Response Ambulance Service

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This is the first assessment for this service. This key question has been rated good. This meant patients were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

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

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. 

The service reviewed safety events effectively, with clear actions identified and learning shared thorough established feedback mechanisms.  

Leaders maintained daily oversight of all safety events, reviewing the event information and ensuring immediate actions taken were effective.  Leaders and staff held team meetings every month where learning from incidents, communication and results from audits were discussed.  

Leaders promptly referred all safety events involving NHS patients to the provider who contracted the service. A joint investigation of all safety event took place, with learning shared with all Response Ambulance Service (RAS) staff via team meetings. Leaders told us a debrief took place with the staff involved.  

Staff had received training in safety events, what they were and how to report them. Staff told us they knew which safety events to report, how to do so and were comfortable reporting them.  

Staff reported safety events using Personal Digital Assistant/handheld computers (PDA).  

Staff told us of safety events they had reported and, most could tell us what the outcomes had been.  One example was damage to a vehicle whilst out on the road.  Staff reported and discussed safety events with the registered manager immediately to ensure safety of staff and patients.

We reviewed safety events reporting whilst onsite and could see comprehensive details of what had occurred, the level of harm, actions taken and outcomes which were effective and detailed. There had been no serious incidents in the past 12 months.

The service had a Duty of Candour and Openness Policy and Procedure in place. Leaders demonstrated a clear understanding of duty of candour and explained the process to us. They told us staff had to record duty of candour actions on the electronic safety event system to ensure they were completed correctly. There had been no safety events requiring statutory duty of candour.  

All staff received yearly duty of candour training and compliance was 100%. Staff provided examples of being open and  honest with patients and how they apologised when safety events occurred. 
 

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service accepted patients based on assessment by the local NHS provider who contracted the service, which included clear criteria for referring and accepting patients. The service received all essential patient information and used it to determine whether it could safely meet the patient's needs.

Leaders used a digital system to book patients, ensuring staff and resources needed were available. The electronic system provided vehicle tracking and immediate reporting of any concerns. 

Leaders had provided staff with local NHS provider action cards, PDA instructions, Clinical Hub directions, emergency call-handler instructions and approved clinical guidance to support them in their day to day working. These were available in all ambulances or on staff’s individual PDA’s. 

The service had a Recognising and Responding to Deterioration, Pain and Emergency Escalation Procedure to effectively support and monitor patient whilst they were being transported by the service. This described how staff should monitor patients whilst being transported. 

We observed 5 patient journeys from home to hospital with safe, seamless handover and transition seen in all.   

Staff recorded their name, call sign and  arrival time at both ends of journey. Staff told us they worked at the speed required by patient as occasionally they needed more time and that the company was very patient focussed.  

The local NHS provider who contracted the service told us that, as part of the contractual requirements, RAS had to undergo site and vehicle inspections every six months and bi-monthly quality and performance review meetings. 

The local NHS provider who contracted the service told us RAS consistently met the 4 quality key performance indicators which were in place.

The Register manager, who was the Safeguarding Lead, did not have an up to date safeguarding training record. However, the service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. 

The service did not ensure that safeguarding competencies for the registered manager were maintained in line with the provider's policy and national safeguarding requirements. 

The registered manager completed Level 4 safeguarding training for adults and children in 2021. The safeguarding policy stated that staff will receive safeguarding training and maintain competencies in accordance with the NHS England Safeguarding Roles and Competencies Framework. This framework requires Level 4 safeguarding training to be renewed every three years. The registered manager had not renewed this training within the required timeframe and was therefore not up to date with the renewal requirements.  However, following the assessment the registered manager informed CQC that she was currently undertaking  a Level 5 Diploma in Management and Leadership with completion expected in June 2027.  She advised that the local NHS provider who contracted the service was aware of this. 

All other staff were trained to the appropriate level in adult and children safeguarding. Staff knew who the safeguarding lead was and how to identify adults and children at risk of harm and how to report any concerns. Staff provided us with good examples of things which would require reporting as safeguarding, how to protect  patients from harassment and discrimination, including those with protected characteristics under the Equality Act 2010.

Leaders were able to provide examples of safeguarding referrals the service had made.

The service had both an adults and children’s safeguarding policy in place. The service had a Prevent policy and procedure in place to support staff with identification and referral of vulnerable patients who were at risk of radicalisation.

The service used an electronic system to record any safeguarding concerns which was accessible via staff’s individual PDA’s. 

We saw a safeguarding action card in each vehicle to support staff whilst out and about which identified action to take and who to contact.  

Safeguarding referrals and actions were discussed at the team monthly meetings. 

The local NHS provider who contracted the service told us RAS were consistently good at reporting and flagging safety any safeguarding concerns to themselves. They said RAS responded quickly to requests for information and had worked closely with themselves on 17 cases. 

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Leaders used the information to understand and assess any patient risk, this included name, date of birth, weight, mobility needs, and additional needs. This was available for staff on the PDA’s.

RAS followed the same process for private patients.

RAS undertook risk assessments for all private patients prior to accepting the transfer. We viewed 3 risk assessments, one risk of falls, one communication needs and one stretcher and manual handling needs. All were comprehensive with a risk matrix used and actions in place to reduce risk. 

The service had a health and safety policy in place. This identified what risk assessments to undertake, included staff training needs and all subjects relevant to health and safety.

Before starting any shift staff completed a checklist of the vehicle to ensure it was safe to use. Staff told us they completed dynamic risk assessments of patients and would contact the managers immediately if they identified any risks.  

Staff told us they had built up good relationships with regular patients. They said they would contact their manager to let them know if they were staying longer at the drop off point to support a patient with their individual needs. 

We saw staff communicating well with patients in a way which helped them understand what was happening and were comfortable with using the appropriate equipment. 

Leaders told us patient feedback was via an electronic platform. We viewed this and could see many positive comments. Since the on-site inspection the service has produced a poster for each vehicle with a QR code and email address so patients can provide both complaints and compliments.  

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The registered manager maintained oversight of the vehicles and equipment to ensure ambulances were safe, well-maintained and ready for use. Vehicles were equipped for the type of services provided, this included safety seatbelt straps and child seats (if needed). Records of equipment maintenance and schedules were available.  The service stored ambulances in a barrier-controlled, fenced area outside the head office, preventing access by unauthorised persons. Staff securely stored the vehicle keys inside the head office.

Staff were trained and confident in the safe use of all equipment. Staff carried out daily vehicle and equipment checks before leaving the compound. Staff used an electronic checklist to reported faults immediately to leaders. 

Staff cleaned ambulances between each patient, and an external company carried out a thorough clean and equipment check each night. The external company used a checklist to ensure compliance with the cleaning schedule and provided leaders with a copy of this checklist for oversight. Once a month, unless required sooner, each vehicle underwent a deep clean. 

We inspected 5 vehicles and all were clean, well-stocked and equipped. We observed no damage to the interior or exterior of the vehicles. The service provided hand gel for staff and patients in each vehicle. All equipment maintenance due dates were identified on each piece of equipment. Each ambulance had a poster in place identifying the use of CCTV within each vehicle. 

We reviewed the risk assessments leaders available for each piece of equipment used by staff and patients. These were well structured, detailed and contained all relevant information required to reduce risk of harm to patients and staff.

Leaders and staff used a leased office, with all electrical and fire safety checks undertaken by the lease company. The registered manager was provided with copies of these checks. All were in date. 

The office was secure with a receptionist at the main desk and all other entrances for staff were locked with electronic access. Leaders and staff used the office. The service did not use the office for patients. All emergency exits were secure and free from clutter.  

Emergency fire alarm call points were in place. The office had CCTV and a poster was in place informing staff and visitors of this. 

The service stored portable defibrillators locked cupboard in the office, when ambulances were not in use. Staff took out one portable defib for each vehicle at the beginning of the day and then brought them back at end of day. 

The service stored clinical waste in a locked container in a locked gated external storage area with CCTV in place. A contract for removal of clinical waste was in place. The service required no sharps boxes.  

Leaders made consumables available in the office for staff to use in ambulances. Staff used an electronic system dispense and reorder consumables. All single use equipment was in date.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service had enough staff with the right skills, experience and training to keep patients safe and meet their needs. Leaders planned and reviewed staffing levels based on patient activity. 

The service had 2 full time members of staff, with all other staff being self-employed.  The service ensured each vehicle had two staff members for each journey. Leaders told us there had been no cancelled patient journeys owing to not having enough staff. If short staffed one of the full time members would provide support to the staff. We reviewed 3 months’ worth of staffing levels and skill mix audits.  All shifts had 2 staff for each ambulance. No shifts were unfilled and 9 last minute changes managed.

We reviewed the services Competence, Training and Development Procedure, which included roles and responsibilities of leaders and staff, competencies required and with a training needs analysis in place. 

Staff underwent a detailed classroom based and practical based induction programme.  Classroom based covered the role and expectations, base orientation, walkaround, vehicle, equipment, basic life support, manual handling, risk evaluation, incident reporting, sign off and behaviour expectations. Vehicle based training included an ambulance driving assessment. If a staff member did not pass, they were provided with further support or not contracted.

New staff shadowed experienced staff for their first shift, with a peer review and buddy checklist in place. Leaders undertook a 4 week review with new staff.

Mandatory training was via e-learning and classroom, including defibrillator and Cardiopulmonary resuscitation updates, drug and alcohol abuse, manual handling, accident reporting and investigation, safeguarding adult and children. Staff could access eLearning at home and on mobile phones. Leaders monitored staff mandatory training compliance. All staff were up to date with their training. 

Leaders undertook driving licence checks every 3 months and ended contracts for staff who had over 6 points on their licence. 

Staff clocked into and out of work using a QR code to record exact time, date and location.

We checked each member of staff personnel file and all the correct documents were in place for ID checks, right to work and safety driving. Leaders used alerts to flag when documents were to expire to ensure compliance. 

Staff were able to view and request work availability a month in advance. Leaders told us it was rare for shifts to be unfilled. Leaders would check to ensure less experienced staff worked with more experienced and, if necessary, female only staffed ambulances were available for those patients who have requested a female staffed only ambulance.

Leaders provided individual 1:1 meetings with staff to discuss progress and support development, with some staff having used this employment to learn the skills required to become an NHS paramedic. Leaders did not provide formal appraisals for self-employed staff as this could create a high risk of triggering a false employment status under UK tax and employment law. 

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff told us they had access to an up-to-date infection, prevention and control (IPC) policy and supporting guidance. Staff received IPC training, which supported them to respond to risks such as transmittable infections.

Staff had access to well-stocked personal protective equipment (PPE) and could replace vehicle supplies during pre-shift checks. We saw staff following infection control principles, including compliant handwashing and appropriate use of PPE as outlined in the service’s standard operating procedure.

All staff we saw had bare arms below the elbow and they all adhered to the uniform policy which supported infection prevention. A best practice poster for how to clean your hands was in place at all sinks to remind staff who to wash their hands correctly to reduce infections. 

Leaders undertook spot-checks and monthly IPC audits, including hand hygiene and touch point checks, using an electronic system. We reviewed the most recent audit, which confirmed staff had completed spot checks and monthly audits. Leaders discussed results of audits and issues found at the monthly team meeting. 

Staff disposed of clinical waste safely, both inside vehicles and in designated external storage areas. 

The service made sure that medicines and treatments were safe and met people’s needs

No medicines other than oxygen were stored on the ambulances.  Staff were not responsible for any patients own medication whilst travelling in the ambulances. 

Patients using oxygen were transported with their own cylinders, which were stored securely during journeys. 

The service had oxygen cylinders secured on each vehicle in the event of people requiring oxygen support. RAS could only supply routine oxygen to patients following  documented safety guidelines. Staff had received training in medical gas administration depending on their role with yearly mandatory training provided.

Staff checked oxygen cylinders each evening to ensure a minimum cylinder level for the  next day’s journey. The service had a contract with a gas supplier for direct one-for-one replacement cylinders. 

The service had a Medical Oxygen and Medical Gases Management Procedure and a Recognising and Responding to Deterioration, Pain and Emergency Escalation Procedure in place to support the correct use of oxygen. This included information on training required prior to use. how to use oxygen, about the hazards of using oxygen, and  outlined the registered manager’s responsibility to report any adverse reactions to the local NHS provider who contracted the service and Medicines and Healthcare products Regulatory Agency (MHRA).