Archived: Manone Medical Ltd

Ambulance Station is operated by Manone Medical Ltd. The organisation offers ambulance transport on an ‘as required’ basis and does not have a set contract to provide regular pre-planned transport.

Transport for NHS patients is organised when specially designated NHS staff make direct contact with the service when required. The service also receives NHS referrals from a specialist agency working on behalf of different NHS ambulance trusts. The service sends an invoice for payment after each journey.

Transfers include patients going for hospital appointments and patients detained under the Mental Health Act 1983 going to or from mental health units.

We inspected this service using our comprehensive inspection methodology. We carried out a short notice inspection on 6, 7 and 14 June 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.

The main service provided by this organisation was patient transport.

Services we do not rate

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 issues that the service provider needs to improve:

• The service did not have effective systems and processes to assess, monitor and improve the quality and safety of the services provided. Checks on the quality of the care were incomplete because the provider did not evaluate the information gathered about the standard of care.
• Policies and procedures did not fully promote safety because they were not always in date and /or based on the most recent best practice guidance.
• Comprehensive information about the care provided was not always available because processes did not enable staff to record detailed information about the care and treatment given to patients during a journey.
• At the time of the inspection visit, the provider did not follow best practice guidance relating to safeguarding and protecting children. This was because, none of the staff had completed level three safeguarding children’s training and the designated safeguarding lead had not completed level four training. Since the inspection, all staff directly employed by the provider had completed level three child protection training and the organisation’s lead for safeguarding has enrolled onto a level four safeguarding course.
• The service did not have effective systems to make sure patients with mental health conditions were transported in accordance with the Mental Health Act (MHA) code of practice requirements. This was because the systems in place did not include a written proforma to support staff in recognising the correct documents that were required to authorise ambulance staff to transfer the patient. Restraint to prevent harm to the patient or others was used and records kept did not always include enough information about the incidents such as, details of how long the restraint was applied and which staff held different areas of the patient’s body. However, the details recorded did show the least restrictive form of restraint was used when caring for patients.

• Records showed that although incidents were reviewed the investigations were not in-depth and, learning to share with staff, to reduce the risk of a repeat incident, was not always identified.
• The service did not carry out effective infection control audits to monitor staff adherence to policies and guidelines for infection prevention and control.

We found the following areas of good practice:

• There were effective recruitment and staff support processes in place. The staffing levels and skill mix met patient’s needs.
• Staff had access to a well-planned and comprehensive training and induction programme.
• Staff told us, and we saw that, the leadership of the service was open, approachable and inclusive. There was effective verbal communication between all staff and the management team.
• The fleet of ambulances was well maintained and visibly clean.
• The managers were open and engaged well with the inspection process.

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 three requirement notices that affected patient transfer services. Details are at the end of the report.

Professor Ted Baker

Chief Inspector of Hospitals