QE Facilities Patient Transport

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care.

We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff transported patients from the local hospital and were given patient details and an assessment of their individual needs at the time of transfer from the discharge lounge and discharging wards where appropriate. Details received at discharge were used to determine essential information such as confirmation of the patient transport, for example collection on the ward or discharge lounge and destination and home addresses. During this process details of any escort for the patient were also noted.

The service did not undertake a further assessment of the patient but before transport, had received a handover from hospital staff and the discharge lounge. Moving and handling needs were assessed by ward and discharge staff, patients were moved and transported in line with the handover.

We plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The service ensured compliance with National Institute for Health and Care Excellence (NICE) guidance by incorporating relevant standards into daily operational practice, staff training, and processes. NICE guidelines related to non-emergency patient transport, safeguarding, infection prevention and control and management of deteriorating patients were regularly reviewed and updated.

All staff received training aligned to national guidance, including safe moving and handling techniques, basic life support and infection control. Training materials were updated if guidance changed.

Staff followed clinical guidelines and quality standards appropriate to the service, including protocols for children and other patient groups in line with their cultural needs. Vehicle cleaning protocols and hand-hygiene practices followed NICE ‘Quality Standard QS61’ and audits were completed using checklists based on NICE guidance.

We saw safe moving and handling guidance on falls and mobility support was reflected in a risk-based approach to patient handling. Staff conducted dynamic risk assessments, used equipment such as slide sheets and transfer boards in line with guidance, and documented any mobility concerns to maintain continuity of care. Staff were trained to recognise indicators of abuse or neglect, report concerns promptly, and document information accurately to support safeguarding procedures, which aligns with safeguarding guidelines.

NICE guidance was applied when transporting patients with dementia. Staff used communication methods appropriate to the individual patient such as pictorial communication boards allowed additional time for transfers and ensured appropriate use of seatbelts and comfort measures. All staff completed dementia awareness training to ensure consistent practice.

The service had an audit schedule in place confirming compliance with guidance, for example, risk assessments, patient records, safeguarding, infection prevention and control and management of deteriorating patients. These were reviewed on a regular basis and procedures updated when necessary.

We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service demonstrated effective teamwork, both internally and with external partners, particularly the host NHS trust and when needed the local NHS ambulance service. We saw effective communication between the service and the local host NHS trust.

All journeys were arranged through the discharge lounge or from wards within the host trust. Patient details, further destination information, individual needs, and other circumstances were given to crews through a handover from the discharge lounge and wards when applicable. We were told by managers and staff this process worked well.

The service did not routinely benchmark itself against other providers but placed emphasis on internal monitoring and quality assurance, using patient feedback, incident reporting and staff supervision to continually assess and improve. This ensured the service maintained standards of safety, reliability and patient care. Although the service did not currently benchmark itself against other providers there was a commitment to do develop mechanisms to do so.

We support people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

We scored the service as 3. The evidence showed a good standard. The service always supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

The service provided a patient transport service to the host NHS trust. This involved collecting patients from wards or the discharge lounge and transporting them to their home address or other location.

The service did not have the opportunity to impact directly upon the way patients were living their lives. However, all staff were aware of the need to report incidents affecting patients’ individual circumstances. Staff were trained to recognise indicators of abuse and neglect, report concerns promptly, and document information accurately to support safeguarding procedures.

Staff had received specific training in transporting patients with dementia. Staff used communication techniques relevant to the individual needs of the patient, allowed additional time for transfers, and ensured appropriate use of seatbelts and comfort measures. All staff completed dementia awareness training to ensure consistent practice.

We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service continuously monitored and supported the care and treatment it provided to patients and families. To ensure an effective service key performance indicators were monitored, including monthly numbers of journeys (broken down to mobility types), average journey times, patient journeys by day and hour, and patient feedback.

These indicators showed a consistent number of journeys each month, between approximately 400 and 500. There was a clear pattern of journeys by day, with most scheduled Monday to Friday and fewer at weekends. All journeys were completed between 10 a.m. and 7 p.m. and lasted between 35 and 45 minutes.

Journeys were completed by a single man or double man crew depending on individual need, and an average of 56 journeys a month needing the use of a stretcher.

Performance indicators enabled the service to appropriately plan staffing to meet demand and the individual needs of patients, such as number of crew members and equipment needed. This led to effective outcomes for patients.

We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights as to consent and respected these when delivering person-centred care and treatment.

The service had a ‘consent and mental capacity’ standard operating procedure’ in place to ensure patients had the capacity and competence to consent by making an informed decision, or by a representative with authority to do so. All staff had the responsibility ‘…to ensure the safest and most effective delivery of patient transport services for patients and staff.’

Within the protocol mental capacity was defined as the ability of an individual to make decisions and identified a number of conditions that can affect an individual’s capacity to make a decision, including dementia, stroke, unconsciousness (due to illness or treatment) or substance misuse. The service had adopted the key principles that all staff should take into account:

• a presumption of capacity – assumed that every adult has capacity to make their own decisions until it is proved otherwise;
• the right of individuals to be supported to make their own decisions – all practicable help should be given before they are treated as lacking capacity;
• the right for individuals to make unwise decisions – should an individual make an unwise decision; it should not be assumed, and they should not be treated as lacking in capacity;
• best interests – anything that is done for or on behalf of people without capacity must be in their best interests; and
• the less restrictive option – anything done for or on behalf of people without capacity should be the least restrictive of their basic rights and freedoms.

The protocol outlined responsibilities crews had to ensure the best interest of the patient was at the forefront when delivering patient transport services. Confirmation of consent to travel had to be gained on arrival from the patient or from the person responsible or acting on behalf of the patient if determined not to have capacity. This included gaining consent for discharge in the appropriate clothing.

Crews consistently explained their rights to patients and obtained their consent, which was recorded on the patient record form. We spoke to staff who were all aware and understood consent requirements. Staff received and kept up to date with training in the application of the Mental Capacity Act and understood when to assess whether a patient had the capacity to make decisions about their care.