Lancashire HQ

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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 was the first assessment for this service. We rated the effective key question as requires improvement. This meant understanding outcomes and exploring best practice was not always part of every day work.

The service was in breach of legal regulation relating to suitably qualified staff.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

The service used information provided by the referring organisation to identify patient needs. Staff told us this information was used to support decision making around providing the most effective support for individual patient’s needs prior to the first contact.

We heard that dynamic risk assessments would be carried out at the point of first contact with a patient. There was a document available to be completed for all service users requiring transport.

The service did not plan and deliver people’s care and treatment with them. Staff did not follow legislation and current evidence-based good practice and standards.

The Mental Health Policy referred to practices of de-escalation, using least restrictive options and emotional regulation. However, we saw no detail regarding the use of evidence-based practice or legislation when delivering care to people. Staff we asked were not clear about evidence-based practice relating to the regulated activity provided.

There were no systems to ensure that staff were up to date with national legislation and evidence-based good practice.

The service did not always work well across teams and services to support people. Staff did not always share their assessment of people’s needs when people moved between different services.

The Duty of Care Policy identified that staff would work within the scope of their training and competencies. This policy provided guidance on the use of additional medical escorts, however, it was not clear whether this policy referred to the regulated activity of mental health transfer or non-regulated activity also carried out by the provider. Therefore, it was difficult to determine a clear duty of care within the mental health transfer setting.

The policy referenced actions to take should a patient deteriorate or there become a medical emergency during a transfer, including contact with emergency services as appropriate.

We did not gather enough evidence to report on this quality statement.

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

We were told that there were no formal key performance indicators (KPIs) but the provider set their own informal target of 60 minutes to start a patient journey and that there were no times when this target had not been met. We were told that journey times were recorded and would be discussed in governance meetings. We did not see clear evidence of discussions within meeting minutes provided.

We were not given any examples of monitoring outcomes with other commissioning partners.

The service did not tell people about their rights around consent or respect these when delivering care and treatment.

The service provided transport for people based on implied consent by the referral being made by a health professional working with the patient. We saw there was a box to tick on the dynamic risk assessment to confirm the patient consented. We did not see any guidance regarding the responsibility of the ambulance staff in obtaining consent.

There were inconsistencies in the understanding of the use of restraint and the training required. The provider was a member of the Restraint Reduction Network. Training was not compliant with the BILD Restraint Reduction Network training standards 2019. The Care Quality Commission expect all care services to only use training in restrictive practices that is certified as complying with the Restraint Reduction Network training standards.

These are standards set out to protect human rights and support the elimination of unnecessary restrictive practices. We were not assured that the service was compliant with these standards.