Secure Care UK Limited

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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

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.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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 worked well with external services to understand individual patient's needs and documented these in a timely manner. Staff described how they used risk assessment care records, completed by control room staff, with dynamic risk assessments and handover processes to ensure patients received a safe experience of care.

Water was available on every vehicle to ensure all patients were offered hydration. The service did not provide food for patients, but staff were familiar with the process of how to request appropriate snacks or food from the transferring service. When long transfers were expected, planning assessments were undertaken for individual patients to identify access to hygiene facilities, if this was safe to do so. This included toilet stops at police stations or section 136 suites. Leaders and staff were familiar with how these arrangements were organised with external stakeholders. When this could not be undertaken safely due to individual patient risks, hygiene supplies such as bottles, wipes and sanitary towels were available on all vehicles. However, the service did not identify what was considered a long transfer. Despite this, there were no incidents or patient complaints related to access to hygiene facilities or nutrition and hydration.

We reviewed a sample of 5 paediatric transport risk assessment care records. The service used a risk scoring system from low to very high risk. This determined the number and type of staff needed to ensure safe transport and management of clinical risks. The assessments were detailed and considered needs such as whether a carer or other support was required and gender preference for safety and prevention of escalating behaviours. Triggers and recommended de-escalation techniques were recorded in all records. This included triggers such as ‘doesn't like to be spoken with directly or touched’. This meant staff reduced and prevented use of restraint as they were aware of patients’ needs and preferences.

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.

Staff and leaders used recognised tools to improve the monitoring and response for restraint reduction before, during and after the patient transport experience. This was a key element of patient safety and improvement of patient outcomes. The service delivered restraint reduction training to all staff during induction, accredited by Bild Association of Certified Training (ACT) Restraint Reduction Network (RRN) Training Standards.

Leaders monitored incidents of unplanned use of restraint which were not identified at the booking stage. In 2024, there were 22 incidences of unplanned mechanical restraint and 6 unplanned uses of the vehicle safe area. These were related to sections 135 and 136 transport activities. Sections 135 and 136 are powers under the Mental Health Act 2007, allowing people with a mental disorder to be taken to a place of safety for assessment. Leaders recognised these patients with more complex needs were more likely to become agitated or aggressive and therefore were more likely to need restraint. Overall, monitoring information showed staff used the least restrictive interventions.

We scored the service as 4. The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

Staff and leaders managed relationships with external stakeholders effectively to proactively identify and manage patient care safely. There were established processes to support risk information sharing between the service and external stakeholders. External stakeholders said staff were good at establishing their concerns and demonstrated strong patient advocacy skills. They gave examples where staff had challenged decision making appropriately and leaders worked well to manage these conflicts. Staff and leaders protected patients from harm by ensuring patients were only transported with the correct legal framework and documentation in place.

Although transitions in care were not always seamless due to the complexity and changeability of patient needs, operations room staff communicated well with referring health and care services to assess patients’ needs effectively. This meant staff such as mental health care staff were usually prepared in advance, to meet the individual needs of the patients they were supporting.

Some staff did not always feel supported by the out of hours control room staff but reported working well with their local control room team. There were 829 deployments between May and July 2025. Audit data showed 809 of 829 patient journeys had the correct number of staff with the right skills when reviewed against bookings form risk assessments. Senior leaders identified 16 occasions where staff had mitigated risks appropriately, when less staff were available to be deployed. For the remaining 4 incidents, senior leaders delivered extra training and support for control room staff.

We scored the service as 3. The evidence showed a good standard. The service 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, reduced their future needs for care and support.

Leaders collected data on patients who regularly used their transport services. This information was used to ensure patient and staff safety. Samples of data from 2025 showed staff used historical information relating to environmental risks or previous incidences of discrimination to protect staff from harm. Although there was little opportunity for staff to engage with patients for health promotion, staff encouraged patients to maintain independence by providing time for patients to use their mobility aids. Staff used information about behavioural triggers to prevent patient agitation and poor experiences.

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 collected and monitored details of restraint and restraint avoidance use for every patient care episode. This information was shared with external stakeholders to demonstrate progress in preventing escalating behaviours and encouragement by staff to de-escalate. However, leaders were unable to compare their performance directly with other local services due to the specialist nature of their service model.

Senior leaders met with partnered mental health hospital trusts regularly to learn from this information and improve service planning. Senior leaders recognised peaks of transport activity occurred between 12:00-20:00 and managed staffing levels to support this. Monitoring information between January and March 2025 showed over half of patients using the service did not have altered behaviours from start to end of their transport journey. One third of patients were calmer at the end of the journey.

Leaders monitored every episode of restraint, including where preventative action had been taken to avoid restraint entirely. Staff recorded information related to restraint in detail. This included information related to periods of agitation or aggression, instances and types of restraint per patient, type of transport journey and length of care episodes. For example, in the service’s 2024 annual restraint data, there were 2983 patient transport episodes and 1074 of these were managed through comfort, guiding and prompting or support holds.

Senior leaders at provider level identified variations in use of restraint avoidance and restraint techniques across service locations. Staff were more likely to use guiding and prompting techniques at the Keynsham location. This meant patients were protected from excessive use of restraint.

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

Senior leaders were confident patients being transported whilst detained under the MHA, had the appropriate documentation authorising the transfer of a patient. Although, there was no formal auditing process monitoring this, staff maintained a high standard of record keeping documenting patients’ section status and details of required paperwork.

Records showed leaders had sought learning and reported concerns to commissioners when incidents occurred. Staff understood their responsibilities to protect patients’ rights. Staff followed the service’s procedures to only undertake transport journeys when section paperwork or digital documents had been confirmed. We observed 2 transport journeys where staff had ensured the correct section paperwork was present before commencing transport.