Archived: Alexandra Private Ambulance Service

Updated 2 May 2019

Alexandra Private Ambulance Service is operated by Alexandra Private Ambulance Service. The service opened in 1997. It is an independent ambulance service in Cheadle, Cheshire. The service primarily serves the communities of Cheshire. However, patients are transported across the UK as required. The service predominantly provides patient transport services to adults only and provides bariatric transport with the appropriate bariatric equipment in use.

The service provides medical patient transport services to a private hospital and an air ambulance trust.

The service is registered to provide the following regulated activities:

Transport services, triage and medical advice provided remotely

We last inspected Alexandra Private Ambulance Service in February 2013. Suitable arrangements were in place to ensure people using the service were provided with effective, safe and appropriate personalised care.

The service has had the same registered manager in post since 2011. This person is also the managing director.

Updated 2 May 2019

Alexandra Private Ambulance Service is an independent ambulance service provider based in Cheadle, Cheshire. Alexandra Private Ambulance Service is registered to provide patient transport services. Alexandra Private Ambulance Service offers ambulance transport on an ‘as required’ basis and provides pre-planned transport. The service provides patient transport services to and from a private hospital as well as a repatriation service for people from the Isle of Man who require further inland medical treatment. Alexandra Private Ambulance Service collects these patients from a local airport.

We inspected this service using our comprehensive inspection methodology. We carried out a scheduled comprehensive inspection on 16 January 2018. The service had one registered base which we inspected.

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.

The main service provided by this service was patient transport.

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 the following areas of good practice:

• Staff were knowledgeable about how to report an incident and had access to incident reporting forms including while on the ambulances.
• The service ensured a minimum of two staff were allocated to each patient transfer depending on risk and need. The staffing levels and skill mix of the staff met the patients’ needs.
• The ambulance at the station and the ambulance station itself were visibly clean and systems were in place to ensure ambulances were well maintained.
• All equipment necessary to meet the various needs of patients was available.
• Services were planned and delivered in a way that met the needs of the local population. The service considered the needs of different people, such as bariatric patients or people whose first language was not English, and journeys were planned based upon their requirements.
• We observed good hand hygiene, and infection control processes.
• The service had a system for handling, managing and monitoring complaints and concerns.

However, we found the following issues that the service provider needed to improve:

• Although staff were aware of how and when to report incidents, a policy on incident reporting was not in place. Staff followed the incident policy for the local hospital where the service was based, but this process was not formalised.

• Records did not show that staff were up to date with training, to ensure they were able to carry out the duties they were employed to perform. The registered manager told us that staff attended some of the training provided by the local hospital where the service was based, however this was not formally recorded.

• The provider did not have robust safeguarding procedures and processes that made sure patients were protected. Not all staff were up to date with safeguarding training.

• The provider did not have systems and processes in place to implement the statutory obligations of Duty of Candour and ensure all staff are trained and understand it.

• The provider did not have records management or consent policies.
• Not all staff received an annual appraisal.

Ellen Armisted

Deputy Chief Inspector of Hospitals (North), on behalf of the Chief Inspector of Hospitals

Updated 2 May 2019

We found the following areas of good practice:

• Staff were knowledgeable about reporting incidents and had access to incident reporting forms while on the ambulance.

• The ambulance on site and the station were visibly clean and staff followed infection control procedures. Staff used hand gel in clinical areas to maintain good hand hygiene and used personal protective equipment.

• Systems were in place to ensure ambulances were well maintained with equipment to meet the needs of patients.

• Systems were in place to identify, assess and manage patients whose condition deteriorated.

• Staff carried or had access to a pocket guide with clinical information which was developed from the latest guidance.

• The service had systems and processes to monitor how the service was performing.

• Systems were in place for the planning of patient journeys and the care patients required.

• The service took account of the needs of patients and ensured flexibility, choice and continuity of care.

• The service had a system for handling, managing and monitoring complaints and concerns.

• Staff knew how to advise a patient if they wished to make a complaint.

• The service had plans to develop the service.

However

• Although staff were aware of how and when to report incidents, the service did not have a policy on incident reporting. Staff had access to the policy belonging to the hospital host site, but the protocol for using this was not defined.

• Systems and processes were not in place to implement the duty of candour requirements.

• Records indicated staff were not up to date with mandatory training, however not all training was formally recorded.

• The service did not have a records management policy.

• The service did not have documented safeguarding systems, to protect adults, children and young people from avoidable harm.

• Recruitment systems did not ensure that staff were properly vetted prior to undertaking employment.

• Appraisals had not been carried out for the three members of staff for 2015 to 2016.

• The service did not have a formal process for managing risks or performance.