Specialist Medical Transport - North

Updated 13 June 2023

Specialist Medical Transport - North is commissioned by a number of NHS trusts and Integrated care boards (ICB) to provide non-emergency patient transport for patients attending hospital or clinic appointments. Specialist Medical Transport – North also provides a secure transport service for both adults and young people over the age of 14, including those detained under the Mental Health Act 1983. Transportation is available out of hours including weekends.

Specialist Medical Transport - North is registered with the CQC to provide the following regulated activity;

• Treatment of disease, disorder or injury
• Transport services, triage and medical advice provided remotely

The provider has had a registered manager in post since May 2021. The patient transport service did not have a clear inclusion and exclusion criteria. However, was accessible to transport all patients. This included patients with mental ill-health.

The provider’s activity levels for January 2020 to December 2022 were:

• 6,716 total journeys
• 5,052 patient hospital discharge transfers
• 1660 secure patient transfers
• 64 transfers that were not within the scope of regulation

The main service provided by this provider was patient transport services.

Although registered for Treatment of disease, disorder or injury, the service was not providing this regulated activity or urgent and emergency care services. The service had not provided this activity in the six months prior to inspection, although the manager told us the service had plans to do so.

As a result of its findings, CQC took urgent enforcement action to suspend the service. The decision was appealed and the Tribunal found that the level of risk was not such that the urgent action was necessary, reasonable or proportionate. The full Decision can be found here: Care Standards Tribunal > Decisions > View Decision (tribunals.gov.uk).

Updated 13 June 2023

We rated it as inadequate because:

• The service was not safe. The service did not provide mandatory training in key skills to all staff and make sure everyone completed it. Staff did not understand how to protect patients from abuse and the service did not work with other agencies to do so. Not all staff had training on how to recognise and report abuse. Staff did not complete or update risk assessments for each patient to remove or minimise risks. The information needed to plan and deliver effective care and support was not available at the right time. Staff did not keep detailed records of patients’ care. Records were minimal but stored securely. Managers did not investigate incidents or use incidents as opportunities to learn and improve the service.
• The service did not consistently provide effective care. The service did not provide care based on national guidance and evidence-based practice. Managers did not check to make sure staff followed guidance. Staff did not protect the rights of patients subject to the Mental Health Act 1983. Staff did not support patients to make informed decisions about their care. National guidance to gain patients’ consent was not followed.
• Staff treated patients using the hospital discharge service with compassion, kindness and respected their privacy and dignity. Staff did not demonstrate the same commitment to providing compassionate care to people using the secure mental health service. The service did not evidence staff provided emotional support to patients. There was no evidence that patients were supported to understand the information they were given about their care. This included during transition or transfers.
• The service did not consider patients’ individual needs and preferences. The service did not use the complaints system to inform changes or improvements to the service.
• The service was not well-led. Leaders did not understand or manage the priorities and issues the service faced. Leaders did not operate effective governance processes, throughout the service and with partner organisations. Leaders did not identify and escalate relevant risks and issues. They did not have plans to cope with unexpected events. Managers did not collect reliable data or analyse it appropriately.

However:

• Staff kept equipment, vehicles and the premises visibly clean.
• The design, maintenance and use of facilities, vehicles and equipment kept people safe. Staff managed clinical waste well.
• The service had enough staff to run the service and meet contractual demand.
• The service was responsive because it monitored, and met, agreed response times.
• Staff treated patients using the hospital discharge service with compassion and kindness, respected their privacy and dignity.

This service has been rated as inadequate overall and so has been placed into special measures. One of the purposes of special measures is to ensure that providers found to be providing inadequate care significantly improve.

Updated 13 June 2023

• The service was not safe. The service did not provide mandatory training in key skills to all staff and did not make sure everyone completed these. Staff did not understand how to protect patients from abuse and the service did not work with other agencies to do so. Not all staff had training on how to recognise and report abuse. Staff did not complete or update risk assessments for each patient to remove or minimise risks. The information needed to plan and deliver effective care and support was not available at the right time. Staff did not keep detailed records of patients’ care. Records were minimal but stored securely. Managers did not investigate incidents or use incidents as opportunities to learn and improve the service.
• The service did not consistently provide effective care. The service did not provide care based on national guidance and evidence-based practice. Managers did not check to make sure staff followed guidance. Staff did not protect the rights of patients subject to the Mental Health Act 1983. Staff did not support patients to make informed decisions about their care. National guidance to gain patients’ consent was not followed.
• Staff treated patients using the hospital discharge service with compassion, kindness and respected their privacy and dignity. Staff did not demonstrate the same commitment to providing compassionate care to people using the secure mental health service. The service did not evidence staff provided emotional support to patients. There was no evidence that patients were supported to understand the information they are given about their care. This includes during transition or transfers.
• The service had no clear system to inform patients how to raise a complaint. There was no complaint process on the services website and only hospital discharge patients received feedback forms to complete. Mental Health patients transferring on a secure vehicle were not asked about the quality of the service provided to them.
• The service was not well-led. Leaders did not understand or manage the priorities and issues the service faced. Leaders did not operate effective governance processes, throughout the service and with partner organisations. Leaders did not identify and escalate relevant risks and issues. They did not have plans to cope with unexpected events. Managers did not collect reliable data or analyse it appropriately.