CIPHER Medical

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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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we did not rate. At this assessment the rating is good.

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.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Crews completed a comprehensive health assessment of every patient that they attended using established clinical guidance. If a mental health need was identified, staff worked collaboratively with local mental health crisis teams, General Practitioner (GPs) and community mental health teams to refer patients to the appropriate care pathways.

During the assessment we attended and directly observed crews attending emergency calls. We found that staff carried out comprehensive assessments, used structured clinical judgement and made appropriate decisions to determine whether patients required conveyance to hospital. Crews explained their reasoning clearly to patients and documented their decisions accurately.

Emergency vehicles were equipped with non-verbal communication cards to support patients with speech, language, cognitive or sensory impairments. Staff were trained to adapt their communication style to support patients to engage in their care, where appropriate.

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 followed up to date policies to plan and deliver high quality care according to best practice and national guidance.

Crews who worked on the emergency and urgent care (EUC) contract at the NHS ambulance trust had access to the Joint Royal College Ambulance Liaison Committee (JRCALC) guidelines in assessing a patient’s clinical presentation. The JRCALC guidelines are a nationally recognised body which produces clinical guidelines for ambulance professionals.

Frontline crews were further supported by access to the Clinical Hub, which provides real-time clinical advice to inform assessment, risk management, and decision-making.

We reviewed 6 electronic patient care records whilst observing the crews. Crews documented comprehensive assessments that reflected the use of evidence-based tools, clinical pathways and national guidance, Records showed that staff completed full sets of observations, used appropriate diagnostic equipment to support clinical decision making. We saw examples where mental capacity assessments had been completed and documented appropriately.

Audits of paper patient report form records (PRF )were completed prior to the transition to electronic patient care records (EPFRs). 331 PRFs were audited against national and local standards including safe discharges (93%), demographic details 93% and differential diagnoses (96%). However, it also highlighted areas requiring improvement including 24% incomplete timings, 66% inconsistent National Early Warning Score (NEWS2) documentation and 50% gaps in drug administration. The provider implemented clear corrective actions which included reinforcing the requirement for two full sets of observations, ensuring accurate documentation of drug route, time, batch number and improving the recording of pain scores before and after each intervention.

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.

Staff worked well together and demonstrated a clear understanding of each other’s roles. Crews communicated effectively during patient assessment and handovers ensuring information was shared promptly and accurately.

We observed good multidisciplinary team working between the crews, emergency department teams and urgent care services. Handovers were thorough yet concise. Feedback from system partners was positive.

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.

Staff were trained to identify opportunities for health promotion and early intervention, particularly for people with long term conditions, those who frequently used the service or individuals who were socially vulnerable.

Crews provided tailored advice and signposting based on each patient’s needs and circumstances. This included guidance on managing long term conditions, recognising deterioration, medication compliance and accessing appropriate primary or community services. Staff shared examples of where they had supported patients to make informed decisions about their ongoing care and helped them reduce the likelihood of avoidable hospital admissions. Another example was a patient with chest pain received a thorough clinical assessment. Staff identified that the patient was experiencing low mood and had contacted NHS 111 due to loneliness. The crew took time to explore this sensitively and provided information about local mental health and wellbeing groups including details of upcoming sessions.

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 operated under the NHS ambulance trust contracted framework and had limited access to patient outcome data. The service had recently transitioned from paper PRFs to electronic PRFs in line with the NHS ambulance trust: however, they did not have direct access to the EPRFs system for their own auditable processes. This was an ongoing discussion with the NHS ambulance trust, and the service was working collegiately with the NHS ambulance trust trust to extend the audits that can be undertaken. The NHS ambulance trust provided a performance report, and the provider had requested that this be extended to include EPCR based audit information to support more robust monitoring and quality assurance.

Patient records forms (PRF) audits demonstrated good compliance in key areas such as safe discharge, demographic details, differential diagnoses and signatures. However, documentation of timings, observations, NEWS2 scores and drug administration was inconsistent. The service had recognised these gaps and had implemented clear corrective actions, supported by the transition to Electronic Patient Care Records (EPCR) and strengthened audit processes to improve the quality and reliability of patient records.

The service participated in national clinical audits through the NHS ambulance trust, in line with its role as a third-party provider (TPP). Staff followed the same clinical pathways, care bundles and audit requirements as trust employed staff, and outcomes were monitored through the NHS ambulance trust`s established governance and quality assurance processes.

Data supplied by the NHS ambulance trust demonstrated that the service activity and performance were consistent with wider system trends. Activity volume, job cycle times and utilisation levels aligned with trust averages and there were no indicators that the service was contributing to delays or operational pressures. The data showed that the service was operating as an integrated part of the emergency care systems, delivering safe and effective care in line with the NHS ambulance trust operational model.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff completed mental capacity act (MCA) and deprivation of liberty safeguards (DoLS) training modules as part as their mandatory and statutory training. Recent data showed that staff had achieved 93% compliance which was just below the target of 95%.

The service audited capacity and consent. Recent data showed strong compliance with assessing capacity (99%) and documenting consent (97%). The small number of gaps related to documentation rather than a failure to assess capacity or seek consent. The service had already identified limitations in the paper PRF system and implemented corrective actions, including moving to the NHS ambulance trust electronic patients record form (EPCR) with dedicated capacity and consent section, reinforcing expectations with staff and scheduling ongoing audits.

Staff demonstrated a good knowledge of consent and mental capacity. When questioned, they were able to clearly explain how they would assess capacity, what steps to take when a person lacks capacity, and how to make decisions in a patient’s best interest.