Transport support for patients attending in-centre haemodialysis

In August 2021, NHS England and NHS Improvement published the outcome of a review into non-emergency patient transport services (NEPTS). The review set out a new national framework for NEPTS, with the aim of ensuring that services are consistently responsive, fair and sustainable.

Part of meeting that aim is a recommendation for the introduction of an updated eligibility criteria that built on the high-level criteria set out by the Department of Health in their guidance in 2007. Following extensive engagement with commissioners, providers, patient groups (including Age UK, Kidney Care UK and Healthwatch), and a public consultation, the updated eligibility criteria were published in May 2022.

Included in the updated Eligibility Criteria is a universal commitment of transport support for patients attending in-centre haemodialysis. This document provides guidance to patients, patient groups, haemodialysis units, transport providers and commissioners in support of that universal commitment for transport support.

Who is eligible?

All patients registered with a GP in England who are receiving in-centre haemodialysis should be offered transport support. This offer applies to journeys to or from in-centre haemodialysis only, though dialysis patients attending another type of appointment, or who are being discharged, may be eligible for NEPTS if they meet another of the NEPTS eligibility criteria. Further, subject to meeting the qualifying criteria, dialysis patients may be able to claim support with travel costs from the Healthcare Travel Cost Scheme (HTCS) for other appointment types.

The universal commitment to offering transport support does not mean a universal commitment to provide a NEPTS resource. Rather, the commitment is for the NHS to support a patient’s transport to and from in-centre haemodialysis and/or help them decide which transport option best meets their requirements.

An overarching principle of NEPTS is that most people should travel to and from hospital independently by private or public transport, with the help of relatives or friends if necessary. NHS-funded non-emergency patient transportation is reserved for when this is essential to ensure an individual’s safety, safe mobilisation, condition management or recovery. This principle applies for patients attending in-centre haemodialysis just as it does to other patients, but we are committed to providing enhanced support to those who can travel more independently.

As such, systems should implement flexible mechanisms that offer transport support to:

a) Patients (including friends or family) who are able to travel independently but require reimbursement or a form of expense payment. This includes:

  1. patients who are eligible for the HTCS
  2. patients who require upfront financial support
  3. patients who are happy to be reimbursed.

b) Patients who have a need to travel by NEPTS.

There is no requirement for patients to take up this offer. However, they should be made aware of this and any other related support such as the free car parking offer and any transport signposting services if they are available.

The universal offer of transport support does not extend to a patient’s relatives, friends, escorts and/or carers unless the associated criteria for escorts and carers in the NEPTS eligibility criteria are met. If they are not, an escort or carer is not eligible to travel via NEPTS or to be funded to travel by public transport.

Dialysis away from base

Due to the nature and frequency of treatment, patients may need to have their haemodialysis at a centre other than their usual one, e.g., when they are on holiday. The specific dialysis away from base (DAFB) policy outlines the funding arrangements and the responsibilities of renal units and patients when arranging DAFB.

As part of the universal offer of transport support, when DAFB arrangements are being made the patient’s transport requirements should be considered and agreed. The NHS Who pays? guidance sets out the mandatory rules for establishing the organisation responsible for commissioning, and therefore paying for, NHS services for an individual and that ‘responsible commissioner’ should be party to the arrangements.

The offer of transport support is made to patients registered with a GP practice in England. It does not extend outside England, such as when the DAFB and/or the temporary location of the patient requiring DAFB is not in England.

Transport support

To meet the universal offer of transport support systems should:

a) Ensure that, as part of the principle of shared decision-making, transport to and from in-centre haemodialysis is included in all dialysis planning meetings for relevant patients. For patients currently attending in-centre haemodialysis, systems should consider whether a specific transport-focused meeting is appropriate to ensure transport support is offered as soon as is practically possible.

b) Consider implementing mechanisms to offer patients the following options for transport to and from in-centre haemodialysis:

Option 1: no transport support requirement

Option 2: patient is reimbursed via the HTCS

Option 3: patient is reimbursed by a locally developed reimbursement scheme

Option 4: patient has an agreed Personal Health Budget

Option 5: patient is provided transport by NEPTS in line with their support needs. This may be non-specialist transport, such as a taxi, or if medical needs necessitate, specialist transport.

c) Ensure that patients attending in-centre haemodialysis are aware of the NHS car parking guidance, specifically that car parking at NHS trusts and foundation trusts is available free of charge to outpatients who attend a hospital appointment at least three times a month for at least three months. While this is a separate area of policy, car parking should be considered as a constituent of the universal support offer.

Patients must be fully informed and involved in decisions about the right transport offer for them, in line with the principles of shared decision making and eligibility criteria. This shared decision making should, where possible, be flexible  and acknowledge that a patient may need a different approach for inward and outward journeys and may vary over time. Further, a patient’s medical condition post dialysis may require a change in approach at short notice.

Where a patient is transported by NEPTS, the type of provision (specialist or non-specialist) should be in line with the patient’s support needs. The 2021 review of NEPTS highlighted the scope for many areas to make greater use of non-specialist transport within their NEPTS service and the assessment of needs and shared decision-making process should consider NEPTS based on needs, local availability and value for money.

Where a patient receives reimbursement of costs through a local scheme or HTCS, it is important to aim for a simple and timely reimbursement of expenses incurred by the patient.

We envisage that dialysis units will have a key role in explaining the travel options to a patient and helping the reach a shared decision on which is best for them. In addition, dialysis units, clinicians and patients can also get help with discussing the transport support offer from renal networks and patient groups such as Kidney Care UK.