Archived: W & N Training Limited t/a Want Medical Services

Updated 20 September 2017

Want Medical Services (WMS) is operated by W and N Training Limited. The service opened in 2000. It is an independent ambulance service in Portslade near Brighton. The service primarily serves the communities of the South East of England.

The service has had the current registered manager in post since 2011.

In England, the law makes event organisers responsible for ensuring safety at the event is maintained, which means that event medical cover comes under the remit of the Health & Safety Executive. Therefore, services providing ambulance support at events are not regulated by the Care Quality Commission this is not classed as a regulated activity.

The non-event service at WMS is small and has declined with changes in the way patient transport services have been provided in the region. Prior to the period of suspension of registration, WMS undertook occasional transport work for private patients, health insurance providers (repatriation) and local NHS trusts and intends to continue this now registration has been reinstated.

Updated 20 September 2017

Want Medical Services (WMS) is operated by W & N Training Limited.

CQC inspected the service in 2014 and found non-compliance in relation to infection control practices. An inspection later in the year found the provider was meeting all the regulations and required standards.

We completed a comprehensive inspection of WMS on 14 February 2017 and found the following issues:

• There was insufficient focus on infection prevention and control.

• The management of waste did not meet current guidance.

• Segregated medical gasses were not stored in line with guidance.

• Staff did not manage medicines appropriately, for example the registered manager did not understand their responsibility to hold a Home Office License as controlled drugs were stored on site.

• Equipment used to provide services to patients was not regularly serviced.

• We found numerous consumables that had passed their expiry date.

• There were fire safety and health and safety risks identified.

• There was a lack of systems and processes to assess, monitor and improve the quality and safety of services. There was no formalised system of governance.

• There were unclear audit arrangements and there was no auditing of patient transport services.

• The registered manager had difficulty locating key documents and information when requested and was unable to provide us with documents and records.

• There were limited systems to collect feedback from patients.

• There was a lack of processes to assess, monitor and mitigate risks relating to the health and safety and welfare of patients and others.

• Staff records did not take into account the information required in ‘Schedule 3’ of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

As a result of the above, CQC urgently suspended registration of the following regulated activities until 22 April 2017 to allow the provider to address the issues identified at the inspection:

• Transport services, triage and medical advice provided remotely

• Treatment of disease, disorder or injury

This meant the provider could not carry out these regulated activities.

The purpose of the 11 April 2017 inspection was to review the provider’s progress against the issues identified in February 2017 and assess whether the provider had met standards in order to lift the suspension on 22 April 2017.

This was an announced inspection that was focused on issues seen in the February report. At our 11 April 2017 inspection, we were not assured that people would be safe from avoidable harm and high quality care was not assured by the current governance arrangements. There was also insufficient assurance to demonstrate patients received effective care as the provider was advertising services that staff did not have the skill or knowledge to provide.

We found the following issues:

• The premises and the vehicles still did not meet standards set out in the ‘Health and Social Care Act 2008 Code of Practice of the prevention and control of infections and related guidance (2015)’.

• Medical gasses were still not stored in line with British Compressed Gases Association ‘The Storage of Gas Cylinders (2016)’.

• Equipment had not been serviced or maintained since our previous inspection although there was evidence of some planning to commence this.

• We found some out of date medicines although the provider told us these had all been checked. However, all stocks of controlled drugs had been surrendered to the local police.

• We found items of equipment that were out of date, despite being told that equipment had been checked.

• There was a lack of systems and processes to assess, monitor and improve the quality and safety of services.

• New policies had been formulated, however plans for implementing them were vague and did not include time frames or details regarding staff training. Plans did not include how policies were to be monitored and audited once they had been implemented.

• The action plan rejected by the CQC had not been updated at the time of this inspection.

• Audit activity, plans and schedules had still not been implemented. There was no evidence of how audit outcomes and details were to be reviewed or how audit formed a part of the governance structure.

• A risk register template had been set up, however this was empty. Therefore, risks had still not been identified, neither were plans to mitigate risks in place.

• Disclosure and Barring Service checks were requested by former employers or universities and not by WMS, which is not in line with recommendations set by the Disclosure and Barring Service.

However:

• The prescription only medicines were stored in a locked cupboard and were secured with digital key access. All stock inside the prescription only store was in date.

As a result, CQC extended the suspension of regulated activities until 22 July 2017.

The purpose of the 18 July 2017 inspection detailed in this report was to determine whether the provider had made sufficient improvements that suspension could be lifted on 22 July 2017. Therefore the report does not cover all areas contained within a comprehensive report. Instead it has focused on the areas of concern found at the February and April 2017 inspections.

We found the following improvements:

• The provider had redesigned the management structure to enable a greater focus on key elements of governance.

• A new electronic system was being trialled that ensured all the management team had access to key, current management concerns without meeting face to face.

• The provider had employed an independent consultancy company to support them. We reviewed the service level agreement between the two organisations and found it was current and covered those issues where WMS required specialised support.

• The provider had commenced quarterly clinical governance meetings.

• The provider had commenced collating risks and their mitigations in a formal risk register.

• The provider now has a suite of updated policies covering all essential issues. There were arrangements to ensure that staff were familiar with the policies available and their contents.

• An audit programme to cover infection prevention and control, clinical records and medicines had been developed.

However:

• Cleanliness still did not meet the standards set by ‘Health and Social Care Act 2008 Code of Practice of the prevention and control of infections and related guidance (2015)’. Items in the cleaning cupboard were still stored on the floor, which was dirty. This had been brought to the providers attention at both the February and April 2017 inspections. For example, the staff toilet was dirty, there was black particles and dust on the seat lid, rim and the main body of the toilet.

• During our inspections in February and April 2017, we noted medical equipment that was out of date. At this inspection we still found consumables that were out of date on an ambulance.

• During the period December 2016 to July 2017, engagement with the provider had been poor. CQC requests for information were repeatedly ignored. This resulted in CQC issuing a Fixed Penalty Notice under Section 64 of the Health and Social Care Act 2008.

• As a result of the improvements to governance, risk and implementation planning seen, the inspection team assessed that an appropriate and proportionate response to the above cited failures was to reimplement the providers registration when it expired on 22 July 2017, however CQC would impose conditions to the providers registration.

These conditions to registration included:

• A monthly update on the CQC action plan to be sent to the provider’s CQC relationship owner.

• Quarterly governance meeting updates to be sent to the provider’s CQC relationship owner.

• Quarterly engagement meetings with the CQC relationship owner.

• Evidence of DBS checks for all staff in line with CQC requirements to be sent to the CQC relationship owner within 6 months.

CQC placed these conditions in order to test the providers ability to make all necessary improvements and to test progress and sustain engagement.

Ted Baker

Chief Inspector of Hospitals

Updated 5 May 2017

We found the following issues that the service provider needs to improve:

• Safety was not a sufficient priority as there was no measurement and monitoring of safety performance.

• The management team did not recognise concerns, incidents and near misses. There was no evidence of learning from events or actions taken to improve safety.

• The premises, equipment and facilities were unsafe due to the lack of servicing of equipment and fire risks identified regarding storage facilities.

• There was insufficient attention to safeguarding adults and children and staff did not respond appropriately to abuse.

• Medicines were not managed in line with legal requirements.

• Systems to control and prevent infection were ineffective and standards of hygiene and cleanliness were unacceptable.

• Equipment used to treat patients was not regularly serviced.

• Policies were out of date and care and treatment did not reflect current evidence based guidance.

• There was no assurance patients received care from staff who had the skills and experience that was needed to deliver effective care.

• Consent to care and treatment was not obtained in line with current legislation and guidance.

• There were shortfalls in how the needs of different people were taken into account, for example, people detained under the Mental Health Act, people with Dementia and children and young people.

• Complaints were not always handled appropriately and there was no evidence of learning from complaints and feedback.

• Patients were unable to access the care they needed as the company telephone and email were not responded to.

• There was no clear statement of the company’s vision and values.

• The delivery of high quality care was not assured by the leadership team due to a lack of governance structure.

• There was no effective system for identifying, capturing and managing issues and risks. This reflected the significant issues that threatened the delivery of safe and effective care.

• The leadership team did not have the necessary capability to effectively lead the service. For example, they did not understand the importance of a governance structure or the need for a risk register.

• We were unable to make any judgements regarding whether the service was caring as there were no patient transport service journeys on the day of our inspection. Therefore, we did not view staff interactions with patients and the public. We asked the manager for details of patients we could contact but these were not supplied.