North West Ambulance Service NHS Trust

Updated 22 July 2022

We have not updated trust-level ratings following these core service inspections because we were not able to complete the trust-level well-led inspection. This is due to suspension of routine inspections during the COVID-19 pandemic. Refer to the previous inspection report for the detailed findings on which the ratings are based.

Updated 5 June 2020

Our rating of this service stayed the same. 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, understood how to protect patients from abuse, and managed safety well. Most mandatory training targets were on track to have been met by the financial year. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients. They advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• 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. People could access the service when they needed it and received care in a timely way.
• 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

• EOC staff did not always follow policies and procedures relating to the management of long-waiting and deteriorating patients in terms of re-assessing the need for triage.
• Emergency call handlers did not always re-triage subsequent callers in line with the trust process.
• Safeguarding training and staff appraisal compliance did not always meet trust targets.
• Response times were slower than the England average in all months in the reporting period.
• Not all staff received feedback from incidents they raised. There was not always up to date action plans relating to actions from incidents.

Updated 27 November 2018

We have not rated Resilience before. We rated it as good because:

The service provided safe care and treatment. There were processes and staff followed them to lessen risks to patients, staff and the public posed by the challenging environments and staff had to operate in. Staff followed national guidelines for the delivery of services and care and treatment.

The leadership of the service promoted a positive culture within the resilience service.

Innovation was encouraged and staff were encouraged were to join national improvement groups to influence changes in protocols, processes, equipment and training. There were examples of innovative practice, that were being incorporated into national practices.

There was effective collaborative working between trust staff and partner agencies to manage local, regional and national risks. This ensured paramedic care and treatment was available in a timely manner, to patients in challenging circumstances, such as major incidents and mass casualty incidents.

Training provision met the national guidelines. Staff were highly skilled in delivery paramedic care in a safe manner to patients in challenging and dangerous environments.

The service, location and vehicles, was planned to meet the needs of the local population. This was based on the need to respond to major incidents at government defined sites of strategic importance, major incidents in other areas of the NWAS geographical region and provide mutual aid to neighbouring ambulance trusts in a timely manner.

Updated 19 January 2017

Procedures to ensure the safety of services were good, with systems in place for reporting incidents and equipment checks performed to a good standard. Ambulances were clean, and the service was well staffed. Ambulance crews were trained in using dynamic risk assessments and we saw evidence of this occurring. Effective systems were in place to facilitate the timely maintenance and replenishment of vehicles. Ambulance staff had good access to information about patients and journeys through the use of mobile data terminals which were regularly updated by the control centre teams.

Staff knew what steps to take when a patient became unwell while being transported and were clear on their roles should a major incident occur. Arrangements were in place to respond to emergencies and the service took account of seasonal fluctuations in demand, the impact of adverse weather or disruption to staffing. All areas had sufficient staff numbers to meet the needs of the service. PTS staff in all areas were seen as caring, compassionate and dedicated to improving the service. All staff took their duty to report safeguarding concerns seriously. Local culture was good in most areas and we found that the morale had improved in the control room in Chester immediately after the last inspection. The performance of call centre staff was effectively audited to make sure they followed scripts and algorithms provided. Between 1 May 2015 and 30 April 2016 core service targets were met in Lancashire for nearly all months, for all KPIs related to journey and appointment times

However, we found no evidence that incidents were being managed at an overarching organisational level or that themes were being identified and addressed to prevent the same issues recurring. This meant that some issues were not dealt with effectively, for example ongoing problems with DNACPR forms not being in the correct format. Volunteers used by the service were not given enough supervision as they carried out their roles, and policies needed to be updated in light of the Savile enquiry. Safeguarding concerns were dealt with at a local level, but were not always reported to the safeguarding team in Carlisle.

Enhanced priority service (EPS) patients spent longer on the transport than they needed to because journey times were longer than acceptable limits. Cumbria, Mersey and Cheshire failed to meet the 95% target for the KPI related to appointment times for all 12 months in the period May 2016 to April 2016. At our last inspection we found an apparent disconnect between managers and senior staff across PTS; senior managers acknowledged the challenges of working across such a large geographical area and the need to increase the visibility of the senior management team. At this inspection we found there was still no vision or formal strategy for PTS although we were provided with the service contract and operating model. We did not see any evidence of a project plan or timelines for the delivery and implementation of a PTS strategy. There was no clear governance framework for the service in terms of quality structures, lessons learned or risk registers.

Updated 5 June 2020

Our rating of this service stayed the same. We rated it as good because:

• There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs. The service was inclusive and took account of patients’ individual needs and preferences. This included patients living with dementia, a learning disability or patients with mental ill health. There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that met those needs.
• 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.
• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, and gave patients pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

However;

• The number of staff who completed safeguarding training did not meet trust targets.
• The service did not consistently meet nationally agreed targets for response times. Performance against response times was monitored daily and remedial actions were in place to make improvements to the services.
• The number of staff who completed appraisals did not meet trust targets.
• Whilst staff had access to clinical contact shift supervision, there was inconsistency in how these were applied across the regional teams.