The Care Quality Commission
  • Ambulance service

Special Ambulance Transfer Services Ltd (SATS)

Overall: Good read more about inspection ratings

AJP Business Centre Suite 211, 152-154 Coles Green Road, Staples Corner, London, NW2 7HD (020) 3375 6012

Provided and run by:
Special Ambulance Transfer Services Limited

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Special Ambulance Transfer Services Ltd (SATS) on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Special Ambulance Transfer Services Ltd (SATS), you can give feedback on this service.

18 January 2022

During a routine inspection

Our rating of this service improved. We rated the service Good overall because:

  • The service had made improvements in relation to the management of medical gases. There was an up to date medical gases policy and a process for the signing in and out and of oxygen cylinders so no cylinders could be left on vehicles when they went out for servicing. There was also more secure storage of oxygen cylinders in place at the base.
  • Patient record forms were now being returned to the office after every shift and not left on vehicles for extended periods of time.
  • The service had improved their processes around the safety testing and servicing of equipment. Equipment we checked was all in date and safety tested.
  • The service used an electronic application for vehicle daily inspection checks where videos of equipment checks as well as pictures were uploaded and sent through to management allowing for full oversight of the vehicle checks.
  • The provider had improved their processes for Disclosure and Barring Services (DBS) checks. All staff had up to date DBS checks and the service audited this to make sure processes were working effectively.
  • The provider had improved their process around the re-checking of staff members’ driving licenses. All staff had up to date driving license checks in place and these were now being regularly checked by management.
  • The provider had now implemented a process to ensure that ambulance staff declared their working arrangements outside of the service. This ensured staff did not work excessive hours.
  • Staff knowledge around the Gillick competency had improved. Children under the age of 16 can consent to their own treatment if they're believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment. This is known as being Gillick competent. Otherwise, someone with parental responsibility can consent for them.
  • There were now regular clinical governance meetings where service risks, issues and performance were discussed. The meetings were minuted and included actions to take forward.
  • The service had improved their risk register which reflected risks within the service and was updated and discussed regularly by the management team.
  • The leadership team had significantly improved their governance processes since the last inspection and there were clear processes and systems in place which showed the service assessed, monitored and improved the quality and safety of the service.
  • Staff reported a positive working culture and commented on a supportive leadership team who were friendly and approachable.
  • Staff knowledge around infection, prevention and control was comprehensive and ambulances we inspected were visibly clean.
  • The service’s vehicles were bespoke to the services offered by the provider.

However:

  • While staff we spoke with reported that the provider’s main service was patient transport, the service’s Scope of Practice Policy did not reflect the service’s main service delivery offer of patient transport. It did not specify the new service provision for high dependency unit (HDU) transfers whereby transfers were non-time critical, and patients were always accompanied by their own medical teams from hospitals who would bring their own emergency equipment and medicines. The policy still went into detail about medicines administration by certain staff groups however the service no longer stored, prescribed or administered medicine. Information within the policy around medicines administration by certain staff groups was therefore no longer relevant and there was a risk that new staff could be confused about the service’s scope of practice when they read the policy.

Nigel Acheson

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

23 and 24 April 2019

During a routine inspection

Special Ambulance Transfer Service is operated by Special Ambulance Transfer Service Limited . The service provides emergency and urgent care and a patient transport service.

Special Ambulance Transfer Service (SATS) was founded in 2006 and is an independent ambulance service providing a range of different patient transport services based in north west London. This includes the transfer of high dependency and critical care patients, non-emergency transfers, repatriations and event medical cover such as sporting events. The service has contracted work with both NHS and independent hospitals. Journeys are made to various locations within London and longer journeys occur on a regular basis. The service also occasionally transfers patients from international European locations back to the UK. The service has vehicles operated by emergency care assistants, emergency medical technicians and nurses

The service provides patient transport services (PTS) and emergency and urgent care (EUC) services. EUC patient transfers are between hospitals. The provider is registered for the regulated activities: transport services, triage and medical advice provided remotely and treatment of disease, disorder and injury.

SATS operates as a main contractor to an NHS trust in north London, an independent hospital and another ambulance service. SATS also operates as a subcontractor to main contractors (identified as commissioners in this report). A small part of its work is private and for this work the service liaises directly with the private hospitals or private organisations.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 23 and 24 April 2019.

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 last inspected this service in July 2016 but at the time we did not have the legal duty to rate independent ambulance services. However, following this inspection we rated the service Requires Improvement for both core services.

The main service provided by this service was EUC. Where our findings on EUC – for example, management arrangements – also apply to other PTS, we do not repeat the information but cross-refer to the EUC core service.

We rated it as Requires improvement overall because:

  • We found poor medicines management within the service. This included prescribing, ordering, storing and administrating of medicines. For example, the service had no management system in place which recorded what medicines were stored in the service. The service also stored medicines that required a prescriber or patient group directives (PGDs) to be in place, which there were not.

  • We found poor management of medical gases within the service. For example, medical gases were not signed in and out to vehicles and were left on vehicles when they were out for servicing.

  • We found an example of patient record forms (PRFs) being left on vehicles for extended periods of time that contained patient sensitive information.

  • The service had not improved the safety testing and servicing of certain equipment which could leave patients at risk if it failed.

  • The provider had not improved their processes for Disclosure and Barring Services (DBS) checks to ensure it was safe for staff to work with patients.

  • We found some staff members’ driving licences had not been re-checked to ensure they were authorised to drive the vehicles.

  • Staff knowledge around the Mental Capacity Act was good. However, staff knowledge about Gillick competency was poor.

  • The provider did not have access to translation services which meant they relied on staff or relatives who spoke the same language to communicate with patients.

  • There were no regular staff meetings as part of the service’s governance arrangements.

  • The provider did not have systems and processes to ensure that ambulance staff declared working arrangements outside of the service. This was not monitored to make to ensure staff were not working excessive hours.

  • Whilst risk management had improved since the last inspection. However, there were a number of risks we identified which were not on the risk register with mitigations in place.

  • There were clinical governance meetings to discuss and monitor the services risks, issues and performance. However, these were not on a regular basis. We found there had been one meeting in 2018.

However, we found the following good practices within the service;

  • The provider had systems, processes, and practices to keep people safe and safeguard them from abuse. Staff were aware of and knowledgeable about these processes. This had improved since the last inspection. However, this was with the exemption of DBS checks.

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.

  • The service had introduced national early warning scores (NEWS) assessments as part of their mandatory training and patient transfers.

  • Since the last inspection the service had improved the way they reported, monitored and learnt from incidents.

  • We observed effective multidisciplinary working between SATS staff and staff at the various hospitals they worked with.

  • Staff treated patients and relatives with compassion, kindness, dignity and respect. We observed staff acting in a professional and courteous manner at all times.Patient feedback was positive.

  • The service had improved the way they recorded and learned from complaints. All complaints were now documented and any learning was shared with staff via the staff portal.

  • The service had a good audit programme in place which fed into staff appraisals and performance management on a regular basis.

  • Staff reported a positive working culture within the service and found leadership supportive and caring. There were recognition awards in place to reward staff for good work.

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 notice(s) that affected the EUC and PTS service. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

13 and 14 July 2016

During a routine inspection

Special Ambulance Transfer Service (SATS) was founded in 2006 and is an independent ambulance service providing a range of different patient transport services based in north west London. This includes the transfer of high dependency and critical care patients, non-emergency transfers, repatriations and event medical cover such as sporting events.

The service has contracted work with both NHS and independent hospitals. Journeys are made to various locations within London and longer journeys occurred on a regular basis. The service also occasionally transfers patients from international European locations back to the UK. The service has vehicles operated by emergency care assistants, emergency medical technicians and nurses.

We carried out this inspection as part of our comprehensive independent health inspection programme. The announced inspection took place between the 13-14 July 2016.

We saw areas of good and outstanding practice including:

  • Staff adhered to good infection prevention and control practice.
  • Vehicles were maintained to a high level of cleanliness.
  • There were good systems in place for checking drugs on ambulances.
  • Patient record forms were stored appropriately and audited to ensure good completion by staff.
  • There was good coordination with other providers.
  • We saw staff treating and caring for patients with compassion, dignity and respect.
  • Staff felt valued and proud to work for the service.
  • Staff feedback was collected and used in service development.

However, there were also areas of poor practice where the service needs to make improvements:

  • There was no formal documented log of all incidents and staff were unable to show us how to access the incident reporting form. Therefore, we was not assured all incidents were being reported.
  • Staff were not trained to the recommended level of safeguarding training, as per national guidance.
  • The safeguarding policy was out of date and did not include updated relevant national guidance.
  • There were no hand hygiene audits.
  • Oxygen canisters were not being stored appropriately, which put people at risk.
  • Medications were not stored appropriately.
  • Some equipment was not safety checked and maintained.
  • Staff had no training in information governance.
  • We saw no evidence of early warning scores being used during the transportation of patients.
  • We found limited evidence that complaints and low level concerns were being documented.

Importantly, the service must ensure:

  • Staff are appropriately trained in safeguarding adults and children. All staff should be trained to level two in safeguarding and the safeguarding lead should be trained to level four. The service needs to establish systems and processes to effectively respond to any safeguarding concerns raised and prevent abuse and improper treatment of service users.
  • The safeguarding policy is up to date and incorporates relevant national guidance.
  • Oxygen and medications are stored safely and securely and do not pose a risk to others.
  • All staff receive information governance training.
  • All staff receive training on duty of candour and understand their role with regards to the regulation. Duty of candour must be incorporated into the serious incident investigation process.
  • Equipment is serviced and safety checked on a regular basis and staff know how to check equipment appropriately.
  • That any serious incidents are appropriately investigated and the duty of candour is applied. The manager will need to ensure a written record is kept, investigation reports are documented and patients receive a written apology.

In addition, the provider should ensure:

  • The incident reporting policy is adhered to and a log is kept of incidents reported in order to identify themes and appropriate learning identified.
  • Early warning scores are used to assess for deteriorating patients during journeys.
  • All staff have a Disclosure and Barring Service (DBS) check completed by the service to ensure staff are suitable to work with vulnerable people.
  • They establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints by service users. Any complaints received must be investigated and necessary and proportionate action taken. The service should ensure responses to complaints are recorded.

The above list is not exhaustive and the service should examine the report in detail to identify all opportunities for improvement when determining its improvement action plan.

    Professor Sir Mike Richards

    Chief Inspector of Hospitals

8 January 2014

During a routine inspection

Special Ambulance Transfer Service (SATS) provided patient transport services, repatriation services, event services and bariatric transport services for adults, children and babies. Staff had various qualifications ranging from First Person on Scene Intermediate to Registered Nurses with Intensive Care Experience. This ensured that the provider was able to deal with all forms of patient transport.

We were not able to speak to patients using the service on the days we visited. We were told by the provider that they consulted regularly with the hospital trust's transport department to obtain feedback on the service provided. Patients mobility needs were appropriately assessed and the transport provided promoted their safety, comfort and dignity.

Suitable arrangements were in place should a patient become unwell whilst they were being transported.

Patients were transported in a clean, hygienic environment. Appropriate protective equipment had been supplied to staff.

We looked at one ambulance used by the provider and found that these were appropriately equipped to promote the independence and comfort of patients. We were shown records that evidenced the equipment used in ambulances was regularly serviced and maintained.

We looked at a range of records maintained by the provider. We found that these records were relevant to the management of the service and were accurate and fit for purpose.

We found that there were enough qualified and experienced staff to meet patients needs.

31 December 2012

During a routine inspection

We were not able to speak to people using the service because they were not present during the inspection. We gathered evidence of people's experiences of the service by reviewing their feedback and talking to two of the hospitals and primary care trusts the service is contracted with.

We read a few comments by people, who gave satisfactory comments to questions about staff's competency, integrity and general conduct. Their comments included, 'very friendly and pleasant crew', 'very reassuring', 'excellent service and would recommend' and 'absolutely great'.

This was affirmed by relevant hospitals, who commended the service for punctuality, professionalism, competency and excellence. Their comments included, 'staff are fully trained to the level we require', 'patient care is excellent', 'response time is good and 'constantly in touch with the operations manager, who is a phone call away'.

We were satisfied that patients' privacy and dignity were respected. From reviewing patients' comments and talking to staff, it was clear patients experienced effective, safe and appropriate care, treatment and support that met their needs and protected their rights. The familiarity of staff with safeguarding policy and relevant procedures along with appropriate management support structures, meant patients were protected from abuse.

The provider had systems to monitor the quality of the service, some of which we saw and were up to date.

10 February 2012

During an inspection in response to concerns

We did not speak to people using the service on this occasion. We noted that the service gives people feedback forms which they can complete and return. The feedback we saw was positive about the service.