Archived: Beverley Ambulance Service Limited

Beverley Ambulance Service Limited is operated by Beverley Ambulance Service Limited. The service provides non-emergency patient transport service for adults, and occasionally children, who are unable to use another means of transport due to their medical conditions. This includes transportation between hospitals and planned discharges from hospital wards. The service holds no contracts with NHS hospitals or commissioning groups. The service also provides occasional emergency ambulance services, private emergency first aid and medical cover to sporting events.

We carried out an announced routine comprehensive inspection on 1 March 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

We regulate independent ambulance services, but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found areas of practice that the service provider needs to improve:

•  We found that effective governance systems were not in place to protect patients when areas of concern had been highlighted, for example lone working. We also found that effective systems were not in place to record disclosure and barring service checks prior to commencing employment. These were also not checked regularly during employment. There was no evidence that staff had read company policies and were able to implement these.

•  From observations, records and staff we spoke with we found that outcomes of patients’ care and treatment were not routinely collected and monitored. The service did not record information on the patient’s journey; therefore, staff did not record any variances during the journey. Not collecting this performance information does not allow the service to benchmark and compare against other providers and to identify and take action to improve performance and ensure they were delivering an effective patient transport service.

•  There was a lack of assurance that the safeguarding training delivered to staff meets the guidance specified in Safeguarding children and young people: roles and competences for health care staff intercollegiate document third edition: March 2014.

•  We found a lack of evidence that all drivers of ambulance vehicles had the correct category of licence for driving heavier vehicles or that they had received the correct level of training for driving heavier vehicles or driving on blue lights.

•  The service did not have a central log of all risk assessments recorded.

•  From training files we reviewed, we found that not all staff working in the company were trained to the correct level required by the company to carry out the role. There was not an effective process of competency assessment and from records we reviewed it was not evident that staff always had the appropriate skills and knowledge to be delivering the care required. Not all staff employed had received an up to date appraisal.

•  The service did not have a clear business continuity plan, which detailed the plans for example on adverse weather and loss of telephone systems.

•  The service did not participate in surveys or audits of patient experience.

However, we also found the following areas of good practice:

•  During the inspection, we had a limited opportunity to observe care and speak with patients. We observed care on one transfer and found the staff engaged positively with the patient and explained expectations during the journey. The service provided us with a number of compliment letters and cards sent to them from people who accessed their services. These showed that the service respected and valued patients that used the service; staff were praised in these compliments for their patience, respect and caring nature that was shown. It was clear from reading the compliments that the care people received from the service was above their expectations.

•  From the observations and discussions, we had with staff it was clear that staff regarded patients as partners in their care and were committed and passionate about the services they provided.

•  The service consistently supported patients with access to food and drink during long journeys.

•  The service planned journeys to encompass a route of the patients choice for example: around the sea front or via a special place.

•  Staff had access to pictorial communication guides, which gave a range of symbols and signs used to communicate with people who may be cognitively impaired, lack speech or may have English as a second language.

•  Staff were aware of interpretation services used to support patients whose first language was not English.

•  The majority of the patient journeys were booked and delivered on the day of request.

•  The service reported a good working relationship with the local NHS hospitals that they provided a service.

•  Vehicles we inspected were visibly clean, tidy and well maintained.

•  Staff we spoke with were confident to report incidents and variances in the patient’s journey to the senior management team.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices that affected the service. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)