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Non-Emergency Patient Transport Service (NEPTS) Eligibility Criteria Policy

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Version: 9.0

Name of Author: Julie Bryan (Contracts Manager)

Date Approved by responsible committee: Clinical sign off 24/04/23

Date Issued: 25th April 2023

Date of Next Review: April 24

Contents

1. Purpose of Document

2. Introduction

3. Eligibility Criteria

4. Qualifying Criteria

5. Patient Relative/Carer Escort

6. Finance and Social Requests

7. Appeals

Appendix 1 – Guidance for Assessing Eligibility

Appendix 2 – Eligibility Criteria Question Set and Flow Diagram

1.       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This set out guidance for the NHS on the operation, use and performance standards for emergency and urgent Ambulances, superseded by the Eligibility Criteria for Patient Transport Services (PTS) document issued in August 2007.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:

i) Limited resources are available for those who really need them.

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.

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 further guidance.

4.       Qualifying Criteria

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

i) They have a medical need

ii) They have a cognitive or sensory impairment

iii) They have a significant mobility need

iv) They are travelling to or returning from in-centre haemodialysis

v) A safeguarding concern has been raised

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:

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

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

See Appendix 2 for the question set and flow chart.

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:

i) Is aged under 16 years – in this instance there must be an escort to accompany the child;

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)

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).

i) Income Support

ii) Income Based Jobseekers Allowance

iii) Income Related Employment and Support Allowance

iv) Pension Credit Guarantee Credit

v) Child Tax Credit

vi) Working Tax Credit

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:

i) Local Authority provided transportation

ii) Public transport, including bus routes

iii) Voluntary sector transport provision

iv) Private hire/taxi services

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

Appendix 1: Guidance for Assessing Non-Emergency Patient Transport Service (NEPTS) Eligibility

Eligible

A patient is eligible for NEPTS where one or more of the following applies:

  • The patient has a medical condition which impairs mobility.
  • The patient attends regular haemodialysis appointments.
  • Travelling by any other means would have a serious detrimental effect on the patient’s condition or recovery.
  • The patient has restricted mobility and is unable to self-mobilise (i.e. unable to stand or walk more than a few steps), including from a pre-existing condition, where it would be detrimental to their condition or recovery to travel by any other means.
  • The patient requires support from a NEPTS crew during the journey and is required to lie down for at least part of the journey or they are a stretcher patient.
  • The patient is being transferred to another NHS facility.
  • The patient has a mental health difficulty, illness or a learning disability/condition or mental capacity issues, which makes it difficult or impossible to travel by other means.
  • The patient has a clearly recognisable disability and is unable to travel by private or public transport to and from their appointments.

Not eligible

A patient is not eligible for NEPTS where one or more of the following applies:

  •  The patient is not registered with a Leicester, Leicestershire or Rutland GP practice, and is not in a Leicestershire healthcare facility.
  • The patient does not have a medical or mental health condition which impairs mobility.
  • The patient is able to travel by their own means. They do not require support from a NEPTS crew and it would not have a serious or detrimental effect on their condition or recovery to do so.
  • The patient has a family member, friend or carer who could help with travel to and from the appointment.
  • The patient is registered as disabled but has their own means of transport which is suitable for travel to and from the appointment.
  • The patient is sectioned under the Mental Health Act 2007 at the time of the journey. In this instance the patient/healthcare professional will need to contact a specialist transport provider.
  • The patient is able to but is not willing to pay for transport and is not medically eligible.
  • The patient requires clinical support or supervision, continuous oxygen or other medical gases or intravenous support, without a medical escort.
  • The patient is not medically eligible for NEPTS but is unable to afford to pay for transport. In this instance, patient may be eligible for support through the Hospital Travel Cost Scheme (HTCS).

Eligible for Relative/Carer Escort

A patient would qualify for an escorted NEPTS journey where one or more of the following applies:

  • The patient is under 16 years of age
  • The patient has communication difficulties that prevent him/her travelling alone and is a suitably qualified carer required to escort the patient
  • The patient has mental health needs including learning disabilities that prevent him/her travelling alone
  • The patient’s medical condition including any learning disabilities is such that he/she requires constant supervision for safety
  • The patient requires a carer to assist him/her at their destination
  • The patient is considered to be a Vulnerable Adult/Child (over 16) (Safeguarding Issue)

Appendix 2: Eligibility Criteria for Patient Transport Service

Stage 1

Flowchart. Question 1.1: Is the patient registered with a GP within the Leicester, Leicestershire and Rutland ICB area? • If yes, the patient may be eligible - proceed to question 2. • If no, go to question 1.1a. Question 1.1a: Is the patient currently in a Leicestershire healthcare facility (Acute or Community Hospital)? • If yes, the patient may be eligible - proceed to question 2. • If no, the patient IS NOT eligible for transportation under this contract. Question 1.2: Is the patient attending haemodialysis? • If yes, the patient IS ELIGIBLE for transport - proceed to stage 5. • If no, the patient may be eligible - proceed to question 1.3.
Flowchart. Question 1.3: Is the patient in receipt of Mobility Allowance: • DLA (Higher Rate Element) • PIP (Higher Rate Element) • If yes, the patient may not be eligible for transportation under this contract - proceed to stage 4. • If no, the patient may be eligible - proceed to stage 2.

Question 1.1: Is the patient registered with a GP within the Leicester, Leicestershire and Rutland ICB area?

  • If yes, the patient may be eligible – proceed to question 2.
  • If no, go to question 1.1a.

Question 1.1a: Is the patient currently in a Leicestershire healthcare facility (Acute or Community Hospital)?

  • If yes, the patient may be eligible – proceed to question 2.
  • If no, the patient IS NOT eligible for transportation under this contract.

Question 1.2: Is the patient attending haemodialysis?

  • If yes, the patient IS ELIGIBLE for transport – proceed to stage 5.
  • If no, the patient may be eligible – proceed to question 1.3.

Question 1.3: Is the patient in receipt of Mobility Allowance:

  • DLA (Higher Rate Element)
  • PIP (Higher Rate Element)
  • If yes, the patient may not be eligible for transportation under this contract – proceed to stage 4.
  • If no, the patient may be eligible – proceed to stage 2.

Stage 2

Flowchart. Question 2.1: Is the patient receiving NHS funded treatment and requires inter-facilities transport between NHS funded organisations (i.e. from one hospital to another)? • If yes, the patient may be eligible - proceed to stage 3. • If no, the patient IS NOT eligible for transportation under this contract. Question 2.2: Does the patient require transport to or from an NHS funded organisation for the purpose of receiving NHS funded treatment? • If yes, the patient may be eligible - proceed to stage 3. • If no, the patient IS NOT eligible for transportation under this contract. Question 2.3: Is this a discharge from an NHS funded organisation after receiving NHS funded treatment? • If yes, the patient may be eligible - proceed to stage 3. • If no, the patient IS NOT eligible for transportation under this contract. Question 2.4: Does the patient require transfer between their own home and a care home? • If no, the patient may be eligible - proceed to stage 3. • If yes: Is the patient in receipt of CHC funding? • If yes, the patient may be eligible - proceed to stage 3. • If no, the patient IS NOT eligible for transportation under this contract.

Question 2.1: Is the patient receiving NHS funded treatment and requires inter-facilities transport between NHS funded organisations (i.e. from one hospital to another)?

  • If yes, the patient may be eligible – proceed to stage 3.
  • If no, the patient IS NOT eligible for transportation under this contract.

Question 2.2: Does the patient require transport to or from an NHS funded organisation for the purpose of receiving NHS funded treatment?

  • If yes, the patient may be eligible – proceed to stage 3.
  • If no, the patient IS NOT eligible for transportation under this contract.

Question 2.3: Is this a discharge from an NHS funded organisation after receiving NHS funded treatment?

  • If yes, the patient may be eligible – proceed to stage 3.
  • If no, the patient IS NOT eligible for transportation under this contract.

Question 2.4: Does the patient require transfer between their own home and a care home?

  • If no, the patient may be eligible – proceed to stage 3.
  • If yes:

Is the patient in receipt of CHC funding?

  • If yes, the patient may be eligible – proceed to stage 3.
  • If no, the patient IS NOT eligible for transportation under this contract.

 

Stage 3

Flowchart. Question 3.1: How does the patient attend their GP surgery currently? • If the patient uses own effort (drives, public transport, taxi), or family, friends or carer, and the GP does not visit the patient at home, the patient may be eligible - proceed to stage 4. • If the patient does not use own effort, or family, friends or carer, and the GP visits the patient at home, the patient IS eligible – proceed to stage 5

Question 3.1: How does the patient attend their GP surgery currently?

  • If the patient uses own effort (drives, public transport, taxi), or family, friends or carer, and the GP does not visit the patient at home, the patient may be eligible – proceed to stage 4.
  • If the patient does not use own effort, or family, friends or carer, and the GP visits the patient at home, the patient IS eligible – proceed to stage 5

Stage 4

Flowchart. Question 4.1: Does the patient suffer from severe mental health difficulties that means they are unable to travel by alternative transport? • If no, the patient may be eligible - proceed to question 4.2. • If yes, go to question 4.1a Question 4.1a: Is the patient sectioned? • If no, the patient may be eligible - proceed to question 4.2. • If yes, go to question 4.1b Question 4.1b: Will the patient still be sectioned at the time of travel? • If no, the patient may be eligible - proceed to question 4.2. • If yes, the patient IS NOT eligible for transportation under this contract - contact specialist services.
Flowchart. Question 4.2: Is the treatment likely to cause severe physical side effects that means the patient is unable to travel by alternative transport? • If no, the patient IS NOT eligible for transport - refer to sign-posting guidance. • If yes, the patient may be eligible for transportation - refer to guidance notes. Question 4.3: The journey is too long or too complex on public transport? • If no, the patient IS NOT eligible for transport - refer to sign-posting guidance. • If yes, the patient may be eligible for transportation - refer to guidance notes. Question 4.4: Other forms of transport are not suitable? • If no, the patient IS NOT eligible for transport - refer to sign-posting guidance. • If yes, the patient may be eligible for transportation - refer to guidance notes. Question 4.5: Due to medical reasons, the patient is unable to use own efforts? • If no, the patient IS NOT eligible for transport - refer to sign-posting guidance. • If yes, the patient may be eligible for transportation - refer to guidance notes. Question 4.6: The patient is unable to use public transport, parking or other transport due to cost? • If yes, the patient IS NOT eligible for transport - refer to sign-posting guidance. • If no, the patient may be eligible for transportation - refer to guidance notes. Question 4.7: The journey is inconvenient? • If yes, the patient IS NOT eligible for transport - refer to sign-posting guidance. • If no, the patient may be eligible for transportation - refer to guidance notes. Question 4.8: Any other exceptional circumstances? • If no, the patient IS NOT eligible for transport - refer to sign-posting guidance. • If yes, the patient may be eligible for transportation - refer to guidance notes.

Question 4.1: Does the patient suffer from severe mental health difficulties that means they are unable to travel by alternative transport?

  • If no, the patient may be eligible – proceed to question 4.2.
  • If yes, go to question 4.1a

Question 4.1a: Is the patient sectioned?

  • If no, the patient may be eligible – proceed to question 4.2.
  • If yes, go to question 4.1b

Question 4.1b: Will the patient still be sectioned at the time of travel?

  • If no, the patient may be eligible – proceed to question 4.2.
  • If yes, the patient IS NOT eligible for transportation under this contract – contact specialist services.

Question 4.2: Is the treatment likely to cause severe physical side effects that means the patient is unable to travel by alternative transport?

  • If no, the patient IS NOT eligible for transport – refer to sign-posting guidance.
  • If yes, the patient may be eligible for transportation – refer to guidance notes.

Question 4.3: The journey is too long or too complex on public transport?

  • If no, the patient IS NOT eligible for transport – refer to sign-posting guidance.
  • If yes, the patient may be eligible for transportation – refer to guidance notes.

Question 4.4: Other forms of transport are not suitable?

  • If no, the patient IS NOT eligible for transport – refer to sign-posting guidance.
  • If yes, the patient may be eligible for transportation – refer to guidance notes.

Question 4.5: Due to medical reasons, the patient is unable to use own efforts?

  • If no, the patient IS NOT eligible for transport – refer to sign-posting guidance.
  • If yes, the patient may be eligible for transportation – refer to guidance notes.

Question 4.6: The patient is unable to use public transport, parking or other transport due to cost?

  • If yes, the patient IS NOT eligible for transport – refer to sign-posting guidance.
  • If no, the patient may be eligible for transportation – refer to guidance notes.

Question 4.7: The journey is inconvenient?

  • If yes, the patient IS NOT eligible for transport – refer to sign-posting guidance.
  • If no, the patient may be eligible for transportation – refer to guidance notes.

Question 4.8: Any other exceptional circumstances?

  • If no, the patient IS NOT eligible for transport – refer to sign-posting guidance.
  • If yes, the patient may be eligible for transportation – refer to guidance notes.

Stage 5

Flowchart. Question 5 .1: is the patient to be transported under 16 years old? • If no, the patient IS NOT eligible for an escort • Is yes, the patient IS ELIGIBLE for an escort Question 5.2: is a carer or escort required to support the patient during the journey? e.g. the patient: • Has communication difficulties that prevent him/her travelling alone and is a suitably qualified carer required to escort the patient • Has mental health or learning disabilities needs that prevent him/her travelling alone • Has a disability or medical condition that he/she requires constant supervision for safety • Requires a carer to assist him/her at their destination • Is considered to be a Vulnerable Adult/Child (over 16) (Safeguarding Issue) • If no, the patient IS NOT eligible for an escort • Is yes, the patient IS ELIGIBLE for an escort

Question 5 .1: is the patient to be transported under 16 years old?

  • If no, the patient IS NOT eligible for an escort
  • Is yes, the patient IS ELIGIBLE for an escort

 

Question 5.2: is a carer or escort required to support the patient during the journey?

e.g. the patient:

  • Has communication difficulties that prevent him/her travelling alone and is a suitably qualified carer required to escort the patient
  • Has mental health or learning disabilities needs that prevent him/her travelling alone
  • Has a disability or medical condition that he/she requires constant supervision for safety
  • Requires a carer to assist him/her at their destination
  • Is considered to be a Vulnerable Adult/Child (over 16) (Safeguarding Issue)

 

  • If no, the patient IS NOT eligible for an escort
  • Is yes, the patient IS ELIGIBLE for an escort

Eligibility Criteria Guidance Notes

Section 1 – GP Registration

The ‘usually resident’ test must only be used to establish the responsible commissioner when this cannot be established based on the patient’s GP practice registration. The patient must advise where they consider their home address to be.

Section 1 – Mobility Allowance

It is expected that anyone in receipt of Mobility Allowance will use this benefit to cover costs for transport to and from premises providing NHS funded healthcare.

If the patient requires frequent journeys for regular treatment e.g. renal dialysis, chemotherapy or radiotherapy, and their Mobility Allowance does not cover the increased travel costs; additional help can be requested via the Healthcare Travel Costs Scheme.

Further information can be found on NHS Choices website: Healthcare Travel Costs Scheme

Section 4 – Exceptional Circumstances

Complexity of journey on public transport

A journey is considered complex if it is made up of three or more individual journeys on public transport. 

For example:

  • Three or more bus journeys of different numbers that involve changing buses twice or more. Three or more train journeys that involves changing trains twice or more.
  • Any combination of bus or train journeys that results in three or more individual journeys which involves changing mode of transport twice or more.

Length of time a journey will take on public transport. A journey is considered too long if:

  • It takes more than two hours to from door to destination.
  • Frequency of public transport is such that the individual may arrive at the destination more than two hours before their appointment time or have to wait more than two hours after their appointment before appropriate public transport is available.

Due to medical reasons the patient is unable to use own efforts.  Medical reasons may include:

  • Able to drive locally to own GP but unable to drive to receive treatment at NHS funded organisations.
  • A medical condition that would be exacerbated if transport is not

The exceptional circumstance questions in Appendix 2 are not exhaustive, and therefore, if a patient is not eligible but the Provider thinks that there are further exceptional circumstances that need to be taken into consideration then it should be referred to the Provider’s Patient Experience Manager/Supervisor (Inhours) or On-Call Silver/Gold (OOH).

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