E-Zec Medical Wellington

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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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

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

The service supported people well and ensured those in need could access the service. Patients’ needs and preferences were incorporated in the booking notes.

There was a policy covering the safe handling of patients, and risk assessment forms that staff used to select appropriate resources and equipment. Staff told us the information received about journeys was useful, but not always accurate, and they sometimes had to request additional support or contact the control room to abort journeys. Staff at the trust told us communication was sometimes difficult, but the link service provided by the patient transport liaison officers (PTLOs) was beneficial.

Staff referred to national guidance for the care of patients who deteriorated in transit, including end-of-life patients. Staff understood the consent process.

The service regularly monitored performance and patient outcomes. Data indicated people were being affected by the service falling short in several key performance targets relating to timeliness. E-Zec Medical Wellington was actively working on improvement actions, in collaboration with the ICB, the trust, and NHS England, however the expected outcomes had not yet been realised.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff knew how to perform dynamic risk assessments prior to moving or transferring patients. We saw an example of a dynamic bariatric/plus sized & complex risk assessment form that staff used to log issues with access, patient position, and to determine if any additional resources were required. Staff gave an example of calling for assistance when a dynamic risk assessment on an end-of-life patient highlighted that additional resources were required for safe transportation.

There was a safer person handling policy which covered the assessment of risk, principles of efficient movement, selection of appropriate resources and equipment, wheelchairs, tissue viability issues and falls.

Staff were trained in the safe transportation of children. We saw evidence of the last 6 months of paediatric journeys which detailed the type of transport requested and the escort requirements.

We scored the service as 3. The evidence showed a good standard. 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.

The service referred to national guidance when dealing with patients who deteriorated in transit, ensuring staff were aware of their responsibilities to act in line with their level of training and scope of practice when patients suffered a cardiac arrest or reversible causes, such as airway obstruction or diabetic emergency.

We saw an End-of-Life policy, which ensured staff knew how to safely transport patients that had a Do Not Attempt Resuscitation (DNAR) form or a Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form, which records a patient’s personalized treatment preferences for emergency situations. Crews were made aware of these orders via the booking team.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people.

The ACAs could review their assigned journeys on their mobile personal digital assistant devices (PDAs). Staff told us the patient information they received from PTAC was useful, but not always accurate. This meant crews sometimes had to perform dynamic risk assessments and liaise with the control team to request extra support or abort journeys. The control team would contact the hospital if a journey needed to be amended or cancelled. Control room staff sometimes felt they had to absorb a lot of frustration from crews, patients and staff at the hospital. The Regional Senior Operations Manager told us she was trying to foster open communication among staff, and active recruitment was underway for a permanent control room supervisor to support the control team.

Some staff felt the journeys could have been organized better and we were told issues with timings were common, but this was partially limited by constraints in the contract with the ICB. They felt the service would benefit from a full-time journey planner.

Staff at the trust told us communication with the service was sometimes difficult, but the link service provided by the PTLOs was beneficial.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

The service supported people well. Journeys were assigned based on strict eligibility criteria, so only patients in need could access the service. Information was logged at the time of booking and captured on the booking form. This was then visible to all staff.

We saw examples of how patients’ needs and preferences were incorporated in the booking notes. This included information such as mobility, anxiety, pain, or the need to be home at a certain time for childcare responsibilities.

We scored the service as 2. The evidence showed some shortfalls. The service did routinely monitor people’s care and treatment to continuously improve it. However, not all patients arrived in good time for their appointment, so outcomes were not always positive and consistent.

We saw 6 months of data showing the number of journeys undertaken each month, as well as those cancelled, delayed and on time. This indicated people were being affected by the service falling short in several key performance targets relating to timeliness. This meant patients were delayed in receiving the treatment they required and not being discharged in a timely manner. However, E-Zec Medical Wellington was actively working on improvement actions, in collaboration with the ICB, the trust, and NHS England.

The data validations administrator retrospectively reviewed journeys for each vehicle to see if the information agreed with that on the crews’ mobile personal digital assistant devices (PDAs).

When a patient’s journey had to be cancelled, there was a system in place called a ‘Service Recovery Board' (SRB). The patient would be added to the SRB and monitored for the next 5 journeys to ensure a successful transition and treatment. The patient was also offered the opportunity to raise a complaint.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood the consent process. When patients refused to consent, they would escalate this and inform the hospital. Staff told us they would explain the reason for the transfer but would not force patients.

We saw staff policies defining consent, and processes that provided guidance on aborting and cancelling journeys including when patients refused to travel.