Western Medical Services Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This is the first assessment for this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

The service had processes to investigate and learn from incidents, and people could raise concerns. People were kept safe from abuse and improper treatment. Equipment met the needs of people. Vehicles were visibly clean and there were processes to prevent the spread of infections. Staff followed processes to keep people safe.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There were systems and processes to investigate incidents and near misses. There were up-to-date policies to support incident investigations. Learning from incidents was identified by leaders and shared with all staff through various communication methods.

Staff understood what needed to be reported as an incident. They told us it was important to report all incidents to prevent recurrence and keep people safe. Staff told us they had confidence leaders would take reported incidents seriously. Staff told us they received feedback from leaders on incidents.

The service transported people detained under the Mental Health Act. When restraint was used, these were reported and investigated as an incident. Records demonstrated the service held debriefs after each secure transport. Leaders told us debriefs were an important tool in identifying learning and to reduce future use of restraints. Leaders reviewed records to ensure restraint was justified and the least restrictive restraint was used.

Staff understood the importance of professional duty of candour (being open and honest when things go wrong). Leaders involved in incident investigations understood their responsibilities in following statutory duty of candour requirements. During the assessment of the service, we reviewed records that demonstrated the service followed duty of candour.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s booking process captured patient information and risk factors to enable the safe planning of care. The service used criteria to identify people who were suitable to use the service. Where people were not eligible to use the service, alternative services were contracted to provide care. Where booking information indicated the patient required a higher level of support, staff reviewed the entire patient journey to plan safe care.

Staff carried out appropriate patient observations when transporting people. Records showed staff carried out regular observations on people being transported.

The service had a process to identify patients who were not suitable to be transported. The service did not have a vehicle with a secure cell to transport high risk patients detained under the Mental Health Act. The service used risk assessments to identify low and medium risk patients that could be transported. Leaders said they had good working relationships with local approved mental health professionals. They said this helped to plan, and provide, good quality safe care.

For people detained under the Mental Health Act there were processes to ensure their property was secured. Records showed staff checked possessions being transported and these were logged and checked with a healthcare professional at the pick-up and drop-off location.

Staff reviewed booking information with healthcare professionals when collecting people for transport to ensure information was up-to-date. They carried out dynamic risk assessments to respond to changing patient conditions.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The service had up-to-date policies and processes to protect adults and children from abuse and improper treatment. Staff followed processes to report concerns. The service had safeguarding information displayed at the base.

Staff received role specific training in safeguarding adults and children. Staff completed training level 2 or 3 safeguarding depending on their role. Records showed all staff had completed safeguarding training.

Staff understood their role in safeguarding people from abuse and improper treatment. Staff could identify signs of abuse and understood how to raise safeguarding concerns. They knew who to contact to get safeguarding advice when performing patient care.

The service had a named safeguarding lead who was trained to level 4. They had access to level 5 support under a service level agreement with an external organisation.

The service carried out appropriate recruitment checks. This included checks with the Disclosure and Barring Service (DBS) for both adults and children barred lists. There was a process to review risks identified in recruitment checks.

Staff received training to understand threat from terrorism and extremism and support people susceptible to radicalisation. Records showed all staff completed prevent training.

Staff received regular safeguarding supervision to support them to identify safeguarding concerns.

The service identified when crews of the same sex as the patient needed to be deployed.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service had processes and policies to support patients having a medical emergency. Staff providing patient transport services were trained to give life support until urgent and emergency services arrived at the scene. Staff were confident in describing what they needed to do in an emergency.

Staff said the booking process captured most of the information needed to provide good quality care. They would work with colleagues or external healthcare professionals should information not be correct.

There were plans to respond to vehicle faults when transporting people. The service had access to vehicle recovery support. The service had capacity to attend a broken-down vehicle to collect people and complete patient transfers. A person using the service told us the vehicle they were being transported in developed a puncture, the service sent a different vehicle to complete the journey.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff carried out regular safety checks to ensure ambulances were safe to drive. Vehicles were insured, taxed and had valid MOTs (required vehicle safety checks). The service had a process to ensure all vehicles had a full service within the allotted time period.

The service had a robust process to check the quantities of stock on vehicles. Vehicles carried suitable equipment in sufficient quantities to support patient care. Consumable products in vehicles and at base were in-date and suitable to use.

The service had a system to ensure defective equipment was removed from use. Staff reported equipment defects to managers and understood how to identify unsafe equipment.

The service had a process to check equipment was safe to use. Managers kept records of equipment servicing and monitored when the next service was due. There was a process to check electrical appliances were safe to use. Electrical equipment had a test date displayed. All equipment we checked was within the electrical safety date.

Staff had access to specialist equipment to support people using the service. Staff told us they had enough equipment to look after people safely.

Chemicals or substances hazardous to health (COSHH) were stored securely. COSHH risk assessments had been completed and were available for staff to view.

The service used soft cuffs to restrain patients when needed. Restraints were clean and free from damage. There was a process to ensure these were safe to use and made available when transporting people detained under the Mental Health Act. Vehicles had ligature cutters and resuscitation equipment in case of emergencies.

Staff received training to use specialist equipment. Records showed all staff had competed this training.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service transported people 24 hours-a-day with office hours 9am to 5.30pm. Clinical staff operated an on-call system to provide crews with clinical and operational advice outside of office hours.

The service employed full-time and flexible working staff. There were a number of professional roles which had clearly defined competencies. All staff were required to complete mandatory training. There was a process to monitor completion of mandatory training. Records showed staff had completed mandatory training for their roles.

Staff received training in supporting people with a learning disability and autistic people. All staff had completed the online part of this course. However, the face-to-face part had not been completed. Leaders had dates for the face-to-face courses and were booking staff on to them.

The service had staff with train the trainer qualification to mentor and manage training standard.

Staff who were deployed to transport people who were detained under the Mental Health Act received training in line with Restraint Reduction Network standards. Staff refreshed restraint training every year.

The booking process identified patient needs which enabled the service to plan how many staff to deploy on each transport. The service planned staffing levels based on the amount of planned work and retained staff on stand-by for transport requested at short notice.

Crews were deployed based upon their job role and patient needs. Where staff stepped down into a role, they performed in line with the scope of practice required for that transport. Leaders said they had enough staff to meet demand.

The service had a process to check and monitor ambulance crews’ driving licences. The service did not use blue lights for patient transport.

Staff received an induction to the service, regular supervision and annual appraisals which help them perform their roles. Appraisals were completed annually and covered performance, development, training and gave staff an opportunity to discuss concerns. Records showed that all staff had received an appraisal within 12 months prior to our assessment.

People using the service told us they felt staff were skilled and were able to look after their needs.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service had up-to-date infection prevention policies and procedures. Vehicles and the base were visibly clean and tidy. The service completed cleaning between patients, daily vehicle cleans, and vehicles were regularly scheduled for deep cleaning. The service carried out testing to monitor the quality of cleaning. Cleaning records were up-to-date.

Staff received training in preventing the spread of infections. Staff knew what to do if a vehicle became contaminated while transporting a patient.

Healthcare waste was stored appropriately on vehicles and at the base. The service had a contract with a third party to collect and dispose of healthcare waste. Staff told us that as soon as they return to base, they would empty waste from vehicles to the correct bin. We saw waste was segregated into the correct bins.

The service identified patient infections prior to transport and had systems and processes to reduce the risk of infections spreading. Personal protective equipment (PPE) was available on vehicles.

Vehicles had adequate supplies of cleaning equipment and were visibly clean.

Leaders monitored processes to prevent the spread of infections. Records showed hand hygiene and vehicle cleaning standards were being met.

People using the service told us they felt vehicles were kept clean and were happy to travel in them.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs.

The service only administered oxygen for patient transports. Staff followed up-to-date policies and processes to administer oxygen. Staff were trained to use oxygen in an emergency. Oxygen cylinders were stored safely on ambulances and at the base. Patients’ own medications were transported securely during transport.