The Care Quality Commission
  • Ambulance service

Medical Response Services

Overall: Good read more about inspection ratings

Cricket Street, Wigan, Greater Manchester, WN6 7TP (01942) 217395

Provided and run by:
Mr Warren Bolton

All Inspections

5 April 2022

During a routine inspection

Our rating of this service improved. We rated it as good because:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills and understood how to protect patients from abuse. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records.
  • Staff provided good care and treatment. The service monitored agreed response times. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients.
  • The service planned care to meet the needs of local people and made it easy for people to give feedback. People could access the service when they needed it.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • Staff could not fully explain their understanding of the Mental Capacity Act and Deprivation of Liberty or duty of candour. Staff did not collect safety information or use it to improve the service. Staff did not advise service users on how to lead healthier lives.
  • Care did not always take account of patients’ individual needs.

01 December 2020 - 03 December 2020

During an inspection looking at part of the service

Our rating of Medical Response Service improved. We rated it as requires improvement because:

  • Staff had not received children’s safeguarding training in line with the national guidance; Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff, Fourth edition: January 2019.This meant they may not have been able to identify or manage children’s safeguarding concerns that occurred during their work with patients.
  • We were not assured that staff managed medicines well because the provider did not record or review staff competency in administering oxygen.
  • Managers did not always make sure staff were competent. Most staff appraisals were out of date at the time of our inspection. Managers showed us they had developed a new system for supervisions and appraisals, but this had not been embedded into the service.
  • Managers did not monitor response times. We were told managers did not collate or monitor pick up and drop off times and that no key performance indicators had been developed in relation to this to ensure patients were receiving the service in a timely way.
  • Not all files contained two staff references which were required by the service’s recruitment policy to ensure the service met the requirements of the Health and Social Care Act 2008 and that staff were fit and proper to undertake their role.
  • We were not assured the provider had robust processes to ensure that directors who had responsibility for the quality and safety of care and for meeting the fundamental standards of care were fit and proper to carry out the role. The recruitment policy did not contain information about fit and proper person’s requirements for the directors of the service.
  • The provider did not oversee the frequency of clinical waste removal from the ambulance base.
  • There was insufficient scrutiny of staffing requirements when reviewing the staff rota. We found instances on the rota where staff members who had not received basic life support training had been put on a crew together. This meant that staff may not have been able to carry out cardio pulmonary resuscitation effectively, in the event of patient deterioration.
  • Whilst risks were identified they did not always have actions identified to effectively mitigate the risk and there was limited evidence of signed agreements with partner organisations to ensure effective delivery and monitoring of services.
  • The service was committed to learning to help to improve services but during this inspection there was limited evidence of innovation

However:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills. The service controlled infection risk well. Staff assessed risks to patients, acted on these and kept good care records. The service had systems in place to manage safety incidents.
  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff knew how to protect the rights of patients’ subject to the Mental Health Act 1983. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • Leaders supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.
  • The service had a vision and engaged with patients to improve and manage services and all staff were committed to improving services continually.

15 September 2020

During an inspection looking at part of the service

Medical Response is operated by Mr. Warren Bolton . The service provides a patient transport service.

We inspected this service using our focused inspection methodology. We carried out a short-announced inspection visit on 15 September 2020 in response to risks found at the last inspection for which enforcement action was taken. We did not rate the service.

To ensure that the provider was now meeting the requirements outlined in the enforcement action we looked at some aspects of the safe, effective, responsive and well-led domains. Specifically, we looked at the key lines of enquiry:

In ‘Safe’ we looked at:

  • Mandatory training
  • Safeguarding
  • Assessing and responding to patient risk
  • Incidents

In ‘Effective’ we looked at:

  • Consent, Mental Capacity Act and Deprivation of Liberty Safeguards

In ‘Responsive’ we looked at:

  • Learning from complaints and concerns

In ‘Well Led’ we looked at:

  • Leadership
  • Governance
  • Managing risks, issues and performance

Following the inspection, we put our concerns formally in writing to the provider and asked that urgent actions be put in place to mitigate the risks to patient safety. The provider provided a detailed response including improvement actions already taken or planned. All actions were due for completion by 31 October 2020. This provided assurance that sufficient action had been taken to mitigate any immediate risks to patient safety. We will continue to monitor this information through our routine engagement with the provider.

We found:

  • The service did not always provide mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff were not up to date with safeguarding training.
  • There were no risk management plans in place to mitigate identified risks.
  • Staff had received inappropriate restraint training and the restraint policy did not reflect best practice regarding the use of restraint.
  • The inclusion/ exclusion policy, that provided guidance about which patients the service could safely transport, was not freely available to staff and we found examples where it had not been followed.
  • Incidents were not always reviewed well and we found key concerns, where staff were not following the services policies, had been missed.
  • Policies were not in place and staff were not trained appropriately to protect the rights of patients’ subject to the Mental Health Act 1983.
  • It was not always apparent that leaders had the skills and abilities to run the service or that they understood and managed the priorities and issues the service faced.
  • Leaders did not always operate effective governance processes, either throughout the service or with partner organisations. Staff at all levels were not always clear about their roles and accountabilities.

However, we found the following areas of good practice:

  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff, including those in partner organisations.
  • Management meetings were documented appropriately and audits and staff performance were reviewed at managers meetings.

Following this inspection, we told the provider that it must take some actions to comply with the regulations. We also issued the provider with two requirement notices that affected the Patient Transport Service. Details are at the end of the report.

Ann Ford

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

7 to 8 January 2020

During a routine inspection

Medical Response Services is operated by Mr Warren Bolton . It is an independent ambulance service which was first registered with the Care Quality Commission in July 2011. The service is located in Wigan, Greater Manchester and serves a number of regional acute NHS hospital trusts, local authorities and clinical commissioning groups. The service provides patient transport services which encompasses the transfer of mental health patients, including those detained under the Mental Health Act 1983.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced inspection on 7 and 8 January 2020.

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.

We had not previously rated this service. We rated it as Inadequate overall.

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

  • Staff did not always receive the appropriate training or support to enable them to carry out the duties they were employed to perform.

  • Medicines were not always managed appropriately.

  • Incidents, near misses and patient safety issues were not always managed well. Staff did not always recognise and report incidents and incidents were not always documented appropriately; in line with policy and best practice guidance.

  • Patient outcomes were not always measured or monitored and policies did not always follow best practice guidance or standards.

  • It was not always apparent that patients transferred and transported with mental ill health were managed safely or appropriately.

  • Leaders did not always operate effective governance processes or use systems to manage performance effectively.

  • Leaders did not always identify or escalate relevant risks and issues or identify actions to reduce their impact.

  • Leaders and teams could not always access and find the data they needed, data was not always collected and was not always available in accessible formats to allow staff to understand performance, inform decisions and drive improvement.

However, we found the following areas of good practice:

  • The service worked well with other agencies and all those responsible for delivering care to benefit patients. They supported each other to work effectively to provide good care.

  • The service managed and controlled infection risk well. Equipment and control measures were used effectively by staff to protect patients, themselves and others from infection.

  • Staff were focussed on patient care and treated patients with compassion and kindness.

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 took enforcement action telling the service that it had to make significant improvements. This is detailed at the end of the report.

Ann Ford 

Deputy Chief Inspector of Hospitals (North), on behalf of the Chief Inspector of Hospitals

14 November 2017

During a routine inspection

This report describes our judgement of the quality of care at this location. We based it on a combination of what we found when we inspected and from all information available to us, including information given to us from people who use the service, the public and other organisations.

Medical Response Services is an independent ambulance service provider based in Wigan, Lancashire. Medical Response Services is registered to provide patient transport services. Medical Response Services offers ambulance transport on an ‘as required’ basis and provides pre-planned transport. The service provides services on request from local NHS ambulance trust and Clinical Commissioning Groups.

The patient transfers included patients detained under sections of the Mental Health Act 1983 going to or from mental health units.

We inspected this service using our comprehensive inspection methodology. We carried out a scheduled comprehensive inspection on 14 November 2017. The service had one base which we inspected.

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 main service provided by this service was patient transport.

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 issues that the service provider need to improve:

  • Although there were processes in place for reporting incidents, staff did not receive feedback and shared learning to prevent them from occurring again and to ensure the safety of people using the service.
  • Staff did not receive the appropriate training, to enable them to carry out the duties they were employed to perform.
  • The provider did not have robust safeguarding procedures and processes that made sure patients were protected. Staff did not receive safeguarding training that was relevant and at a suitable level for their role. We found no evidence that it was updated at appropriate intervals and enabled them to recognise different types of abuse and the ways they could report concerns.
  • The provider did not ensure that staff had completed pre-employment checks completed prior to undertaking employment including fit and proper persons assessments for directors.
  • Although, the provider had a duty of candour policy in place and were open and transparent, staff did not receive training in the duty of candour.
  • We did not find robust systems to assess monitor and improve the quality and safety of the services provided.
  • We found concerns regarding the governance and strategic risk management processes of the service. There were no effective governance arrangements in place to evaluate the quality of the service or to improve delivery.
  • There was no formal risk register in place at the time of the inspection and therefore we had no assurance that risks were being tracked, managed or mitigated.
  • A vision and strategy for the service had not been developed.

However, we found the following areas of good practice:

  • Staff were knowledgeable about how to report an incident and had access to incident reporting forms including whilst on ambulances. We saw evidence and examples of incident reporting.
  • The service ensured a minimum of two staff were allocated to each patient transfer depending on risk and need. The staffing levels and skill mix of the staff met the patients’ needs.
  • All vehicles and the ambulance station were visibly clean and systems were in place to ensure vehicles were well maintained.
  • All equipment necessary to meet the various needs of patients was available.
  • Services were planned and delivered in a way that met the needs of the local population. The service took into account the needs of different people, such as bariatric patients or people whose first language was not English, and journeys were planned based upon their requirements.
  • We observed good hand hygiene, and infection control processes.
  • The service had a system for handling, managing and monitoring complaints and concerns.

Ellen Armistead

Deputy Chief Inspector of Hospitals  (North), on behalf of the Chief Inspector of Hospitals

28 January 2014

During an inspection in response to concerns

Our visit was carried out in response to information we had received. We visited to check that the service was continuing to meet the essential standards of quality and safety.

On this occasion we did not speak to people about the service. The service does not provide support to a regular core of individuals who we could refer to.

During our visit we saw that systems were in place to identify people's needs and wishes to help ensure that individuals were transported safely.

Systems were in place to help ensure that equipment in use was clean and suitably maintained.

9 August 2013

During a routine inspection

On this occasion we did not speak to people about the service. This service does not provide support to a regular core of individuals who we could refer to.

We found that systems were in place to identify people's needs and wishes to ensure that they were transported in a manner that protected their health and welfare.

Equipment in use was clean and maintained.

We saw that improvements had been made to the services recruitment procedures and the support staff received to carry out their role.

5 March 2013

During a routine inspection

On this occasion we did not speak to people about the service. This service does not provide support to a regular core of individuals who we could refer to.

We found that the service had procedure in place for ascertaining people's consent to treatment.

Systems were in place to identify people's needs to ensure that they were transported in a manner that protected their health and welfare.

We found that people's personal records were managed in a manner that protected their personal information.

We found that improvements were needed on what checks were carried out on newly recruited staff prior to them starting their role. In addition, staff employed by the service need to have the opportunity to discuss their role on a regular basis with their manager.