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AGREEMENT FOR SERVICES between HER MAJESTY THE QUEEN IN RIGHT OF HER GOVERNMENT IN NEW ZEALAND (acting by and through the Ministry of Health) together with ACCIDENT COMPENSATION CORPORATION AND [PROVIDER NAME] 3347181.10
Transcript of Emergency Ambulance Service - service agreement€¦ · Web viewIndependent Contractor The Provider...
AGREEMENT FOR SERVICES
between
HER MAJESTY THE QUEEN IN RIGHT OF HER GOVERNMENT IN NEW ZEALAND (acting by and through the Ministry of Health)
together with
ACCIDENT COMPENSATION CORPORATION
AND
[PROVIDER NAME]
3347181.10
Table of ContentsTable of Contents............................................................................................................................... 2
Agreement for Services...................................................................................................................... 5
Execution........................................................................................................................................... 6
Part 1: Organisational Terms and Conditions.....................................................................................8
Schedule 1: Quick Reference Information..........................................................................................8
Schedule 2: General Terms and Conditions.......................................................................................9
1 Service Schedule to take Precedence........................................................................................9
2 Relationship of Parties................................................................................................................9
3 Parties Remain Responsible....................................................................................................11
4 Responsibilities of Parties.........................................................................................................11
5 Information/Confidentiality........................................................................................................12
6 Variation of Agreement.............................................................................................................13
7 Inability to Deliver the Services.................................................................................................13
8 Circumstances beyond Control.................................................................................................14
9 Agreement Termination or Service Cancellation by Notice.......................................................14
10 Termination on Insolvency........................................................................................................15
11 Termination for Breach.............................................................................................................16
12 Cancellation or Expiry - Rights Preserved................................................................................16
13 Indemnity.................................................................................................................................. 17
14 Disputes.................................................................................................................................... 17
15 Notices...................................................................................................................................... 17
16 Conflicts of Interest/Financial Incentives...................................................................................18
17 Cost and Volume Shifting.........................................................................................................18
18 Other Arrangements................................................................................................................. 18
19 No Extension or Renewal.........................................................................................................19
20 Multiple Providers..................................................................................................................... 19
21 Waiver...................................................................................................................................... 19
22 Services for Injured Employees of Accredited Employers........................................................19
23 Where ACC Approval, Price or Cover is Uncertain...................................................................20
24 Definitions and Interpretation....................................................................................................20
Schedule 3: Organisational Quality Standards.................................................................................26
1 Introduction............................................................................................................................... 26
2 Written Policy, Procedures, Protocol, Guideline, Policy............................................................26
3 All Staff Informed...................................................................................................................... 26
4 Philosophy................................................................................................................................ 26
5 Quality Standards..................................................................................................................... 26
6 Risk Management..................................................................................................................... 28
Schedule 4: Monitoring and Evaluation............................................................................................29
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1 Service Evaluation.................................................................................................................... 29
2 Service Review......................................................................................................................... 29
3 Audit Provisions........................................................................................................................ 30
4 Reporting.................................................................................................................................. 30
Schedule 5: Prices and Payments...................................................................................................31
1 Prices........................................................................................................................................ 31
2 No Additional Payments...........................................................................................................31
3 Billing and Payment.................................................................................................................. 31
Part 2: Individual Service Schedules................................................................................................32
Service Schedule – Emergency Road Ambulance Services............................................................32
Part A: Terms and Conditions Specific to the Ministry related Services..........................................37
1 Payment Details....................................................................................................................... 37
2 Invoicing................................................................................................................................... 37
3 Payment Schedule.................................................................................................................... 37
4 Coverage Area......................................................................................................................... 37
5 Service Specification................................................................................................................37
6 Service Provision...................................................................................................................... 37
7 Payment of Services................................................................................................................. 37
8 Part Charging........................................................................................................................... 37
Part B: Terms and Conditions Specific to ACC-related Services....................................................39
1 Coverage Area......................................................................................................................... 39
2 Pricing....................................................................................................................................... 39
3 Service Description................................................................................................................... 39
4 Completion and Turn-Over Of Forms.......................................................................................42
5 Invoicing and Payment.............................................................................................................43
Appendix 1: Injury Assessment Criteria............................................................................................46
Part C: Service Specification for emergency road ambulance services...........................................48
1 Term......................................................................................................................................... 48
2 Purpose.................................................................................................................................... 48
3 Service Objectives.................................................................................................................... 48
4 Principles.................................................................................................................................. 48
5 Overview of Emergency Ambulance Services..........................................................................48
6 Background.............................................................................................................................. 49
7 Service Description................................................................................................................... 51
8 Maori Health and Cultural Requirements..................................................................................53
9 Exclusions................................................................................................................................ 53
10 Service Linkages...................................................................................................................... 54
11 Quality Requirements...............................................................................................................54
12 Reporting.................................................................................................................................. 55
13 Incident reporting...................................................................................................................... 56
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14 Monitoring and Evaluation........................................................................................................57
Appendix 1: Service Capability Levels as per NZS 8156............................................................58
Appendix 2: Response Time Targets...............................................................................................59
Appendix 3: Reporting Templates....................................................................................................61
Appendix 4: Allocating the Severity Assessment Code (SAC Score)...............................................64
Appendix 5: Serious and Sentinel Events Quarterly Reporting Template........................................66
Appendix 6: Volume Template – Adverse Events............................................................................67
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Agreement for Services
This Agreement is made on the day of 2012
Between
1 Her Majesty The Queen In Right Of Her Government In New Zealand (acting by and through the Ministry of Health) together with the Accident Compensation Corporation, a statutory corporation continued by the Accident Compensation Act 2001 (together called “the Purchasers”)
and
2 Provider name (“the Provider”)
The Purchasers and the Provider agree that:
1 The Provider will provide each Service described in the Individual Service Schedules in Part 2 for the Term described in the applicable Service Schedule.
2 The Purchasers will pay for each Service provided during the relevant Term for that Service, subject to and in accordance with the terms and conditions set out in this Agreement which are applicable to that Service.
3 Each Party will comply with all the provisions of this Agreement that apply to that party.
4 This Agreement includes the Parts listed below, and any variations to this Agreement made at any time:
Part 1: Organisational Terms and Conditions
Part 2: Individual Service Schedules
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Execution
Signed for and on behalf of the Ministry of Healthby:
Name Signature
In the presence of:
Witness signature
Witness name
Witness Occupation
Witness Address
Signed for and on behalf of the Accident CompensationCorporation by:
Name Signature
In the presence of:
Witness signature
Witness name
Witness Occupation
Witness Address
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Signed for and on behalf of [Provider’s Name)by:
Name Signature
In the presence of:
Witness signature
Witness name
Witness Occupation
Witness Address
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Part 1: Organisational Terms and Conditions
Schedule 1: Quick Reference Information
1 Provider’s Bank Account (Schedule 5, clause 3.3)
Payments will be made into the account(s) nominated by the Provider.
2 Addresses for Notices (Schedule 2, clause 15)
NOTICES FOR THE PURCHASERS TO:
ACCVogel Centre (For deliveries)19 Aitken StreetPO Box 242 (For mail)Wellington
Marked: “Attention: Health Procurement”
The Ministry of Health133 Molesworth Street (For deliveries)PO Box 5013 (For mail)Wellington
Marked: “Attention: Group Manager, National Ambulance Sector Office”
NOTICES FOR PROVIDER TO:
Provider NamePhysical Address (For deliveries)Physical address 2CityPostal Address (For mail)Postal Address 2CityMarked: “Attention: Name, Position”
Facsimile: (##) ### ####
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Schedule 2: General Terms and Conditions
1 Service Schedule to take Precedence
1.1 Documents forming part of the Agreement
This Agreement comprises these terms of agreement, including all schedules and appendices attached to them and the documents listed below. In the event of any conflict of meaning or ambiguity, the documents that comprise this Agreement shall have the descending order of precedence set out below:
a any variations to this Agreement agreed in writing between authorised representatives of the parties after the date of this Agreement;
b Part 2 Individual Service Schedules;
c the terms of Part 1 Schedule 2 General Terms and Conditions;
d any appendices
1.2 Precedence
If there is any conflict of meaning between information contained within the documents having the same level of precedence in the hierarchy described above then the order of precedence shall be reverse chronological order, that is, information contained in later documents shall prevail over information contained in earlier documents. However, requirements stated in earlier documents that are omitted in later documents shall continue to apply unless the later documents expressly exclude those requirements or those requirements are clearly inconsistent with the provisions of the later documents.
2 Relationship of Parties
2.1 Relationship Principles
a Both parties acknowledge that our relationship is fundamental in achieving both of our objectives in entering into this Agreement.
b Both parties agree to foster a long-term co-operative and collaborative relationship to enable us both to achieve our respective objectives efficiently and effectively. We both agree that the following relationship principles will guide each of us in our dealings with each other under this Agreement.
c Both parties agree to observe the principles of natural justice in giving effect to this Agreement.
d The Provider acknowledges that the Purchasers are subject to, and must comply with, the strategic and policy directions of the Crown. Equally, the Purchasers acknowledge that the Provider has its own strategic and policy directions.
e The Purchasers recognise the Provider’s right to maintain its clinical and business autonomy.
f Both parties agree that clinical interventions should be based on the best evidence available at the time.
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g Both parties will respect and maintain patient confidentiality.
h Both parties recognise and value the other’s skills and expertise and commitment to high quality performance.
i Both parties will negotiate and implement agreements in good faith and respect, and trust the other to work together to find solutions to problems.
j Both parties will communicate directly with each other, openly and in a timely manner.
k Both parties will work in a co-operative and constructive manner, and where appropriate undertake joint projects.
l Both parties will encourage continuing quality improvement and innovative service development to achieve the objectives of both parties to the extent possible within available funding.
2.2 This Agreement is to be interpreted in light of the principles set out in clause 2.1 above. To the extent that a clause in this Agreement can be given a meaning that is consistent with the principles set out in clause 2.1 above, that meaning is to be preferred.
2.3 Meetings
Both parties acknowledge that holding meetings is important for developing and maintaining an effective working relationship. Accordingly, we both agree to make appropriate personnel available as might be reasonably required by either of us to discuss matters arising in relation to this Agreement, including:
a how the contractual relationship is functioning and how the Services are being delivered;
b whether there are aspects of the functioning of the relationship or the delivery of the Services that either of us could improve;
c how such improvement might be implemented; and
d wider issues in the health and injury prevention, treatment and rehabilitation sectors that are relevant to either Party, which may include issues relating to implementation of the Government's strategies for these sectors.
2.4 Independent Contractor
The Provider is an independent contractor, contracted by the Purchasers to provide the Services described in this Agreement. Nothing contained or implied in this Agreement shall be construed as creating, and neither Party shall state, imply or do anything to suggest, that this Agreement creates an employer/employee partnership or principal/agent relationship between the Purchasers and the Provider or any of its proprietors, officers, employees or subcontractors.
2.5 Privity of Contract
Nothing in this Agreement is intended to confer any enforceable rights or benefits on a Service User or any other person.
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2.6 Complete Agreement
This Agreement represents the whole of the agreement between the parties, and any provisions in tenders, correspondence or other documents prior to the date of this Agreement and all representations are excluded.
2.7 No Adverse Comments
Neither Party will make any oral or written statement or comment to the media, any Service User or any member of the public in relation to the operation of this Agreement which criticises the other Party or which could adversely affect a Service User’s or public opinion of the other Party or which brings the other Party into disrepute. If such a statement or comment is made, that Party will, at the request and with the prior agreement of the other Party, promptly make an appropriate retraction or take such other remedial steps as are appropriate and reasonable in the circumstances. This will be without prejudice to any other rights, remedies or actions available to the other Party.
2.8 Contract Excludes Regulations
This Agreement and any other agreement in effect between the parties at the relevant time exclusively regulates the provision by the Provider for the Purchasers of personal health and disability services of the kinds included within the Services that are to be provided under this Agreement and the pricing and the payment obligations of the Purchasers for those Services.
3 Parties Remain Responsible
3.1 Assignment/Subcontracting
The Provider shall not assign, transfer, subcontract or otherwise dispose of any benefits, rights, liabilities or obligations under this Agreement or any part of this Agreement without the prior written consent of the Purchasers, such consent not to be unreasonably withheld.
3.2 Ensure Subcontractors Bound
Subject to clause 3.1, the Provider shall ensure there is included in every agreement entered into with a subcontractor provisions which enable the Provider to discharge and secure compliance with its obligations under this Agreement including (without limitation) clause 4 of this Schedule 2.
3.3 Provider not Relieved
The assignment, transfer, subcontracting or other disposal of any of the Provider’s liabilities or obligations shall not relieve the Provider from any liability or obligation.
3.4 Change in Control
If at any time there is a change in the shareholding or ownership of the Provider that alters the effective control of the Provider (other than where the Provider is a company whose shares are listed on any recognised Stock Exchange) without the Provider obtaining the Purchasers’ prior written approval to the change, then the Purchasers may, within 15 working days of receiving notice of the change, give to the Provider notice of breach pursuant to clause 11.1.
4 Responsibilities of Parties
4.1 Provider to Provide Services
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The Provider agrees to:
a provide the Services in accordance with the provisions of this Agreement;
b advise the Purchasers immediately if an Insolvency Event occurs in respect of the Provider or on the bankruptcy or liquidation of the Provider.
4.2 Request for additional services
The Purchasers may from time to time request the provision of additional services or the extra provision of existing Services. This request, if accepted by the Provider, will be governed by the terms of this Agreement unless otherwise agreed. All additional Services will be by way of a variation to this Agreement.
4.3 The Purchasers to Pay for Services
The Purchasers agree to:
a pay the Provider for the Services as required by this Agreement and in accordance with and subject to the provisions of this Agreement;
b comply with all Law applicable to them.
4.4 Good Faith
The Parties agree to act in good faith and consult with each other whenever and as often as may be appropriate on matters affecting their respective obligations.
4.5 Statutory Obligations
Nothing in this Agreement shall affect the statutory obligations of either Party to Service Users or shall bind either Party to do or refrain from doing anything in a manner that is not consistent with the Law.
5 Information/Confidentiality
5.1 General
All matters relating to this Agreement and all information acquired or received by either Party in the course of providing the Services under this Agreement shall be held confidential and shall not be divulged in any way to any other person without the prior written approval of the Party which provided the information.
5.2 No Breach
Disclosure of information in the following circumstances shall not be a breach of clause 5.1:
a to the extent that the information has become generally available to the public other than as a result of unauthorised disclosure by a Party;
b to the extent that a Party is required to disclose the same pursuant to the Official Information Act 1982 or any other Law;
c to the extent that it is necessary and reasonable for the Purchasers to disclose certain information (such as the name of the Provider) to ensure the efficient and uninterrupted operation of this Agreement;
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d as provided in this Agreement.
5.3 High Profile Issues
a The Provider will immediately advise the Purchasers if it becomes aware of any issue relating to the provision or non provision of the Services, or the operation of this Agreement which, in the Provider’s opinion, has or may have media or public interest.
b Neither Party will make or issue to the media or any member of the public any oral or written statement or comment concerning a Service User, the Service User’s treatment or the operation of this Agreement, without prior consultation with the other Party.
c Each Party will promptly advise the other if it is required to provide information to a Service User, professional disciplinary body or other person under the Official Information Act 1982, the current Code of Health and Disability Services Consumers’ Rights or other legislation or is the subject of a complaint, concerning a Service User, the Service User’s treatment or the operation of this Agreement.
6 Variation of Agreement
6.1 Variations by Agreement
No variation of this Agreement shall be effective, unless it is agreed in writing by the Parties or unless it is made pursuant to clause 6.2 or clause 6.3.
6.2 The Purchasers may Amend Specifications
After consultation with the Provider, the Purchasers may at any time give notice to the Provider that the provisions of any one or more of the Parts of, or Schedules, to this Agreement (excluding prices) are amended or added to with effect from a date stated in the notice, and this Agreement shall be deemed varied accordingly with effect from that date, provided that notice may not be given if this would have the effect of reducing the prices payable under this Agreement. The Provider may claim any additional costs from the Purchasers that it can show that it will suffer as a result of the variation, and upon obtaining the Purchasers’ agreement, the Purchasers shall be liable to pay such additional costs to the Provider. If agreement cannot be reached, either Party may require the matter to be resolved under clause 14 (Disputes).
6.3 Variations to give Effect to Government Policy Changes
Notwithstanding clause 6.2, where a change in legislation or regulations or a ministerial directive under the Accident Compensation Act 2001 or the New Zealand Public Health and Disability Services Act 2001 is stated by notice given to the Provider by the Purchasers to have the effect of requiring this Agreement to be varied in any respect, this Agreement shall be deemed varied accordingly from the date stated in the notice. The Provider may claim any additional costs from the Purchasers that it can show it will suffer as a result of the variation, and upon obtaining the Purchasers’ written agreement, the Purchasers shall be liable to pay such additional costs to the Provider. If agreement cannot be reached, either Party may require the matter to be resolved under clause 14 (Disputes).
7 Inability to Deliver the Services
7.1 Where the Provider believes that it will not be able to deliver any of the Services described in this Agreement to the extent that this Agreement requires, the Provider will notify the Purchasers of
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the extent to which the Provider is prevented from providing those Services and the reasons for that inability.
7.2 Without limiting any right of either party under this Agreement, both parties will then discuss the reasons why the Provider is prevented from performing those Services and both parties will seek to reach agreement about changes to the Provider’s levels of Service provision by way of an amendment to this Agreement.
7.3 If the parties are unable to reach agreement about the scope of any amendments to this Agreement within one month of notice being given by the Provider under clause 7.1, any party may refer the matter to mediation by notice in writing to the other parties. The mediator will be appointed by agreement of the parties or, failing agreement, by the President for the time being of the New Zealand Law Society.
7.4 The cost of mediation must be borne equally between the parties unless otherwise agreed in writing prior to the commencement of mediation.
8 Circumstances beyond Control
8.1 Suspension of Obligations
Neither Party shall be liable for failure to perform nor delay in performing this Agreement to the extent that the cause of such failure or delay is beyond that Party’s reasonable control (this does not include lack of funds) providing notice claiming suspension of its obligations is given under clause 8.2.
8.2 Notice Claiming Suspension
A Party claiming suspension of its obligations shall, within three working days after the Party becomes aware of the cause and its supervening effects in respect of which suspension of its obligations is claimed, give notice of the cause, furnish all available information detailing the cause and give an estimate of the period of time required to remedy the cause (if such remedy is deemed practicable), to the other Party.
8.3 Period of Suspension
Any suspension of the obligations of a Party shall be limited to the period during which the cause falling within clause 8.1 continues to exist.
9 Agreement Termination or Service Cancellation by Notice
9.1 By Notice as of Right
Either Party may, without incurring any liability to the other for damages or other compensation, at any time give to the other no less than:
a six calendar months’ notice of termination of this Agreement and all the Services; or
b six calendar months’ notice of the cancellation (or any lesser notice period for cancellation permitted under the applicable Service Schedule) from this Agreement of a particular Service Schedule and the Service(s) described in that Service Schedule.
9.2 Termination Date
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The later of six calendar months after the date upon which such notice is received by the Provider and any date specified in the notice as the date upon which this Agreement shall come to an end, shall be the date upon which this Agreement and all the Services shall come to an end (the “Termination Date”).
9.3 Cancellation Date
The later of six calendar months (or any lesser notice period for cancellation permitted under the applicable Service Schedule) after the date upon which such notice is received by the Provider and any date specified in the notice as the date at which the Service Schedule is to be cancelled, shall be the date (“Cancellation Date”) when the Service Schedule and the Service(s) described in that Service Schedule are removed from this Agreement. From the Cancellation Date the Provider is released from the obligation to provide the Service(s) described in that Service Schedule, and the Purchasers are released from the obligation to pay for such Service(s) provided after that date.
9.4 Disengagement Process
a Upon any party giving notice of termination, or otherwise six months prior to the expiry of this Agreement, the parties agree to meet to formulate a transition plan to facilitate the transfer of the Services to the new provider.
b The Provider acknowledges that the Purchasers must be able to maintain continuity of the Services upon the termination of this Agreement.
c The Provider agrees to cooperate to the extent reasonably expected of an emergency ambulance service provider in order to ensure that any hand-over of the Services to another provider or to the Purchasers itself is conducted smoothly and professionally. The Purchasers acknowledge that in complying with this clause, the Provider is not required to provide access to or disclose or make available its know-how, techniques, intellectual property rights or information that is confidential to the Provider, and is not required to divest any assets (including the benefit of any contracts to which it is a party).
d In the event of the need for a hand-over of the Services to another service provider, the Provider will provide the Services until such time as the Agreement is terminated in accordance with its terms unless the parties otherwise agree in writing.
10 Termination on Insolvency
10.1 Immediate Termination without Prior Notice
This Agreement and all the Services shall end immediately (without any requirement for prior notice) by reason of a deemed breach of this Agreement by the Provider on the insolvency or liquidation of the Provider. (This shall not apply, however, in the case of a liquidation of the Provider for the purpose of reconstruction or amalgamation where the terms have been approved by the Purchasers.)
10.2 Termination Date without Prior Notice
The date the Provider is adjudicated bankrupt or the date of appointment of a liquidator in respect of the Provider is the date upon which this Agreement and all the Services shall end (the relevant date being the “Termination Date”).
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10.3 Immediate Termination on Notice
If an Insolvency Event has occurred in respect of the Provider and if, at any time thereafter, the Purchasers give notice to the Provider of termination of this Agreement and all of the Services, this Agreement and all the Services shall end immediately by reason of a deemed breach of this Agreement by the Provider.
10.4 Termination Date on Notice
The date a notice given by the Purchasers in accordance with clause 10.3 is received by the Provider is the date upon which this Agreement and all the Services shall end (the relevant date being the “Termination Date”).
11 Termination for Breach
11.1 Notice of Breach
If either Party considers that the other has breached any provision of this Agreement, that Party may give notice to the other specifying the breach and giving the other Party 10 Working Days for the breach to cease and/or to remedy the breach if it is capable of remedy.
If the breach has not ceased or if the breach being capable of remedy has not been remedied within the period of 10 Working Days, then the Party which gave the notice may forward to the other Party a notice of termination of this Agreement and all of the Services.
11.2 Termination Date
This Agreement and all the Services shall terminate on the date of receipt by the other Party of the notice of termination given under clause 9.1 or any later date specified for that purpose in the notice (the relevant date being the “Termination Date”).
12 Cancellation or Expiry - Rights Preserved
12.1 Release from Cancellation Date or Date of Expiry
From the Cancellation Date for a particular Service Schedule or from the Date of Expiry of a particular Service Schedule, the Provider is released from the obligation to further provide the Service(s) described in that Service Schedule, and the Purchasers are released from the obligation to pay for such Service(s) provided after that date.
12.2 Termination Cancellation or Expiry Without Prejudice to Rights
Termination of this Agreement or the cancellation or the expiry of any particular Service Schedule, shall be without prejudice to the rights, other remedies and obligations of either Party under this Agreement or under the Law which may have arisen before or on the Termination Date for this Agreement or the Cancellation Date or the Date of Expiry for the particular Service Schedule, and such rights, other remedies and obligations continue to have effect and may be enforced after the relevant date. Termination or cancellation shall also be without prejudice to any other rights or remedies of the Party who gave the notice of termination or cancellation. The Purchasers may deduct any amount to which they are entitled as a result of the Provider being found to have breached this Agreement and therefore has been funded for services which the Purchasers have no legal entitlement to pay from moneys otherwise payable to the Provider.
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13 Indemnity
13.1 The Provider will indemnify, and will keep indemnified, the Purchasers against all claims, costs (including solicitor and client costs), liabilities and losses suffered or incurred by that other party as a result of any act or omission by the Provider in any way related to this Agreement or to any alleged breach by the Provider of any Law, except to the extent that the same arises as a result of any act or omission of the Purchasers. The Purchasers may deduct any amount to which they are entitled to be so indemnified from moneys otherwise payable to the Provider once the amount to be deducted has been agreed by the Provider or determined as provided in clause 14 (Disputes).
14 Disputes
14.1 Endeavour to Agree
If a dispute arises in any way related to this Agreement (other than any renewal of it or the fixing of any prices upon any renewal), the Parties shall in good faith endeavour to resolve the dispute by agreement.
14.2 Reference to Senior Executives
If the dispute is not promptly resolved, it shall be referred to the Manager, Claims Management Health Procurement ACC, and the Director, National Health Purchasing, National Health Board Ministry of Health and the chief executive of the Provider jointly to seek agreement upon a resolution.
14.3 Mediation / Arbitration
If the dispute is unable to be resolved by agreement, either Party may, in writing, request that the dispute be referred to mediation. If the other Party does not wish the dispute to be referred to mediation or if it is not possible to agree on a mediator within 10 working days or to resolve the dispute through mediation, either Party may refer the dispute for determination by arbitration of a single arbitrator (to be appointed by the President of the NZ Law Society if not agreed within 10 working days of reference) under the Arbitration Act 1996.
14.4 Parties to Continue to Comply with Agreement
Notwithstanding the existence of a dispute, the Parties shall continue to fully comply with their obligations under this Agreement in accordance with and subject to its provisions.
15 Notices
15.1 Sending
All notices and other communications provided for or permitted under this Agreement shall be sent by email, mail with postage prepaid, or by hand delivery, or by facsimile as shown on the relevant addresses set out in Part 1, Schedule 1 or to such other address or person as that Party may specify by notice in writing to the others.
15.2 Deemed Time of Giving
All such notices or communications shall be deemed to have been duly given or made:
a Four days after being deposited in the mail by the sender with all postage prepaid;
b On delivery when delivered by hand or on behalf of the sender;
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c If sent by facsimile, when a completed transmission report is received by the sender unless a verifiable query as to material illegibility is promptly raised.
15.3 Deemed Time (delivery or fax)
Delivery by hand or transmission by facsimile prior to 5.00 p.m. on a Working Day shall be deemed effected on the date of delivery or transmission, and delivery or transmission after 5.00 p.m. shall be deemed effected on the next Working Day.
16 Conflicts of Interest/Financial Incentives
16.1 The Provider will at all times during the Term of each relevant Service Schedule use its best endeavours to ensure that no action is taken by itself, its personnel and sub-contractors which could or might result in or give rise to the existence of conditions prejudicial to or in conflict with the interests of the Purchasers if such action touches upon or relates to this Agreement or the delivery of the Services.
16.2 If the Provider has a financial interest in an entity supplying, procuring or manufacturing products or services, the Provider shall ensure that those products or services are not utilised in providing, nor comprise, the Services described in the Service Schedules without prior approval from the Purchasers
16.3 Where in order to provide the Services, the Provider procures products or services, the Provider shall not accept or receive (or permit any person associated with the Provider to accept or receive) any incentive or reward for providing those products or services, whether by way of any gift, voucher, cash, trip or travel, merchandise or equipment or any discount, rebate or credit towards such items or in any other form whatsoever.
16.4 The Provider shall under no circumstances accept or receive (or permit any person associated with the Provider to accept or receive) any incentive or reward conditional upon, based on, or linked to the recommendation or procurement of any products or services utilised in providing or comprising the Services.
17 Cost and Volume Shifting
17.1 The Provider must not:
a act in such a way that increases cost to another provider,
b be party to any arrangement which results in the Purchasers effectively having to pay more than once for the supply of the same Services or any component of them,
c act in such a way that shifts volumes relating to Services being provided separately by the Provider where such volumes have been specifically related to that Service.
18 Other Arrangements
18.1 The Provider must not enter into any other contract or arrangement which might prejudice its ability to meet its obligations in this Agreement. The Provider may (subject to its obligations in this Agreement), agree to provide services for any other person.
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19 No Extension or Renewal
19.1 Unless otherwise stated in this Agreement, nothing in this Agreement shall be taken or read as expressly or impliedly warranting that the provider is entitled to an extension or renewal of any of the Service Schedules comprised in this Agreement at any time, or to any further agreement with the Purchasers in respect of any or all the services described in the Service Schedules. The Provider shall not have any claim against the Purchasers for any costs or expenses incurred in anticipation of a further agreement or that any or all the services or the Service Schedules will be extended or renewed, or for any anticipated income, profits or other sums whatsoever.
20 Multiple Providers
20.1 If this Agreement is signed by more than one provider, the liability of all providers under this Agreement shall be joint and several.
21 Waiver
21.1 No failure or delay on the part of either Party to exercise any right, power or privilege under this Agreement shall operate as a waiver nor shall any single or partial exercise or the exercise of any other right or power or privilege whether arising under the law or this Agreement
22 Services for Injured Employees of Accredited Employers
22.1 Purchase of Services by Accredited Employers
The Provider agrees that Accredited Employers are permitted to purchase the Services for their Injured Employees and that the Provider will provide Services to those Injured Employees, subject to the provisions of clauses 22.2 to 22.4 below.
22.2 Information to Accredited Employers
ACC may, from time to time and for the purpose of facilitating purchase arrangements between the Provider and Accredited Employers, release information about this Agreement including prices to Accredited Employers, provided the Accredited Employer has first agreed in writing with ACC to keep that information confidential and to use it only for the purpose of purchasing Services.
22.3 Access
During the period from the date of any Referral made or approved by an Accredited Employer, until expiry of the Term of the applicable Service Schedule, the Provider will provide Services to Injured Employees of such Accredited Employers on the same terms and prices as specified in this Agreement (subject to any minor adjustments to this Agreement which may be necessary to give effect to this clause 22, and to any changes in those terms and prices subsequently agreed between the Provider and Accredited Employer) as if “ACC” in this Agreement was a reference to the particular Accredited Employer. For the purposes of this clause any Injured Employee of an Accredited Employer is deemed to be a “Claimant”.
22.4 ACC not Liable for Purchasing by Accredited Employers
ACC’s role is to bring the Provider and Accredited Employers together. The Provider agrees that ACC and each Accredited Employer is only liable in respect of the individual purchases made by ACC or that employer (as the case may be) and neither of them has any joint liability (except as provided in section 187(3) of the AC Act). Accordingly, all communications, invoicing and
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reporting about Injured Employees will go to the Accredited Employer of the Injured Employee or Injured Employees who receives the Services.
23 Where ACC Approval, Price or Cover is Uncertain
23.1 If prior to the commencement of a Service, the Provider is uncertain whether or not:
a a particular person or Claimant is eligible for the Service; or
b a person is a Claimant; or
c a price has been agreed for the Service; or
d the services required for the Claimant are within the scope of the Services that can be provided under this Agreement
then the Provider will immediately request a written determination of the issue from ACC. ACC will provide a written decision within 5 Working Days of receiving the request or will notify the Provider if there will be a delay. ACC’s determination may include a direction that the person be transferred to an appropriate facility at the relevant Purchaser’s cost. The Provider will provide the service sought while cover is being determined. If ACC determines that the person is a Claimant who is entitled to the Service, then retrospective payment will be arranged by ACC in accordance with the relevant Service Schedule.
24 Definitions and Interpretation
24.1 In this Agreement, unless the context otherwise requires, the following terms have the meaning in the corresponding definition:
Term Definition
AC Act Accident Compensation Act 2001
ACC Accident Compensation Corporation
Accredited Employer
An employer accredited by ACC under the Accredited Employer Programme in accordance with the framework established under section 183 of the AC Act under which the employer and ACC may agree that the employer will provide entitlements in relation to work-related personal injuries suffered by the employer’s employees; and includes, where appropriate, any subcontractor appointed in accordance with the accreditation agreement between ACC and the Accredited Employer; and “Accredited Employers” has a corresponding meaning
Advanced Paramedic (or equivalent)
An ambulance officer trained to the level of National Diploma in Ambulance Paramedic, or its equivalent, provided by an ambulance education provider recognised by Ambulance New Zealand.
Agreement and this Agreement
The agreement of which this provision forms part including all schedules (including service schedules), and appendices to it, as varied at any time
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Ambulance Any motor vehicle, aircraft, or vessel:
(a) designed and used principally for the transport of sick or injured persons; and
(b) operated by an ambulance operator.
Ambulance crew member/staff member/officer
A crew member who has completed an appropriate ambulance/paramedic or first aid qualification and who has met the standard set by the accrediting Education Provider/Industry Training Organisation.
Attending ambulance personnel will have the skills, education, experience and support (if necessary) to do an assessment and make a decision, based on the assessment, with full documentation to support the decision made.
Ambulance Operator
A person who –
(a) (For the purposes of this Agreement) has a contract or arrangement with ACC and the Ministry of Health for the emergency transport of sick or injured persons; and
(b) is a member of Ambulance New Zealand.
Call A request for Service to be provided by the Emergency Ambulance Service or Police or other dispatch service recognised in this Agreement
Claimant Any person who has been accepted by ACC as eligible for cover in respect of personal injury under the Accident Compensation Act 2001.
Note the term “service user” includes a Claimant.
Commencement Date
The date when the term for any Service described in a Service Schedule commences as stated in that Service Schedule
Coverage Area Described in the Service Schedule for any particular Service (and in respect of either Purchaser if relevant).
Crew One or more ambulance staff
Date of Expiry For any Service described in this Agreement has the meaning defined in the Service Schedule for that particular Service
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Emergency For medical cases, emergency means an ambulance response to a call from the public indicating that a person is triaged as life threatening or potentially life threatening by the EACC and services provided to a patient who requires medical attention (not caused by trauma) from the time of the EAS being notified of the need for services; to the time the patient arrives at a place of appropriate care, or completion of care/attendance at the scene.
For ACC-related cases, emergency means an ambulance response to a call from the public indicating that a person is triaged as life threatening or potentially life threatening by the EACC and services provided to a patient who requires medical attention as a result of a personal injury caused by accident. Medical attention will be required from the time of the EAP being notified of the need for services to the time the patient arrives at the place of definitive care, or completion of care/attendance at the scene. EAS may start within 24 hours of suffering a personal injury or within 24 hours of being found after suffering a personal injury (whichever is the later).
Emergency Ambulance Communications Centre (EACC)
A call-receiving centre provided by a Provider, which receives requests for the provision of Emergency Ambulance Services and which dispatches and co-ordinates the response to these requests.
Emergency Inter-hospital transfer
For the purposes of an ACC-related transport, this is an Emergency Transport involving the transfer of a Claimant from one treatment facility to a higher level of care within 24 hours of suffering a personal injury or within 24 hours of being found after suffering a personal injury (whichever is the later)
Emergency Transport
For the purposes of an ACC-related transport, is transport by ambulance as defined under the IPRC (Ancillary Services) Regulations 2002 that:
(a) starts within 24 hours of a Claimant suffering a personal injury or being found after suffering a personal injury, whichever is the later, and
(b) is necessary for the purposes of obtaining treatment urgently for the Claimant’s personal injury, and
(c) is required to be provided under this Agreement to discharge ACC’s liability for “Emergency Transport” under the IPRC (Ancillary Services) Regulations, and that
(d) is by an ambulance that has been dispatched at the request of an Emergency Ambulance Communications Centre.
GST Goods and services tax under the Goods and Services Tax Act 1985
Health Practitioner As defined at section 5 of the Health Practitioners Competence Assurance Act 2003.
Health Professional Authority
Any authority or body that is empowered by or under any law, or the rules of any body or organisation, to exercise disciplinary powers in respect of any person who is involved in the supply of Health and Disability Services
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Injured Employee A person who has suffered a work-related personal injury and who was, at the time the work-related personal injury was suffered, an employee of an Accredited Employer in that employment and “Injured Employees” has a corresponding meaning.
Insolvency Event (a) the appointment of a receiver or receiver and manager or statutory manager in respect of the whole or part of the activity or property of the provider;
(b) the Provider entering into; or resolving to enter into; a scheme of arrangement or composition for the benefit of creditors or any class of creditors; or
(c) the Provider suspending or stopping payment to its creditors generally or ceasing to carry on business as normal; or threatening or stating that it will do any of those things.
Inter-hospital transfer
A transfer of Claimants between publicly funded hospitals, for the purpose of accessing appropriate treatment that is not available at their existing facility.
IPRC (Ancillary Services) Regulations
The Injury Prevention, Rehabilitation, and Compensation (Ancillary Services) Regulations 2002.
Job Cycle Time The total elapsed time from the receipt of a call until the patient arrives at a medical facility.
Law Includes:
(a) any legislation; decree; judgement; order; regulation or by law; and
(b) any rule; protocol code of ethics or practice or conduct and other ethical or standards guidelines and requirements of any relevant professional authority; in effect at the relevant time
Material and materially
In relation to any state of affairs, event or effect, anything which in a major way affects or will affect the ability of a Party to perform or comply with the terms of this Agreement.
Medical Practitioner
A person registered, or deemed to be registered, under the Health Practitioners Competence Assurance Act 2003 who provides primary and/or specialist and/or continuing care to individuals, families, and to a practice population.
Non-Emergency Transport by Ambulance (NETBA)
A road ambulance service required to be provided under this Agreement to discharge ACC’s liability under Regulation 10 of the IPRC (Ancillary Services) Regulations.
Paramedic An ambulance officer who has successfully completed all the requirements of the National Diploma IV/Cardiac (Paramedic), or its equivalent.
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Parties The Provider and the Purchasers; and “Party” refers to either the Provider or the Purchasers. For the avoidance of doubt, the Purchasers constitute one Party to the Agreement and any reference to a Party means a reference to the Provider or to the Ministry of Health and ACC together as the Purchasers.
Provider The Party whose reference name is “the Provider” in this Agreement and, where the context requires, includes its employees, agents and permitted contractors, and its successors and permitted assigns
The Purchasers and the purchaser
The Accident Compensation Corporation continued under the Accident Compensation Act 2001 and, where the context requires, includes its employees, agents, consultants and contractors, and its successors and assigns, acting together with Her Majesty the Queen in Right of New Zealand acting by and through the Ministry of Health including, where the context requires, its permitted consultants, subcontractors, agents, employees and assignees.
Registered Nurse A Registered Comprehensive, General and Obstetric, or General Nurse as described under the Health Practitioners Competence Assurance Act 2003.
Required Response Time
A response time as defined in the Schedules to this Agreement; this is a component of the quality measurements of the Service to be provided.
Request point The geographical location at or to which an ambulance has been requested
Response Time The interval in time from when a call is received by the Emergency Ambulance Communications Centre until the ambulance arrives at the patient scene.
Retrieval The organised transfer of a patient from one facility to a facility that is able to provide a higher level of care.
Search and Rescue
(a) any search for a lost person; or
(b) any rescue operation for a person who is considered to be sick or injured in a remote bush, mountain or close to shore setting where there is or may be difficulty in locating the person; or
(c) any search or rescue operation where distance or location can be affected by weather conditions (e.g. alpine terrain); and
(d) includes any operation mounted solely for the purpose of recovering bodies from a remote location.
Services, service, and the services
The services (or some or all of them, as the context may require) that are to be provided by the Provider in accordance with the Service Schedules.
Service Level A performance requirement expressed as a minimum percentage of calls of a particular category of call and particular Service area which meet the required response time for calls of that particular category of call and particular Service area as described in a Service Schedule.
Service Period The interval in time which commences and ends at a specific time during a day.
Service Schedule An individual service schedule contained in Part 2 of this Agreement.
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Service User Any person who requires emergency road ambulance services as defined in the service specifications.
Note the term “service user” includes a Claimant.
Shift An operational duty period.
Term The period described in a Service Schedule during which the Service(s) described in that Service Schedule are to be provided.
Termination date The date that this Agreement and all the Services are terminated pursuant to Schedule 2.
Triage A system of prioritising requests for medical or ambulance assistance or attendance according to the severity of the trauma (or injury) suffered by a patient.
Working day A calendar day other than any Saturday or Sunday, any public holiday or any day falling within the period 24 December to 5 January inclusive.
Urgent Treatment Where treatment is required for a life threatening or potentially life threatening dispatch, or when a non emergency dispatch is found to be of higher acuity on assessment, and the patient needs transport to treatment to address a life threatening or potentially life threatening condition.
24.2 Interpretation
In this Agreement, unless the context otherwise requires:
a Expressions defined in this document bear that defined meaning in the whole of this Agreement;
b A reference to one gender shall include the other;
c References to schedules, sections, clauses and subclauses are references to schedules, sections, clauses and subclauses of this Agreement;
d The singular shall include the plural and vice versa;
e Clause and other headings shall be ignored in construing this Agreement;
f Any obligation not to do anything shall be deemed to include an obligation not to suffer, permit or cause that thing to be done;
g References to statutes, regulations, ordinances, bylaws or other instruments include any amendment, substitution or re-enactment;
h A person includes a company or other entity. Any reference to a person applies to his/her personal representatives or to its legal successors.
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Schedule 3: Organisational Quality Standards
1 Introduction
These organisational quality standards outline the requirements that the Provider must meet in providing all Services described in this Agreement. These standards are subject to audit but are not subject to regular reporting unless stated elsewhere in this Agreement.
2 Written Policy, Procedures, Protocol, Guideline, Policy
Where a standard refers to the requirement for a written policy, procedure, programme, information or plan, the Provider will provide the Purchasers with a copy on request.
3 All Staff Informed
The Provider will ensure that employees and sub-contractors are aware of their responsibilities under these organisational quality standards and relevant Service Schedules as they relate to the Services.
4 Philosophy
The Provider will provide Services:
a that promote the concept of best practice as an ongoing provider quality assurance mechanism;
b that are necessary, appropriate, timely, of the required quality, and not excessive in number or duration;
c that abide by all relevant legislation (for example Accident Compensation Act 2001, Privacy Act 1993, Human Rights Act 1993, the Code of Health and Disability Consumers’ Rights);
d that demonstrate a commitment to the principles of the Treaty of Waitangi and promoting the purchase of culturally appropriate services for Maori and other ethnic groups;
e that promote open communication, honesty and respect;
f which are accessible in a timely manner and promote the concepts of equity and fairness;
g which are organised and administered in a way that will provide an optimum service to service users in accordance with the service requirements outlined in this Agreement;
h which are service user focused. Choices and service user responsibilities will be clearly specified where appropriate;
i that comply with the Code of ACC Claimants’ Rights;
j that comply with the Health and Disability Commissioner Act 1994, and with all aspects of the Health and Disability Commissioner (Code of Health and Disability Services Consumers Rights) Regulations 1996 (H&DC Code).
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5 Quality Standards
5.1 Quality standards
The Purchasers are committed to purchasing Services from providers who can provide and demonstrate a quality service. To this end, the Provider will:
a ensure that all timeframe requirements in this Agreement as more particularly described in the Service Schedule for each Service in Part 2 are met;
b provide the Services in accordance with all current clinical, ethical and professional standards and guidelines, including the Health and Disability (Safety) Act 2001, and with the degree of professional skill, care and diligence expected of an appropriately qualified person experienced in providing the same or similar services;
c ensure the stipulated time, cost and quality objectives of the Purchasers for each Service are met;
d advise the Purchasers immediately if the Provider becomes aware of any matter which may change or delay the performance of the Services. The advice must include detailed particulars of the likely change or delay and recommendations to minimise any adverse effect from it;
e when requested by the Purchasers, provide evidence that they have a system for ensuring continued compliance with the Health and Disability Services (Safety) Act 2001;
f comply with all relevant provisions of the National Minimum Data Set, Dictionary (the current version) published by New Zealand Health Information Service (available on Ministry of Health website at www.health.govt.nz.
5.2 Quality systems
The Provider is required to:
a Have developed written and applied protocols and policies which outline the standards for the Services.
b Have in place, and follow, written protocols, procedures and policies for the management of the Services. This document needs to be kept up to date and made readily available for staff to read. The document will include written procedures on the following:
i receiving and responding to complaints
ii systems to measure service user satisfaction with the Service
iii collection, privacy and storage of information
iv roles and responsibilities of those providing the Services
v systems for recording and reporting sentinel and serious events
vi culturally appropriate practices
vii rights and responsibilities of Service Users
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viii compliance with relevant legislation, regulations, ethical standards and clinical protocols.
c Ensure that records and documentation are maintained in a manner that is current, detailed and organised and enables effective provision of Services.
d Comply with all reasonable instructions and directions of the Purchasers.
5.3 Service Providers
The Provider will:
a ensure the Services are performed by contractors and personnel who have the knowledge, qualifications, skill base and experience appropriate for the provision of the Services, and who have been trained and briefed appropriately to provide the Services;
b ensure that all registered health professionals providing the Services are registered or enrolled with the appropriate professional body and have current practising certificates where applicable; and
c ensure that assistants, volunteers and other support personnel receive adequate training to allow them to provide the Services safely, and will work only under the supervision and direction of appropriately qualified staff.
5.4 Facilities and equipment
The Provider shall ensure that:
a all facilities shall be accessible to people with disabilities;
b the service provider will provide the Services from safe, well-maintained, hygienic facilities that are suitably designed and equipped for the Services;
c all equipment used in the Services shall be safe and maintained to comply with safety and use standards.
5.5 Interpreting services
Where Service Users require interpreting services in order to communicate adequately with service providers, the Provider will ensure that such Services will be supplied without additional cost to the Service User as part of the Services.
6 Risk Management
The Purchaser will have in place well developed processes for:
a identifying key risks including risks to health and safety;
b evaluating and prioritising those risks based on their severity, the effectiveness of any controls you have and the probability of occurrence;
c dealing with those risks and where possible reducing them.
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Schedule 4: Monitoring and Evaluation
1 Service Evaluation
1.1 The Purchasers’ rights to evaluate
As part of the ongoing management of this Agreement, the Purchasers may evaluate the provision of the Services by the Provider. This is part of the evaluation requirements of the Purchasers and contributes towards reporting to Ministers. The purpose of such evaluation is to monitor progress and quality of delivery of Services under this Agreement in terms of results against expected performance.
1.2 Scope of evaluation
The evaluation undertaken by the Purchasers may include (but shall not be restricted to):
a the processes outlined in this Agreement and used in the ongoing management of the Services;
b the prices of the Services provided in relation to the outcomes;
c satisfaction of any referrer with the Provider and the quality of the Services;
d satisfaction of Service Users with the Provider; and
e any other matters reasonably considered to be relevant by the Purchasers.
1.3 Appointed person
An appropriately qualified person may be appointed and retained by the Purchasers to conduct an evaluation of the Service. Prior to making the appointment, the Purchasers will consult with the Provider as to the suitability of the appointee to conduct the evaluation. In conducting such evaluations the appointee may (subject to the rights of Service Users or other persons receiving Services) attend the provision of Services, talk with service users and/or any of the service providers.
1.4 Notice
The Purchasers shall give the Provider at least 10 working days’ notice of intention to conduct an evaluation.
1.5 Cost
The provision and initial cost of this evaluation is the responsibility of the Purchasers. However, if the evaluation demonstrates that the Provider is not complying with the service requirements contained in this Agreement or that any reports provided to the Purchasers pursuant to this Agreement are not valid, and the Provider does not improve their service standards to the level required by the Purchasers within a reasonable length of time, then any further evaluations which are required in relation to the same performance issues may, at the Purchasers’ discretion, become the cost of the Provider.
2 Service Review
2.1 Reviewing this Agreement
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If either Party requests it, the Parties will meet annually (with the first meeting no earlier than the anniversary of the Commencement Date) to review the Services and any business relationships including without limitation, information flows, timeliness of service provision and prices payable under this Agreement.
3 Audit Provisions
3.1 General right of the Purchasers to audit
The Purchasers shall have the general right under this Agreement, in addition to any audit and evaluation rights expressed elsewhere in it, to undertake clinical and operational audits, at the Purchasers’ expense, of the Services and compliance with this Agreement.
3.2 Notice
Notice will be given to the Provider of the proposed audit and its timing, at least 10 working days before the audit is due to commence.
3.3 Access to records and premises
Subject to observance of the requirements of the law, the Provider will (and will ensure every one of its subcontractors will) allow the Purchasers access to those records and premises of the Provider and any relevant subcontractor retained by the Provider which are necessary for the purposes of audit of quality, service delivery, performance requirements, organisational quality standards or information standards and organisational reporting requirements as detailed in any part of this Agreement. The Provider will (and will ensure every one of its subcontractors will) provide the Purchasers with every reasonable facility for and assistance in obtaining access for the purpose of such audits.
4 Reporting
4.1 Measures
This Agreement requires the Provider to provide results to the Purchasers against a number of contract monitoring measures. The measures are specified in each Service Schedule.
4.2 Purpose
The purpose of these contract monitoring measures is to monitor progress and quality of delivery of the Services in terms of results against expected performance.
4.3 Level of reporting
The reporting is to be at an individual Service User level. Sentinel events will be reported in accordance with any relevant Service Schedule.
4.4 Results to relate only to Service Users
Results against the measures shall relate to only those Service Users who have received the Services.
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Schedule 5: Prices and Payments
1 Prices
The prices payable by the Purchasers for the Services are the prices specified in each Service Schedule.
2 No Additional Payments
Unless otherwise specified in each Service Schedule, the price for each Service is the entire amount chargeable in relation to that Service, and no additional amount may be charged to the Purchasers, any Service User or other person (whether by way of co-payment or part-charge or otherwise) for that Service.
3 Billing and Payment
3.1 Invoicing and payment arrangements
Invoicing and payment arrangements for each Service are specified in the Service Schedule for that Service.
3.2 GST invoice
Each invoice will constitute a GST invoice under the Goods and Services Tax Act 1985, and will be in a format, and contain such information as reasonably requested by the purchasers from time to time.
3.3 Payment terms
If the Provider has complied with its obligations under this Agreement the Purchasers will pay the invoice into the Provider’s bank account as indicated in Part 1, Schedule 1, clause 1 of this Agreement on or before the 20th day of the month following receipt of the invoice.
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Part 2: Individual Service Schedules
Service Schedule – Emergency Road Ambulance Services
1. This Service Schedule for Emergency Road Ambulance Services includes three parts:
Part A Terms and conditions specific to Ministry of Health (the Ministry) related Services;
Part B Terms and conditions specific to ACC-related Services;
Part C Service Specification applicable to all Services.
2. The Parties agree that in addition to the other terms and conditions of this Agreement, the Provider will comply with the Service Specification and the relevant Purchaser-specific terms and conditions set out in the Service Schedule which apply to the Services being provided (i.e. terms and conditions specific to the Ministry when providing the Ministry related Services; and terms and conditions specific to ACC when providing ACC related Services).
3. In this Service Schedule, unless the context otherwise requires, the following terms have the meaning in the corresponding definition:
Term Definition
Adverse Event An event or circumstance which could have resulted in unintended or unnecessary harm to a person and/or a complaint, loss or damage or failure of a mission
Alternative Care Pathway
An Alternative Care Pathway includes triage, assessment and referral to an agreed health provider appropriate to the patient’s needs, when the dispatch of an Emergency Ambulance Resource is not required. The responsibility remains with the EACC until a clinical pathway has been agreed and accepted by the other party, and a warm handover has been completed, as per the developed protocols and/or guidelines.
An Alternative Care Pathway may be regional or local, and may differ from area to area, to meet the specific needs of that community. Alternative pathways of care are based on agreed guidelines and best practice.
Ambulance New Zealand
Ambulance New Zealand is the organisation that represents the Ambulance sector in New Zealand. It was set up to promote common interests of ambulance services providers in this country, Its goal is to make sure a safe, reliable and efficient ambulance service meets the needs of New Zealanders.
Ambulance New Zealand is made up of representatives of all the major providers and a paid executive director.
Ambulance and paramedical Services Standard
Standards for the operation of emergency ambulance services developed and promulgated by Standards New Zealand (NZS 8156).
Best Endeavours
An obligation to do what is reasonable in the circumstances known to the relevant party at the time of the performance.
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Term Definition
Delegated Authority to Practice
Under the requirements of the Medicines (Standing Order) Regulations 2002, the delegated authority to practice is issued under the direction of the Medical Director, and processes are in place to monitor and assess delivery of services under the delegated authority to practice. The authorising Medical Director remains responsible for the service delivery under the delegated authority to practice.
District A geographical catchment area for which a District Health Board has responsibilities as defined by the NZ Public Health and Disability Services Act.
EAP Emergency Ambulance Provider –emergency ambulance operators who hold contracts with the Ministry and ACC to provide Emergency Ambulance Services.
EAS For the purpose of this Service Specification, Emergency Ambulance Services (EAS) may include Emergency Ambulance Communication Centres, Emergency Road Ambulance Providers, Emergency Air Ambulance Providers, and other services such as PRIME and Water Ambulance when required.
Eligible Persons for ACC EAS Services
Eligibility refers to:
(a) People who have suffered personal injury in terms of the “Act” for which a claim for cover has been accepted, or is likely (in the EAP’s experience) to be accepted.
(b) Eligible people are those for whom EAS starts within 24 hours of suffering a personal injury or within 24 hours of being found after suffering a personal injury (whichever is the later), and for whom the emergency transport is necessary for the purpose of obtaining treatment urgently for the claimant’s personal injury.
(c) Those eligible are all those resident in New Zealand and visitors to New Zealand.
Eligible Persons for Ministry EAS Services
Eligibility refers to:
(a) conditions expressed in the latest ‘Eligibility Criteria’ published in the New Zealand Gazette, available from www.dia.govt.nz;
(b) overseas residents and visitors who are usually resident in countries with which New Zealand has reciprocal health arrangements:
New Zealand has reciprocal agreements for healthcare with the United Kingdom. However this is limited to citizens who are normally resident in the United Kingdom. New Zealand has reciprocal agreements for healthcare with Australia, however this excludes the provision of emergency ambulance services.
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Term Definition
Emergency Care Coordination Team (ECCT)
Roadside to Bedside recommends that there should be five regional acute networks made up of representatives of an emergency pre-hospital and hospital emergency services based in Auckland, Hamilton, Wellington, Christchurch, and Dunedin. Each region is funded to have an Emergency Care Coordination Team which acts in a networking, monitoring and advisory role to the regional emergency care system. Representation includes but is not limited to: EAPs, DHBs, General Practitioners, PRIME providers, the Fire Service, Police etc.
The contracts for these services are managed by the DHBs (Auckland, Waikato, Hutt valley, Canterbury and Otago or their designee) and ACC.
Events An attendance by the EAP at a function to supply first aid for individual organisations in which the EAP enters into an individual agreement with the organisation.
Medical Advisor/Medical Director
A registered medical practitioner who holds an appropriate post graduate specialist qualification or relevant experience, appointed by an ambulance service to undertake specified duties. These should include: overseeing and advising on patient care, authorising (in writing) delegated medical procedures and drug regimes carried out by ambulance officers, and being responsible for medical audit of patient care.
Medical Emergency
Includes illness, injury or obstetric emergency that requires an emergency response.
Non-emergency For the purpose of this service specification, non emergency refers to triage assessment of the patient by the EACC where the patient does not require an immediate or urgent response and may be suitable for an Alternative Care Pathways.
Patient Care Protocols
Are a set of clinical guidelines for use by appropriately trained ambulance personnel which are authorised by the Medical Director of the service.
Patient Report Form
A record outlining the patient’s details, clinical status throughout the event and any clinical interventions undertaken upon the patient through the event and up until transfer of clinical responsibility to the receiving hospital. This may be paper or electronic.
Performance Indicators
Specific performance measures collected and reported regularly to enable monitoring of service performance.
PRIME Primary Response In a Medical Emergency – a system using rural doctors and nurses who are funded under contracts between those providers and ACC and the EAPs.
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Term Definition
Place of Definitive Care
For the purposes of Emergency Ambulance Services, a place of definitive care is a receiving treatment facility which provides services and definitive care delivered by the most suitably qualified and experienced staff able to deal effectively with the patient’s presenting condition.
The place of definitive care may be determined by the EAS clinical personnel in conjunction with the receiving treatment facility, and will always be dependent on the patient’s condition and need for urgent care or stabilisation.
It may be deemed appropriate to transport the patient to a specialist facility, where services available better meet the needs of the patient, rather than the nearest facility
Privately funded A commercial activity undertaken by the EAP in which they enter into an agreement with individuals or organisations for the provision of non-emergency ambulance services.
ProQA Is an internationally recognised emergency medical dispatch system and triage tool.
ProQA Determinant Level
The level of severity indicated by ProQA: i.e. Echo, Delta, Charlie, Bravo, Alpha, Omega. Each ProQA determinant has been given a response plan that includes the prescribed crewing level and response priority.
ProQA Determinant: Echo
Immediately life threatening – Allows for the early recognition of life threatening conditions and early dispatch of the closest resource, and provides links to pre-arrival instructions to callers to assist with best practice clinical outcomes - Dispatch occurs at the beginning of the question sequence and is normally Advanced Life Support Priority 1.
ProQA Determinant: Delta
Critical but not immediately life threatening – Allows for early recognition of critical conditions less life threatening. Dispatch occurs at a given point during the Key Question sequence depending on severity and is usually either Advanced Life Support or Intermediate Life Support Priority 1.
ProQA Determinant: Charlie
Serious but unstable – Allows for recognition of serious conditions not immediately Life threatening and Dispatch occurs at a given point during the Key Question sequence depending on severity and is usually either Advanced Life Support or Intermediate Life Support Priority 1 or 2.
ProQA Determinant: Bravo
Serious but stable – Allows for recognition of conditions not immediately critical and Dispatch occurs at a given point during the Key Question sequence depending on severity and is usually either, Advanced Life Support, Intermediate Life Support or Basic Life Support Priority 1 or 2.
ProQA Determinant: Alpha
Stable with the potential to deteriorate, – Allows for recognition of non critical conditions.
ProQA Determinant: Omega
Ambulance Response Not Required.
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Term Definition
Sentinel Event A sentinel event has led to an unanticipated death or major loss of function not related to the course of the person’s injury, illness or underlying condition, and/or was a life threatening event.
Serious Event A serious event has the potential to result in death or major loss of function, not related to the natural course of the person’s injury, illness or underlying condition and/or has resulted in significant harm and/or significant additional treatment.
Severity Assessment Code Score
The Severity Assessment Code (SAC) is an agreed scoring system used to determine the appropriate action to take following an incident.
Service Capability Levels
Means the BLS (Basic), ILS (Intermediate) and ALS (Advanced) levels of service for emergency road and air ambulance services.
Service Level Agreement
A contractual agreement between the EACCs and the EAPs, which outlines the operational aspects of their relationship.
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Part A: Terms and Conditions Specific to the Ministry related Services
[Include usual template info eg price and invoicing etc]
1 Payment Details
1.1 [Insert]
2 Invoicing
2.1 [Insert]
3 Payment Schedule
3.1 [Insert]
4 Coverage Area
4.1 The Provider is contracted to provide Emergency Ambulance Services in [enter coverage areas]
4.2 There may be instances where Emergency Ambulance Services may cross coverage boundaries to ensure the patient is transported to the place of definitive care.
5 Service Specification
5.1 The service specifications for the following purchase units are contained within this agreement:
Emergency Road Ambulance Purchase Unit (TR0202)
6 Service Provision
6.1 The Ministry and the Provider agree that a total amount of [$XXXXXX] (GST excl) has been allocated to the purchase of Emergency Road Ambulance Services for the period from [insert date] to [insert date].
7 Payment of Services
7.1 In accordance with Part 1 of the Public Finance Act 1989, both parties acknowledge that payment to the Provider beyond [insert financial year] is contingent upon the appropriation of adequate levels of funding for services of the type covered by this Agreement under an Act of Parliament for that financial year.
8 Part Charging
8.1 The Ministry recognises that the Provider may elect in some situations to levy a part charge on individuals attended by a road ambulance crew.
8.2 Where the Provider elects to impose a part charge:
a the Provider will be entirely responsible for the enforcement of and any legal consequence relating to the imposition of the charge, including on whom the charge is imposed and in what circumstances.
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b the Ministry accepts no legal or other responsibility in relation to the imposition of such a charge.
8.3 Details to be developed
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Part B: Terms and Conditions Specific to ACC-related Services
1 Coverage Area
The Provider will provide Services to Claimants in [enter coverage areas]
Emergency Ambulance Services may cross coverage boundaries to ensure the Claimant is transported to the place of definitive care.
2 Pricing
ACC agrees to pay the prices set out in [insert] for services to Claimants provided in accordance with this Agreement.
Insert Pricing Schedule
Prices exclusive of GST. Services to match or exceed the minimum standards listed above.
3 Service Description
This Agreement between ACC and the Provider covers the provision of one or more of the types of Service described in the attached Service Specification for the contracted Coverage Area. The types of Service are listed below.
Where it is necessary and appropriate to transport an injured person by a specialised ambulance vehicle with qualified ambulance crew, the Provider will provide Services in accordance with this Agreement and ACC will pay for the following Services:
a Road Services – as outlined in the attached Service Specification
b Transfers
i Emergency Inter-hospital Transfer
An appropriate transportation road vehicle is dispatched by an Emergency Ambulance Communications Centre (EACC), at the request of a DHB staff member, to collect a Claimant from an originating medical facility and transport them to a destination medical facility that can provide a higher level of specialist care; and
The following conditions apply:
A The emergency transport occurs within 24 hours of injury or of the injured person being found (whichever is later); and
B The injured person’s condition deteriorates or the injuries are such that the originating hospital is not able to provide the higher level of specialist service required;
The Provider will ensure that suitably qualified escorts/crew accompany the Claimant in order to provide inter-hospital treatment/care en route. Standards for transport, inter-hospital treatment and reporting shall be in accordance with the standards stipulated in this Agreement. The Emergency Inter-Hospital Transfer service, if provided by road
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ambulance, will be delivered to one of the three service levels specified in this agreement, as directed by the EACC.
Where the patient will be escorted by the hospital clinical team from bed (originating hospital) to bed (receiving hospital), the appropriate handover of clinical notes and transport documentation will take place with the clinicians taking over the duty of care at the receiving hospital.
Exceptions
If the originating hospital should have been able to provide the service under normal circumstances but is unable to do so (for example, the intensive care unit is full or there is no specialist cover) then the costs of the emergency inter-hospital transfer are not covered by ACC. In these circumstances ACC expects that the cost of the emergency inter-hospital transfer is paid for either by the hospital requesting the transfer or under the Ministry/District Health Board contract arrangements with providers of ambulance services.
If for some reason the patient is not transported from bed to bed (e.g. a “tarmac” handover takes place following an air transfer) this is to be reported to ACC within 24 hours of the event or on the first business day after the event occurs, outlining the reasons why the criteria were not met.
ii Helipad/Airport to Hospital – Hospital to Helipad/Airport
An appropriate transportation vehicle is dispatched to meet an aircraft and transport the Claimant to their destination hospital, or to transport the Claimant from their originating hospital to a waiting aircraft. The crew will meet one of the service levels outlined in the appropriate Service Specification depending on the requirements of the injured person. The hospital clinical team will accompany the Claimant in order to provide treatment/care enroute. Standards for transport, pre-hospital care and reporting shall be in accordance with the standards stipulated in this Agreement.
iii Transport from a private facility to a public facility for Claimants who have undergone elective procedures funded by ACC where the transfer is necessary for reasons of clinical safety.
c Planned Non-Emergency Transport to Attend Treatment by Ambulance (NETBA)
i This service covers the provision of non-emergency transport to rehabilitation by ambulance, by Emergency Ambulance Providers.
ii The objective of planned NETBA is to provide a means by which ACC claimants can attend treatment and rehabilitation, when emergency transport is not needed.
iii The desired outcome of planned NETBA is that ACC claimants who require access to non emergency ambulance transport in order to achieve a desirable rehabilitation outcome, do so easily.
iv Services are to be provided to the standards in accordance with the principles of Roadside to Bedside (Ministry of Health et al, 1999), that people receive “the right care at the right time in the right place from the right people”. This specification relates only to the road ambulance element of EAS.
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v In addition, services are to be provided to meet the requirements of Regulation 10 of the Injury Prevention, Rehabilitation and Compensation ( Ancillary Services) Regulations 2001
vi The crewing and qualification level for Planned NETBA is an ambulance or other vehicle crewed and equipped at the basic Life Support level as specified in the Ambulance and paramedical services standard (NZS 8156)
vii Service Provision
A Services are initiated where a Medical Practitioner, on behalf of a claimant, requests ambulance transport to specified types of rehabilitation in relation to a personal injury (for which ACC has accepted cover)
B Planned NETBA occurs when a claimant or their representative requests ambulance transport and where ACC has given prior approval for the Planned NETBA
C To apply for prior approval from ACC, the claimant or their representative must provide a medical certificate that justifies use of an ambulance as opposed to other forms of private or public transport. The medical certificate must provide the original ACC45 or claim number.
D The ambulance transport is dispatched by an EACC
E The EAP is required to make all reasonable efforts to identify where planned NETBA services are being utilised, and to invoice ACC appropriately
F The invoice submitted to ACC by the EAP must include the claimant’s ACC45 or claim number, and the name of the doctor supplying the medical certificate.
G Planned NETBA services end when the claimant is delivered to the nominated treatment provider, or when the claimant is returned to the place of residence/point of departure following the scheduled rehabilitation treatment.
viii Access to Planned NETBA
A Planned NETBA is available to all eligible people who require the service and meet the requirement in clause 3 c vii C.
B Access to planned NETBA will result from a call received and allocated by the EACC.
ix Exclusions
A This service excludes inter-hospital transfer of patients and situations that meet the criteria for emergency ambulance transport, as specified in the joint ACC and Ministry of Health Service Specifications for emergency road ambulance services.
d Dispatch
i All requests for road ambulance assistance shall be made through the EACC regardless of whether the request is for an emergency or non-emergency service.
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ii All requests for road ambulance assistance and all dispatches shall be made in accordance with the Injury Assessment Criteria attached as Appendix 1.
e Rescue/Retrieval
i Where the Provider receives a request to respond to a Search and Rescue (SAR) incident the co-ordination of the operation is a Police responsibility. The Provider shall liaise with both Police Communications and the EACC, who will work together to dispatch the appropriate vehicle for the incident. Where the Provider is dispatched by the EACC for that part of the SAR mission relating to emergency ambulance Services (e.g. when an injured person has been found), the Provider will be paid for that part of the Service by ACC.
ii The Provider shall develop working protocols with the Police SAR officer in their Coverage Area. The protocols will include information regarding the availability of the Provider’s services, the medical equipment and capabilities of the crew, and hand-over procedures to facilitate the smooth running of any SAR operation.
iii Payment under this clause shall be in accordance with the requirements under clause g below.
f Exceptions
This Agreement does not include the delivery and purchase of search services or the recovery of bodies. “Search” means an attempt to locate a person who has been reported and accepted as missing by the Police.
g Payment for Transport
ACC is only liable to pay for the provision of emergency and non-emergency transport of Claimants under this Agreement where an ACC45 has been submitted and cover has been granted and approved for payment, and/or an ACC claim number has been provided.
h Payment for accommodation
When a Provider transports a Claimant to a place of definitive care and is then unable to return to their home base (e.g. when maximum driving hours have been reached or deteriorating weather prevents the return trip) ACC agrees to pay the actual and reasonable cost of overnight accommodation and meals to a maximum of $200 per night, per crew member.
4 Completion and Turn-Over Of Forms
a Collection services
i For every collection Service where the Provider is the initial provider of services, they shall complete (as far as possible) an Ambulance Patient Report Form and an ACC 45 form. The Service Provider shall not, however, sign the Medical Practitioner declaration part of the form (Part F), unless a Medical Practitioner completed the form.
ii On each ACC45 form the Service Provider shall include the vehicle number (where applicable), and Ambulance Officer, Medical Practitioner or Registered Nurse number (where applicable) for each transport provided under this Agreement.
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iii Within the Provider’s Coverage Area the Provider shall establish protocols with medical facilities for the completion and forwarding of ACC 45 forms to ACC.
b Emergency Inter-hospital Transfer
To facilitate adequate hand-over for every emergency inter-hospital transfer, the Provider will complete relevant forms to accompany the patient to the designated medical facility. The Provider will develop protocols to ensure effective hand-over procedures are in place, and will also ensure that all Ambulance Officers, Medical Practitioners and Registered Nurses are aware of these procedures.
5 Invoicing and Payment
5.1 Service Item Codes
The following table represents service item codes used by ACC in the processing of Provider invoices and schedules. The Provider must use these codes to identify individual service items on Provider invoices and/or schedules submitted to ACC:
SERVICE ITEM CODE ITEM DESCRIPTION
Sundry
ACCOM1 Accommodation for Assessor or Service Provider
Road
ETR10 Road ambulance - Contracted Emergency Transport
ETRT01 Inter-hospital Transfer - Road - Basic Life Support
ETRT02 Inter-hospital Transfer - Road - Intermediate Life Support
ETRT03 Inter-hospital Transfer - Road - Advanced Life Support
ETRT04 Transfer to or from helipad/airport
Non-Emergency Transport
NETBAOP Planned Non-Emergency Transport by Ambulance - over 50km
NETBAUP Planned Non-Emergency Transport by Ambulance - under 50km
5.2 Basis of ACC Payments
a ACC will pay the relevant amount set out in Part B, clause 2 to the Provider on a fee-for-Service basis for each Service provided to a Claimant for accident-related Services where:
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i ACC is satisfied that the Service relates to a claim for cover accepted under the AC Act; and
ii the invoice submitted has a valid and related ACC45 number (note that ACC may determine the validity of an invoice by evaluating the information provided).
b Lodgement of ACC45
Where the Provider is the first provider of services to a Claimant, they must submit an ACC45 claim registration form completed by an Ambulance Officer, Medical Practitioner or Registered Nurse who is competent to complete the form, to the appropriate ACC Service Centre for the region; alternatively there may be arrangement with the medical facilities in their Coverage Area that ensures ACC receives a ACC45 claim registration form for all Claimants within 24 hours of the date on which the Service was provided. This should be submitted in electronic format where possible.
c The Provider will ensure that all mandatory fields in the ACC45 are completed accurately and that the Claimant signs the form prior to lodgement with ACC.
d Where the Claimant is unable to sign the form due to their injuries, the Ambulance Officer, Medical Practitioner or Registered Nurse may sign on their behalf clearly citing the reason the Claimant could not sign.
e Where a claim relating to an invoice with an ACC45 number is not accepted under the AC Act, ACC will inform the Provider. Where extra information is required to determine the validity of the claim, the onus is on the Provider to provide that additional information.
5.3 Multiple Claimants/Patients for Emergency Transport In A Single Road Ambulance
a Where more than one Claimant is transported in the same ambulance, the EAP may invoice for the transport of each claimant.
b For the avoidance of doubt, where a Claimant and a medical patient are transported in a single ambulance, the EAP may submit an invoice to ACC the full price for transport for the Claimant.
5.4 Bulk Billing
a The Provider will submit ACC40 (Bulk Billing Schedule) invoices electronically as soon as possible following the date on which the ACC45 claim was lodged. This ACC40 must detail all amounts payable for Services in accordance with Part B, clause 2 (Pricing grid) covering the period since the close of the last Bulk Billing schedule.
b For invoices submitted in accordance with this Schedule ACC will pay the Provider the total amount for all invoices that have a corresponding ACC45 number and that have been accepted for cover by ACC and which meet all the terms and conditions of this Agreement.
c If an acceptable invoice is received ACC will lodge the payment amount in accordance with Part B, Clause 2 (Pricing Grid) into the bank account nominated by the Provider within twelve (12) working days of date of receipt of the invoice/schedule by ACC subject to the information contained in the invoice/schedule being complete and accurate.
d Advice of payment will be forwarded separately by ACC detailing the individual invoices that accounted for the total amount lodged.
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e If an invoice cannot be approved for payment, ACC will advise the Provider, detailing the reasons for the decline and the steps needed to be taken to obtain approval. Where ACC requires further information in order to establish cover, ACC will advise what this process is. If cover is subsequently granted, payment will then be made within ten (10) working days.
f Any queries regarding the non-payment of an invoice should initially be referred to the ACC Provider Helpline (on 0800-222-070). If the issue remains unresolved it may then be referred to National Ambulance Sector Office for investigation and resolution.
5.5 Submission Of Invoices
Providers will ensure invoices/schedules for Services are submitted to ACC within 90 days of the Services being delivered. For the avoidance of doubt, the parties agree that ACC will not pay for a Service where the invoice is submitted more than 12 months after the date the service was provided.
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Appendix 1: Injury Assessment Criteria
Decision-Making Tool for the assessment of the injured person with regard to Mechanism of Injury and Physiological and Anatomical Assessment Criteria
Three methods may be used to assist in determining severity of major trauma or serious illness in conjunction with Patient Status (as assessed by the ambulance crew). The three methods and the criteria for each one are listed below:
Mechanical
Physiological
Anatomical
a Mechanical criteria
The following mechanisms, which imply high energy transfer, would usually indicate a higher level of care is required for the transport of the injured person, and accordingly will impact on the decision of which ambulance and crew to use for collection, retrieval, transport and pre-hospital care.
Vehicle roll over
Major deformation of the vehicle
Fatality in the same vehicle
Ejection from the vehicle
Unrestrained child in a motor vehicle crash
Cyclist or pedestrian hit by a motor vehicle
Fall of over five metres
Any mechanism that causes injuries to multiple body regions.
b Physiological criteria
Physiological triage is based on the present state of vital signs and level of consciousness. Examples include:
Respiratory rate < 10 or > 30 per minute (or assisted respiration)*
Systolic blood pressure < 90mmHg*
Pulse > 130 per minute or < 50 per minute*
Difficulty of arousal or falling level of consciousness.
* In children and the elderly the same principles apply but physical criteria must be taken in context of both age or size.
c Anatomical criteria
Specific examples of anatomical criteria include the following:
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Deep penetrating injury to head, neck, chest, abdomen, peritoneum, or back
Head injury with coma, a dilated pupil, open head injury, or severe facial injury
Chest injury with flail segment or subcutaneous emphysema
Abdominal injury with distension and/or rigidity
Spinal injury with weakness and/or sensory loss
Limb injury involving vascular injury with ischaemia of the limb; amputation; crush injury of the limb or trunk; or bilateral fractures of the femur
Burns (partial or full thickness) more than 20 percent in adults and more than 10 percent in the elderly or children.
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Part C: Service Specification for emergency road ambulance services
1 Term
This Agreement will start on 1 April 2012 or when duly executed by the parties and will, subject to Part 1, Schedule 2 clause 11 (Termination) or clause 16 (Conflict), continue for a period of 48 months to 31 March 2016 with a further right of renewal for a 24 month term. The right of renewal is at the sole discretion of the Purchasers subject to the satisfactory performance of the Services
2 Purpose
Emergency Ambulance Providers (EAPs) provide Emergency Ambulance Services (EAS) to the public. EAS includes timely, appropriate emergency care and where necessary, emergency transport of patients to a place of definitive care.
3 Service Objectives
The objectives for this Service are:
a That it is essential that people get the right care, at the right time, in the right place from the right person1.
b Emergency ambulance services ensure the care given facilitates the best possible outcomes, for patients who access emergency ambulance services and complies with quality requirements.
c Integration of EAS into the wider health sector.
4 Principles
4.1 The following are guiding principles for primary retrievals / treatment / transport:
a Treatment delivered is necessary, appropriate and of the required quality.
b Treatment is delivered by the staff with the appropriate skill level and support.
c Transport to treatment is undertaken only when necessary and appropriate and is related to patient need.
5 Overview of Emergency Ambulance Services
5.1 Emergency Ambulance Services includes Emergency Ambulance Communication Centres (EACCs) and Emergency Ambulance Providers.
5.2 EACCs:
a provide the telecommunication interface between the caller and the EAP;
b determine the patient need through an agreed telephone triage system;
c effectively manage ambulance resources to ensure emergency calls are appropriately responded to.
1 Roadside to Bedside – A 24-hour Clinically Integrated Acute Management System for New Zealand; ACC/Health Funding Authority/Ministry of Health and Council of Medical Colleges; 1999. Available from www.moh.govt.nz
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5.3 The types of resources available to the EACC for dispatch are:
a Emergency Road Ambulances including water ambulances2;
b Emergency Air Ambulances; and
c Primary Response in Medical Emergency (PRIME) doctors and nurses.
5.4 EAPs:
a provide road ambulance services across New Zealand, with a range of services and capability levels to meet the needs of their communities within available resources;
b are dispatched by the EACCs;
c respond in a timely manner to calls for assistance made through the EACCs in order to provide appropriate care and, where necessary, emergency transport of people requiring urgent treatment as a result of one of the following medical emergencies: illness, injury or obstetric emergency.
5.5 The Crown expects that the resource most appropriate to the patient’s triaged needs will be utilised. This means an ambulance resource will be dispatched and/or referral to an alternative care pathway.
5.6 It is expected, that if an ambulance has been dispatched and it is deemed clinically appropriate, then the EAP shall refer the patient to an alternative care pathway rather than transport the patient to a place of definitive care.
6 Background
6.1 Roadside to Bedside
a Roadside to Bedside outlines the framework necessary to provide the best possible outcomes for people who need to access emergency services by ensuring that people get ‘the right care, at the right time, in the right place, from the right person’.
b EAPs must follow the Roadside to Bedside framework.
6.2 The New Zealand Ambulance Service Strategy
The New Zealand Ambulance Service Strategy3 (the Strategy) was announced in June 2009. The Strategy was developed by the Accident Compensation Corporation (ACC) and the Ministry in consultation with the ambulance sector and other stakeholders. The Strategy provides a framework for future development and growth of emergency ambulance services, and ongoing collaboration between Crown, sector and stakeholders. The 10 initiatives from the Strategy were developed taking into consideration advice and recommendations following several reviews of the Ambulance Sector. These initiatives have been prioritised and are being implemented over time.
2 Services usually organised through EAPs and provided by Coast Guard services3 The New Zealand Ambulance Service Strategy – The first line of mobile emergency intervention in the continuum of health care. 4 June 2009. Available from www.naso.govt.nz.
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6.3 Integration into the wider health sector
The integration of Emergency Ambulance Services into the wider Health Sector may contribute to more services being delivered in local communities. Thereby potentially reducing the demand on secondary and tertiary services. This may lead to providing better care for patients, closer to home.
6.4 Obligations for response to major emergencies
EAPs must comply with the following:
a The National Civil Defence Emergency Management Plan Order 2005.
b The Ambulance New Zealand Ambulance National Major Incident Plan (AMPLANZ) framework.
c The New Zealand Standard, Ambulance and paramedical services standard (NZS 8156).
6.5 EAP and EACC Interface
a The EACCs dispatch EAP resources to the scene of the medical emergency, as appropriate, based upon information received from the caller. Allocation and dispatch of resources is based on patient need, within available resources. EAPs are responsible for the supply of the EAS resources.
b EAPs are required to have a formal, signed Service Level Agreement (SLA) with EACCs that describes the operational relationship, including location finding responsibilities. Communication between the EAP and EACCs is paramount at all times and this will be reflected in the SLA. A copy of the signed SLA will be provided to the National Ambulance Sector Office (NASO). Any subsequent changes will be formally agreed and signed by the EAP and EACCs, and then advised to NASO.
c The EAP will be a participating member of the Emergency Ambulance Communication Centre User Group. The Terms of Reference4 should be revised at least every two years with EACCs leading the process with involvement of all EAPs and NASO.
6.6 Emergency Care Coordination Teams
EAPs must be participating members of the appropriate regional Emergency Care Coordination Team (ECCT), where they exist.
6.7 Interface Between the Ministry and ACC
a The NASO is a joint ACC and Ministry team which manages all EAS contracts, including EACC and EAP contracts, on behalf of the two Crown Agencies.
b ACC and the Ministry have different funding models for EAS; these will continue until such time as a joint funding model has been agreed and approved for implementation. Any changes to the funding model will be recorded in a contract variation.
4 EACC User Group Terms of Reference are approved by NASO, Ambulance New Zealand and the EACC Oversight Committee. Current ToR are available from Ambulance New Zealand
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6.8 ACC Responsibilities
ACC is responsible for the funding of EAS for certain eligible people5 who have suffered personal injury in terms of the ‘Act’ for which a claim for cover has been accepted, or is likely (in the EAP’s experience) to be accepted. Eligible people are those for whom the EAS starts within 24 hours of suffering a personal injury or within 24 hours of being found after suffering a personal injury (whichever is the later), and for whom the emergency transport is necessary for the purpose of obtaining treatment urgently for the claimant’s personal injury. Those eligible are all those resident in New Zealand and visitors to New Zealand.
6.9 Ministry Responsibilities
a The Ministry funds EAS for all Eligible People6 who have a need for emergency medical attention. For the purposes of this service specification emergency medical attention means services provided to a patient who requires medical attention (not caused by trauma) from the time of the EAS being notified (via the EACC) of the need for services; to the time the patient arrives at a place of definitive care.
b Transport between public hospital emergency departments within three hours of arriving by ambulance is included in the service provided under this Agreement.
c In this specification, “emergency” means those cases triaged as life threatened or potentially life threatened as determined by the Triage system used in the EACC.
d The EAS is capacity funded to meet this urgent demand and may be used to respond to non emergency situations but non emergency volumes are not considered a basis for change in funding levels.
e The use of funded capacity to respond to non-emergency situations must not impact on the ability to respond to emergency situations.
7 Service Description
7.1 General
The Emergency Ambulance Provider must:
a Comply with NZS 8156 (including but not limited to clinical governance) and relevant legislation outlined in NZS 8156.
b Be a member of Ambulance New Zealand.
c Comply with International Organisation for Standardization 9001: 2001 (ISO 9001:2001).
d Use best endeavours to meet the required response time targets (refer Appendix 2).
e Respond and supply an emergency road ambulance service for people requiring assistance as a result of a medical emergency when required and dispatched by the EACC.
f Be available 24 hours a day, 7 days a week inclusive of statutory and public holidays, and have contingency services in place for back-up in the event of their inability to provide the Services for any reason.
5 Refer to Part Two, Service Schedule – Emergency Road Ambulance Services for the definition of Eligible Persons for ACC EAS Services.6 Refer to Part Two, Service Schedule – Emergency Road Ambulance Services for the definition of Eligible Persons for Ministry EAS Services.
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g Respond to requests by the EACC to transport a treatment provider(s) to the scene of an incident where it is clinically appropriate (eg where the patient is not able to be moved), and where it is reasonable, to return that treatment provider to town or residence, (e.g. emergency physician, anaesthetist, lead maternity carer).
h Crew road ambulances with appropriately skilled staff (refer Appendix 1).
i Meet service delivery requirements described in this service specification.
j Send the most appropriate, closest/fastest resource regardless of geographical boundary.
7.2 Clinical Governance
a The EAP must have an established Clinical Governance Framework within their organisation, and must be able to demonstrate both the framework, and application of the framework to daily business, if requested by NASO.
b The EAP will be a participating member of the ambulance sector’s National Clinical Leadership Group (NCLG)7.
c The EAP shall implement policies and procedures directly relating to clinical issues which have been promoted by the NCLG.
7.3 Training and Education
The EAP will have a continuing clinical education programme to ensure that ambulance personnel maintain clinical competence and currency.
7.4 Staff and Service Capability Levels
a The Service Capability Levels (refer Appendix 1) describes the crewing required of the EAP.
b If Ambulance Personnel become regulated and registered health professionals under the Health Practitioners Competence Assurance Act (HPCA Act) 2003, then each Ambulance crew member/staff member/officer will hold an annual practicing certificate and will work within their scope of practice (if any).
c The EAP will be responsible to ensure staff meet the registration requirements under the HPCA Act, in a timeframe agreed by the EAP and NASO (on behalf of ACC and the Ministry).
7.5 At the Scene of a medical emergency
The EAP must:
a ensure Services provided comply with NZS 8156;
b ensure all Ambulance Personnel are appropriately trained and work within the current authorised patient care protocols issued by the responsible Medical Advisor/Medical Director; and
c co-ordinate with other emergency services present at the scene (e.g. Police and Fire).
7 The purpose of the NCLG is to provide a consistent approach to all clinical issues across the New Zealand Ambulance Sector.
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7.6 Patient Handover
The EAP must ensure continuity of care for the patient is maintained by :
a The seamless transfer of care to the accepting treatment facility.
b Handover by both a verbal report, and a properly documented copy of the Patient Report Form (PRF), and, where appropriate, the ACC45, to the receiving treatment facility
Where it is appropriate, the ACC45 must be signed by the patient wherever possible; if the patient is unable to sign, the reason for this must be documented on the PRF.
The responsibility remains with the EAP until an alternative clinical pathway has been agreed and accepted by the other party, and a warm handover has been completed, as per the developed protocols and/or guidelines.
8 Maori Health and Cultural Requirements
8.1 EAPs will provide services in a culturally appropriate way and will comply with relevant cultural requirements as prescribed by the Ministry and ACC from time to time.
9 Exclusions
9.1 EAS services for the following incidents are excluded from this Agreement:
a for the Ministry:
i the inter-hospital transfer of patients with the exception of those medical patients transferred between facilities within three hours of arrival at that facility; and
ii non emergency attendances including attendance at public events, standby in support of other emergency services and any transports privately funded.
b for ACC:
i patients transferred more than 24 hours after suffering their personal injury;
ii non-emergency transport unless the transport meets the Planned Non Emergency Transport by Ambulance (NETBA) service descriptions. Prior approval must be obtained for Planned NETBA
iii any time spent in the search for a Claimant; and costs incurred if the Claimant dies before the EAS arrives; and
iv patients, where the location of the patient is outside New Zealand’s territorial waters.8
10 Service Linkages
10.1 The purpose of key linkages is to maintain a working relationship of communication, consultation and inclusion. Those organisations identified in clause 10.2 are not exclusive and the EAP is encouraged to explore opportunities to develop and maintain key linkages with other organisations nationally, or within the region that enable and/or promote effective service delivery and achievement of the objectives of this service specification.
8 Territorial Sea, Contiguous Zone and Exclusive Economic Zone Act 1977 and Injury Prevention, Rehabilitation, and Compensation Act 2001.
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10.2 The EAP must maintain key linkages with the following organisations or entities in order to provide an efficient and effective emergency ambulance service:
a other EAPs (road and air) in the region and neighbouring regions;
b PRIME providers;
c EACCs;
d receiving District Health Boards which have an involvement in emergency care as well as DHBs which provide specialist services on a national or sub national basis (e.g burns, spinal injury);
e the ECCT for the region;
f the Ministry;
g ACC;
h NASO;
i other emergency services including New Zealand Police, Fire, Search and Rescue;
j relevant national Sector and Stakeholder groups eg Ambulance New Zealand;
k other local organisations with a direct interest in the provision of emergency care including Primary Health Organisations and private emergency medical clinics.
11 Quality Requirements
11.1 General Quality Requirements
The EAP will:
a comply with the quality requirements in the overarching Agreement(s); and
b be certified as compliant with the current version of NZS 8156.
Response time targets are defined in Appendix 2 (Response Time Targets).
11.2 Data Quality
a The EAP must work with EACCs to ensure that the data stored by EACC is accurate and reliable.
b The EAPs will work with EACCs to ensure that the classifications (ie Urban, Rural and Remote) that are applied to each Service Area are aligned with the latest Census data available.
c Agreement is required by the EAP, the EACC and NASO to apply a classification to a Service Area(s) that is not in line with the latest census data available. The reason for the change must be documented by the EACC and reported in the next Quarterly Report.
12 Reporting
12.1 The EAP will provide reports electronically to NASO, in an agreed format.
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12.2 The EAP will provide reports to NASO as per the following table. Data should be provided in Microsoft Excel spreadsheet format where appropriate. Appendix 3 contains indicative templates for data required.
Reporting Requirement Frequency/Period Due
1. Response Time Performance (Latest month and 24 months history)Performance against response time targets as defined in appendix 2
Monthly20th calendar day of the following month
2. Volume Data (Latest month and 24 months history)
a. Volume of incidents attended where there was no patient transported
b. Volume of incidents attended where there was at least one patient transported (by life threatening, potentially life threatening and non emergency)
Monthly20th calendar day of the following month
3. Frontline StaffingStaff establishment Full Time Equivalent (FTE) numbers by Skill level for
a. FTE paid establishment
b. FTE vacancies for paid positions
c. Headcount of Volunteers
Six-monthly:July-DecemberJanuary to June
20th January20th July
4. Clinical outcomes:
The EAP will to report on clinical outcome measures for at least one medical condition and one trauma related condition.. This report must also be sent to the NCLG.
The conditions and reporting requirements are determined by the NCLG with NASO and may be reviewed annually.
Six-monthly:July-DecemberJanuary to June
20th January20th July
5. Quality
a. Copy of Annual Patient Experience Survey
b. Copy of the NZS8156 audit summary with any corrective actions
Annual As available
12.3 The EACC service providers may provide data to NASO. Where the data represents an individual EAP the data will first be sent to the EAP for the opportunity to verify the data and provide commentary.
13 Incident reporting
All incidents will be assigned a Severity Assessment Code (SAC) rating for the actual and potential outcome of the incident. Ratings shall be in accordance with the New Zealand Incident Management System (NZIMS). See Appendix 4 for details.
13.1 Incident Reporting - Serious and Sentinel Events
a Specific Event Reporting
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Serious and Sentinel events with a SAC 1 or SAC 2 rating of the outcome of the incident must be reported as per NZIMS.
i NASO must be notified of SAC 1 and SAC 2 events no later than five working days from identification of the event. The EAP will provide NASO with a copy of the NZIMS report.
b The EAP will provide NASO with updates of any developments regarding the investigation including:
i Progress of investigation
ii Findings of the investigation
iii Media releases/responses
iv Mitigation strategies.
c Media
The EAP will immediately advise NASO if it becomes aware of a serious or sentinel event which in the EAP’s opinion has or may have media or public interest. This may be provided orally in the first instance, and followed up in writing.
d Quarterly Reporting
i The EAP must provide NASO with quarterly reports summarising Serious and Sentinel events.
ii These reports should be from the same data source as the NZIMS reports.
iii The minimum data required is shown in the template in Appendix 5 (Serious and sentinel events quarterly report). This data may either be entered into the template or in an alternative format.
13.2 Incident Reporting - Adverse Events and Complaints
a Media
The EAP will immediately advise NASO if it becomes aware of an adverse event or complaint which in the EAP’s opinion has or may have media or public interest. This may be provided orally in the first instance, and followed up in writing.
NASO will be informed of the following information, following internal investigation:
i Cause of incident
ii Impact/Potential Impact
iii Mitigation Strategies
iv Outcome.
b Quarterly Reporting
The EAP must report to NASO, volumes of adverse event, using the template in Appendix 6 (Volume Template – Adverse Events). This will be used to monitor trends.
13.3 Other Reporting
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NASO may make reasonable requests for ad-hoc information relating to the provision of EAS and the EAPs must provide any such requested information within an agreed timeframe that is reasonable for the information requested.
14 Monitoring and Evaluation
14.1 Representatives from NASO will meet quarterly with the representative from the EAP to review and discuss the reports received by NASO and any performance issues.
14.2 All reports that are provided to NASO from both the EAP and EACCs will form the basis for quantitative measurement of performance of that EAP.
14.3 Prior to the regular performance monitoring meetings as detailed in clause Error: Reference source not found4.1, the EAP will provide NASO with written commentary/explanations regarding
a changing trends and exceptions identified in the reports
b regional/district performance issues
c activities planned and being undertaken to improve performance
14.4 The EAP will participate in the EACC User Groups as per clause 6.5c.
14.5 Upon reasonable notice (not less than 10 working days), the EAP will collate and provide information for audit to the Ministry and ACC.
14.6 NASO retains the right to evaluate any aspect of the EAP’s performance. At least 10 days notice will be given of any evaluation audit.
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Appendix 1: Service Capability Levels as per NZS 8156
Service Capability Levels Road
Basic Life Support
(BLS)
All emergency Basic Life Support capable ambulances must be crewed with at least one crew member who holds at a minimum: the Ambulance New Zealand recognised National Diploma in Ambulance Practice (NZQA Level 5) or equivalent.
Intermediate Life Support (ILS)
All emergency Intermediate Life Support capable ambulances must be crewed with at least two crew members who hold an Ambulance New Zealand recognised ambulance qualification. One must hold a minimum: the Ambulance New Zealand recognised Bachelor of Health Science, ILS Pathway (WFA/OSJ) or equivalent.
Advanced Life Support
(ALS)
All emergency Advanced Life Support capable ambulances must be crewed with at least two crew members who hold an Ambulance New Zealand recognised ambulance qualification. One must hold a minimum of Post Graduate Certificate in Speciality Care – Advance Paramedic Practice or equivalent as recognised by Ambulance New Zealand.
OTHER SERVICE CAPABILITY LEVELS
Service Capability Levels Road
First Responder A response which may have a qualification of less than BLS and is the first resource available to respond to an incident. This may or may not be a response in a vehicle with patient carrying capability. This may include the fire service.
Rapid Response Unit A response is a non transport capable vehicle. This response is designed for early arrival at cases where immediate intervention is required and can also be used for back up for lower skilled crew levels.
Urgent Community Care (UCC)/Extended Care Paramedics (ECP)
A response with a skill level of ECP/UCC who are trained to assess patients conditions to determine the best patient care pathway, which may be typically involve treatment at home or referral to other care pathways, rather than direct transport to ED.
PRIME PRIME is a co-response with ambulance services, for medical emergencies in identified PRIME locations. PRIME Practitioners are Doctors and Nurses who are PRIME trained.
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Appendix 2: Response Time Targets
Response times will be reported for the following types of incident:
1 Immediately Life Threatening Incidents
2 Potentially Life Threatening Incidents, and
3 Non Emergency Incidents
ProQA is an internationally recognised medical dispatch system and triage tool. The definitions for the various ProQA determinant levels are in the Service Schedule glossary. The determinant level assigned to each incident will form the basis of classifying the type of incident.
Type of Incident
Urban service area
(Main urban centres > 15,000 population – responses
within city boundary as specified on service area map)
Rural service area
(Rural areas surrounding urban cities, or non-remote
rural areas, or minor urban/provincial town centres <
15,000 population as specified on service area map)
Remote rural service area
(Very rural and remote locations as specified on
service area map)
Immediately Life
Threatening
Emergency
Incidents
Arrive at request point
within 8 minutes from
time of sufficient
information collected for
the call to be entered into
the queue for 50% of calls
Arrive at request point
within 20 minutes from
time of sufficient
information collected for
the call to be entered into
the queue for 95% of calls
Arrive at request point
within 12 minutes from
time of sufficient
information collected for
the call to be entered into
the queue for 50% of calls
Arrive at request point
within 30 minutes from
time of sufficient
information collected for
the call to be entered into
the queue for 95% of calls
Arrive at request point
within 25 minutes from
time of sufficient
information collected for
the call to be entered into
the queue for 50% of calls
Arrive at request point
within 60 minutes from
time of sufficient
information collected for
the call to be entered into
the queue for 95% of calls
Potentially Life
Threatening
Emergency
Incidents
Arrive at request point within 20 minutes from the time
of sufficient information collected for the call to be
entered into the queue for 80% of calls
Arrive at request point within 30 minutes from the time
of sufficient information collected for the call to be
entered into the queue for 80% of calls
Arrive at request point within 60 minutes from the time
of sufficient information collected for the call to be
entered into the queue for 80% of calls
Non Emergency
Incidents
Time out as requested or specified by control and
within normal road restrictions
Time out as requested or specified by control and
within normal road restrictions
Time out as requested or specified by control and
within normal road restrictions
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Time intervals
The following diagram shows the intervals that are used for time based reports
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Appendix 3: Reporting TemplatesResponse Time Performance
ProviderPeriodDate
Potentially life threatening emergency incidents
Potentially life threatening emergency incidents
Potentially life threatening emergency incidents
50% 95% 80% 50% 95% 80% 50% 95% 80%8 minutes 20 minutes 20 mintues 12 minutes 30 minutes 30 minutes 25 minutes 60 minutes 60 minutes
Jul-09Aug-09Sep-09Oct-09Nov-09Dec-09Jan-10Feb-10Mar-10Apr-10
May-10Jun-10Jul-10
Aug-10Sep-10Oct-10Nov-10Dec-10Jan-11Feb-11Mar-11Apr-11
May-11Jun-11Jul-11
Urban Rural Remote
Immediately Life threatening emergency incidents
Immediately Life threatening emergency incidents
Immediately Life threatening emergency incidents
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Volume Reporting
ProviderPeriodDate
Immediately life threatening Potentially life threatening Non-emergency
Jul-09Aug-09Sep-09Oct-09Nov-09Dec-09Jan-10Feb-10Mar-10Apr-10
May-10Jun-10Jul-10
Aug-10Sep-10Oct-10Nov-10Dec-10Jan-11Feb-11Mar-11Apr-11
May-11Jun-11Jul-11
Volume of incidents attended where there was at least one patient transportedVolume of incidents attended where
there was no patient transported
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Front Line Staffing
ProviderPeriodDate
ALS ILS BLS Total
Full Time Equivalent Paid Establishment
Full time Equivalent vacancies for paid positions
Headcount of volunteers
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Appendix 4: Allocating the Severity Assessment Code (SAC Score)
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Source: http://www.moh.govt.nz/moh.nsf/indexmh/improvingquality-reportableevents-resources
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Appendix 5: Serious and Sentinel Events Quarterly Reporting TemplateO
rgan
isat
ion
Eve
nt R
ef
Dat
e R
epor
ted
to
NA
SO
Type
of I
ncid
ent
Dat
e of
inci
dent
Reg
ion
Ser
ious
, Sen
tinel
or
Adv
erse
Act
ual /
Pot
entia
l (N
ear M
iss)
Act
ual S
ever
ity
Ass
essm
ent C
ode
(SAC
) Sco
re
Incident CategoryDescription of what
happened and immediate actions taken
Fina
l SA
C S
core
(fo
llow
ing
inve
stig
atio
n /
miti
gatio
n)
Findings/Outcome of Investigation Recommendations Mitigation (Investigation /
Response / Actions) Media coverage (if any) Media Story (if any)
Com
plai
nt?
Inci
dent
Num
ber
(select) (select) (select) (select) (select) (select) (select)
Incidents - Quarterly Report
(select)Operator:
Quarter: Year:
Date Reported:
Reported by:
Required for SAC1 and SAC2 events (not required for SAC3 & SAC4) If known:Required fields
(name)
(date)
2010/11(select)
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Appendix 6: Volume Template – Adverse Events
This template relates to clause 13.2.b
(name)(select)(date)
2010/11(select)
Attitude The attitude of the attending member(s)
Late Late arrival
Driving Any issues around the driving of the ambulance
Payment Specific issues involving payment
Refusal Refusal of patient to transport or the member believes there is no need to transport
Equipment Specific equipment issues - maybe safety related
Injury Where the patient is injured as a direct result of transporting to destination
Treatment Medical treatment - suitability thereof etc.
Communication Whether there may have been a breakdown in Communication with crew and RCC or even hospital / patient
Cultural Any issues around cultural matters
Privacy Issues involving privacy concerns
Other Where complaint does not neatly fit into any of the other categories
0
Adverse EventsCategories
Total
Reported by: Operator:
Date Reported: Year:
Quarter:
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