Supporting patients to attend appointments

Health boards should provide patients with information regarding the various transport options available to them in their local area including:

Public transport
Community transport
Hospital volunteer transport
Third sector support to attend appointments
Taxis
Non-emergency patient transport (subject to eligibility criteria)

Follow this link for information about the Welsh Ambulance Service Non-Emergency Patient Transport Service (NEPTS)

SBUHB will support patients to inform services if they have any barriers to attending appointments including mobility issues, caring responsibilities and health issues which impact on patient’s ability to travel so a suitable plan can be agreed.

SBUHB will maximise virtual appointments and one-stop clinics in line with clinical need to minimise the need for patients to travel to a hospital site.

Where available, SBUHB will support the use of public transport, community transport including community car-pool schemes and eco-friendly transport partnerships, volunteer drivers and taxis (as appropriate).

Some patients may be expected to travel outside their local health board area to access care. In some cases, this may involve patients travelling longer distances to access services in NHS England or with English independent providers commissioned to deliver services on the health board’s behalf. SBHB will ensure that services adopt a patient-centred approach to booking appointments, considering the patient’s individual needs, to maximise attendance and access to healthcare.

When commissioning services from external providers, SBHB will ensure that as part of this arrangement, a travel plan is in place as part of the care offer. This should include transport for all patients accessing care from commissioned providers, from the point of their local hospital to the external provider site. Additional support should be provided as appropriate for patients with more complex needs in line with the Patient Travel Policy eligibility criteria.

SBUHB effectively communicates the potential need to travel for planned care to all patients at the earliest opportunity. This is included in:

Community Health Pathways where patients can receive information at the point of referral.
Patient information leaflets
Confirmation of acceptance of referral letter.
Health board planned care landing pages.

The SBUHB Travel Policy reflects the consistent and accurate application of the most current RTT guidelines (see Appendix I).

SBUHB will ensure the Policy is communicated to all staff and that their roles and responsibilities in its implementation are clearly understood.

It is recognised that people living in more rural areas of Wales may have reduced access to public transport links. SBHB will consider access to public transport when booking appointments with patients where practicable. This may include timing of appointments to allow time to travel on public transport, this should be discussed and agreed with patients.

SBUHB will include links to Welsh Ambulance Service Non-Emergency Patient Transport Service (NEPTS) NEPTS information in their local Travel Plan which should be communicated to professionals and the public to facilitate patient access to travel support.

The cost of transferring patients from one hospital to another, or to a clinic, or nursing home as part of their treatment should be regarded as part of their treatment cost. Similarly, the travel costs of patients sent home as either part of their treatment (e.g., Home First), or to meet a hospital’s convenience should be regarded as part of their treatment costs.

If it is assessed that a patient requires an escort, a family member, carer, or friend may travel with the patient. The escort must be an able-bodied adult. Escorts will have their expenses refunded based on the eligibility of the patient (see Escorts below).

Escorts

The Policy should clearly state when funding for an escort will be authorised.

Escorts will be funded if this is required for medical reasons, for example:

Where the patient has a significant physical or mental disability that necessitates the support of another person to travel safely.
Where the patient is undergoing a procedure or therapy that results in them requiring assistance to travel home.
Where the patient is attending an appointment that involves self-management that a carer or relative will be undertaking on their return home.
Where the patient lacks the mental capacity to take decisions or has a legal guardian.

Escorts may be funded in other circumstances where:

The parent or guardian of a child under 16 years of age accompanies them to the hospital or clinic. Only the travel costs of one escort will be funded, unless a clinician determines a medical reason for the child to be accompanied by two adults. Siblings of the child patient to also travel with parent escort(s) will not be provided for under the terms of the policy.
The patient is aged between 16 and 18 and requests a parent or guardian to accompany them.

Escorts are not funded for pregnant women attending a hospital or clinic, unless there is a medical reason, e.g. multiple births, complications, or an inability to lift.

Non-emergency patient transport (NEPT)

The Welsh Ambulance Service Trust (WAST) provides transport to patients who meet specified criteria to attend hospital appointments including:

Outpatient appointments.
Dialysis and Oncology treatment.
Day centre and psycho-geriatric clinics.
Planned admissions and discharges including inter-hospitals transfers.

Follow this link for the Non-Emergency Patient Transport Service (NEPTS) - Welsh Ambulance Services University NHS Trust.

Patients are eligible for NEPT if they meet any of the following criteria:

They suffer with Motor Neurone Disease
They are undergoing Renal Treatment
They are undergoing Oncology Treatment
They need support from walking aids.
They use their own wheelchair.
They need to travel in a stretcher.
They require oxygen.
They have medical needs that prevent them using public transport.

Healthcare Travel Costs Scheme (HTCS)

(HTCS) found in Welsh Health Circular WHC/2017/006. This is a mandatory scheme under the National Health Service (Travelling Expenses and Remission of Charges) (Wales) Regulations 2007 which came into force on 1 April 2007 and was amended in 2010.

Reimbursement of travel costs should be made to those patients who do not have a clinical need for non-emergency patient transport, but who require assistance with their travel costs.

All patients who are on low income or benefits as defined by the regulations are entitled to reimbursement of necessary travelling expenses and are refunded at the agreed local mileage rate or public transport costs.

The NHS Patient Travel Policy should clearly state which forms are required for each scheme and this should be clearly communicated to the patient.

The Policy should clearly indicate the process patients are required to follow to claim reimbursement of their travelling costs including:

The need to provide proof of entitlement along with evidence of their appointment/treatment to enable the NHS to process their claim.
Deadlines for claiming reimbursements, e.g., 3 months following the date of their appointment.
Who they can claim for (if they are entitled to claim for an escort to accompany them)
The eligibility for escorts.
Any relevant travel costs/cap rates which can be claimed.
Where the forms should be taken or sent.
Means of reimbursement, e.g., cash, cheque.
How long it takes to process their claim.

SBUHB must ensure that the claimant is entitled to such help and that no fraudulent claims are processed in line with health board financial control procedures.

Eligibility criteria and qualifying benefits and allowances

All patients who are referred to a hospital, regional centre or other health care providers commissioned by the health board for specialist treatment or diagnostic tests may be eligible to claim a refund of reasonable travel costs under the Healthcare Travel Costs Scheme (HTCS).

Patients should be reimbursed for reasonable travelling expenses in respect of direct travel to and returning from a clinical appointment for treatment deemed to be clinically necessary and booked in-line with NHS Access to Treatment policies, at a hospital or similar setting as defined above.

As stipulated by the Healthcare Travel Costs Scheme (HTCS), patients MUST meet ALL the following criteria to qualify for either full or partial reimbursement towards travel costs incurred to attend appointments:

At the time of the appointment, the patient, or their partner (including civil partner) must receive one of the qualifying benefits or allowances listed in Appendix II or meet the eligibility criteria for NHS Low Income Scheme (See Appendix III).
The patient must have a referral for specialist care from a healthcare professional to a secondary care specialist or a hospital for further NHS treatment or tests.
The appointment must be on a separate visit to when the referral was made. This applies whether treatment is provided at a different location (hospital or clinic) or on the same premises as where the GP or another health professional issued the referral.

Children under 16 whose parents or guardians meet the eligibility criteria are entitled to reimbursement under the HTCS scheme.

Young people aged 16-18 who are in full-time education and whose parents or guardians meet the eligibility criteria are entitled to reimbursement under the HTCS scheme.

Young people aged 16-18 and classed as a dependant of someone who meets the eligibility criteria are entitled to reimbursement under the HTCS scheme.

The costs of overnight accommodation are not available under the Scheme.

Patients travelling abroad for treatment arranged and paid for by the NHS may claim reimbursement of their necessarily incurred travel costs to a port in Great Britain under HTCS. However, the reimbursement of the travel costs necessarily incurred from this port to their place of treatment may not be paid through HTCS. The reimbursement of these costs should be claimed through an application in writing to the health board which arranged the services within 3 months of the expenses having been incurred or such further period as that body may for good cause allow.

Exclusions to the scheme

Exclusions to the HTCS include:

Patients who attend an establishment to receive primary medical or primary dental services.
Patients who attend a hospital to receive NHS services but have not been referred for those services by a doctor, optometrist, or dentist (e.g.: self-referral).
Patients who have a medical need for ambulance transport – this is provided through Non-Emergency Patient Transport Services (NEPTS) commissioned by health boards and NHS trusts (see above).
Private patients.

Calculating reimbursements and ‘reasonableness’

Where patients meet the eligibility criteria set out above, the 2007 Regulations state that the amount of any NHS travel expenses to be reimbursed must be calculated by reference to the cost of the cheapest means of transport, which is reasonable, having regard to the patient’s relevant circumstances.

The test of reasonableness is made on the basis that the patient should be able to reach the hospital in a reasonable time and without detriment to their health and well-being. When assessing a patient’s claim, the NHS should consider issues such as:

the distance that the patient has to travel.
how long the journey has taken to complete.
whether the patient has to make the journey frequently.
the availability, suitability, and accessibility of public transport.
the medical condition of the patient.
the age of the patient,
the time of the appointment.

In all cases, patients (or their parents / guardians) should be asked to produce proof of entitlement before their expenses are reimbursed. Proof will be required on each occasion, as an individual’s eligibility may change.

In all cases, patients (or their parents / guardians) should be asked to produce receipts relating to travel costs incurred before their expenses are reimbursed.

Patients are expected to use the most cost-effective means of transport suitable to their needs. The final decision as to what is considered ‘the most reasonable means should rest with the health board. relative/carer. Places may be offered if there is space, it does not affect the aircraft efficiency and does not impede clinical care.

Only mileage where a patient is in a vehicle is refundable. Return legs of journeys where a relative or friend has dropped a patient off cannot be claimed.

Costs associated with loss of earnings, meals, parking, or motoring fines will not be reimbursed under the policy.

If a patient uses the transport provided/funded by the health board and does not attend the appointment, the health board should write to the patient to seek an explanation for why they used the NHS funded transport but did not attend their appointment. Failure to provide a reasonable explanation within 14 days for the cancellation will result in an invoice being issued to the patient for the full cost incurred.