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Thames Ambulance Service Requires improvement Also known as Thames Group Uk

Inspection Summary


Overall summary & rating

Requires improvement

Updated 27 August 2019

Thames Ambulance Service Canvey Island is operated by Thames Ambulance Service Limited (TASL). The service provides a non-emergency patient transport service from several sites throughout England. Thames ambulance Service Ltd had 17 ambulance stations throughout the UK from which patients transport services were delivered. This inspection report details our findings at the Canvey Island, Essex location and Sussex satellite hub.

We inspected this service using our comprehensive inspection methodology. We carried out the short notice announced part of our inspection on the 1 May 2019 at the Sussex location and 2 May 2019 at the Canvey Island location, along with an unannounced visit to the service on 13 May 2019. Service opening hours were 5.30am to 2am at the Canvey Island location, Monday to Sunday. The service provides patient transport for several clinical commissioning groups (CCGs) in the areas of Essex and provides patient transport services for an NHS ambulance service trust from the Sussex satellite hub.

We last inspected this location in September 2017 to follow up on concerns raised at our previous inspection of this location in November and December 2016 (please see previous reports https://www.cqc.org.uk/sites/default/files/new_reports/AAAF7922.pdf) (see previous report https://www.cqc.org.uk/sites/default/files/new_reports/AAAH1339.pdf). Both of these previous inspections were conducted under our previous methodology where we did not rate ambulance services.

This inspection was part of our scheduled programme of our inspections. We also needed to follow up on significant concerns raised at our inspections at other TASL locations in October 2018. Although we did not inspect Canvey Island location as part of the October 2018 inspection, we could not gain assurances that the significant concerns we found at other locations were not systematic and widespread. During our inspection of the other locations in October 2018, there were several safety concerns identified, primarily regarding the safe transport of patients with mental health needs, transport of patients with bariatric needs and transport of children aged under 12 years. Because of this, we issued the provider with a warning notice over their non-compliance of Regulations 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In order to ensure that patients using the services of this provider were safe, we imposed four conditions of registration across all of the provider’s registered locations.

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 non-emergency patient transport services (PTS).

This is the first time we have rated the service and Canvey Island. We rated it requires improvement overall.

  • Risk management systems and processes were in their infancy.

  • Processes to improve staff and patient engagement were in their infancy.

  • There were limited systems and processes in place to oversee governance around patient transportation being carried out at the Sussex satellite hub.

  • We found eleven out of date policies at the Sussex satellite hub. Staff did not have access to electronic polices at this site.

  • The service was not meeting the majority of key performance indicators with regards to patient transportation times.

  • Staff survey (September 2018)) showed that staff lacked confidence in employer commitment to training and developing staff, staff knowledge of directors, fair treatment of staff and a lack of confidence in leadership of the company.

  • Local management structures were clear but in their infancy.

  • There was no formal inclusion/exclusion/eligibility criteria in place for patients that self-referred to the service for transportation.

  • We could not gain assurances that specialist bariatric equipment had been maintained and serviced in line with manufacturer’s recommendations.

However, we also found:

  • Equipment (including vehicles) were in working order and regular maintained inline with manufacturers recommendations.

  • The service had systems and processes in place to prevent and control the spread of infection.

  • Staff had received and were up to date in several mandatory training subjects, including but not limited to; safeguarding adults and children level two, IPC and information governance.

  • Complaint handling systems were imbedded, with oversight from local managers at Canvey Island.

We rated the service as Requires improvement overall.

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, to help the service improve. We also issued the provider with one requirement notice that affected patient transport services. Details are at the end of the report.

Nigel Acheson

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

Inspection areas

Safe

Requires improvement

Updated 27 August 2019

Effective

Requires improvement

Updated 27 August 2019

Caring

Good

Updated 27 August 2019

Responsive

Good

Updated 27 August 2019

Well-led

Requires improvement

Updated 27 August 2019

Checks on specific services

Patient transport services

Requires improvement

Updated 27 August 2019

The service had made some improvements following the last inspection. However, we found the following areas for improvement:

The service did not complete and update risk assessments for all patients, including those who booked private transportation.

There was a lack of systems and processes in place to prevent the booking and transportation of bariatric and paediatric patients. This was against the conditions of registration placed on Thames ambulance service in January 2019.

Staff did not always have access to a range of information relating to the patient.

The service monitored response times and used these to improve the service, however, several response times and key performance indicators were not being met.

Appraisal processes at the Sussex location were in their infancy after a period of not being completed.

The service was not always planned and delivered to provide services in a way that met the need of local people.

Waiting times were not always in line with good practice.

Local leaders were recently implemented at the Sussex location and governance processes were in their infancy.

Local risk registers had not identified all the risks the service may have faced.

Staff engagement methods and processes were in their infancy.

However, we also found:

The service managed patient safety incidents well. Staff recognised and reported incidents and near misses.

There were mostly effective systems and processes in place to monitor and oversee staff compliance with mandatory training.

Managers recognised the importance of regular mandatory training for staff.

Staff understood how to protect patients from abuse and received the recommended level of training.

Patient feedback for the Canvey Island location was positive. People were able to give feedback and raise concerns about care received.

Emergency and urgent care

Updated 20 April 2017

Overall we have not rated urgent and emergency care at Thames Ambulance Service because we were not committed to rating independent providers of ambulance services at the time of this inspection. Emergency and urgent care at Thames Ambulance Service was provided by two of the service’s nine locations, we inspected the Canvey Island location as part of this inspection.

There were no paramedics or technicians employed by Thames Ambulance Service as their contractual obligations to NHS emergency care providers was to provide purely back-up services. This meant that they would attend alongside emergency services and transport patients in an emergency capacity after paramedic attendance in a car or motorbike. It was possible for Thames staff to be first on scene to an adult or child emergency.

Staff employed to fulfil the emergency contract were emergency care assistants and under the contracts with NHS ambulance providers were not authorised to administer medicines apart from Entonox and oxygen.