Met Medical

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• 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 means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment of this service at this location.
This key question has been rated as good, this meant that people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed a good standard. 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 had a clear policy and process of reporting incidents. Incidents were reported using an electronic incident reporting system that staff could access via their personal devices. All staff and managers were aware of their responsibilities for reporting and investigating incidents. Incidents were reviewed and discussed at governance meetings with learning and themes cascaded to staff in monthly staff newsletters and bulletins. There were 166 incidents reported between July 2024- June 2025. The service also reported incidents to other healthcare partners, such as the NHS ambulance trust, whom the service held a contract with and carried out joint investigations if needed. For example, we reviewed the investigation of a medicines error that was jointly investigated. Following the investigation, drugs bags were reviewed, drug ampoules changed so clear differences could be seen and procedures around drug administration highlighted to staff. The NHS ambulance trust told us that the service responded to incidents in a timely manner and that there was evidence of learning from them.
There was a duty of candour policy. Staff and managers were aware of the need to be open, transparent and give explanations to patients and their families when things went wrong. We saw evidence that duty of candour was triggered and followed at the time of the medication error with staff involved informing the patient and their family at the time when the error occurred.

The service showed a good standard. 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.
We observed staff gaining information from patients and their families when responding to 999 calls as part of the contract with the NHS ambulance trust. This enabled them to determine the patient’s needs so that a plan of treatment and care could be put into place. All the information was documented and shared with other healthcare providers as necessary. This supported consistent care as patients moved between services helping to maintain patient safety. Staff had access to other pathways of care and treatment if a patient was not required to go to accident and emergency (A&E) or if they were experiencing symptoms requiring more specialised care.
Healthcare partners told us that the service worked with them to establish and maintain safe systems of care with regular engagement allowing for any issues to be discussed.

The evidence showed a good standard. 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 shared concerns quickly and appropriately.
The service had safeguarding policies for adults, children and young people which staff had access via their electronic devices.
They had a safeguarding lead trained to level 4 in safeguarding adults and children with two other managers trained to the same level. The service also had an external safeguarding advisor trained to level 5. All staff received training specifically for their role on how to recognise and report abuse and trained to level 3. This was reflected good practice in line with the Royal College of Nursing intercollegiate document on safeguarding. There was 100% staff compliance in safeguarding training for both adults and children. The safeguarding lead had a portfolio of continuous personal development which enhances skills and knowledge to improve response to safeguarding concerns and support to staff.
The staff we spoke with knew how to identify adults and children at risk of abuse or harm. Staff gave examples that demonstrated that they knew what actions to take to protect patients. Staff knew their responsibilities for the notification of safeguarding incidents and the referral process. Healthcare partners told us that they monitored the services safeguarding referrals and had not identified any concerns. Safeguarding was discussed at monthly governance meetings and there was a focus on learning from safeguarding incidents on staff bulletins and updates.

The evidence showed an exceptional standard. The service always worked well with people to fully understand and manage risks by thinking holistically. They provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.
We observed staff actively listening to patients they were treating, considering not only what they needed but what they wanted making the whole care experience patient centred. We observed evidence of capacity assessment, consent gained and the consideration’s associated to risk with transport to hospital verses remaining at home discussed, resulting in the patients being able to make an informed decision. One patient did not have capacity, so discussion was had with family and lasting power of attorney for health and wellbeing. Clear, care and treatment plans were put into place, shared decision making was observed with other healthcare providers, documentation completed, and the patients involved safety netted with advice given should anything around their condition change. They were also advised how to seek further help if it was needed. Safe discharge documentation was completed in line with their contracted NHS ambulance service safe discharge policy.
We were assured that staff could manage risk with a patient that was deteriorating. The service had a deteriorating patient policy which contained guidance in the event of a life-threatening emergency. Staff also used Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines for the management of medical and emergency situations. Staff used patient observations and tools such as National Early Warning Score 2 (NEWS2) to aid them with this. NEWS2 is a standardised tool used across the NHS to assist and respond to acute illness in adult patients.
All staff were trained to provide Basic Life Support (BLS) Intermediate Life Support (ILS) or Advanced life Support (ALS) in both adults and children depending on their clinical grade and scope of clinical practice.

The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.
The vehicles were seen to be visually clean inside and out and free from damage. This was confirmed through an inspection of three vehicles used for emergency and urgent care work during our assessment. Staff undertook daily vehicle inspections at the beginning of their shift which was documented electronically.
There were not always effective arrangements to monitor the safety and upkeep of the equipment. On one vehicle the bracket holding the defibrillator was not appropriate for the model of defibrillator used therefore it was loose and not secure; in addition, one set of adult defibrillator pads were out of date as were other consumables including equipment used to manage and maintain a patient’s airway. A bag of 10% Glucose was also out of date. The hand sanitising gel was also empty. We reported this to a manager; we reviewed these findings on our second day and found that they had been rectified. We witnessed the disposal of out-of-date consumables.
The fire extinguisher on one vehicle was out of date with one also loose and not secure in the front cab of the vehicle.
It was unclear from stickers on equipment if it had been serviced or had been portable appliance tested (PAT). Data received following our onsite visit indicates that equipment was regularly serviced, and we saw that PAT testing was being undertaken on the second day of our assessment.
We had received concerns prior to our assessment that vehicles were being restocked by people that were untrained to do so and that often equipment was missing. We did not find evidence during our assessment to support these concerns. Each day there is a member of staff on an operational support shift; to restock vehicles with photographs of equipment to aid restocking. We did not see any missing items of equipment on our assessment apart from hand sanitiser.
The service had appropriate safety harnessing for the transportation of children.
The service had a fleet lead who took responsibility for vehicles. This included servicing and MOT which were up to date. Data received showed that one vehicle was out of its service date, this was a recently acquired vehicle and was not being used operationally. The vehicles were fitted with AI technology that monitored the driving of staff.
Fire alarm checks are completed and documented with a fire risk assessment having been completed. There was a digital key safe to keep all vehicle and store cupboard keys locked and secure.
The service had a Control of Substances Hazardous to Health (COSHH) policy and a COSHH substance folder with appropriate signage. However, the COSHH cupboard was found to be unlocked increasing the risk of accidental exposure to hazardous and harmful substances.
The non-clinical environment appeared generally well maintained. Staff had a social area and lockers. However, there is no on-site toilet facilities. As a result, staff used a shared toilet that is not within the compound of the premises. These toilets were not visibly clean. The toilets were not owned by the service and therefore the cleaning of them was not in their remit. Hand washing facilities and soap was available for staff to use. We enquired about staff safety at night. Staff we spoke to said that although not ideal there was lighting in the area, CCTV and a security guard, and they did not feel unsafe.
Confidential waste was shredded and then disposed of appropriately.

The evidence showed a good standard. 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 a recruitment policy and safe recruitment process. All staff employed by the service, either on a permanent or an ad-hoc basis, were subject to an enhanced Disclosure and Barring Service check (DBS). All paramedics, both permanent and ad-hoc, were registered with the Health and Professional Council (HCPC) and this was reviewed. New staff receive induction and orientation into the service. Support was further provided by assigning them to shifts where they operated alongside a crew as an additional team member.
All staff were qualified within their own clinical competencies to undertake their role, and they were aware of their scope of practice within their clinical skill group. The service had a policy that outlined this, using a traffic light-coded system that staff could access. The staff observed were experienced and qualified and had the right skills and knowledge to treat and care for the patients that they were presented with. Staff said that if they were presented with a patient requiring treatment outside of their clinical competency, they would request additional assistance to the scene or seek clinical advice via the contracting NHS ambulance trust or a Met Medical manager.
Three members of the management team and one other paramedic were training as Apprentice Advanced Clinical Practitioners (AACP). They were being supported and guided by the Medical Director who oversaw the service. As apprentices they can only practice within this role when working under the supervision of the Medical Director. If they completed shifts for the contracted NHS ambulance trust they could only work within their clinical competencies as a paramedic, as the NHS ambulance service did not allow AACPs to work for them from independent health ambulance services. Therefore, the AACP’s could only practice their competencies when working at events when they work alongside or under the guidance of the Medical Director. Events work is not currently regulated by CQC.
The service has a clinical team leader who had oversight of staff training and compliance. There was an education and training policy in place. All staff are 100% compliant with their mandatory training, including training around learning disabilities, autism and dementia. The service had access to computer software which enabled staff to see if training was current, due or expired. The system triggered an email to staff 3 months before any mandatory training was due to expire. Staff training and compliance was also shared with their contracted NHS ambulance trust, who the service supported with 999 calls. This meant that the ambulance trust was assured that the staff provided by the service were trained and able to carry out their roles.
Training was a mix of online and face to face training. Staff were trained in end-of-life care with paramedics trained in medications for people approaching end of life as per the contracted NHS ambulance trust policy and training for end-of-life care. Staff we spoke to felt supported by paramedic mentors and by the service when it came to their training and development. Staff had yearly appraisals, but the service acknowledged that there is still work to be done in this area with only 80% of staff receiving their yearly appraisal.
The people we spoke with said that they felt confident the staff that treated them were trained and knowledgeable.
65 staff were blue light emergency driving trained and staff drivers’ licenses were checked yearly. Blue light driving assessments are carried out 5 yearly and are up to date.
The NHS ambulance trust with whom the service held a contract for 999 emergency support told us that staffing levels and skill mix was usually in line with their requirements and staffing was discussed as part of a weekly operations meeting.

The evidence showed some shortfalls. The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.
The service used an external company to deep clean vehicles; and some vehicle deep cleaning was observed on the first day of the assessment. The service infection prevention and control (IPC) policy stated that vehicles used for urgent and emergency care should be deep cleaned every 6 weeks. However, audit data indicated that, at times, vehicles went between 9 and 15 weeks without undergoing deep clean. On one vehicle, swab testing conducted before the deep clean revealed elevated levels of microbial contamination on both the windowsill and the trolley bed indicating that cleaning in between deep cleans was not being done properly increasing the risk of spreading infections.
The service had an (IPC) lead and an IPC policy, that all staff had access to via their electronic devices, which outlined clear responsibilities for staff and managers around IPC. Staff were 100% compliant in IPC mandatary training.
The vehicles and reusable equipment that we inspected were visually clean and tidy, personal protective equipment (PPE) was available to staff. There was safe disposal of clinical waste and sharps. Sharps bins were dated and labelled correctly. The service had a contract with a company to collect and dispose of clinical waste. Decontamination wipes and clean linen were available. One vehicle did not have any hand sanitising gel, but this was rectified once it was pointed out to a manager.
Staff carried out vehicle cleaning at the beginning and end of their shift, as well as between patient transfers throughout the day. This was observed on both of our assessment days. If a person was transported with a known infectious disease a manager was contacted for guidance around appropriate cleaning. Staff were observed to be bare below the elbows with regular hand washing taking place, PPE was worn when appropriate with aseptic techniques demonstrated when needed in the delivery of patient care.
There was signage around IPC and cleaning at the ambulance base to remind staff of the processes that should be followed. Staff had access to cleaning products. Mops and buckets were colour coded, and disposable mop heads were used.
The service complete staff hand hygiene audits and uniform spot checks 37 staff were randomly audited over a three-month period. Results showed 100% compliance. It is not clear from data how frequently these audits take place. Staff said that the contracted ambulance NHS Trust management often did random checks on staff and vehicles around IPC.
All non-clinical areas were observed clean and tidy maintained by staff as part of their daily operational roles. IPC was discussed at governance meetings. The NHS ambulance service did not report any IPC issues when we spoke to them about the service.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involve people in planning, including when changes happen. Staff followed systems and processes to prescribe and administer medicines safely. The provider had access to up-to-date national guidance which they followed. Staff only administered medicines within their scope of competency and within approved lists of medicines set out by their NHS contracts. There was an up-to-date medicines policy in place. This included information which signposted staff to refer to contracting NHS organisations patient group direction (PGDs) when conducting work for that organisation. A PGD or Patient Group Direction, is a legal framework in the UK that allows certain registered healthcare professionals to supply and administer specified medicines to groups of patients without a prescription under clearly defined conditions.
Medicines, including controlled drugs (CDs, medicines requiring additional security measures due to their risk of abuse) were stored securely, recorded accurately and access was restricted to authorised staff only. Tamper-evident seals were used on medicines bags, with serial numbers recorded and audited to confirm integrity prior to use. Medical gases were stored in line with best practice, and a process was in place to monitor and identify when oxygen and nitrous oxide gas cylinders required replacement.
Staff followed national practice to check patients had the correct medicines when they were transported, or they moved between services. Staff told us they would take a medical history from the patient when attending a scene where possible. We observed that staff consistently recorded individuals’ medical histories, current medicines and allergies. Records included details of medicines administered by staff, including the use of medical gases. Staff received regular training in medicines management, including the use of medical gases, and had access to supporting information to promote safe practice. Staff learned from safety alerts and incidents to improve practice. Certain staff were subscribed to receive medicines safety alerts and management ensured actions were taken and recorded when relevant to the service.