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Emergency support framework: discussion questions for independent ambulance services

  • Organisations we regulate

The conversation with your inspector will focus on four areas. The questions are for the inspector to answer, helped by the discussion prompts. This helps us to understand how you are managing currently and whether you need support with anything. Your inspector may not need to cover all the questions as things may already be clear, so you don’t need to spend time preparing for them.

1. Safe care and treatment

1.1 Are infection risks to people using the service being thoroughly assessed and managed?
  • How effective are infection prevention and control (IPC) arrangements? How do you audit the IPC measures in place to deal with COVID-19 to ensure staff compliance?
  • How are routine processes and escalations working?
  • Have the arrangements been reviewed and amended in response to the pandemic?
  • Are systems in place to ensure prompt identification of people who have, or are at risk of developing, an infection?
  • Are there systems in place to ensure that all staff (including contractors and volunteers) are aware of and discharge their responsibilities in the process of preventing and controlling infection?
  • What arrangements do you have in place to support you to keep up to date with current Government, DHSC, PHE and NHS infection prevention and control (IPC) Guidance, and ensure adherence?
  • How are changes in guidance and processes being communicated to staff and any necessary training provided?
  • What contingency plans are in place if arrangements fail?
  • How is the service safely handling disposal of waste?
  • If the service is sub-contracting, how is it maintaining oversight and ensuring the sub-contractor has robust IPC arrangements?
1.2 Does the service have the resources to obtain, and reliable access to, all the supplies, personal protective equipment and COVID-19 testing it needs, for both staff and people who use the service?
  • Is appropriate equipment by patient group available for confirmed and suspected COVID-19 and non-COVID-19 patients?
  • What assurances does the provider have that staff are sufficiently skilled to use equipment in COVID-19 and non-COVID-19 areas?
  • What are the arrangements for fit testing personal protective equipment (PPE)?
  • What is your current level of risk in relation to access to equipment, including PPE?
  • What arrangements do you have in place to access PPE and do you know who to contact if you require additional support?
1.3 Does the location’s environment and layout support preventing and containing transmission of infection?
  • Have you identified any risks within your environments (vehicles, people’s homes, care homes, other premises) in relation to managing COVID-19?
  • How have you managed these risks?
  • Are staff still able to work in a way that respects and maintains people’s dignity?
  • What changes have you made to the layout/environment of your vehicles in response to COVID-19?
  • How are patients managed in accordance with their suspected or confirmed COVID-19 diagnosis where multiple patients are conveyed?
  • Has there been any impact from the pandemic on the routine checking and maintenance of equipment and vehicle checks? How have these risks been managed if so?
1.4 Are working arrangements and procedures clear and accessible to staff, people who use the service, their supporters, and visitors to the service?
  • How are you managing access to the service to ensure that high-risk patients are being identified and prioritised?
  • Where you have made changes to how you operate to manage COVID-19 and non-COVID-19 patients:
    • is this clearly communicated to patients?
    • how do you ensure staff are aware of these changes?
  • How have you taken into consideration vulnerable people and those with communication requirements, including, as appropriate, the provision of accessible information, including interpretation (both language and BSL)?
  • What changes have you made to facilitate/improve access to your services in response to COVID-19? (For example increasing vehicle numbers to enable social distancing)
  • What tools are being used to inform decision making regarding decision to convey?
  • How are you meeting the needs of patients who:
    • do not speak English as a first language?
    • have a cognitive or hearing disability
1.5 Are medicines managed effectively?
  • Has COVID-19 affected the provider’s ability to manage medicines?
  • What steps have been and are being taken to ensure adequate and ongoing supplies of medicines are maintained?
  • What steps have been taken to ensure infection prevention and control is maintained when handling, administering and transferring medicines and associated paperwork? This includes handling and transferring patients’ own medicines.
  • What system blocks (including legislation and guidance blocks) have you experienced or are experiencing, which have affected how you manage medicines?
  • What steps have been taken to track and take action on incidents related to medicines during the COVID-19 period
1.6 Are risks to the health and wellbeing of people using the service being properly assessed, monitored and managed?
  • Are there systems in place to manage and review existing risks?
  • Has the service taken action in response to new and emerging risks, including but not limited to those posed by COVID-19?
  • Have there been any significant incidents related to COVID-19? If yes, how is learning from these being identified and shared?
  • Is the service managing risk in immuno-suppressed patients?
  • Is the service maintaining effective patient escalation protocols, such as NEWS2?
  • If the service is sub-contracting, how is it maintaining oversight and ensuring the sub-contractor has robust procedures for identifying and managing patient risks?

2. Staffing arrangements

2.1 Are there sufficient numbers of suitable staff to provide safe care and treatment in a dignified and respectful way?
  • Has the pandemic affected the provider’s ability to staff the service?
  • Has the service been able to make sure that people get care and support from workers with the right knowledge and skills?
  • How are you supporting staff to deliver services where there have been significant to changes to staffing arrangements?
  • How is the service making sure that new staff and any volunteers are suitably skilled, and safety recruited?
  • Are there reasonable induction arrangements for new staff and volunteers?
  • Have you made changes to your recruitment and training processes in response to COVID-19, in line with relevant national guidance?
  • If the service is sub-contracting, how is it maintaining oversight and ensuring the sub-contractor has robust and safe recruitment practices?
2.2 Are there realistic and workable plans for managing staffing levels if the pandemic or other causes lead to shortfalls and emergencies?
  • How has the pandemic affected your ability to staff the service?
    • Has your workforce increased to deal with any increase in regulated activity? If yes, what new roles/qualifications have been recruited, and on what type of contract?
    • What has this meant for patients who use your services?
    • What have you done to mitigate any impact on staffing levels?
    • Where do you go to seek support?
    • Have any staff been furloughed?
  • Have you been able to engage with local system arrangements to share staff where required?
  • How are you monitoring the working hours of staff who are self-employed, or who have substantive contracts with other providers?
  • If the service is sub-contracting, how is it maintaining oversight and ensuring the sub-contractor has robust arrangements for safe staffing levels?

3. Protection from abuse and protection of human rights

3.1 Are people using the service being protected from abuse, neglect and discrimination and are their human rights being upheld?
  • Has the pandemic affected the provider’s ability to protect people?
  • Are people’s human rights being recognised and respected, especially those people detained under the Mental Health Act?
  • Are any people at risk of being deprived of their liberty through restrictions imposed as a result of the pandemic? How is this being managed?
  • Have you encountered any issues that may affect the equality, diversity and human rights of your patients?
  • Do you have access to, and are you following, guidelines around Treatment Escalation Plans (TEPs), anticipatory care planning, do not Resuscitate (DNR) orders and individualised care plans?
3.2 Are the service’s safeguarding and other policies and practice, together with local systems, properly managing any concerns about abuse and protecting people’s human rights?
  • Have safeguarding arrangements and systems in the provider’s area of operation remained effective?
  • Have you identified any risks relating to your management of safeguarding issues? (For example barrier to information-sharing with relevant stakeholders such as local authority; or the resilience of safeguarding functions when staff are called to the frontline)
  • How have you mitigated these risks?
  • If the service is sub-contracting, how is it ensuring robust safeguarding arrangements?
  • What systems are in place to identify vulnerable patients during the pandemic? For example, elderly isolated patients, domestic abuse victims etc?

4. Assurance processes, monitoring and risk management

4.1 Is the provider monitoring and protecting the health, safety and wellbeing of staff?
  • How are you supporting and protecting the health and safety of staff during this period?
  • Are staff being adequately risk-assessed and supported to protect their health and safety, including BAME staff?
  • How are you managing staffing issues such as sickness and caring/childcare responsibilities?
  • What changes have you made to ways of working to support your staff and ensure their safety? For example, remote working solutions
  • Are there systems in place to manage the occupational health needs and obligations of staff in relation to infection?
  • Is debriefing being used effectively and are staff being provided with appropriate access to emotional support, for example counselling?
4.2 Does the provider have effective systems and methods for monitoring the overall quality of the service and for responding to business risks and issues as they arise?
  • Has the pandemic affected your ability to monitor the overall quality of care?
  • How are you keeping up to date with relevant standards and guidance relating to the delivery of care and treatment?
  • Have you been able to develop effective contingency plans relating to COVID-19?
  • How are ‘business as usual’ processes and systems being managed?
  • How have you updated and communicated to staff any changes in policies and practices if you are deviating from your core business?
4.3 Is the provider supporting staff and people who use services to raise any concerns and give feedback?
  • Have you made any changes to the way staff are able to speak up and raise concerns?
  • Are senior staff available for advice and support?
  • Are you still able to have team meetings?
4.4 Is care and treatment provided to people being properly recorded?
  • Has the impact of the pandemic led to changes in how records are kept and shared?
  • Are you experiencing any barriers to sharing or accessing patient information with other providers?
4.5 Is the provider able to work effectively with system partners when care and treatment is being commissioned, shared or transferred?
  • How are you working in your area, and sharing information with other services and/or providers?
  • How are you working with external partners and/or stakeholders, including information-sharing? For example, sub-contractors, local commissioners, national bodies, Royal Colleges?

Data indicators we will use to prioritise assessments

Your inspector will use their knowledge of your service and will look at some specific indicators for the data that we hold to help decide what risk you may be facing.

The information we use will evolve as the situation changes, moving from this initial focus on what we know about services from existing data, to a focus on COVID-related priorities and recovery plans.

Data indicators for independent ambulance services:

  • Time since most recent rating published
  • Never been inspected
  • No registered manager in place
  • New complaints recorded in last 12 months
  • Qualified whistleblower reports received in last 12 months
  • Serious Injury notifications received in last 12 months
  • Unexpected Death notifications received in last 12 months
  • Safeguarding notifications received in last 12 months
  • Police Incident notifications received in last 12 months
  • Events that Stop Service notifications received in last 12 months
  • Abuse or Allegation notifications received in last 12 months
Last updated:
01 July 2020