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Thames Ambulance Service Also known as Thames Group Uk

We are carrying out checks at Thames Ambulance Service using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Updated 20 February 2018

Thames Ambulance Service is operated by Thames Ambulance Service Limited. The service provides patient transport services from 16 sites nationwide.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 19 September 2017 along with an unannounced visit to the service on 4 October 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The service had experienced fast-paced expansion in its PTS work over the past 12 months. However, we were concerned it did not have the systems and processes in place to carry this out safely and reliably, due to our findings for example around lack of monitoring service activity, lack of audit, poor support and management for operational staff and patient complaints.

Services we do not rate

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas where the service needs to improve:

  • There was a poor culture around incident reporting, investigating and learning. The service’s incident management process was not embedded across all sites. Not all staff were aware of the service’s incident management policy.

  • We were told about a patient death that had occurred, which was not notified to the Care Quality Commission as a statutory notification.A service lead could not locate the incident report or explain where they were in terms of the investigation of this.

  • The service did not have a clinical quality dashboard or similar to provide an overall picture of safety and quality at any given time by collating information, for example around incidents, infections, safeguarding referrals, and complaints among other indicators.

  • The process and responsibility for deep cleaning vehicles at the Grimsby and Scunthorpe sites was unclear and inconsistent with the service policy on deep cleaning and infection prevention and control (IPC)

  • There were no audits for deep cleaning or IPC being carried out at the Grimsby and Scunthorpe sites.

  • It was not clear who had oversight of vehicle and equipment safety at the Grimsby and Scunthorpe sites as there was no documentation around this.

  • The service did not have clear records to show that all vehicles had received an MOT.

  • The documentation of safeguarding referrals and investigations was unclear and inconsistent.

  • Service leads were not able to demonstrate effective oversight of training compliance to ensure staff were up to date with mandatory training.

  • It was not clear what the service policy and procedure was relating to transporting children and the risks this could present.

  • There was a lack of consistency in how to access policies and procedures across sites. There was no evidence that updates to policy and guidance, was being shared between sites to ensure staff were working to the same standards. Many of the policies at the Grimsby site were out of date.

  • There was no audit activity taking place at Grimsby and Scunthorpe for the service to monitor its own performance in terms of quality and safety aspects.

  • There was no formal induction procedure for staff at the Grimsby and Scunthorpe sites. Team leaders, who were responsible for the day to day operations at site level, had received no additional training or induction to ensure they were competent in this role.

  • Staff at Grimsby and Scunthorpe raised concerns they had not been trained to use equipment such as wheelchairs, ramps and stretchers. The service did not provide evidence of staff competencies in this.

  • There was no system to ensure appraisals were carried out annually. Staff at Grimsby and Scunthorpe confirmed they had not had appraisals. This was not compliant with the service’s guidance on staff appraisals.

  • Staff said they did not always receive the information they needed from a discharging hospital, such as whether a patient had MRSA, was living with mental health difficulties, or any particular mobility needs. This meant they often arrived and realised they would not be able to carry out the transfer.

  • Managers at each site could not explain how the service was monitoring any key performance indicators to ensure services were planned and delivered to meet patients’ needs, or show us any systems for this.

  • There was no clear process for managing and learning from complaints across all sites.

  • There was no vision or strategy for the service.

  • Governance, risk management and quality measurement processes were not embedded at all sites. Service leads could not explain their local risks and were not aware of any systems for monitoring and mitigating risk.

  • No meetings for staff or service leads were taking place in the northern region.

  • There was evidence of a poor culture and morale at the Grimsby and Scunthorpe sites, in relation to staff feeling unsupported.

  • There were no systems for public or staff engagement at the service.

However, we also found the following areas of good practice:

  • Vehicles at the Canvey Island base had ‘deep cleaning passports’ to document deep cleans, and were deep cleaned every six weeks at this site in accordance with service policy.

  • Equipment on vehicles at the Canvey Island base was checked and in accordance with the equipment and vehicle checklist. This was also audited by an external company, with actions highlighted for improvement.

  • At the Canvey Island site, there had been initiatives to improve safeguarding awareness, reporting and learning since our previous inspection. For example, the service had employed a safeguarding lead since our last inspection, trained to level four in safeguarding, and staff at this site confirmed they could access them for advice and support.

  • The service had a deteriorating patient policy, which was an improvement from the previous inspection.

  • Operational staff displayed a patient-focused approach and ensured patients’ privacy and dignity were maintained. This was reflected in positive feedback from patients about the care from frontline staff.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notice(s) that affected patient transport services (PTS). Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

Inspection areas

Safe

Updated 20 February 2018

Effective

Updated 20 February 2018

Caring

Updated 20 February 2018

Responsive

Updated 20 February 2018

Well-led

Updated 20 February 2018

Checks on specific services

Patient transport services (PTS)

Updated 20 February 2018

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found:

  • There was no effective system across the service for incident reporting, investigation and learning from incidents.

  • There was no clinical quality dashboard to display and monitor safety and quality information.

  • Procedures and good practice around cleanliness and IPC were not embedded across the service.

  • There was no evidence that vehicles at Grimsby and Scunthorpe were receiving regular deep cleans and it was not clear who was responsible for deep cleaning.

  • At the Grimsby base, there was a potential health and hygiene risk due to bird faeces on the floor within the station where the ambulances parked and were cleaned.

  • There was a lack of clear processes including auditto ensure consistent maintenance of the environment and equipment across all sites and to ensure vehicles and equipment were safe for use.

  • Safeguarding procedures and awareness were not embedded across all sites.At Grimsby and Scunthorpe, it was not clear what the escalation arrangements were, or how the service ensured appropriate learning and feedback.

  • There was a lack of clear consistent processes across all sites to ensure all staff were up to date with mandatory training.

  • It was not clear what the service policy and procedure was relating to transporting children and the risks this could present.

  • We were unable to assess staffing levels against patient needs as the service was not monitoring the rate of unfilled shifts.

  • There was a lack of consistency in policies and procedures between sites.

  • There was no audit activity taking place at Grimsby and Scunthorpe.

  • There was no clear system to monitor response times for patients; therefore it was not clear whether the service was meeting targets set by each clinical commissioning group.

  • There was a lack of clear processes to ensure all staff had the necessary skills, knowledge and competencies and a lack of support for operational staff.

  • There was no evidence to show that staff were appropriately trained and supported to use the equipment required in their day to day roles

  • There was no system for monitoring appraisals to ensure staff were competent and supported. Staff, particularly in Grimsby and Scunthorpe, said they had not had appraisals.

  • There was no consistent procedure across sites for maintaining staff files and it was unclear who had overall responsibility for this.

  • Staff did not always receive the information they needed about a patient’s condition and needs, meaning they sometimes arrived for a journey and realised they were not able or equipped to carry it out.

  • Staff did not receive training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards.

  • Operational staff displayed a patient-focused approach to their work, and patients we spoke with felt that operational staff were caring, friendly and helpful.

  • There was no evidence of the service monitoring any key performance indicators to ensure services were planned and delivered to meet patients’ needs.

  • There was no specific training for staff in meeting the needs of patients living with learning disabilities or dementia.

  • The service did not have its own access to translation services for patients whose first language was not English.

  • We had concerns about patient access and flow due to the high level of delayed journeys..

  • There was an up-to-date complaints policy and procedure at Canvey Island; however, there was no evidence this was in place at Grimsby and Scunthorpe. Staff at these sites could not give examples of feedback or learning from complaints.

  • There was no record of complaints for any sites in the northern region, so we were not assured complaints were being reported and monitored.

  • The complaints records for the southern region were not collated, audited or tracked to monitor themes and trends and act appropriately to resolve and reduce complaints.

  • Management and governance structures were not clear at site level.

  • Staff consistently reported that the senior management team was not visible and at the Grimsby and Scunthorpe sites they were not clear about escalation processes for concerns.

  • There was no documentation of any meetings taking place in the northern region.

  • There was a poor culture and morale at the Grimsby and Scunthorpe sites.

  • There was no vision or strategy.

  • We were concerned that governance and risk management processes had not been fully established prior to taking on new contracts nationwide to ensure the service was able to manage these effectively and safely.

  • There was a lack of oversight from regional service leads about the risks in their areas and about their performance.

  • There were no systems in the northern region for monitoring and mitigating risk, such as a local risk register.

  • There were no means of staff or public engagement with the service.

Emergency and urgent care

Updated 20 April 2017

Overall we have not rated urgent and emergency care at Thames Ambulance Service because we were not committed to rating independent providers of ambulance services at the time of this inspection. Emergency and urgent care at Thames Ambulance Service was provided by two of the service’s nine locations, we inspected the Canvey Island location as part of this inspection.

There were no paramedics or technicians employed by Thames Ambulance Service as their contractual obligations to NHS emergency care providers was to provide purely back-up services. This meant that they would attend alongside emergency services and transport patients in an emergency capacity after paramedic attendance in a car or motorbike. It was possible for Thames staff to be first on scene to an adult or child emergency.

Staff employed to fulfil the emergency contract were emergency care assistants and under the contracts with NHS ambulance providers were not authorised to administer medicines apart from Entonox and oxygen.