Alliance-Pioneer Ambulance Ltd Also known as APG

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 means we looked for evidence that people were protected from abuse and avoidable harm. We reviewed the safety of care, including whether staff were suitably trained, equipment met people’s needs, and medicines were managed safely. We also considered how incidents were investigated and how the service communicated with other care providers to ensure continuity of care.

This is the first inspection for this newly registered service. This key question has been rated good. This meant people 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.

Description: We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.

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.

There was a positive culture of incident reporting, with staff demonstrating a clear understanding of reporting procedures. Staff told us they felt confident and comfortable raising concerns, and described managers as approachable, supportive, and responsive when issues were identified.

Records showed incidents were investigated in line with the provider’s policies and procedures, with professional obligation for duty of candour followed when required. Information and learning from incidents was shared with staff via team development days, with verbal debriefs and group messaging for more immediate concerns. An example was given where additional training was arranged following an incident. The service worked with partners when required to support joint investigations and to monitor patterns and trends.

Description: We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between different services.

The evidence 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.

There was a strong awareness of the risks to people across their care journeys. The service’s booking processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. In most cases, bookings came through another organisation or the local ambulance trust. However, the service had their own booking system for patient transport and high dependency transfers. Staff were clear on the different processes. When there were concerns about the booking information, staff always had access to a duty manager for support, including for contracted work where booking details were provided directly by the commissioner. We observed staff referring to booking information to verify patient details. Patients were conveyed safely between locations by staff with the necessary driving skills and experience. Clinically skilled staff accompanied patients throughout the journey to ensure their needs were met. A patient told us they felt safe throughout their transfer.

The service maintained detailed and secure records of patient journeys, which were shared with healthcare partners as needed. When conveying a patient to the emergency department, the service used an electronic record system that enabled crews to easily share digital records directly with hospitals. We were told the NHS Trust had invited the Clinical Team to take an active role in the design, development, and governance of the system for the local ambulance service.

Description: We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, and we make sure we share concerns quickly and appropriately.

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 with relevant organisations quickly.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did so when needed. Staff completed safeguarding training for adults and children to level 2 or 3 depending on their role. Compliance with safeguarding training was 100%.

The service worked with partners when raising safeguarding concerns. Learning from safeguarding concerns was shared with staff.

There were effective systems, processes and practices to make sure people were protected from abuse and neglect. The service had up-to-date safeguarding policies and procedures which outlined staff responsibilities and provided clear guidance on reporting safeguarding concerns relating to adults, children, young people and staff. The service had a safeguarding lead, and there was always a duty manager on call to support with safeguarding concerns.

The service carried out appropriate recruitment checks. References and disclosure and barring service (DBS) checks had been completed in line with recruitment policy and legal requirements. Where a DBS check identified a record of convictions, leaders used a company risk assessment tool as part of the employee risk assessment process to determine whether the applicant was suitable for appointment.

Description: We work with people to understand and manage risks by thinking holistically so that care meets their needs in a way that is safe and supportive and enables them to do the things that matter to them.

The evidence showed a good standard. 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.

Risks were assessed, and people and staff understood them. The booking process ensured all necessary information was collected to support patient safety. The service worked with partner organisations to manage risks for contracted work.

Staff could contact the local ambulance trust’s Emergency Operations Centre (the central dispatch and control hub) for support in assessing patient risk for contracted NHS work, for example by requesting information from special notes. These provide concise summaries of key information to support safe, continuous care for patients with complex needs, such as mobility issues or dementia.

Staff followed the service’s health and safety policy which outlined the risk assessment process, including for manual handling. In cases where unexpected risks were identified, staff could escalate concerns to senior leaders, who responded in a prompt manner.

Description: We detect and control potential risks in the care environment and make sure that the equipment, facilities and technology support the delivery of safe care.

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

Staff carried out daily checks to ensure vehicles were safe. All vehicles had up-to-date insurance, tax, and MOT certificates, and were regularly inspected for safety. The fleet manager was a qualified mechanic, enabling the prompt management of vehicle maintenance and breakdowns. This helped minimise vehicle downtime and reduce the impact of service disruptions. Staff understood how to report vehicle defects and breakdowns and told us that leaders responded promptly.

The vehicles we inspected were clean and equipped with the necessary equipment to provide safe care. Vehicles were fitted with CCTV to support the safety of both crews and the people being transported.

There were processes to monitor stock levels on vehicles and at base. The make-ready team, responsible for cleaning and restocking vehicles, were also trained to carry out testing and maintenance of electrical equipment. We saw that consumable items were within their expiry dates, suitable for use, and securely stored at the base.

The ambulance base and offices were clean and well organised.

There were effective arrangements to monitor the continuity of the service. The Business Continuity Plan set out how the service would maintain operations and ensure continued access for all service users in the event of a loss of critical functions. The business continuity management system had been accredited by the International Organisation for Standardisation (ISO), an independent worldwide group that creates global standards for many industries.

Description: We make sure there are enough qualified, skilled and experienced people, who receive effective support, supervision and development and work together effectively to provide safe care that meets people’s individual needs.

The evidence showed an exceptional standard. The service made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

The service had sufficient staffing levels and skill mix to provide the right care and support. Managers monitored staffing levels and skill mix for each shift.

Employed staff received annual appraisals. Ambulance crews were self-employed and therefore did not undergo annual appraisals; however, they told us they received regular feedback and one-to-one discussions when required.

There was a strong focus on learning and development. Staff received training appropriate and relevant to their role. Mandatory training also included an understanding of the Mental Capacity Act, dementia awareness, restraint, and learning disability and autism. Processes were in place to monitor and manage completion of training, and at the time of assessment, compliance across all modules was 100%.

New staff completed a comprehensive, role-specific induction, delivered by a full-time training lead, before commencing work.

All staff completed a driving assessment as part of their induction. Where required, staff had legally recognised Emergency Driving Qualifications and were able to drive under blue lights. Annual checks of driving licences were completed.

The service offered a structured preceptorship programme for newly qualified paramedics and technicians, supporting them through the early stages of their careers. This programme was developed in-house and was recognised by the local NHS ambulance trust as meeting required standards. The service also ran annual development days which mirrored those held by the NHS ambulance trust. Trainers were invited to attend the NHS Ambulance Service’s dedicated Train the Trainer days, helping to ensure those delivering training remained up to date with current teaching methods, clinical guidance, and professional expectations.

The service demonstrated they responded to staff learning needs. The training lead developed bespoke learning sessions to support staff in improving their knowledge. Staff told us they were able to approach the training lead with any identified gaps in their knowledge or requests for refresher training. Previous refresher training included the use of paediatric resuscitation equipment and intraosseous cannulation. Intraosseous cannulation is a medical procedure that places a specialised needle directly into the inner cavity of a bone to access the marrow for delivering fluids and medications when intravenous access has been unachievable. Staff indicated the training service provided went beyond standard expectations, and described the training lead as knowledgeable and approachable.

Managers identified performance concerns promptly and took suitable action to support staff in improving their performance.

We checked 4 sets of recruitment files, which and were all completed in line with legal requirements.

Description: We assess and manage the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

The evidence showed a good standard. 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.

The service had up-to-date infection prevention and control (IPC) policies and procedures. There was an IPC lead, who was responsible for ensuring the IPC policy was up-to-date and followed best practice guidance. Staff received training in preventing the spread of infections.

Staff were informed when patients presented an infection risk. Staff had access to personal protective equipment (PPE) to work safely. We observed staff use PPE correctly and follow proper hand hygiene practices. Effective waste management processes were in place, including the use of sharps containers, and there was a contract for the safe collection of clinical waste.

The Make-Ready team ensured vehicles were cleaned and prepared for use each day. Crews were responsible for cleaning vehicles at the end of each shift and following every patient transport. Vehicles were deep cleaned at least once a month, with testing carried out to verify the effectiveness of cleaning procedures. The service used a luminometer to quickly assess surface cleanliness. This specialised device detects organic residues and the presence of microorganisms, providing rapid assurance of cleaning effectiveness. If a vehicle required additional deep cleaning between jobs, staff would contact the base to arrange a replacement. IPC practices were monitored, and a log of all deep-cleaning activities was maintained.

Description: We make sure that medicines and treatments are safe and meet people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

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 involved people in planning, including when changes happen.

There were arrangements for the safe management, use and oversight of medicines. The service had policies and standard operating procedures setting out responsibilities for the administration of medicines. It held controlled drugs under a Home Office licence. Healthcare professionals were supported by Patient Group Directions (PGDs) issued by the service, which provided a legal framework allowing authorised practitioners to supply and/or administer specified medicines without a prescription from an independent prescriber. These PGDs were reviewed annually to ensure they continued to align with current professional guidance.

Medicines were stored securely both at the headquarters and within vehicles. The oxygen cylinders we inspected were within their expiry dates and stored in accordance with national guidance. Controlled drugs and prescription-only medicines were subject to regular audits. The fridge temperature was checked and recorded daily. While there was no high/low temperature breach monitoring system in place, an alarm was fitted that would sound in the event of a power failure.

Medicines were monitored and controlled using an electronic management system, enabling the service to maintain effective oversight of stock levels and expiry dates. Staff conducted regular checks to ensure medicines were available when required, suitable for use, and within their expiry dates. A commercial waste contract was in place to support the safe disposal of medicines.