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Thames Ambulance Service Also known as Thames Group Uk

Action is being taken against the provider of this service. Find out more

  • We have served two fixed penalty notices on Thames Ambulance Service Limited for non-compliance with the Regulations in the carrying on of the regulated activity of transport, triage, and medical advice provided remotely, as follows:

    • Failure to give the Care Quality Commission a statement of purpose containing the information listed in Schedule 3 and to keep under review and, where appropriate, revise the statement of purpose as required in Regulation 12(1) and 12(2) of the Care Quality Commission (Registration) Regulations 2009.
    • Failure to give notice in writing to the Commission, as soon as it is reasonably practicable to do so, of a change in the address of the body, as required in Regulation 15(1)(e)(i) of the Care Quality Commission (Registration) Regulations 2009.

    These notices were served on Thames Ambulance Service on 9th April 2018. Fines totalling £2,500 have been paid as an alternative to prosecution.

Inspection Summary


Overall summary & rating

Updated 20 July 2018

Thames Ambulance Service is operated by Thames Ambulance Service Limited. The service provides a patient transport service from 16 sites nationwide.

This inspection was an unannounced focused follow up inspection to assess the service’s compliance with the warning notice we had issued in October 2017, details of which are included in the background section, below.

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 areas of improvement in relation to the warning notice we had issued in October 2017:

  • Locality risk registers had been introduced and named individuals knew of their responsibilities to maintain these. These fed into a centralised system, overseen by the associate director of corporate services.
  • Audits had been implemented to monitor quality and safety aspects of the service and results of these were being collated into monthly reports by a dedicated compliance member of staff.
  • There was a quality and governance dedicated team whose responsibilities included assessing safeguarding concerns and escalating incidents for review, and carrying out ad hoc quality visits at sites.
  • There were clear separate logs to record incidents and safeguarding concerns and these were overseen and updated by the quality and governance team.
  • Investigations into incidents were more robust, clear and comprehensive than at our previous inspection.
  • There was improved clarity of job roles, particularly at team leader/area manager levels, towards improving accountability for specific tasks.
  • Safeguarding procedures had been strengthened and leads identified to support staff with safeguarding concerns.
  • There had been improvements in accessibility of policies via the staff portal app which flagged up clearly when there was a new or updated policy.
  • There had been some improvement in measures to ensure regular communication and engagement with operational staff including newsletter updates and information via the mobile app.

However, we also found the following issues in relation to the warning notice where the service provider still needs to improve:

  • Processes such as risk management, quality and governance meetings and feedback from incidents were not yet embedded within the organisation.
  • Whilst we saw that standardised agendas had been developed for the ‘three tier’ meetings mentioned in the CQC action plan, there was no evidence that these meetings had taken place. We spoke with two members of staff at Scunthorpe base who advised us that they had held one meeting and were awaiting the minutes from that meeting.
  • Staff who were not new recruits were still out of date with refresher training, including in safeguarding. Although governance leads and senior managers were able to explain there was a plan in place to address this, evidence from staff indicated there had been a lack of communication and updates to staff as to when this would be fully effective.
  • Not all policies were up to date and relevant for the scope of the service, and shared effectively with staff.
  • The service needed to ensure they were identifying specific themes and trends in incidents. Although quality and governance leads verbally recognised this as the next part of the plan, it was not formally documented and there was no set timescale for this.
  • There was a lack of clear systems or measures to ensure specific learning, feedback and actions from incidents were shared with all staff across the organisation to reduce the risk of similar incidents reoccurring and to improve staff knowledge and awareness.
  • The service needed to ensure they were identifying specific themes and trends from audit results. Quality and governance leads verbally recognised this needed to be implemented and embedded, but there was no clear plan or timescale for this at the time of inspection
  • It was not clear whether actions were being taken in response to concerns highlighted from specific audits, where these actions were documented, and how audit results were shared with the wider staff group.
  • There was discrepancy between individual sites in relation to communication and information sharing with operational staff. For example while some sites were having weekly meetings or using a ‘speak out’ system for escalating concerns, other sites had not yet implemented regular meetings.
  • There was also evidence that suggests Grimsby remains a particular point of concern. We discussed this with the quality and governance team at the time of inspection. This included concerns that staff continued to feel disengaged; low morale; lack of effective and consistent communication with staff.

Following this inspection, we told the provider that it must continue to implement and embed measures to comply with the regulations. We also issued the provider with one requirement notice that affected patient transport services. Details are at the end of the report.

Heidi Smoult

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

Inspection areas

Safe

Updated 20 July 2018

Effective

Updated 20 July 2018

Caring

Updated 20 July 2018

Responsive

Updated 20 July 2018

Well-led

Updated 20 July 2018

Checks on specific services

Patient transport services (PTS)

Updated 20 July 2018

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.

This was a focused inspection to follow up the warning notice we had issued in October 2017 under Regulation 17: Good governance. Therefore this report does not provide a comprehensive overview of all aspects of the service.

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.