Introduction
In August 2021, NHS England 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.
We worked with stakeholders to develop these NEPTS mobility categories, to assist integrated care systems (ICSs) in planning their process for commissioning these services and providers in provision of their services. This is best practice guidance, reflecting the collective insight of the NHS and wider stakeholders. Following this guidance is not a statutory requirement or a mandatory requirement on integrated care boards (ICBs) but is intended to:
- improve service responsiveness and enable investment and innovation
- provide consistency and standardisation across contracts
- incentivise responsiveness and enable learning and accountability.
Within the updated eligibility criteria is a set of qualifying criteria, one of which is having a significant mobility need:
They have a significant mobility need that means they are unable to make their own way with relatives/friends and/or escorts/carers whether by private transport (including a specially adapted vehicle if appropriate for the journey), public transport or a taxi.
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 with a mobility need just as it does to other patients.
Further, each patient has their own support needs for their NEPTS journey which, in turn, determines the type and nature of the resource(s) required. The level of support need is classified by a mobility code and description which, currently, varies across providers/commissioners. The mobility codes are then a fundamental part in service/journey planning, ensuring the right resource is allocated to the right patient.
This document introduces a national standard set of mobility codes and descriptors to support transport providers and commissioners to determine the right level of resource requirements to match a patient’s mobility need, to support improved commissioning and to improve transparency of the service to enable benchmarking and service improvement.
Mobility categories
Following engagement with stakeholders, including providers and commissioners, a new national set of mobility codes, descriptors and definitions has been produced. The mobility descriptors are separated into 5 high-level categories which all the sub-categories feed into. Each sub-category includes the number of crew required and a list of mobility definitions.
The high-level categories are listed below:
- Walker (W)
- Double crew (DC)
- Wheelchair (WC)
- Stretcher (ST)
- Complex (C)
The full set of mobility descriptors and definitions is provided below:
| Mobility category | Mobility category | Number of crew* | Mobility definitions |
|---|---|---|---|
| Walker | W | ||
| Walker | W1 | 1 | Able to bend into a car |
| Can manage their own mobility needs | |||
| Requires no lifting or moving | |||
| No specific medical assistance requirements during the journey | |||
| Walker with assistance | W1A | 1 | Unable to bend into a car |
| May require assistance from driver | |||
| Requires no lifting or moving | |||
| No specific medical assistance requirements during the journey |
| Mobility category | Mobility code | Number of crew* | Mobility definitions |
|---|---|---|---|
|
Double Crew |
DC |
|
|
|
Double crew 2 |
DC2 |
2 |
Requires the assistance of a 2-person crew to/from the vehicle and/or during the journey |
|
May require lifting or moving | |||
|
May require a wheelchair/carry chair from/to home/appointment to/from vehicle | |||
|
Can transfer from wheelchair to vehicle with support |
| Mobility category | Mobility code | Number of crew* | Mobility definitions |
|---|---|---|---|
|
Wheelchair |
WC |
|
|
|
Wheelchair 1 |
WC1 |
1 |
Needs to travel in their own wheelchair |
|
May require assistance to and from the vehicle | |||
|
There is simple access at home and destination (no more than one step) | |||
|
Wheelchair 2 |
WC2 |
2 |
Needs to travel in their own wheelchair |
|
May require assistance to and from the vehicle/during the journey. | |||
|
There are steps at home and/or destination | |||
|
Electric wheelchair 1 |
EWC1 |
1 |
Needs to travel in their own electric wheelchair |
|
May require assistance to and from the vehicle | |||
|
There is simple access at home and destination (No more than one step) | |||
|
Electric wheelchair 2 |
EWC2 |
2 |
Needs to travel in their own electric wheelchair |
|
May require assistance to and from the vehicle/during the journey. | |||
|
There are steps at home and/or destination |
| Mobility category | Mobility code | Number of crew* | Mobility definitions |
|---|---|---|---|
|
Stretcher |
ST |
|
|
|
Stretcher |
ST2 |
2 |
Requires transportation whilst on a stretcher |
|
Needs to travel on a stretcher for the duration of the journey | |||
|
May require assistance during the journey |
| Mobility category | Mobility code | Mobility code | Mobility definitions |
|---|---|---|---|
|
Complex |
C |
|
|
|
Bariatric wheelchair | BWC2 | 2 |
Needs to travel in their own bariatric wheelchair |
|
|
|
|
May require assistance to and from the vehicle/during the journey |
| Bariatric stretcher | BST2 | 2 |
Requires transportation whilst on a stretcher
|
|
Needs to travel on a stretcher for the duration of the journey
| |||
|
May require assistance to and from the vehicle/during the journey
| |||
|
Multi-crew 3 |
MC3 |
3 | Requires 3 staff |
|
A risk assessment is usually completed to determine if specialist equipment is necessary. | |||
Multi-crew 4+ | MC4+ | 4+ |
Requires 4 or more staff |
|
A risk assessment is usually completed to determine the number of crew required and if specialist equipment is necessary. |
* Number of crew: 1 crew member includes the driver only
Additional requirements
In addition to the set of mobility categories above, providers will need an ‘additional requirements’ section to identify any additional support requirement a patient has, for example, escorts, child seats and equipment. Whilst separate to the mobility needs, this information should be captured in a booking form and forms part of the planning process. The information also needs to be reportable in datasets.
Adoption
Commissioners and providers should implement this set of mobility categories as soon as practically possible. However, it is understood that these mobility codes may vary from the codes currently in use and therefore providers may need to map their current codes to the national codes as an interim solution. Systems should develop a realistic, but timely, implementation plan.
Systems may wish to include additional sub-categories to meet the needs of their local populations/service, but each would need to be mapped to one of the national sub-categories introduced. Future iterations of the national minimum dataset will include data captured at mobility sub-category level.
As specified within the commissioning, contracting and core standards guidance, estimating activity from actual activity data is a key element of commissioning NEPTS. Therefore, a breakdown of activity by mobility codes is required to improve commissioning decisions and service provision, and it should also assist anticipation of changes in demand.
NHS England have completed an Equality and Health Inequalities Assessment of the introduction of these mobility descriptors and definitions. However, systems should complete their own Equality and Health Inequalities Assessment and Quality Impact Assessment as part of the implementation process.
Publication reference: PRN00338