer/relatives in any

of the following circumstances:

• When the carer/relative is not able to use a car to visit.

• When the public transport journey is longer than 45 minutes (door to door) or the complexity of the travel arrangements mean that the time spent on travelling is longer than 45 minutes

• When carer/relative have individual access requirements which make their

journey more difficult (e.g. elderly carers/relatives, young carers/relative, those with disabilities or health difficulties, those with young children)

• Where the patient is located in comparison to carers/relatives home address

11.7 The following solutions/options are available and agreement should be made via the GTKY process

• Travel planning and support to access public transport and community

transport • Use of the ward car to collect/drop off at a convenient bus stop/metro station

etc. • Car sharing where appropriate • Taxi - The use of taxis will not be prohibited solely on the grounds of the

expense to the Trust, there may be a valid reason and requests should be reviewed on an individual basis to take into account of the reason for the request and the carer/relative’s personal circumstances. For guidance on the use of Taxis please follow Transport Policy CNTW(O)37 – PGN 04. in relation to booking of taxis

• Purchase of train tickets • Reimbursement of Parking fees – if charged

11.8 Where arrangements are made to support carers/relative’s travel to visit

patients in receipt of care, arrangements should be recorded in the carers action plan in ‘Getting to know You’ (located in the e record).

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11.9 Carer’s champions (supported by ward managers or named nurses) are able

to support carers and their families by providing information about local public transport links. Staff on the ward should be signposting patients and their carers to their carer’s champion and Carer Support Services

11.10 There will be no Car Parking charges applied to visitors on CNTW Trust sites.

Local arrangements eg the use of a disc will be made available to carers and patient visitors. Unfortunately, CNTW cannot offer the same arrangement for non-Trust owned sites, where the Trust delivers a service. This includes, for example, the Tranwell Unit, Newcastle General Hospital and Royal Victoria Infirmary (RVI).

11.11 Payments for carer/relative travel costs will be made via petty cash as per

SFI-PGN-07-02 – Application for the use of Petty Cash. Alternatively arrangements can be made to make payment directly into a claimant’s personal bank account by emailing [email protected] and providing the relevant information eg. Claimant’s full name and address, Sort code, Account number, payee, cost centre and authorisation to make payment.

12 Fraud and Corruption 12.1 Information regarding the reimbursement of patient’s/carers/relatives’ travel

expenses will be disclosed to and by the Trust and NHS protect for the purpose of verification and for investigation, prevention and detection and prosecution of fraud.

12.2 Any suspected cases of fraud and corruption will be referred immediately to the

Trust’s Local Counter Fraud Specialist and investigated in accordance with Trust Policy (CNTW(0)23) Fraud Corruption Response Plan Policy

mailto:[email protected]

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Appendix 1

Eligibility Matrix – Benefits providing Automatic Entitlement

Benefit Eligibility Criteria

Entitlement Covers Evidence Required by

Trust Income Support (IS).

All patients in receipt of Income Support are entitled to payment of NHS Travel Expenses through HTCS.

Recipient, partner and any dependents for which the recipient or partner is responsible including children and young people under 20 named in the award. Escorts: Where deemed medically necessary by a doctor or other health care professional involved in the provision of services to a patient may be also claimed as part of the patient’s cost. Where children under 16 are travelling for treatment escort costs may be paid for a parent or guardian attending the appointment with the child.

Letter from DWP stating benefit entitlement.

Income Based Employment and support allowance (ESA (IB)).

All patients in receipt of Income based Employment and Support Allowance.

Recipient, partner and any dependents for which the recipient or partner is responsible including children and young people under 20 named in the award. Escorts: as for IS above.


Income Based Jobseekers Allowance (JSA (IB)).

All patients in receipt of Income based Job Seekers Allowance.



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Working Tax Credit (WTC) Child Tax Credit (CTC).

Patients who are receiving or are named on an award certificate for:- a) WTC with CTC b) WTC with a

disability element or a severe disability element

c) CTC but is not eligible for WTC

Provided that the relevant income of the member to whom the tax credit is made is not more than £15050 on their award notice.


Award Certificate.

Pension Credit – Guarantee Credit.

All patients in receipt of Pension Credit – Guarantee Credit. Pension Credit – Savings credit on its own does not automatically provide entitlement to assistance through HTCS. However, patients in receipt of this benefit may qualify for full or partial payment of their NHS travel expenses via their NHS Low Income Scheme (detailed on Appendix 2).


Letter from Pension Service stating benefit entitlement

Universal Credit

a) All patients who receive Universal Credit and either had no earnings or had net earnings of £435 or less in

Recipient, partner and any dependents for which the recipient or partner is responsible including children and young people under 20 named in the award.

Award notice

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their last Universal credit assessment period. b) All patients who receive Universal credit, which includes an element for a child, or the patient or their partner had limited capability for work and work-related activity, and they either had no earnings or net earnings of £935 or less in their last Universal Credit assessment period.

Escorts: as for IS above.

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Appendix 2

Eligibility Matrix – Other routes providing eligibility to HTCS

Passport to Support

Eligibility Criteria

Entitlement Covers Evidence Required by

Trust People claiming on the grounds of low income.

Patients who are not in receipt of a qualifying benefit but are on low income and whose savings are less than £16k (or £23250 if in a care home) may be eligible for assistance with their NHS travel expenses. The calculation of patient’s entitlement is carried out by the Pricing Prescription Department. Patients who might not consider themselves to be on a low income should be encouraged to make a claim if their savings are below the current limits. Where successful, they will be sent a certificate showing how much they would be expected to pay for their travel per week and would be entitled to a refund of anything above this amount.

Recipient, partner and dependent children or young people under 19 whose names are shown on the notice of entitlement (known as HC2 or HC3 Certificate) Escorts: Where deemed medically necessary by a doctor or other health care professional involved in the provision of services to a patient may be also claimed as part of the patient’s cost. Where children under 16 are travelling for treatment escort costs may be paid for a parent or guardian attending the appointment with the child.

HC2 or HC3 certificate.

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Persons living permanently in a care home or accommodation provided by a local authority.

To qualify the claimant must reside in one of the following and have satisfied the authority that he is unable to pay for that accommodation at the standard rate or as the case may be the full rate: • A care home • Residential

accommodation provided by a local authority for persons aged eighteen or over who by reason of age, illness, disability or any other circumstances are in need of care and attention which is not otherwise available to them;

• Residential accommodation for expectant and nursing mothers.

Claimant only. Letter confirming residential address within home or accommodation.

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Asylum Seekers for whom support is provided under Part VI of the Immigration and Asylum Act 1999.

A person who is an asylum seeker for whom support is provided under Part VI of the Immigration and Asylum Act 1999. This part of the Act makes provision for support being provided for asylum seekers who appear to the Secretary of State to be destitute or likely to become destitute. (Destitute is measured by reference to a lack of, or lack of access to, adequate accommodation and food and other essential items).

Recipient and any dependents where a dependent is classified as someone in the UK who is: • A spouse; • A child of his, or of his

spouse who is under 18 and dependent upon him

Proof that the person is under Part VI of the Immigration and Asylum Act 1999.

Children of 16 or 17 being supported by a local authority.

A child of 16 or 17 years of age who has been in local authority care and is being supported by a local authority under section 23B (8) of the Children Act 1989.

Claimant only. Proof from local authority or communication from Care Manager.

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Appendix 3

Example of Travelling Expenses Paid from Petty Cash Book

Ensure Patient’s name, full address and ward/clinic is recorded

Ensure amount paid is written in both numbers and words to prevent anyone adjusting the figures

Record patient’s National Insurance Number and NHS number (if available)

Record mode of transport e.g. bus, car etc.

Record evidence produced e.g. DWP letter, or HC2 or HC3 Certificate and number

Ensure Patient signs and dates the declaration

Ensure you complete section and include cost centre and subjective codes here

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Appendix 4

Flowchart for Process of Reimbursing Patient’s Travel Expenses

Has the patient provided an appointment card or letter? No

Yes

Can the patient provide proof of eligibility as per eligibility criteria?

Contact Consultant or Nursing staff to prove attendance

Ask the patient to return for reimbursement when they can

provide proof of eligibility No

Was the patient’s mode of transport reasonable and

appropriate to their circumstances? No

Reimburse the equivalent public transport cost for the journey

Yes Reimburse costs in full

and complete a Payment of Travelling expenses from Petty Cash Form

If the claim includes travel costs for an escort or carer, has the patient’s consultant or Nursing

team confirmed their attendance was necessary?

Yes

Reimburse the patient’s escorts travel expenses in full and record on Patients Travelling expenses

from Petty Cash form

No Reimburse the patient’s costs only, and provide HC5 (T)

form so that the information can be included in a retrospective claim

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Appendix 5

Framework for determining travel support for Carers

Cumbria Northumberland, Tyne and Wear NHS Foundation Trust is committed to supporting carer and relative travel as part of a service user’s overall package of care.

Ward managers are asked to promote an individual approach and should use this as a framework for determining whether carers/relatives should be supported with travel arrangements/costs.

T

Has the “getting to know you” process been completed?

Yes

Has the patient’s care plan indicated that it would be

beneficial for them to receive visits from carers/ relatives?

Has support for travel been identified as a need?

Yes No

Carer/relative can support the cost of transport and are able to make own arrangements

Carer/relative has support available to bring and/or collect them from hospital

The carer/relative is able to access public transport

No mobility problems or time constraints linked to journey

Carer/relative is not able to use a car to visit.

Public transport journey is longer than 45 minutes (door to door) / the complexity of the travel arrangements mean that the time spent on travelling is longer than 45 minutes

Carer/relative has individual access requirements which make their journey more difficult (e.g. elderly carers/relatives, young carers/relative, those with disabilities or health difficulties, those with young children) Decision based on patient location in comparison to carers/relatives home address Clinical staff should record their decision to support travel and arrangements made in the carers action plan in ‘Getting to know You’ (located in the e record).

This decision will be regularly reviewed to take into account any changes in circumstances

Financial assistance will be provided

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Appendix 6

Monitoring Tool Statement The Trust is working towards effective clinical governance and governance systems. To demonstrate effective care delivery and compliance, policy authors are required to include how monitoring of this policy is linked to auditable standards/key performance indicators will be undertaken using this framework.

Payment of Patients Travelling Expenses from Petty Cash - Monitoring Framework

Auditable Standard/Key Performance Indicators

Frequency/Method/Person Responsible

Where Results and Any Associate Action Plan Will Be Reported To Implemented and Monitored; (this will usually be via the relevant Governance Group).

1. Compliance check of documentation submitted at Cashiers/General Offices for claims to include: Patients Appointment Confirmation Patients Eligibility Mode of Transport Mileage check Proof of Transport costs Correct Financial Coding completed.

Upon Reimbursement Cashiers/General Office/Reception Staff .

Reported to Ward/Clinic for correction. Repeated non-compliance will be reported to the Patient’s Consultant and Budget Holder.

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2.

Compliance check of documentation submitted for reimbursement, to include: Excel Spread sheet Used Location Completed Period Covered Completed Serial No. Completed Security Plus Reference on Sheet Details of Expenditure correct e.g. date, expenditure type. Correct Financial Coding completed. Cumulative Figure correctly completed Cash in hand correctly completed. Expenditure and cash in hand add back to the float total Reimbursement summary sheet signed by Authorised Signatory.

Upon Reimbursement/Cashiers Department.

Reported to Float Holder for correction. Repeated non-compliance will be reported to the Budget Holder.

The Author(s) of each policy is required to complete this monitoring template and ensure that these results are taken to the appropriate Quality and Performance Governance Group in line with the frequency set out.