Ministerial Decision- Patient Air Transfers
Supplementary Report
Background
The Health & Social Services Department (HSSD) chartered aircraft for 158 emergency patient transfers to UK hospitals in 2005. This included the transfer of critically ill incubated babies. Jersey figures suggest that between 1 and 9 infants (medical, surgical and cardiac) are transferred ex-utero per year. A further 3 infants are delivered on the mainland following in-utero transfer, and require repatriation.
This service was predominantly delivered by four main aircraft operators at a total cost of over £1 million. This cost does not include the significant administrative time spent by HSSD personnel attempting to contact an available aircraft operator and coordinating the transfer from Jersey General Hospital to ambulance, to aircraft and receiving UK hospital.
Issues
The current ad hoc arrangements with multiple providers for air transfer present the organisation with the following risks:
Potential to delay emergency transfer of critically ill patient due to burdensome process of identifying an available air operator.
Increased staff costs resulting from HSSD staff failing to be repatriated following transfer out of hours.
Increased risks to patients and staff from the use of non standardised aircraft minimising the opportunity to standardise equipment and training.
Recommended Action:
Develop contractual arrangement with single aircraft operator to manage all air transfers.
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States of Jersey
The Health & Social Services Department
Patient Air Transfers
Tender Specification Document
Applications are invited from approved aircraft operators who are licensed under applicable legislation who wish to tender for the provision of aero medical transfer of patients to and from the States of Jersey Health & Social Services Department. The tender specification document can be seen on application to the undersigned.
Applications stating present commitments must be submitted in writing to the undersigned by noon on 30th November 2006. The Minister for Health & Social Services reserves the right to select from the list of applicants and does not bind himself to accept the lowest or any tender.
Richard L Jouault
Director of Corporate Planning & Performance Management,
Health & Social Services Department
SPECIFICATION
CONTENTS
1. Definitions.
2. Availability and Aircraft and Equipment.
3. Maintenance of Service.
4. Compliance with Statutory and other Requirements.
5. Additional Responsibilities.
6. Health & Social Services Department (HSSD) Responsibilities
7. The Tenderer’s Insurance
8. Variations and Amendments.
Appendix 1.
Appendix 2.
1. Definitions
In this Specification:
“Aircraft” means the aircraft identified in the Tenderer’s Form of Tender and referred to in the Further Terms and Condition of Tender (“Tender Documents’) (together with any substitute therefore approved by the HSSD) in provision of the Services (as referred to in the Tender Documents”)
“Authorised Officer” means the duly authorised representative of the Minister of Health and Social Services (HSSD) for the purposes of this Tender.
“Tenderer” means the duly authorised representative of the Tenderer and any Aircraft operator used by the Tenderer to provide the Services in accordance with the Form of Tender and Further Terms and Conditions of Tender for the purposes of this Tender.
“Flying Time” means the period from when the aircraft’s wheels leave the ground to when they touch the ground as evidenced by the aircraft’s log sheet.
Flying time shall be calculated to the nearest 5 minutes.
‘Passenger’ means any person carried in an aircraft other than the Tenderer’s Personnel or any employee servant or agent of the Tenderer.
“‘Patient” means any person required by the HSSD to be transported by aircraft during the performance of the Services.
“Statutory Requirements” means all provisions relevant to the compliance by the Tenderer with its duties either expressed or implied by this Tender under any Act or Statutory Instrument and/or every Regulation or directive of the Bailiwick of Jersey and European Union and/or every Statutory Instrument Order or Regulation made pursuant to such Act or Directive.
2. Availability and Aircraft and Equipment
2.1 The Tenderer must be contactable by telephone 24 hours per day/365 days of the year.
2.2 The Tenderer must ensure that a suitable aircraft appropriately fitted out for air ambulance duties (including the transport of an incubator) is based at Jersey Airport or available for take off from Jersey Airport within 2 hours of call from HSSD for 365 days of the year.
2.3 The type(s) of aircraft to be used will need to facilitate the easy loading/unloading of a stretcher patient or incubator with adequate door openings etc. In particular the height of the aircraft floor or of any mechanical lifting and handling system should not exceed three foot six inches from the ground unless the aircraft is fitted with a suitable ramp
Detailed specifications of the aircraft to be used should be set out in Appendix I
2.4 The Tenderer will be responsible for ensuring that the air ambulance provided has Civil Aviation-approved fixings and electrical connections for:
Stretcher
Incubator
Medical equipment
It must also be fitted with a ‘Lifeport or equivalent loading system including suction, and oxygen and be fitted with D.C. power connections. (This equipment would be the responsibility of the Tenderer in terms of purchasing and maintenance recharging with gases etc but would be subject to regular audit by the HSSD).
2.5 The space inside the aircraft should be sufficient to accommodate a stretcher or an incubator with room for up to three clinical staff to attend to the patient during the flight.
2.6 The patient should be transferred from road ambulance to air ambulance and vice-versa under cover. However a system of direct transfer between the ambulance on the tarmac would also be acceptable on occasion when it is deemed in the patient’s best interest. NB Tenderer’s should describe in some detail how the transfers would he managed.
2.7 The Tenderer will be required to guarantee that the time from receiving a telephone call requesting an air ambulance to the time when the aircraft is ready to take-off from Jersey Airport will not exceed two hours under normal circumstances.
2.8 Should the Tenderer unreasonably delay the departure of the aircraft beyond the two hour period mentioned in paragraph 2.7 above the HSSD will be entitled at its discretion to recover its costs at the rate of ONE THOUSAND POUNDS (£1000) per hour delay or part thereof.
2.9 The use of identifiable markings on aircraft provided hereunder shall be subject to mutual agreement by both parties.
2.10 It is the responsibility of the Tenderer to ensure that any equipment provided by the Department is appropriately located and secured within the aircraft and that any necessary services are provided. The Tenderer hereby indemnifies the HSSD in respect of any loss or damage thereof caused by the failure of the Tenderer to discharge the foregoing obligation.
2.11 The Tenderer shall not use any patient care equipment provided or purchased by the HSSD for any tasks out with the provision of the Services unless specifically authorised by the Minister of HSS’s authorised officer.
Note for information and guidance only:
a) The Tenderer will be responsible for making all arrangements with Jersey Airport Authorities to open the airport and to receive the patient being transported by the Department by road ambulance to Jersey Airport.
NB For guidance it has been necessary to extend opening hours at Jersey Airport for such a reason on six occasions and to open it outside normal operating hours after 24 00 hrs on a further 4 occasions during 2005. See Appendix 2 for Air Transfer Movement details for 2005-2006 to date.
3 Maintenance of Service
3.1 The Tenderer shall provide and maintain equipment and operate the aircraft from Jersey Airport for the performance of the Services in accordance with this Specification and any reasonable operational requirements including training of HSSD staff notified by the Department during the contract period. In doing so, the tenderer should manage all contractual relationships including any annual charges with Jersey and UK based handling agents.
3.2 The Tenderer shall maintain repair and overhaul the aircraft in accordance with the manufacturers specification throughout the contract period as necessary and shall thereby ensure that the aircraft is in a fully serviceable condition and available for the provision of the Services as and when required.
3.3 The Tenderer shall have in place suitable arrangements to cover for planned and unplanned maintenance to ensure aircraft availability at all times during the contract period.
4. Compliance with Statutory and Other Requirements
4.1 The Tenderer shall maintain a valid Certificate of Airworthiness in the Public Transport Category in respect of the aircraft
4.2 The Tenderer shall obtain all licences and permits necessary for the operation of the aircraft in the Operational Area
4.3 The Tenderer shall operate the aircraft within the Operational Area as required by the Department from time to time, provided that final decisions as to whether or not a flight should be undertaken, and as to the manner of performing operations hereunder including without limitation aircraft serviceability, acceptable load limits, routes, weather, flying and landing site conditions prevailing at the time, shall be made by the Tenderer.
4.4 All aircraft and equipment provided and used by the Tenderer shall conform to all relevant public transport regulations and all other applicable Statutes and Regulations pertaining to the transport of patients and passengers by aircraft.
4.5 The Tenderer shall at all times perform the Services in a good and safe manner in accordance with the Tenderer’s Operations Manual and with public transport criteria as laid down by the Civil Aviation Authority and the Joint Aviation Authorities.
4.6 The Tenderer shall ensure that two aircrew are available for all operations and all pilots of the aircraft shall be Civil Aviation Authority qualified, possess current and valid Instrument Rating and are fully trained in air ambulance operations. Details of aircrew experience should be provided by the tenderer.
4.7 The Tenderer shall ensure that all engineers shall be qualified and possess current licences applicable to the aircraft type operated.
4.8 Where there is in force an appropriate EC standard (or British standard where there is no equivalent EC standard) all goods used or supplied and all work undertaken shall as a minimum requirement be in accordance with that standard but compliance with such standard shall be without prejudice to any higher standard required by the Tender.
4.9 The Tenderer shall comply with its obligations under the Data Protection (Jersey ) Law 2005, including adherence to the Data Protection Principles and such provisions as HSSD shall reasonably stipulate.
5. Tenderer’s Additional Responsibilities
5.1 The Tenderer shall comply with all reasonable instructions and directions of the Department relating to the provision of the Services.
5.2 The Tenderer shall assign sufficient qualified and trained staff to provide and supervise the Services at all times. Those supervising staff shall have the skills and competencies that are necessary and appropriate for the proper performance of the Services.
5.3 Whilst it is the HSSD’s intention to provide medical staff for the operation of the air transfers, the Tenderer should have access to appropriately trained medical staff to call upon as emergency cover. The tenderer should set out fee rates for these services.
5.4 The Tenderer shall make available an aircraft for all HSSD air transfer training courses and provide appropriate training for HSSD staff in connection with air ambulance transfers.
5.5 The Tenderer shall ensure that its staff give a full passenger safety briefing to all passengers as necessary.
5.6 The Tenderer shall ensure that only its nominated staff together with patients and other persons authorised by the Department are permitted to travel in any aircraft whilst being used in the provision of the Services.
5.7 Whilst the clinical care of a patient being transferred by air ambulance remains at all times the responsibility of the Department, responsibility for the general safety of the patient transfers to the Tenderer whilst the patient/stretcher/ incubator or other equipment is fixed into position in the aircraft.
5.8 The Tenderer shall be responsible for the security of all aircraft and equipment provided and used by the Tenderer in or about the provision of the Services or otherwise belonging to the Tenderer or its staff.
5.9 The Tenderer shall arrange appropriate extensions at airports which the Tenderer’s aircraft may require to use outside the normal hours of operation of those airports and ensure that all arrangements are in place with the handling agents in Jersey or the UK to ensure availability as required and to include any charges related to these arrangements.
5.10 The Tenderer shall provide appropriate uniforms and safety equipment for its pilots.
5.11 The Tenderer shall reimburse all expenses associated with its personnel including but without limitation, all wages, taxes, benefits, allowances, social security contributions and (save as expressly provided for) the cost of accommodation travelling and subsistence.
5.12 The Tenderer shall ensure that its staff report to it all matters which occur in the provision of the service which are of an irregular or questionable nature or which may cause civil or criminal legal proceedings to be taken against the Tenderer, the Department, the aircraft operator (if relevant) or any members of their respective staff.
5.13 The Tenderer shall forthwith inform the authorised officer verbally of any such matter arising under paragraph 5.12 and shall also complete a full written report to the authorised officer as soon as reasonably practical.
5.14 The Tenderer and its staff shall at no additional charge assist the Department in any enquiry or action subsequent and pursuant to any matter arising under paragraph 5.12.
5.15 A record of all incidents or accidents involving the aircraft, any personal injury or death or significant risk of personal injury to, or death of any person arising out of the provision of the service shall be kept by the Tenderer detailing:
5.15.1 the member of staff or other person reporting the incident or accident
5.15.2 the name and address (if known) of each person involved in the
incident or accident
5.15.3 the nature and extent of the incident or accident including details of
any personal injury or death actually suffered
5.15.4 the date and time of the incident or accident.
5.16 The notification of any incident or accident by the Tenderer to the authorised officer in no way relieves or excuses the Tenderer or its staff from any liability incurred by reason of such incident or accident.
5.17 The record of incidents and accidents shall be open to inspection by the Department’s authorised officer at all reasonable times.
5.18 The Tenderer shall record information on each mission in a format agreed with the Department.
5.19 The Tenderer shall be fully responsible for ensuring that any aircraft operator which it uses to provide the Services complies in all respects with the Form of Tender this Specification and the Further Terms and Conditions of Tender.
6. Department’s Responsibilities
6.1 Except as otherwise specified in these documents the Department shall provide the following equipment supplies and services throughout the duration of the Tender period:
6.1.1. fully trained doctors, nurses, paramedics, ambulance technicians, or escorts or any combination of these as deemed appropriate by the Department on each operational flight
6.1.2 Full employee liability insurance cover for HSSD personnel via the States of Jersey Insurers.
6.1.3 all medicines and medical supplies/equipment required to be carried on board the aircraft not identified in this document as being the responsibility of the Tenderer.
6.1.4 all necessary protective clothing for its personnel to be transported in the aircraft.
6.2 HSSD reserves its rights entirely and shall be under no obligation to accept the lowest tender or any tender at all following this tender process.
7. The Tenderer’s Insurance
The Tenderer shall effect and maintain the following insurance from January 2007 for the period of the Contract:
7.1 Aircraft third party and passenger legal liability insurance with a minimum limit of indemnity of FIFTY MILLION POUNDS (£50,000,000) for each claim or such higher limit as the Department may reasonably require from time to time.
7.2 Employers liability insurance with a minimum limit of indemnity of FIFTY MILLION POUNDS (£50,000,000) for each claim or such higher limit as the Department may reasonably require from time to time.
7.3 Hull “All Risks” insurance and Hull “War Risks” in respect of all aircraft with a limit of not less than the full replacement value of each aircraft.
7.4 In respect of detachable medical equipment all risks insurance in the sum of FIFTY THOUSAND POUNDS (£50,000) for each claim or such higher limit as the Department may reasonably require from time to time
7.5 Any excess or deductibles under such insurance shall be the sole and exclusive responsibility of the Tenderer.
7.6 All such policies of insurance shall be with an EU insurer of repute on normal commercial terms and shall:
7.61 Be endorsed to preclude any rights of subrogation against the
Department or any employee or agent of the Department
7.6.2 Be endorsed where possible under the relevant insurance policy designating the Department as additional named insured.
7.7 The Tenderer will deal speedily and efficiently with all claims submitted to it by third parties which shall be dealt with either by staff or by referring such claims to its insurers.
7.8 The Tenderer shall not be entitled to settle any claim or action in respect of which the Tenderer had an obligation to insure and to indemnify the Department without the prior written consent of the Department and the Tenderer shall if so required by the Department assign to it the right to defend any claim or action on behalf of the Tenderer and shall grant the Department such reasonable assistance (at the Departments expense) as it may require in defending any claim or action.
7.9 The Tenderer shall ensure that any aircraft operator which it uses to provide the Services is noted on the Tenderer’s insurance policy or policies and is covered by such policy or policies in accordance with this clause 7 AND/OR the said aircraft operator carries its own insurance which complies with this clause 7 to the satisfaction of the Department.
7.10 The Tenderer shall fully indemnify HSSD and its servants/agents in respect of any loss or damage howsoever arising from any act or omission of the Tenderer and its servants/agents. HSSD reserves the right to offset any loss or damage against any sums owed to the Tenderer
8. Variations and Amendments
8.1 The Department may, upon giving to the Tenderer not less than one month’s written notice of any proposed variation and by mutual consent with the Tenderer add to, delete from or otherwise amend in any way whatsoever the provisions of this Specification and/or the other Tender Documents
8.2 No variation required by the Department shall vitiate this Tender
APPENDIX 1
Information for the Tender to supply and return in this format.
Organisation
- Name of the company in whose name the tender would be submitted.
- Contact name:
- Address (including telephone, fax and e mail address)
- Is your organisation: (please circle)
- a public limited company
- a limited company
- a sole trader
- a partnership
- a subsidiary of another company
- Please provide on a separate sheet a brief resume of your organisation.
Finance
- Please enclose the audited accounts for your organisation for the last three years of trading.
- The name and address of your banker.
Insurance
- Please provide details of your organisation’s insurance protection in respect of professional indemnity cover.
Business capability
- Describe the principle areas of your business activity.
- Describe number and type of aircraft at the disposal of your business to deliver the required service.
- Number of staff in your organisation over the last three years.
- Staff turnover as a percentage of total workforce for last three years.
- Please describe on a separate sheet your organisation’s previous experience of providing similar services to those required by HSSD (providing reference from existing clients where possible).
- Please describe on a separate sheet using the requirement criteria provided in the Tender Brief, how your organisation would propose to manage HSSD’s air transfer requirements
Fee structure
- Please provide full details of proposed fee rates for flying time of proposed aircraft including:
Price for repatriation of staff.
Price for patient transfer only.
Technical Specification(s) and Equipment
Provide the following technical specification:
- Height from the ground of the floor of the aircraft or of the loading mechanism
on to which the patient will be transferred.
- Internal dimensions of aircraft indicating the amount of space to accommodate the patient and clinical staff.
- Dimensions of aircraft doorway and the method to be used to
embark /disembark the patient.
- Length width and inclination of any loading ramp to be used.
- Method of ensuring that the Departments clinical staff can communicate
during the flight with road ambulance and hospital staff Jersey and
with the receiving road ambulance and hospital staff in the UK
Specific Medical Modifications
21 Provide details of specific modifications, equipment installations, specialist configurations etc. which would enhance the provision of air ambulance services.
Training Course Content for Medical Staff
22 Provide detail of the content of the training courses which would be available to the Department’s medical staff.
Contractual Arrangements
23 Identify anticipated date for commencement of service.
24 Identify preferred duration of contract.
25 Identify preferred length of notice for the termination of contract on behalf of either party on a “no fault” basis.
APPENDIX 2
Air Transfer Movement Details
Jan-Dec 2005 Jan-Mar 2006
gov.je