Transportation Policy NHS Walsall Community Health NHS Walsall Community Health Integrated Governance Sub Group formally approved this policy on 10th March 2011 Please note that the Intranet version of this document is the only version that is maintained. Any printed versions should therefore be viewed as uncontrolled and may not be the most up-to-date. Metadata V1 Page 1 of 17
Version: V 1 Status: Final version Lead Director/Manager responsible Sally Killian Name of originator/ author: Sally Killian Ratified by: Integrated Governance Sub group Date ratified: 10 th March 2011 Date Policy is Effective From 10 th March 2011 Review date: February 2013 Expiry date: March 2014 Date of Equality and Diversity Impact March 2011 Assessment Date of Health Inequalities Impact N/A Assessment Target audience: All NHS WCH staff NHS Walsall/ WCH linked documents Confidentiality Policy Distribution of the document Implementation of the document Document Control and Archiving Monitoring Compliance and Effectiveness CONTRIBUTION LIST Key individuals involved in developing the document Name Designation Sally Killian Operational Manager for n Clinical Palliative & End of Life Care Tracey Grinell Nurse Manager Carl Measey Health & Safety Advisor Emma Collins Risk Facilitator Rose Faulkner Community Oncology Nurse Jo Beech Community Oncology CNS Claire Rochelle Assistant Volunteer Coordinator V1 Page 2 of 17
Circulated to the following individuals for consultation Name Designation Professional Forum Please note that the Intranet version of this document is the only version that is maintained. Any printed versions should therefore be viewed as uncontrolled and may not be the most up-to-date. V1 Page 3 of 17
CONTENT PAGE 1 INTRODUCTION 5 2 RESPONSIBILITIES 5 3 DEFINITIONS 5 4 POLICY 6 4.1 Service Provision 4.2 Operating Times 4.3 Services currently offering Patient Transport Services 5 ELIGIBILITY CRITERIA 7 6 MEDICAL NEED 7 7 SOCIAL OR FINANCIAL NEED 7 8 EXCEPTIONAL CIRCUMSTANCES 8 9 TYPE OF TRANSPORT 8 9.1 Staff Transporting Patients 8 9.1.1 Exceptions 9 10 BOOKING CRITERIA 9 11 ESCORTS 9 12 WHEELCHAIRS 9 13 OXYGEN 10 13.1 Transportation of patient oxygen 10 13.2 Staff members transporting oxygen 10 13.3 Known risks associated with the use of portable oxygen 10 13.4 Transporting oxygen cylinders around the borough 11 14 RESIDENTIAL NURSING HOMES 12 15 PERSONAL ITEMS 12 16 CONTROLLED DRUGS 13 17 DISCHARGE 13 18 CLINIC APPOINTMENTS 13 19 CONSULTANT APPOINTMENTS 13 20 ADVERSE WEATHER CONDITIONS 13 21 SAFETY 14 22 CODE OF CONDUCT 14 23 DISSEMINATION AND IMPLEMENTATION 15 24 DOCUMENT CONTROL AND ARCHIVING 15 25 MONITORING COMPLIANCE AND EFFECTIVENESS 15 25.1 Process for Monitoring Compliance and Effectiveness 15 25.2 Standards / Key Performance Indicators 15 25.3 Data Collection 15 25.4 Comments Suggestion Box 15 25.5 Satisfaction 15 25.6 Audits 16 25.7 Equality Impact Assessment 16 26 REFERENCES 16 APPENDIX A Equality Impact Assessment Tool 17 APPENDIX B Document Checklist 18 V1 page 4 of 17
1 INTRODUCTION NHS Walsall Community Health (hereon in referred to as the organisation ) is committed to providing the highest standards of patient care to the public. This policy covers all issues in regard to patient transportation needed to deliver a quality, punctual and professional service. This ranges from Patient Transport Services (PTS), Volunteer drivers and staff transporting patients as a requirement of their role. This policy also covers the use of portable oxygen in transportation. This includes patients being transported who require oxygen and staff transporting oxygen as a requirement of their role. The purpose of this policy is to ensure that eligible patients receive healthcare (treatment, outpatient appointments or diagnostic service i.e. a procedure that was traditionally provided in the hospital but are now available in a community setting) in a reasonable time and in reasonable comfort without detriment to their medical condition. This policy is only applicable to adults requiring transport. 2 RESPONSIBILITIES The Chief Executive as responsible officer for the organisation has the duty to provide patient transport services necessary to meet all reasonable requirements of the area for which the organisation is legally charted with providing services. The organisation will provide a duty of care to the patient (and accompanying escort or carer) being transported and will exercise reasonable care to ensure patient transport services are provided to a safe and high quality standard. 3 DEFINITIONS The Department of Health formal definitions for a non-emergency patient and non-emergency patient transport services are: A non-emergency patient is defined as a patient who, whilst requiring treatment, which may or may not be of a specialist nature, does not require an immediate or urgent response. n-emergency patient transport services are typified by the non urgent, planned, transportation of patients with a medical need for transport to and from premises providing NHS healthcare and between NHS healthcare providers. Volunteering is an important expression of citizenship and is fundamental to democracy. It is the commitment of time and energy for the benefit of society and the community, and can take many forms. Volunteering is an activity that involves spending time, unpaid, doing something that aims to benefit the environment or individuals or groups other an (or in addition to) close relatives ; this definition is taken from The Compact on Relations between Government and the Third Sector in England (December 2009) document. V1 page 5 of 17
4 POLICY 4.1 Service Provision PTS is a service that includes a wide range of vehicles such as mini buses, taxis and specialist ambulance services that are available for use by eligible patients using health care services within Walsall Community Health. Volunteer drivers use their own vehicles to provide safe transport for patients who are undergoing Cancer or Palliative Care treatment who have no other means of transportation. Volunteer drivers undergo appropriate HR checks and their vehicle documentation is checked on an annual basis. There may be a requirement for specialist staff to transport patients in their own vehicles. This is only permitted with line manager permission and appropriate risk assessments and vehicle business use insurance in place. 4.2 Operating Times PTS runs Monday Friday (excl. Bank Holidays) 8am 5pm. For Intermediate Care Services only an out of hours PTS is available by means of taxi or specialist ambulance service and is booked through the out of hours procedure. Volunteer driver transportation runs Monday Friday (excl. Bank Holidays) 9am 5pm. 4.3 Services currently offering Patient Transport Services Intermediate Care Services The Intermediate Care Service is based at Rushall Mews and operates 7 days a week, 8.30am 10.00pm. The Intermediate Care Services accepts admissions 365 days a year. Specialist Rehabilitation Services The Specialist Rehabilitation Service is based at Dartmouth House and operates Monday Friday (excl. Bank Holidays) 8.30am 4.30pm. Appointment times vary due to specific service areas. Little Bloxwich Day Hospice The Little Bloxwich Day Hospice is based in Stoney Lane, Bloxwich and operates Monday Friday (excl. Bank Holidays) 9.00am 5.00pm. Cancer and Palliative Care Volunteer Service The Cancer and Palliative care volunteer service is based at Blakenall Village Centre and operates Monday Friday (excl. Bank Holidays) 9.00am 5.00pm 5 ELIGIBILITY CRITERIA PTS / Volunteer drivers are not an automatic right for patients and the organisation expects patients to make their own way to and from appointments using public or private transport unless there is a clearly defined medical need for transport to be provided. The patient should be registered to a Walsall GP and / or live in the Walsall borough. V1 page 6 of 17
The patient should be able to get to and from their appointment in a reasonable time and in reasonable comfort without detriment to their medical condition. The patient may find that independent travel is more convenient with less risk of missing an appointment time. Health professionals should note that the use of public transport and existing facilities such as Ring and Ride should be promoted wherever possible. Cost to the patient of getting to the appointment is not a reason for granting transport and patients in receipt of mobility allowance (to help them get around) are not eligible for transport. 6 MEDICAL NEED The medical need for non-emergency PTS / volunteer driver must be established and must be determined by a healthcare professional or non-clinically qualified staff who are clinically supervised and employed by the NHS (or under contract for the NHS). The medical need will depend on an individual assessment of the medical condition and should only be arranged where it is judged that:- The patient s health would suffer through the use of public or private transport and it would be detrimental to the patient s condition if they were to travel by other means. The patient s medical condition impacts on their mobility to such an extent that they would be unable to access healthcare and / or it would be detrimental to the patient s condition to travel by other means. 7 SOCIAL OR FINANCIAL NEED A social or financial need cannot be defined as a medical need. Patients able to travel by public or private transport that are in receipt of income support, family credit or on low income may be able to receive help with their travelling expenses which are available from www.direct.gov.uk (HC11: Help with Health Costs) and / or by contacting Health Cost advice line on 0845 850 1166. 8 EXCEPTIONAL CIRCUMSTANCES The cost to the patient of getting to the appointment is not a reason for granting transport and patients in receipt of mobility allowance (to help them get around) are not eligible for transport and therefore except in very exceptional circumstances, should make their own way to their appointment, using those monies, which are paid specifically to help them to get around which includes attending primary and secondary care appointments. However, there may be times where a patient does not meet the eligibility criteria but requires transport for a limited period. This will be discussed on an individual basis with the Clinical Team Leader of the specialist service area. 9 TYPE OF TRANSPORT The type of transport allocated will be assessed from the initial assessment form by the transport co-ordinator / a delegated member of staff. Transport may vary from a mini-bus, taxi, volunteer driver or specialist ambulance service. Patient eligibility should meet the eligibility criteria as detailed except for the specialist ambulance services which also includes the following criteria:- Patient requires continuous oxygen. V1 page 7 of 17
Patient requires a stretcher. Patient requires a 2 or 4 man lift. 9.1 Staff Transporting Patients In exceptional circumstances staff may be required to transport patients in their own vehicles. This needs to be agreed with the appropriate Head of Service that it is appropriate for the role they are undertaking and the following precautions must be in place. The staff member must be covered by business use insurance that covers them for their professional position. The line manager is responsible for checking this is in place on a yearly basis and a copy should be located in the staff members personal file. The staff member must consent to using their vehicle for these purposes. Appropriate risk assessments / procedures should be in place to support the staff member i.e. in the event of a breakdown. All risk assessments in regard to staff transporting patients should be sent to the health and safety advisor for comments / review. 9.1.1 Exceptions A member of staff should only transport patients on a regular basis in their own vehicle under exceptional circumstances. 10 BOOKING CRITERIA A minimum of 48 hours notice is required for transport bookings (except for Intermediate Care Team emergency appointments). Transport bookings will only be accepted for a maximum period of 6 weeks. After 6 weeks, the clinician should reassess the patient s medical needs along with their transport needs and clearly document this in the patient s notes. If further transport is required, a new transport request should be completed. An initial assessment which identifies a medical need for transport should not be regarded as a continuous or ongoing arrangement. As a patient s medical condition improves or deteriorates the medical assessment for transport will also change. Patients should be aware of this prior to the commencement of their treatment. Patients should also be made aware that there is no guarantee of a volunteer driver following a request. If a volunteer driver cannot be allocated, the patient will be informed within 48 hours of their appointment time. Requests for patient transport may be challenged if it is felt that transport is not being booked on the basis of medical need and the patient does not meet the criteria. 11 ESCORTS Due to the limited space available on transport or the volunteer drivers vehicles, escorts will not be permitted unless the patient falls into one of the following categories:- Patients who have significant communication difficulties, including learning difficulties, impaired sight and / or hearing. V1 page 8 of 17
Patients who have a mental health problem which prevents them from travelling alone. Patients whose medical condition is such that they require constant supervision for their own safety. Patients who require a carer to assist them at their destination. Only one escort should travel with the patient under such circumstances detailed above and escorts should themselves be fit to travel. 12 WHEELCHAIRS Patients may travel in their specially adapted wheelchair on patient transportation. Patients may be able to bring their own wheelchair; however this will need to have been crash test certified. A standard wheelchair is available upon request by clinical staff for the purpose of travel. Volunteer drivers are not permitted to carry patients who require a wheelchair. 13 OXYGEN Oxygen has long been used in hospitals for the acute treatment of respiratory problems. As more acute services are expanding into the community there is an increased need for its use in community care. 13.1 Transportation of Patients with Portable Oxygen Patients attending day care or appointments in the community who require portable oxygen should not be discriminated against. There are known risks associated with the transportation of oxygen which are all clearly documented below. However, with appropriate control measures in place and health and safety guidance, patients who require portable oxygen should still have appropriate access to patient transport services. Volunteer drivers are not permitted to carry patients who require oxygen transportation. 13.2 Staff members transporting oxygen Staff may be required to transport oxygen as a requirement of their role. This could be due to the nature of service and drugs provided within a community setting. With some drugs carrying the risk of hypersensitivity and / or anaphylaxis reactions the transportation of oxygen is essential to maintain patient safety. 13.3 Known Risks Associated with the use of Portable Oxygen Oxygen is a known fire hazard. Given the correct conditions oxygen will accelerate established fires or encourage flammable substance to ignite. V1 page 9 of 17
Oxygen is not explosive. However, it can be absorbed into surrounding combustible material including clothing and hair. Should oxygen enriched material come into contact with fire; accelerated ignition can take place with disastrous consequences. Portable oxygen carries additional risks in that:- The varying environments where oxygen is being used are unpredictable and at times uncontrollable. The environment may be inappropriate for the safe use of oxygen therapy. Oxygen equipment may be at increased risk of damage during transportation People indirectly and directly exposed to the devices may have a lack of understanding and training about safety requirements. People may not be aware that oxygen is being used in the environment thus not take appropriate action to reduce the associated risks. 13.4 Transporting Oxygen Cylinders around the Borough All staff / PTS expected to carry oxygen in their vehicles whilst transporting patients or performing their daily work duties must adhere to the following instructions:- Involve the organisations health and safety representative in producing comprehensive risk assessments and ensuring safety precautions are in place, including relevant training (fire safety and air products training). Ensure the Head of Service is aware that oxygen is being transported and fully agrees that this is a requirement of the role and within the remit of the service provision. All cars / PTS carrying oxygen cylinders must display a warning sign in the back (offside rear) window at all times. The sign must be removed when oxygen is not being carried. Warning signs can be obtained from Air Product Healthcare. All occupants must refrain from smoking whilst travelling with oxygen cylinders in the vehicle. Care must be taken not to damage or drop the oxygen cylinder when placing or removing it from the vehicle. All staff must inform their insurance company that oxygen is being carried inside the vehicle. This must be documented in their personal file. PTS must inform their organisations motor insurance company that oxygen is being carried inside the vehicle. When being transported it is preferable that cylinders have protective covering and value caps in place. At least one 2kg dry powder fire extinguisher must be carried in the vehicle, in a separate compartment to the oxygen and in easy reach of the driver of car occupants. This equipment should be secure in the vehicle, not able to freely move around. Oxygen cylinders must be secured safely in the boot of the vehicle. Oxygen cylinders should never be transported on the front passenger seat. If transporting more than one cylinder they should be carried in a green safety box which can be obtained from Air Product Healthcare. Oxygen cylinders should never be stored in a vehicle when not in use but removed to a designated storage site. Care must be taken at fuel stations. Oxygen should never be used at fuel stations. Oxygen cylinders should be protected from extremes of temperature i.e. direct sunlight. Ventilation in the drivers cabin should be switched on and free flowing (to prevent oxygen enrichment in the event of a leak). In the event of an accident or breakdown advice the emergency services / vehicle breakdown service that oxygen is being carried. V1 page 10 of 17
Cylinders are to be clearly labelled: one green triangle to indicate pressurized gas and a yellow triangle to indicate oxidizing agent. Ensure cylinders are not stored next to highly flammable oils and greases and keep clear of ignition sources. 14 RESIDENTIAL NURSING HOMES Transport will be provided to residential nursing homes; however patients should meet the eligibility criteria. Escorts should accompany patients who receive 24 hour residential care to medical appointments, transport will be declined if an escort cannot be provided. 15 PERSONAL ITEMS It is the responsibility of the patient, patient s family, friend or carer to arrange transportation of their personal items. Drivers will not be held responsible for the transportation of personal items. 16 CONTROLLED DRUGS Arrangements should be in place prior to collection of the discharged patient for controlled drugs. Drivers and / or non-clinical staff are not allowed to sign for controlled drugs. Drivers will not be held responsible for the transportation of medications and / or drugs. 17 DISCHARGE Patients will not be left alone at their property following discharge. Arrangements should be in place for patients to be met appropriately by clinical staff, relatives, friends and/or carers. If this does happen, the driver will contact the Transport Co-ordinator / identified member of staff urgently and the driver will be instructed to return the patient to the pick up point. 18 CLINIC APPOINTMENTS Patients should not be left alone at their clinic appointments. Arrangements should be in place for patients to be met appropriately by clinical staff at the destination clinic. When patients are returned to their property it is not permitted for the driver to enter the patients home under any circumstances. 19 CONSULTANT APPOINTMENTS Transport for patients attending consultant appointments at Walsall Community Health is bookable via their GP. Eligibility criteria will apply and the medical need must be established and determined by the GP or non-clinically qualified staff who are clinically supervised and employed by the NHS (or under contract for the NHS). V1 page 11 of 17
Transport should not be regarded as a continuous or ongoing arrangement and as a patient s medical condition improves or deteriorates the medical assessment for transport will also change. Patients should be made aware of this prior to the commencement of their treatment. 20 ADVERSE WEATHER CONDITIONS In the event of adverse weather conditions, a decision will be made on a daily basis as to the cancellation of transport. If this happens the transport co-ordinator / identified member of staff will telephone and cancel all patients who have planned appointments. An identified member of staff will also contact all of the volunteer drivers to update them on any clinic cancellations. For Intermediate Care Services only: a risk assessment will be carried out at the patient s property prior to home visit / discharge to ensure patient and staff safety. A driver and escort will be provided to ensure safe transportation of the patient (if appropriate). 21 SAFETY Any concerns raised by patients, staff and / or drivers regarding patient, staff or driver safety will be taken seriously and investigated. A risk assessment will be completed by a trained risk assessor in line with organisational policies and procedures which may result in withdrawal of patient transport services for an individual patient if deemed unsafe for patient, staff and / or drivers. If a patient is unhappy with this decision, the patient can write to NHS Walsall Community Health Customer Services Lichfield House Lichfield Street Walsall WS1 1TE Any additional advice or guidance in regard to health and safety matters can be sought from the organisations health and safety advisor. 22 CODE OF CONDUCT Centre Staff & Volunteers will assist all users in a professional, polite and courteous way. Centre staff will expect to be treated in the same way and verbal abuse, violence or aggression towards staff will not be tolerated. NHS Walsall Community Health has a zero tolerance policy towards violence or abuse towards its staff, and legal action will be taken where necessary. All centre staff and volunteers will treat any personal information of users in line with NHS Walsall Community Health s confidentiality policy, and offer a confidential service to users, including the use of private space if requested. V1 page 12 of 17
23 DISSEMINATIONS AND IMPLEMENTATION The Head of Risk Management will ensure this policy is disseminated throughout the organisation by posting in PDF format on the Intranet / Walsall Community Health Internet. 24 DOCUMENT CONTROL AND ARCHIVING This will be controlled by version number. The most up to date version will be available on the intranet. 25 MONITORING COMPLIANCE AND EFFECTIVENESS 25.1 Process for Monitoring Compliance and Effectiveness Monitoring compliance with this policy will be the responsibility of the Operational Manager for n Clinical Palliative and End of Life Care. Compliance with the policy will be monitored by ensuring that all materials provided comply with the quality criteria outlined in the policy and that a database of materials is maintained. 25.2 Standards/ Key Performance Indicators Key performance indicator comprises: Ongoing monitoring of electronic Information Centre database by: Information Centre Coordinator. 25.3 Data Collection Data will be gathered on the number of users Information and Support Services has supported and also the level of intervention required for each user. Data will also be gathered on the topic of information or service area that the users have requested. 25.4 Comments Suggestion Box A Suggestion Box for users comments will be located in the Centre. NHS Walsall Community Health actively seeks feedback on its services from users. Centre staff will encourage users to complete the comments slip, in order to gain public feedback on NHS Walsall Community Health services including those in the Information Centre. 25.5 Satisfaction Surveys The service will use satisfaction surveys annually to identify what users think about the service, providing users with an opportunity to constructively feedback to help with service improvement and development. 25.6 Audits V1 page 13 of 17
User records and data collection systems will be audited to ensure that they meet with NHS Walsall Community Health policies and procedures. Audits will be monitored by the Governance Department. 25.7 Equality Impact Assessment NHS Walsall Community Health aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. An Equality Impact Assessment has been undertaken and there are no adverse or positive impacts (see Appendix A). 26 REFERENCES Department of Health (2006) The White Paper: Our Health, Our Care, Our Say: a new direction for community services: London. HMSO. Department of Health (2009) Eligibility Criteria for Patient Transport Services; London. HMSO. The British Compressed Gases Association (BCGA) published GN5 (1998) The Safe Use of Oxygen Enriched Atmospheres when Packaging Food. This was reviewed in 2002 and not yet been reissued, HSE (2004) Discipline Information te. Review of development in the use of oxygen. www.hse.gov.uk/foi/internalops/hid/din/557.pdf V1 page 14 of 17
APPENDIX A Equality Impact Assessment Title of the policy/guidance: Transportation Policy Yes/ 1 Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2 Is there any evidence that some groups are affected differently? 3 If you have identified potential discrimination, are any exceptions valid, n/a legal and/or justifiable? 4 Is the impact of the policy/guidance likely to be negative? (If no, please go to question 5.) If so can the impact be avoided? What alternatives are there to achieving the policy/guidance without the impact? Can we reduce the impact by taking different action? 5 Health inequalities 6 Please consider the following questions relating to Human Rights Act: Will it affect a person s right to life? Will someone be deprived of their liberty or have their security threatened? Could this result in a person being treated in a degrading or inhuman manner? Is there a possibility that a person will be prevented from exercising their beliefs? Will anyone s private and family life be interfered with? Comments Is further detailed impact assessment required? Name Role Date completed Outcome Sally Killian Operational Manager for n Clinical Palliative & End of Life Care V1 page 15 of 17
APPENDIX B Checklist for the Review and Approval of Procedural Document Title of document being reviewed: Yes/ Comments 1. Title Is the title clear and unambiguous? It should not start with the word policy. Is it clear whether the document is a guideline, policy, protocol or standard? 2. Rationale Are reasons for development of the document stated? This should be in the purpose section. 3. Development Process Is the method described in brief? This should be in the introduction or purpose. Are people involved in the development identified? See contributions list Do you feel a reasonable attempt has been made to ensure relevant expertise has been used? Is there evidence of consultation with stakeholders and users? 4. Content Is the objective of the document clear? Is the target population clear and unambiguous? Are the intended outcomes described? Are the statements clear and unambiguous? 5. Evidence Base Is the type of evidence to support the document identified explicitly? Are key references cited? Are the references cited in full? Are supporting documents referenced? See metadata 6. Approval Does the document identify which committee/group will approve it? If appropriate have the joint Human Resources/staff side committee (or equivalent) approved the document? N/A 7. Dissemination and Implementation Is there an outline/plan to identify how this will be done? See metadata Does the plan include the necessary training/support to ensure compliance? 8. Document Control V1 page 16 of 17
Title of document being reviewed: Yes/ Comments Does the document identify where it will be held? internet Have archiving arrangements for superseded documents been addressed? 9. Process to Monitor Compliance and Effectiveness Are there measurable standards or KPIs to support the monitoring of compliance with and effectiveness of the document? Is there a plan to review or audit compliance with the document? 10. Review Date Is the review date identified? See metadata Is the frequency of review identified? If so is it acceptable? See metadata 11. Overall Responsibility for the Document Is it clear who will be responsible for co-ordinating the dissemination, implementation and review of the documentation? author Lead Director If you are assured that the correct procedure has been followed for the consultation of this policy, sign and date it and forward to the chair of the committee for ratification. Name Signature Date Ratification Committee Ratification Committee Approval If the committee is in agreement to ratify this document, can the Chair sign and date it and forward to the \Head of Assurance Name Date Signature V1 page 17 of 17