1. Purpose
This policy sets out how the Service checks patient fitness for transport, plans safe journeys and escalates when a patient's needs do not match the booked vehicle, Crew or equipment.
The policy is written for planned patient transport, including hospital-to-hospital transfer, hospital-to-home discharge, clinic transport, bariatric transport and end-of-life transport.
2. Sources to verify before adoption
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 9: https://www.legislation.gov.uk/uksi/2014/2936/regulation/9
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 11: https://www.legislation.gov.uk/uksi/2014/2936/regulation/11
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12: https://www.legislation.gov.uk/uksi/2014/2936/regulation/12
- Mental Capacity Act 2005, section 1: https://www.legislation.gov.uk/ukpga/2005/9/section/1
- Mental Capacity Act 2005, section 2: https://www.legislation.gov.uk/ukpga/2005/9/section/2
- CQC guidance on Regulation 9 person-centred care: https://www.cqc.org.uk/guidance-providers/regulations/regulation-9-person-centred-care
- Royal College of Nursing inter-facility transfer guidance, current edition, checked by the Service before adoption.
3. Scope
This policy applies to:
- planned patient transport bookings
- high-dependency transfers accepted by the Service
- bariatric transport
- long-distance patient transport
- end-of-life transport
- patient consent to transport
- booking information supplied by a referring clinician, booking facility or commissioner
- crew on-arrival checks before loading
- deterioration, refusal, cancellation or change of destination during a journey
This policy does not allow the Service to accept a journey beyond its registered activity, insurance, vehicle, equipment, staffing or clinical scope.
4. Patient assessment and fitness for transport
The Service uses a layered assessment process before and during the journey.
4.1 Booking assessment
The booking facility or referring clinician confirms the patient's transport need and fitness to travel.
The booking record captures:
- patient identity and destination
- reason for transport
- mobility and transfer needs
- infection prevention requirements
- clinical observations needed during transport where relevant
- oxygen need and oxygen source
- medicines or infusion information where relevant
- escort requirement
- communication, sensory or cognitive needs
- safeguarding or behaviour risk where relevant
- bariatric equipment need where relevant
- end-of-life care plan or comfort need where relevant
- named clinical contact for escalation
The Service does not treat a booking request as automatic acceptance. The Operations Manager or delegated dispatcher checks that the journey matches available Crew, vehicle, equipment and route plan.
4.2 Crew on-arrival check
Crew complete an on-arrival check before loading the patient.
Crew check:
- the patient's identity
- the journey and destination
- whether the patient appears fit for the planned transfer
- whether the patient's presentation matches the booking information
- whether required paperwork, medicines, oxygen or equipment is present
- whether the patient agrees to travel, where they have capacity for that decision
- whether a representative, escort or receiving facility needs updated information
- whether manual handling and vehicle equipment remain suitable
If the patient's presentation does not match the booking, Crew pause loading and contact the control point or Lead Clinician.
4.3 Capacity and consent for transport
The Service treats consent to transport as decision-specific.
Section 1 of the Mental Capacity Act 2005 includes this load-bearing wording: "A person must be assumed to have capacity unless it is established that he lacks capacity." Staff check the current legislation.gov.uk text before using this policy.
Crew support the patient to decide where possible. Support may include:
- plain explanation of the journey
- time to ask questions
- communication aid
- involvement of family, carer or advocate where lawful and appropriate
- checking whether pain, distress, fatigue or environment is affecting the decision
Where the patient may lack capacity for transport, Crew contact the Lead Clinician or referring clinician before transport continues unless an immediate safety issue prevents delay. The record explains the decision, advice received and least restrictive option used.
4.4 Bariatric assessment and equipment match
The Service confirms bariatric need before accepting the job.
The booking and dispatch record checks:
- patient weight where available and needed for equipment selection
- mobility and transfer method
- number of crew needed
- vehicle capacity
- stretcher, ramp, tail-lift and restraint suitability
- route access at collection and destination
- privacy and dignity arrangements
- contingency plan if equipment does not fit the environment
Crew stop and escalate if the equipment, vehicle or staffing on arrival does not match the patient's need.
5. Journey planning
The Service plans the journey before dispatch and updates the plan if the patient's needs change.
5.1 Standard journey plan
The Operations Manager or delegated dispatcher records:
- collection point
- destination
- planned route
- estimated journey time
- receiving contact
- vehicle assigned
- crew assigned
- patient-handling equipment
- escort arrangement
- infection prevention precautions
- handover documentation needed
The plan considers road conditions, distance, patient comfort, collection access and receiving-facility availability.
5.2 Long-distance journey plan
For long-distance transfer, the Service records additional planning.
The plan includes:
- rest stops and comfort breaks
- patient positioning and pressure-area risk
- nutrition, hydration and toileting plan where relevant
- oxygen need and cylinder capacity checked against current local source material
- medicine continuation plan supplied by the referring clinician
- communication plan with the receiving facility
- escort decision
- contingency plan for delay, deterioration or vehicle breakdown
Staff do not calculate oxygen need from memory. They use current equipment instructions, local clinical guidance and the patient's documented prescription or care plan.
5.3 End-of-life transport
For end-of-life transport, the Service keeps the journey calm, dignified and aligned to the patient's plan.
The booking record checks:
- destination and reason for transfer
- comfort needs
- anticipatory medicine or symptom plan supplied by the clinical team where relevant
- ReSPECT, DNACPR or advance care planning document where provided
- family or carer escort arrangements
- contact details for the responsible clinician
- plan if the patient deteriorates or dies during transport
Crew do not interpret DNACPR as a full care plan. They follow the transport plan, current clinical advice and their local escalation route.
6. Deterioration en route
If a patient deteriorates during transport, Crew act within role, training and scope.
Crew:
- stop the vehicle where safe
- provide immediate support within scope
- call emergency services where required
- contact the Lead Clinician or control point
- contact the referring or receiving clinician where appropriate
- document the change in condition
- update destination if advised and safe
- record an incident after the immediate situation is managed
The incident review checks whether the booking information, on-arrival check, crew scope, vehicle allocation or journey plan should have identified the risk earlier.
7. Responsibilities
- Registered Manager: owns this policy, ensures safe acceptance criteria are in place and signs off annual review.
- Lead Clinician: advises on clinical fitness, deterioration, scope limits and transport decisions that need clinical review.
- Operations Manager: ensures booking, dispatch, vehicle allocation, route planning and escalation arrangements are documented.
- Crew: complete on-arrival checks, support consent, stop unsafe loading and escalate mismatch or deterioration.
- Booking staff: record required information and do not accept journeys that lack essential clinical, mobility or destination information.
- All staff: record concerns promptly and do not pressure Crew to continue a journey that they have escalated as unsafe.
8. Recording requirements
The Service keeps the following records:
- booking assessment
- referring clinician or booking-facility fitness confirmation
- journey plan
- vehicle and crew allocation
- equipment match
- capacity or consent concern record
- on-arrival crew check
- bariatric transport plan where used
- long-distance journey plan where used
- end-of-life transport plan where used
- deterioration record
- incident and improvement action records
Records are kept in the Service governance records and are available for internal review, CQC review, commissioner review and external review where required.
9. Audit cadence
The Service uses the following Verivius default audit rhythm unless current CQC, MCA, commissioner, RCN or local source material requires a different rhythm:
- Weekly: the Operations Manager reviews incomplete booking assessments, rejected journeys and journeys changed after crew on-arrival check.
- Monthly: the Lead Clinician reviews deterioration, capacity, consent, bariatric and end-of-life transport records.
- Quarterly: the Registered Manager reviews patterns by booking facility, route, vehicle type, crew mix and receiving destination.
- Annually: the Service audits this policy against current source material and updates the acceptance criteria.
Audit findings are recorded as improvement actions with an owner and review date.
10. Version control and review date
The Service keeps a controlled copy of this policy. The footer or document-control table records:
- policy owner
- version number
- date approved
- next review date
- changes made since the last version
- source material checked during the review
11. Related records
- Booking assessment
- Journey plan
- Vehicle defect, MOT and roadworthiness policy
- Crew clinical scope and competency policy
- Transfer of care and patient handover policy
- Incident register
- Safeguarding policy
- Duty of candour policy
- Improvement action register
- Risk register
Review cadence: annual or on regulatory change, whichever sooner. Owner: Registered Manager.