Leicester, Leicestershire & Rutland ICB Non-Emergency Patient Transport Service (NEPTS) Eligibility Criteria Policy

Document Purpose

1.1       This document sets out the eligibility criteria for the Leicester, Leicestershire and Rutland (LLR) Integrated Care Board (ICB) Non-Emergency Patient Transport Services (NEPTS), and will be applied to all NEPTS journeys to be provided. This policy will ensure that there is transparency and a standard approach to eligibility assessments is taken, ensuring that patients receive a consistent response to transport requests regardless of where they receive healthcare.

2.       Introduction

2.1       Ambulance and other Non-Emergency Patient Transport Services: Operation, Use and Performance Standards’ [HSG 1991(29)] was published in 1991. This set out guidance for the NHS on the operation, use and performance standards for emergency and urgent Ambulances, superseded by the Eligibility Criteria for Patient Transport Services (PTS) document issued in August 2007.

2.2       In August 2021 NHS England and NHS Improvement published a review of Non-Emergency Patient Transport Services (NEPTS). The review report set out a new national NEPTS framework to support services to be more responsive, fair and sustainable, and included a national eligibility criteria. Read the final eligibility criteria guidance at: https://www.england.nhs.uk/publication/non-emergency-patient-transport-services-eligibility-criteria/. The contents of this document complies with this guidance.  

2.3.      NEPTS are typified by the non-urgent, planned, transportation of patients with a medical need for transport to and from a premises providing NHS healthcare, for example patients travelling for outpatient or haemodialysis appointments. This will also encompass hospital transfers and movement of patients between urgent care and acute facilities. Also included within this policy are discharges from hospital wards to a place of residence. Community and Primary care services (e.g. GP appointments or district nurse clinic appointments) are usually excluded from PTS services. The LLR NEPTS also excludes patients requiring ‘blue light’ transport, i.e. clinical supervision and support by the NEPTS crew.

3.       Eligibility Criteria

3.1       The NHS has limited resources and providing NEPT must be reserved only for those whose medical condition warrants it.  It is expected that most patients should travel to and from hospital independently by private or public transport, with the help of relatives or friends if necessary. NHS-funded patient transport is reserved for when it is considered to be essential for patients where a medical condition means that they would struggle to safely attend their treatment independently.

3.2       Patients attending NHS treatment do not have an automatic right to NEPTS; if they do not fully meet the agreed eligibility criteria, then transport will not be awarded. In general, patients are expected to make their own arrangements for travelling to and from healthcare premises, this ensures that:

1. i) Limited resources are available for those who really need them.
2. ii) If a patient has a medical or mobility condition where they need NEPTS staff to support them to and from a hospital or clinic for treatment, they may be eligible for patient transport.

iii)        NEPTS caters for those patients where the medical condition will require the support of NEPTS staff and/or it would be detrimental to their diagnosed condition or recovery if they were to travel by any other means.

1. iv) Patients in receipt of Disability Living Allowance Mobility Component or equivalent are generally not eligible for NEPTS, as their mobility allowance already makes provision for their transport needs to and from hospitals, unless there are valid exceptional reasons as to why they cannot get to hospital by any other alternative transport.

3.3       Patients must be assessed every time they request NEPTS as their condition may have changed. However, individual patient eligibility for those with long-term conditions will be subject to an eligibility review every 3 months (except for patients attending for haemodialysis).

3.4       Judgement will be made, in line with the eligibility criteria, to assess whether transport is required for both parts of the journey.

See Appendix 1 for the eligibility process flow chart.

4.       Qualifying Criteria

4.1       The patient is likely to qualify for NEPTS if they meet one or more of the following criteria:

1. i) They have a medical need
2. ii) They have a cognitive or sensory impairment

iii)        They have a significant mobility need

1. iv) They are travelling to or returning from in-centre haemodialysis
2. v) A safeguarding concern has been raised
3. vi) They have wider mobility or medical needs that have resulted in treatment or discharge being missed or severely delayed.

4.2       An individual may also be considered for hospital transport if they have no alternative means of transport available, and:

1. i) Are in a wheelchair and cannot transfer in and out of a vehicle without assistance;

1. ii) The patient attending for treatment is likely to have diagnosed severe physical side effects following treatment that would impede driving; or

iii)        Have a diagnosed disability (physical and or psychological) which makes them medically unfit to travel by any other means, and who have no alternative method of travelling to or from the hospital.

5. Patient Relative/Carer Escort

5.1       Patients may be entitled to be escorted by only one representative if the below criteria is met. A representative may include a family member, a parent or guardian accompanying a child, or a carer/support worker if the patient:

1. i) Is aged under 16 years – in this instance there must be an escort to accompany the child;
2. ii) Has a mental health need or learning difficulty and needs constant supervision on the journey;

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

1. iv) The patient requires an escort to communicate with the healthcare professional even if the escort themselves have poor mobility or in a wheelchair.

For clarity, if an individual needs a medical escort (e.g. Nurse or Doctor) this escort is in addition to the escorts identified above.

6.       Financial and Social Requests

6.1       It should also be made clear that NEPTS services will not be provided for social or financial reasons.

6.2       For those patients who do not have a medical need for ambulance transport, but may require help in meeting the cost of travel to and from their care may be entitled to financial assistance under the Hospital Travel Costs Scheme (HTCS).

1. Income Support
2. ii) Income Based Jobseekers Allowance

iii)        Income Related Employment and Support Allowance

1. iv) Pension Credit Guarantee Credit
2. v) Child Tax Credit
3. vi) Working Tax Credit
4. v) Universal Credit

Patients will only be able to claim back the full travel costs by using the cheapest form of public transport available. If travelling by private car, patients may be able to claim for the fuel used and unavoidable car parking costs, up to the cost of the same journey by public transport.

Patients can claim travel costs by taking their travel receipts, appointment letter or card, with proof that they are receiving one of the above qualifying benefits, to a nominated cashiers’ office. Some hospitals and clinics do not have cashier facilities, and in this case, patients can complete a HC5(T) travel refund claim form and return it to the address stated on the form.

Further information can be found at:

https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/

7.       Appeals

7.1       It is expected that the request for NEPTS must be declined and the patient sign-posted to alternative services if the patient fails to meet the eligibility criteria, and there are no other exceptional circumstances. Alternative services may include:

1. i) Local Authority provided transportation
2. ii) Public transport, including bus routes

iii)        Voluntary sector transport provision

1. iv) Private hire/taxi services

Any appeal against the refusal to award NEPTS should be dealt with by the PTS provider.