Lambda Medical Ltd

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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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This is the first assessment for this service. This key question has been rated good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

We reviewed care records for regulated activity transfers from event sites to hospital locations. Comprehensive assessments were carried out in a timely manner. Recognised tools such as National Early Warning Score (NEWS) were used. Staff used electronic forms to record necessary information about patients and care such as observations and past medical history.

A deteriorating patient policy was in place. This outlined an escalation process and appropriate handover point to NHS emergency services. A specific audit regarding escalation of care was not carried out, however, records audits evidenced review of decision making processes which would include escalations.

Pain management was assessed and monitored on an individual basis and tools such as a ‘a pain ladder’ were available for use to support pain management. Picture cards were also available to support assessments of individuals who required additional support.

Staff identified care pathways according to patient need. For example, staff would identify the most appropriate onward healthcare facility such as an urgent treatment centre or an accident and emergency department. We reviewed one case where transfer direct to a stroke unit had been agreed based on patient need. This meant the patient did not need to be taken to an accident and emergency department first.

Staff received training in recognising an unhappy child. This supported assessment of needs for each child as an individual.

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 Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidance.

Staff subscribed to and followed updates on national guidance relevant to their practice such as Resuscitation Council UK updates. Some ambulance staff accessed and shared specialist knowledge such as Helicopter Emergency Medical Service (HEMS) updates. Kit specifications followed national guidance.

Leaders told us they were proactive in researching the frequent kinds of injuries they may come across on sporting events. Whilst onsite event work was not inspected and not regulated this enabled teams to consider the most appropriate intervention that may be required and plan to transfer people to the most appropriate onward service.

We reviewed patient records and found care and treatment were provided in line with best practice, for example National Early Warning Score (NEWS) monitoring. Record audits were routinely carried out and evidenced queries were raised when possible alternative interventions could have been considered.

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 as a team to benefit patients. They supported each other to understand the nature of the job to be carried out. Briefings for events were held in advance to ensure all staff had access to the necessary information.

Consideration was given to nearby local health services to support effective transfers from event sites.

Staff used effective systems to handover information to other healthcare providers.

The team had effective information sharing systems. For example, once jobs were allocated a team was set up on a shared messaging application. An attachment was included within the teams messaging group setting out team members, roles and responsibilities, vehicle allocation, additional equipment required and the full job details.

The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported patients to live healthier lives by implementing the Making Every Contact Count (MECC) public health approach. This approach uses routine conversations and interactions to initiate conversations about improving health and wellbeing. Staff had received MECC training.

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Meeting minutes did not demonstrate key performance indicators (KPI’s) were routinely reviewed by senior leaders. However, leaders described ongoing monitoring of KPI’s to pick up on any deviation from 100%. Leaders explained the current business model did not allow for more routine monitoring of themes and trends over time as there may be months without reportable KPI data due to the nature of jobs taken on.

Staff completed audits to support positive and consistent outcomes for patient care. For example, we saw moving and handling audits were completed. Audit forms included a section for detailing actions required following audits. However, these were individual staff actions. The audits reviewed demonstrated consistent compliance across staff members with moving and handling practices.

The service collected KPI data regarding for example, vehicle availability, staff training and safety incidents. There was a process identified in policy for quarterly review and action taken where deviations were noted. Data was saved electronically.

Leaders monitored cardiac arrests, outcomes of arrests and strokes. We saw clinical review of these cases through record audits. We were told this supported identifying individual staff who may require additional support. However, the service did not demonstrate how themes were identified for wider service development.

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

A consent policy was available outlining all steps to take to enable patients to make their own decisions. There was also a Mental Capacity Act (MCA) 2005 document available within the services policies for staff to access. However, the Consent Policy lacked clarity regarding clear actions to take if a person was assessed to lack capacity. Although the Mental Capacity Act 2005 document provided more detail, the two documents did not reference each other in the associated documents box included on each policy. There was a risk that staff would not follow correct procedures if relying on the policies available due to the lack of clarity. However, there was a prompt on the electronic record keeping system to seek advice from on call leaders to discuss patients where lack of capacity was suspected.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately.

Consent audits were completed as part of the record keeping audits. We saw consent was consistently recorded.

Staff undertaking urgent and emergency care work were required to complete Mental Capacity Act (2005) training.