Meeting of Bristol Clinical Commissioning Group Governing Body. Title: BNSSG Patient Transport Services Re-procurement Agenda Item: 13

Transcription

1 Meeting of Bristol Clinical Commissioning Group Governing Body To be held on Tuesday 26 April 2016 commencing at 1:30pm at the Vassell Centre, Gill Avenue, BS16 2QQ Title: BNSSG Patient Transport Services Re-procurement Agenda Item: 13 1 Purpose The purpose of this paper is to seek the approval of Bristol CCG for the proposed procurement of Non-Emergency Patient Transport Service (PTS) in Bristol, North Somerset and South Gloucestershire (BNSSG). The commissioning exercise covers the three areas of PTS as described in section 2. Commissioning authority organisation Nature of contest Contract value Bristol CCG (lead commissioner) South Gloucestershire CCG North Somerset CCG Open procurement Maximum of 11.8m over a 5 year period (Bristol portion of wider BNSSG contract) Maximum 5 years Duration Review Period Annual review with break clause at 36 months at discretion of CCGs Contract to be used 2016/17 NHS Standard Contract 2 Background Non-Emergency Patient Transport Services in BNSSG are currently provided by South West Ambulance Service (SWAST), with the contract for that service ending on 30 September The Renal Dialysis Transport is run by CTS and that also expires on 30 September As well as the two aforementioned services, PTS also requires formal callhandling. Therefore, the new tender will be in 3 separate lots: 1) A Call Centre to apply the eligibility criteria and ensure that only eligible patients are accepted for transport; 2) The Journey provision of eligible patients, including the cardiac shuttle, bariatric, certain levels of critical care patients and high dependency patients; 3) Patients travelling to/from renal dialysis treatment (including acceptance of calls for booking of these patients). Page 1 of 6

2 Meeting of Bristol CCG 26/4/16 - BNSSG Patient Transport Services Re-procurement This procurement has been split into the above lots to provide the best service available for patients, reduce ineligible journeys, and support the application of strict contract requirements and Key Performance Indicators on all three lots. A copy of a specification for each lot is attached to the end of this report. SCW CSU will conduct a tender exercise to seek suitably qualified organisations to provide services for the three lots outlined above. It is anticipated that through this process, new contracts could be awarded by late June 2016 with a view that the newly appointed providers will commence service delivery on 1 st October Both South Gloucester and North Somerset CCGs gave delegated authority to specifications and tender on 14 April It is therefore respectfully requested that the Bristol CCG Governing Body give their approval to tender. As Bristol CCG is the lead Commissioner of these contracts, approval is therefore sought to publish the specifications and tender immediately to ensure sufficient time to award the contracts and mobilise the new services by 30th September Procurement Approach The South, Central & West Commissioning Support Unit (the CSU) procurement team will conduct the tender exercise on behalf of the BNSSG CCGs. The procedure will be in accordance with all applicable regulation, guidance, and the CCG s Standing Financial instructions and Procurement policy. Approval for the authority to advertise and subsequently award the services will be sought from the CCG s Governing Body, with all interim decisions being made at the already-established Project Board. The Open tender procedure will be adopted to ensure appointment of a suitably qualified provider within available timescale. The Open procedure has a single substantive stage of tendering, and no separate pre-qualification stage. Questions of capability and capacity that would normally be asked at the prequalification stage will instead be asked at the tender stage. The Open procedure has been selected for reasons on proportionality and expediency. As required by law, information related to this procurement exercise will be available on the CCG s In-Tend e-tendering system. Similarly, all stages of the procurement will be conducted electronically, and all information made available to bidders in electronic format. The CSU Procurement lead will act as the single point of contact for bidders throughout the procurement process. The effective functioning of the services will require the development of collaborative and productive relationships between the service and a range of stakeholders. This will be explored and managed by the project team throughout the procurement and mobilisation process for this service. The Project Board, including key stakeholder and patient representatives, will form part of the bid evaluation team, and will score the bids received. Page 2 of 6

3 Meeting of Bristol CCG 26/4/16 - BNSSG Patient Transport Services Re-procurement The high-level procurement timetable is as follows: Step Start date End date Advert and Tender Stage Advert issue and commencement of tender stage 27 April May 2016 Bidder deadline: submission of tenders 27 May Tender evaluations 27 May June 2016 Award approved through Governing Body 28 June Award Issue 29 June Standstill period 29 June July 2016 Issue of formal award notice 12 July Mobilisation Period Mobilisation Period 12 July September Contract Mechanism and Tenure The intention is to award a 5 year contract with annual reviews and the possibility of break at 36 months where performance of the provider is not deemed satisfactory. The contract will be awarded in June The NHS Standard contract will be used to manage all services. Legal advice will be sought as deemed necessary. 5 How have service users, carers and local people been involved? The CSU Procurement Manager will lead on the procurement process for this service. BNSSG CCG Commissioners, acute hospital representatives and patient representatives currently form the project Board and will continue throughout the procurement and mobilisation. It is also expected that the patient representatives will continue to lead on the patient forum required to be managed by the PTS providers under the new contracts. 6 Implications on equalities and health inequalities. No implications on equalities and health inequalities have been identified at present. As part of the specifications and new contracts, Providers will be required to conduct a Privacy Impact Assessment and an Equality Impact Assessment both of which will be formally assessed as part of the evaluation process. CCG Governing Bodies will also receive a commissioning equality impact assessment as part of the formal award process, ensuring that no inequalities have been created or perpetuated during from the process. Additionally, there are strict requirements to treat patients fairly, respectfully and with dignity regardless of race, religion, health, gender or sexual orientation. This also applies to all of the Provider staff. It should also be particularly noted that eligibility criteria for PTS are nationally derived. 7 Evidence Informed Commissioning The commissioners have carried out previous market engagement events to describe the services and ensure the market is ready to respond to the invitation to tender. Page 3 of 6

4 Meeting of Bristol CCG 26/4/16 - BNSSG Patient Transport Services Re-procurement 8 Financial Implications The funding of the services has been identified (see section 1) and Bidders will be expected to meet the financial envelope as set out in the tender documents. The financial envelopes for each BNSSG lot are as follows: FINANCIAL ENVELOPE Maximum PTS Journeys 3,750,000 Call Centre Renal Dialysis 725,000 Total 4,700,000 The Bristol portion of the financial envelope is as follows: Bristol Spend Maximum PTS Journeys 1,993,094 Call Centre 119,586 Renal Dialysis 247,725 TOTAL 2,360,404 9 Legal implications There are no legal issues raised in this paper. The approach outlined in this report ensures compliance with all relevant regulation and guidance, including but not limited to: Public Contract Regulations 2015 Public Services (Social Value) Act 2012 The National Health Service (Procurement, Patient Choice and Competition) (no.2) Regulations 2013 Health & Social Care Act 2012 Equality Act 2012 Monitor Guidance 10 Risk implications, assessment and mitigation There are limited risks associated with the procurement exercise. The current providers (both for the PTS and the renal dialysis transport) have extended the existing contracts as described in section 2. Page 4 of 6

5 Meeting of Bristol CCG 26/4/16 - BNSSG Patient Transport Services Re-procurement Project Risks Delays to the project timescales; The application of Transfer of Undertakings (Protection of employment) Regulations Mitigation / How risks will be managed The Project Board is confident that a formal award can be delivered in good time, however discussions could be held with the incumbent providers to request that they continue to manage the services until an agreed future date. This would ensure there was no disruption to service provision. The application of Transfer of Undertakings (Protection of employment) Regulations for the existing staff and the resulting additional costs of offering comparable pensions provision may reduce the pool of bidders and impact upon price. Clear information will be given to bidders to enable them to assess the degree of risk and price their bid appropriately. Stakeholder management The CSU Project Manager has and will maintain regular engagement with stakeholders including local acute and community service providers and the feedback received from them has been extremely useful in designing the new service. This engagement will continue during mobilisation of the new service and into the beginning of the new contracts. This engagement will also include patient representatives. Bidder unable to fully resource service, leading to lower capacity of service and longer timescales. Service overspend Appointed organisation may dissolve or become bankrupt. Requirements of service change within lifetime of contract. Tender will request evidence of Bidder capability to adequate resource and manage the service. Available budget, service requirements and payment strategy will be clearly defined in service specification. Bidders will be advised to submit bids based on available financial envelope. Tender documentation will examine bidders financial viability, and seek guarantees and indemnities as appropriate. Terms and Conditions will state expectation that small changes in service requirements will be accommodated within contract provided adequate notice is given. This will be as per the NHS Standard Contract. Page 5 of 6

6 Meeting of Bristol CCG 26/4/16 - BNSSG Patient Transport Services Re-procurement 11 Recommendation(s) The Governing Body is asked to approve the procurement strategy as outlined above, and approve the formal advertisement of the aforementioned three Patient Transport Service lots using the attached service specifications. Written by: Deborah Tobin NHS South, Central and West Commissioning Support Unit John Gibbs NHS South, Central and West Commissioning Support Unit Sponsored by: Nicola Dunn NHS Bristol CCG 18 th April 2016 Page 6 of 6

7 Service Specification BNSSG Patient Transport Journey Service 12 April 2016

8 GLOSSARY BNSSG Patient Transport Service Specification definitions Aborted Journey Ambulatory Care Arrival time Bariatric Baseline activity Bed pressures Cancelled Journey Cardiac unit Care provider Chosen place of residence / place of residence CCG Journey that has been terminated after the vehicle has commenced the journey to the specific patient. Ambulatory care is a medical care pathway provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures at a variety of points of care. Patients receiving such treatment may therefore require transport to and from a number of treatment units on the same day as part of a care pathway. This is the time the patient is required to arrive at their destination. All bookings must either specify a required arrival or pick up time. Patients who present with complex manual handling needs and exceed a pre-defined weight (in excess of 133kg / 21 stones) or where their body morphology - size, height, weight, shape and / or width exceeds equipment dimensions: e.g. if a patient s hip to hip anterior measurement is 100 cm or greater, they will be defined as bariatric even if their weight is less than 133 kg / 21 stone. The data held that records all patient transport journeys with specific detail around mobility, distances, eligibility, pickup points and destinations/points of care for a particular trust. This can then be used to plan services and ensure sufficient resources within certain parameters for the future. This may include locations outside of the BNSSG region there eligible BNSSG patients choose to be treated. The transport of adult patients to manage the bed base of an acute trust. This does not include the transport of patients to alternative sites as part of a care pathway where treatment can only be accessed at an alternative site. Journey that is no longer required from the Transport provider, which has been notified to the Transport Provider before the journey has started to the specific patient. A point of care providing specialist care for cardiac patients. Acute, community and mental health services may be referred to as care providers in this specification. This describes the premises at which the patient has chosen to live as any address specified at the time of booking (e.g. home, nursing home, hospice, hospital or treatment centre. For patients with no fixed address, this may include premises such as council offices or homeless hostels. The definition does not include premises that are outside the boundary of BNSSG and chosen places of residence outside BNSSG will be covered under Repatriation. Clinical commissioning groups (CCGs) are NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in England.

9 Contracted geographical scope Critically ill Discharge Disorderly behaviour Dual Validation Eligibility criteria Eligible Emergency transport End of Life The total geographical area covered by this contract. The geographical scope of this contract includes the transport of all BNSSG patients to points of care within BNSSG. Patients that are critically ill in hospital who may, during the course of their stay, require transfer to another hospital or to another department within the same hospital. Indications for transfer include specialist investigation or treatment; lack of availability of a staffed critical care bed and repatriation. Final agreement on the Critical Care Transfer policy will be agreed during mobilisation (example listed in Appendix 6) Discharge is the point at which an inpatient leaves the point of care and either returns to their chosen place of residence or is transferred to an alternative home environment this includes discharges to residential and nursing homes. Journeys from inpatient care to inpatient rehabilitation or other inpatient care facilities such as community hospitals and hospices are considered as transfers. Where the behaviour of a patient has a negative impact on other patients to an extent where it affects their wellbeing. This may include use of offensive language, being under the influence of alcohol or drugs, smoking and threatening behaviour. A system which allows both the Provider and the Care Provider to record the time at key points in the patient journey, this includes arrival at and collection from the point of care. National assessment of medical needs of the patient that will qualify them for the provision of NHS funded transport. Patients that qualify after an assessment of transport need using agreed criteria based on medical need. A life threatening or potentially life threatening incident requiring an immediate ambulance response. These transports are not covered by this contract. The General Medical Council considers patients to be approaching the end of life when they are likely to die within the next 12 months. Imminent end of life transfers refers to patients who are expected to die within the next few hours or days and should be immediately prioritised over other journeys (excluding essential journeys). End of life transport is a journey of significant importance and where it is vital that the patient's pathway and experience at this time in their continuing treatment is as stress free and as fluid as possible. The patient s journey must be allocated in a timely manner and be monitored once allocated to a resource to ensure that the journey is carried out without delay or cancellation. If a patient is near the end of their life (likely to be within next few hours or days) and they need transport to a different setting, it is vital that transport is arranged in a timely manner with an appropriate crew. The transport should be prioritised for these patients without delays or cancellations and should arrive within an hour of booking. These patients are likely to have significant pain and other symptoms, will have DNACPR orders in place and may have distressed family members in attendance.

10 Escort Extra-Contractual Journeys Hand luggage Health and Social Care Professionals High Risk Patients Host Provider Intensive treatment Journey booked in advance Journey booked on the day BNSSG bound journey BNSSG patients Key performance indicator A person or animal who accompanies a patient to provide an element of care, (this may be clinical, or social) that cannot be provided by an ambulance crew and may impact the safety or dignity to the patient. It may be a member of clinical staff, carer, family, friend etc. Escorts may include visual, hearing and medical assistance animals. Ad hoc journeys not covered within the PTS contract: for example, long-distance transfers out of BNSSG. Hand luggage requirements should be determined in proportion to the patient s length of treatment. Discretion will apply but in all cases a handbag plus one item of hand luggage (within the size limits usually applied for hand luggage for airline transport) should be considered reasonable. This may include two small bags that are the equivalent size to airline hand luggage size bag. This will increase to a small suitcase where inpatient treatment is required/has taken place. This is in addition to any essential medical equipment requirements that the patient may have and in the case of escorts should include required medical equipment for the patient and escort. Registered professionals with patient or client care remits, authorised to arrange or deliver care on behalf of the NHS. Patients who have been assessed by a health or social care professional as posing a significant risk to the safety of themselves or those around them OR as being at significant risk of suffering a life-threatening event during the journey. The provider delivering care from whom the patient is being discharged or transferred. A course of treatments, at regular intervals, over a defined period, which are critical to the patient s recovery and for which their arrival is vital. Bookings made in advance of the day that the journey is required and no later than hrs on the preceding day. Journeys booked after hours will be treated as an on the day bookings. Bookings for journeys required on the day. A journey to and or from a point of care within the geographical CCG boundaries of BNSSG. This includes: Patients that reside in BNSSG and are registered with a BNSSG GP. Patients that reside in BNSSG and are not registered with a GP. Patients that do not reside in BNSSG but are registered with a GP within BNSSG. Patients that do not have a registered address and are not registered with a BNSSG GP and wish to be transported to an address within BNSSG following treatment within BNSSG. A quantitative measure of performance based on contract requirement.

11 Learning difficulties Major Incident Mental Health Patient Minimum Data Set Minor Out of area journey Patient who is registered with GP outside of BNSSG but resident in BNSSG Pick up time Point of Care Quality indicator Renal patient Repatriation Learning difficulties can affect the way a person understands information and how they communicate. This means they can have difficulty: understanding new or complex information learning new skills coping independently This may also include patients with severe autism, asperger s, etc. A significant incident or emergency that requires the implementation of special arrangements by one or more of the emergency services, the NHS or local authority for the initial treatment, rescue and transportation to hospital of a large number of casualties. A person who suffers from a diagnosed mental health condition. A mental health patient may find difficulty in life satisfaction, optimism, self-esteem, mastery and feeling in control, having a purpose in life, and a sense of belonging and support. A patient whose feelings, thoughts and actions may put their physical health and wellbeing at risk, whilst potentially or actually also placing others at risk and who requires or may require assessment/intervention from Community Mental Health Services. An endorsed data set used to report on the provision of a service as contractually required. For the purposes of this contract, a minor is a patient who, by virtue of their age, must be escorted by at least one parent or guardian. This will be automatic for children under the age of 16 years and should be the choice of the patient if they are 16 or 17. A journey to a point of care more than 25 miles outside of the contracted scope. A patient residing in the area of BNSSG but registered with a GP outside of BNSSG. Such journeys shall be treated as ECJs. These journeys will need to be authorised by and charged to the CCG in which the patient is registered to a GP. The time designated by the patient, their carer or healthcare professional that the patient is to be collected from their place of residence or point of care. The venue where the patient s care is to be delivered. A patient focussed measurable standard of service provision which may lead to consequences if it is not achieved. Patient receiving dialysis treatment from a renal unit. Transferring or discharging patients that do not live in BNSSG and/or are not registered with a BNSSG GP. Such journeys shall be considered as an ECJ. These journeys will need to be authorised by and charged to the CCG in which the patient is registered to a GP.

12 Repeat bookings Routine Services provided in a Primary Care setting Service Specification Service Standard Special Needs Time bound journeys Time Bound Discharge Care Package Transfer Patients that reside in BNSSG or are of no fixed abode but wish to remain in BNSSG following treatment in BNSSG, and are not registered with a GP and patients that do not reside in BNSSG but are registered with a BNSSG GP are covered by the terms of this contract and are therefore not considered as repatriations. Bookings for a course of treatment which may be over a period of time at regular intervals, made in one instance to avoid repetition. A review of the eligibility of repeat bookings must be triggered by the Provider every three months. Regular appointments for NHS funded treatment known about by all parties and booked in advance. People self-referring to see their GP, dentist, optician/optometrist or another member of the Primary Care team are not covered by PTS. People referred by a health care professional for secondary care treatment in a primary care setting (and who meet the required eligibility criteria) will receive access to PTS. A document that provides detail about the scope and definition of the service required. The defined criteria required to be delivered by the Transport Provider The particular resources needed or provided to help people who have an illness or condition that makes it difficult for them to do the things that other people do regularly for themselves. Time bound journeys are restricted to the following: Oncology/Haematology patients who are receiving IV chemotherapy or radiotherapy The transport of children The discharge of a patient home where a time bound care package is required The transport of patients requiring admission to an inpatient mental health unit Any patient that is deemed to be at the end of their life (i.e., imminent death, hours) A care package-related time bound discharge is one in which the patient must arrive at the required destination within a specified 15 minute time window because failure to do so will have a high probability of causing clinical harm or postpone their discharge from inpatient care. These journeys are restricted to: Meeting social care discharge support teams/carers at the patient s home within a specified time slot; Admission to care facility is required within a specified time slot. E.g. Care and nursing home admissions, The movement of a patient from one point of care to another. This may include transfers to inpatient or non - inpatient facilities, which will be one way, and transfers of inpatients to diagnostic or non-inpatient treatment facilities, that are two way and require the patient to be returned to their collection point. In either case, the patient may be accompanied by a clinical escort. Where care provider staff accompany patients on a one way transfer, the Provider will be required to make appropriate return arrangements for the care provider member of

13 Treatment Centre Urgent Vulnerable Adult Working day staff. Transfers include the repatriation of BNSSG patients that have been treated outside of the BNSSG geographical boundary. The venue where a patient will receive care, this includes acute settings and broad range of community sites. Cases in which a doctor, midwife or other healthcare professional identifies the need for hospital admission as urgent. From 1 April 2007, these calls have been prioritised and classified in the same way as emergency 999 calls. These transports are not covered by this contract. A person who requires additional care due to their abilities. Vulnerable adult is someone aged 18 or over: Who is, or may be, in need of community services due to age, illness or a mental or physical disability Who is, or may be, unable to take care of himself/herself, or unable to protect himself/herself against significant harm or exploitation The department of health national definition can be found here: dults/index.htm An agreed set of core hours that are the usual hours of business within the country of origin.

14 SERVICE SPECIFICATION Service Specification No. Service Commissioner Lead Provider Lead TBC Patient Transport Journey Services Lead Commissioner - NHS Bristol Clinical Commissioning Group Associate Commissioners North Somerset Clinical Commissioning Group and South Gloucestershire Clinical Commissioning Group (collectively known as BNSSG ) Period 1 October 2016 to 30 September 2021 Date of Review Annual from service commencement POPULATION NEEDS National/local context and evidence base The Department of Health defines Non-emergency Patient Transport Service (NEPTS or PTS) activity as being the non-urgent, planned transportation of patients, with a medical need for transport, to and from premises providing NHS healthcare. This encompasses a wide range of vehicle types and levels of care consistent with the patients medical needs. The overarching principle of PTS is that patients who are eligible for transport will receive safe, timely, comfortable and clinically appropriate transport, without detriment to their medical condition. This service is commissioned by NHS Bristol, NHS South Gloucestershire and NHS North Somerset Clinical Commissioning Groups (CCGs) known as the BNSSG region: These CCGs are committed to the provision of a high-quality non-emergency Patient Transport Service ( PTS ). The above referenced organisations will be known as the Commissioner or Commissioners and NHS Patients will be known as Patient or Patients. This service does not apply to privately funded care. The purpose of the PTS service is to ensure that there is an equitable and accessible service to all eligible patients based on their medical need. The model is based on all journeys being booked through a central point of contact where journey requests are made directly by patients/carers and or appropriate health social care professionals. Bookings for eligible patients will then be referred to the Transport Provider which shall transport those eligible patients to and from providers of NHS acute and community care and other agreed places of NHS care based in BNSSG. The specification also includes transfers within the UK for BNSSG patients where the patients choose to be treated. This specification should be read in conjunction with the specification for the PTS Call Centre in BNSSG, tendered at the same time, as the Provider of this service will be required to work very closely with the PTS Call Centre.

15 The Provider must comply with all relevant current and future legislation, national standards and evidence base set out within this Service Specification and required in the provision of this Service. The Provider must comply with all other relevant legislation and regulations which may include, but are not limited to: Eligibility Criteria for Patient Transport Services (PTS) DH 2007 and the "Who pays" responsible commissioner guidance unless separately identified in this specification. Full details of the national eligibility guidance are in: The Provider and Commissioners must agree and comply with any future changes in or modifications to national policy, guidance or survey results and where appropriate, review or update this specification to reflect any changes required. These are normally set out in the NHS operating framework annually, or in other formal notifications. Advance notice of any changes is to be given to care providers within 4 weeks of implementation. Any changes impacting on the care providers and /or patients will only be agreed with appropriate engagement and consultation with Commissioners and each care provider. OUTCOMES NHS Outcomes Framework Domains & Indicators PTS is a facilitative patient service and will therefore support the achievement of all the NHS Outcomes Framework, specifically Domain 4 - Ensuring people have a positive experience of care and Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm. Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Preventing people from dying prematurely Enhancing quality of life for people with long-term conditions Helping people to recover from episodes of ill-health or following injury Ensuring people have a positive experience of care Treating and caring for people in safe environment and protecting them from avoidable harm Local defined outcomes Patients will be transported in safe and timely manner in a vehicle appropriate to their needs Patients will not spend an unreasonable amount of time in vehicles Patients will be collected promptly, in reasonable timescales, following their appointment Patients will be treated with courtesy, dignity and respect at all times There will be no detriment to patients health and wellbeing during their journey The specified requirements of how these outcomes will be measured are detailed in this document.

16 Scope High Level Specification Principles Commissioners are seeking innovation in the introduction of operational models including use of new technologies and/or ways of working over the term of the contract that will improve the Patient Transport Service and its working with the wider local healthcare system to enhance patient experience, improve patient outcomes and assist whole system solutions. In addition to the expected provision of a safe and efficient service, Provider will be expected to demonstrate: How they will approach their role within the management and delivery of a more efficient Patient Transport Service. How their corporate and management structures meet the requirements of this specification How they will adopt new technologies, ways of working and learning and development How they will assist in decreasing ineligible journeys to ensure that there is future capacity for eligible patients by: Improvements in operating models Case reviews and audits with the Call Centre Provider, Commissioners and acute and community hospitals Use of staff, patient and HCP feedback Use of shared learning and developments A balanced approach to quality, performance and value for money Create effective and efficient levels of integration between services, incorporating How they will assist in improving local patient pathways How they can enhance patient pathways with the Call Centre Provider to improve the patient journey and minimise the number of interactions with services. Smooth hand-off between services Ensuring information for patients are effectively shared and used, Seamless transfer of information between Providers Provider will also be required to: show improved access and staff training for patients who need an enhanced level of care for patients or who, for whatever reason, have needs which require a higher level of support. provide access to an interpretation service 24/7/365 to ensure equitable access for patients whose first language is not English provide resilience to meet standards during peaks in demand. Commissioners will require Provider to work with the local systems and stakeholders to create improvements in service, embed evidenced based national and local learning into local service provision and plan for changes in strategy, managing patient pathways, technology and demand and to achieve the aims set out in this specification. In order to achieve this, Provider will need to demonstrate how fundamental principles set out below are reflected in their organisational structure and culture.

17 Partnership and Integrated Approaches Innovative and developmental Listening Flexible Responsive Resilient Excellent Clinical Governance & Assurance processes Robust Policies and Procedures Open and Transparent Focus on Patient Pathways and outcome Delivering value for money Aim and objectives of service The aim of the service is to provide transport for eligible BNSSG patients with a medical need, between their places of residence and community and acute settings in reasonable time and comfort without detriment to their medical condition for secondary care treatment. This shall include secondary care services provided in a primary care setting. The geographical scope of this contract includes the transport of all BNSSG patients to points of care within BNSSG. All required service standards are detailed in this specification. Non urgent patient transport should be seen as part of an integrated programme of care and a non-emergency patient is one who whilst requiring treatment which may or may not be of a specialist nature, does not require an immediate or urgent response. Non-emergency PTS is provided for patients who are being transported to an NHS funded service for NHS treatment and who are deemed medically eligible based on the DOH eligibility criteria. Agreement to NHS requests must be subject to the patient fulfilling the relevant eligibility criteria which primarily ensure that there is a medical need for transport. Exclusions have been detailed further in this specification. The PTS Call Centre is responsible for applying the eligibility criteria for each patient activity, however, the Provider and its employees must identify to Commissioners and the PTS Call Centre any patients that they do not believe are eligible. The PTS Call Centre will then investigate any report of ineligible patients. The Provider must use clinical discretion for identifying these patients and will also identify these patients to Commissioners if requested. Eligibility criteria for the purpose of this contract are set out in Appendix 1. The definition of a reasonable journey time is set out in in the KPIs.. The objectives of the service are to ensure the following service outcomes: Quality and Safety The provision of this service must be a patient centred service and be delivered in a safe, friendly and effective manner by appropriately trained staff. The Provider will keep journey times to a minimum and ensure promptness of arrival and pick-up. The Provider must comply with all aspects of Care Quality Commission registration, or any subsequent organisation. Flexibility and Responsiveness The service must provide flexibility to respond to changing levels in future activity and the patient needs (e.g. new healthcare locations providing NHS treatment, specialist requirements, on-the-day requests, flexible times

18 for pick-up and delivery including evenings, weekends and bank holidays). Timeframe of implementation and redesigned elements to be agreed as part of the monthly meetings. This includes the drive towards seven day working. Communication and Performance Information The service must include high-quality communication with Commissioners and healthcare providers to discuss effective management of the system. The Provider will publish its staffing rota on a weekly basis, by crew type and location, to trusts and commissioners, and provide advance updates of any rota changes. Clear and complete information must be provided monthly on activity, finance and quality of service provision. Additional ad hoc reporting requirements will be agreed at the monthly performance meetings. The minimum data set required is set out in Appendix 2. All reporting must be provided at CCG level. Efficiency Savings Public sector organisations are required to make efficiency savings whilst maintaining and improving quality of service. Savings can be made by improved productivity, performance and/or innovative service delivery redesigns. The Provider must demonstrate innovation in their approach using best practice to support Commissioners to achieve their annual financial objectives. Any initiatives which impact on service delivery will be agreed prior to implementation with the Commissioner. Value for Money The service must be affordable and provide value for money. Environmentally Sustainable The service should be designed to minimise the likelihood of unnecessary journeys and to ensure maximum use is made of technology to reduce both carbon emissions and costs. This requires an analysis of the likely carbon footprint of the whole service with measures to control this and make reductions where there are opportunities. These opportunities relate to types of vehicles used, driving skills, flexible working arrangements, maximum use of electronic communications, procurement of equipment and management of energy and resources at premises. The Provider must abide by the Department of Health s Sustainability Reporting Framework (see Innovation and use of Information Technology The service must be innovative in its approach using best practice to respond to future needs. It needs to make the most effective use of technology for the booking and scheduling of journeys and must include the data as outlined in this specification (or as agreed with Commissioner). As part of the move towards common digital standards, interoperable clinical information systems and a paperless NHS the Transport Provider must comply with interoperability requirements for the NHS, specifically working with, but not limited to, the hospital PAS systems and the Transport Provider. Operational Planning and Booking This contract will be managed by the CSU on behalf of the health care economies of the BNSSG CCGs. The lead commissioner is Bristol CCG. The rules for access and standards of provision will be the same across all heath care economies however from time to time an individual CCGs may need to prioritise journeys to enable the Provider to support local health system needs.

19 The Provider is required to deliver services in accordance with the process map examples inserted as Appendix 3. The final versions of the Process Maps to be agreed during mobilisation. The relevant service standards are set out in Section 7. Data Migration The Transport Provider must work cooperatively with the PTS Call Centre to ensure a seamless transfer of journeys that will be scheduled prior to the commencement of this service, as well as allowing for migration of data to future systems, should this become necessary. This must include the ability to prove the reliability of the data migration process via test or trial loads. Bookings All bookings will specify either a pick up time or required arrival time. The PTS Call Centre will identify all the details necessary to schedule the patient journey and deliver the service standards required. Examples of process maps are set out in Appendix 3. The PTS Journey Provider must liaise with each acute and community hospital to provide an electronic feed of the bookings for each day by 7am in a safe, Caldicott compliant method. This should be in an Excel or.csv format or as agreed with each acute or community hospital. Provider must identify, and the system must record, all the details necessary to schedule the patient journey and deliver the service standards required. The Transport Provider must confirm all journeys booked in advance by contacting patients 24 hours prior to the journey to aid in the reduction of aborted journeys. The method of contact with patients will be identified in advance by the PTS Call Centre with the patient and should include but not be limited to telephone, text and . Contact with the patient must only take place during normal office hours (i.e., 9am to 5pm). Where telephone is preferred, the Transport Provider will attempt to make contact on at least three occasions. Failure to make contact with the patient does not constitute a cancellation of the booking. The Transport Provider must notify any changes to a journey, change in patient details or eligibility to the Call Centre immediately via electronic means or telephone. The Transport Provider must make post-travel enquiries in order to investigate complaints, accidents and appeals. Operational Delivery The Provider is required to have dual performance validation system agreed respectively with the CCGs, acute and community provider trusts. The Provider must establish relationships such that the system is managed effectively. The Provider must provide storage for all paper and electronic records and aim to minimise paper use. The Provider must provide appropriately qualified staff to manage the contract on a daily basis and to deliver the service in accordance with the Service standard.

20 Business Continuity The Provider must demonstrate robustness of emergency planning and business continuity arrangements and demonstrate their ability to deliver a suitable service for unplanned on the day booking requests, where outside the expected levels. Escalation plans to be agreed locally with each care Provider in advance of service commencement. This must be in agreement with the local system escalation plans, and ensure the essential services continue to be delivered. These plans must be tested with commissioners and acute and community providers and reported on at least annually. Providers will have systems and arrangements in place so that in the event of fluctuations in demand, technical failure or staff shortages they can invoke this contingency and continue to provide an acceptable level of service to the population. In this context, acceptable means continued achievement of the agreed Key Performance Indicators. The Call Centre Provider is required to have business continuity and contingency arrangements for use when there is an unexpected problem not related to local surges of demand. For the purpose of clarity, this refers to unforeseeable circumstances that affect the provision of the service. Generally, any such arrangements are used when there is a catastrophic loss of service due to for example, a major technical issue, loss of power or loss of premises. In these situations, Provider may consider diverting calls to a secondary call centre or could have a mutual aid arrangement with another Call Centre provider which allows calls to be diverted until the problem is resolved. Provider must be fully conversant with BNSSG emergency planning arrangements for major incidents and emergencies and to participate and respond as necessary and appropriate. In addition, Provider will be expected to appropriately liaise with and assist other local providers with capacity management issues as part of the area escalation procedure at no extra cost to Commissioners. The Provider is to contribute to the development of a major incident plan for BNSSG and to participate in training in support of that plan. Any plan must include working with the Transport Provider during times of business continuity. Any sub-contractors used in such cases must meet the minimum requirement standards. System Functionality The Provider s booking system must facilitate: Ease and efficiency of booking acceptance from the Call Centre Provider using a Booking Reference Number, including confirmation that suitable arrangements are in place. Functionality for acceptance of regular, repeat bookings Highlighting of ineligible patients and reporting to the Call Centre Provider for investigation Highlighting and investigation of aborted journeys/cancellations (see Appendix 4) The recording of the reason for the aborted journey and whether it was as a result of the Provider, patient, acute or community hospital or other reason. Highlighting and investigation of any patient who regularly refuses to travel, and has not cancelled their booked transport; Relaying of information to Call Centre Provider Recording and reporting of patient information and delivery against quality measures.

21 Highlighting relevant patient specific details such as communicable diseases for example. The Provider will be expected to support the training of relevant staff from other provider organisations in the use of the e-booking system: for example, training super-users who will then cascade the training to their colleagues. Service description/care pathway This document describes the required services but does not specify how the Provider is to manage its service. The Provider will be required to deliver the service outlined in this Specification in accordance with the PTS process map examples set out in Appendix 3, and the outcomes and service standards set out in this specification. These elements will form the basis of the Commissioner s performance management regime. The Provider and the Commissioner must agree and comply with any future changes in or modifications to national policy, guidance or survey results and, where appropriate, review or update this specification to reflect any changes required. This includes but is not limited to, The 5 year forward view and Everyone counts Planning for Patients. The Provider must give providers at least four weeks advance notice of any changes. Any changes impacting on the providers of NHS services and/or patients will only be agreed with appropriate engagement and consultation with Commissioners and each care Provider. The service will need to adapt to ensure congruence with the changing shape of services in BNSSG. The Provider must: Follow government guidance issued in respect of customer service lines, the most recent of which can be found at: Ensure that patients get the transport mode most appropriate to their condition and mobility (See Appendix 4). The Transport Provider will provide a service 24 hours per day inclusive of bank or public holidays, (365 days a year and 366 days in each leap year) and will be configured to match the activity patterns provided by the Commissioner. The flow of service activity will be required to change and develop in accordance with service development across the health and social care system. Significant changes in activity will be agreed as part of regular performance meetings. The provider is required to manage daily flows such as peaks and troughs in demand and seasonal patterns and flex resources accordingly. Accept repeat booking of regular journeys from the Call Centre Provider. Repeat bookings to be reviewed every three months for eligibility. Transport patients needing renal dialysis AND who require special transport outside of the renal transport contract (definitions below). Provide an advance planning function which allocates transport to patients appropriate to their condition and mobility and which ensures that they are collected, delivered and returned, as appropriate, within the key performance standards set out in Section B part 8, below. Provide a day control function which manages the plan and the transport resources on the day of implementation and allocates those resources to deal with on-the-day

22 changes and requests, ensuring that the key performance standards set out in Section B part 8, below, are met. Change services to be responsive to the changing demographic needs of the patient population, such as bariatric patients with increasing complex needs, ageing populations Provide an enhanced level of service to cover all the needs of level 0 and level 1 critically ill patients, where a higher level of crew skills will be needed and where journeys are not covered by the emergency transport provider. Provide an enhanced level of service to cover all the needs of high-dependency patients such as those with complex needs and infectious/communicable conditions/diseases, where a higher level of crew skills will be needed (e.g. technical crew for repatriation of patients following surgery or spinal injuries). Either have BSI ISO 9001 quality management system accreditation or work in accordance with BSI ISO 9001 quality management standards pending accreditation. Ensure good systems of communication exist that contribute to collaborative working with healthcare services, social care and mental health services to ensure continuity. Ensure the service is easily accessible by all eligible patients. Provide an improved supportive response for patients who are deaf or have language, learning difficulties or other conditions which require higher levels of support or those whose first language is not English. Work in unison with the Call Centre Provider to establish and manage a joint BNSSG monthly patient and stakeholder engagement group which inform service planning and development for the first contract year, quarterly thereafter if agreed by Commissioners. The Provider must ensure that staff: Transport patients to chosen place of residence (see glossary for definition)/healthcare facility as requested on the booking. Patients must not be taken to a destination other than specified on the booking unless an authorised Trust employee requests them to do so. Establish and confirm the identity of the patient being collected/set down. Comply with patients who have a current Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) or are established on the end of life care pathway. Transfer end of life patients nearing imminent death within one hour of the receipt of transport booking details in a dedicated, single occupancy vehicle in accordance with their right to respect and dignity. Always treat patients in a courteous manner which pays due regard to their medical condition, age, personal modesty and circumstances, without discrimination and in compliance with equal opportunities and equality and human rights legislation. Ensure that patients are comfortable during their journey with a vehicle that is able to be warmed/cooled and ventilated as patients require. Provide assistance as required to patients (with or without the use of aids) to undertake the journey. Assistance may be required at both the patient s residence and healthcare site. Always ensure that the vehicle does not move when any patient is still boarding or alighting, and all doors of the vehicle have been shut securely and all persons are clear of the vehicle. Always check the vehicle at the last stop before proceeding, to ensure there are no patients or patients property still on board. Any patient property left behind must be