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Thames Ambulance Service Inadequate Also known as Thames Group Uk

The provider of this service has requested a review of one or more of the ratings.

Inspection Summary


Overall summary & rating

Inadequate

Updated 13 February 2019

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

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 23 October 2018.

We previously carried out an announced comprehensive inspection of the service on 22 November 2016 and an unannounced inspection on 8 December 2016, both were at the service’s Canvey Island base, which was one of only two sites operated by the service at the time. We also carried out unannounced inspections of the service at two local hospitals and at the Milton Keynes base on 9 December 2016. At this inspection there were a number of safety and quality concerns identified. Following this inspection, the service voluntarily ceased their urgent and emergency work and became a solely patient transport service. During 2017 the provider expanded their patient transport significantly, taking on a number of patient transport contracts nationwide.

We carried out another comprehensive inspection of the service on 22 September and 9 October 2017 at the service’s Canvey Island, Grimsby and Scunthorpe sites. Following this inspection, we issued a warning notice for breach of Regulation 17: Good governance. We followed this up in February and March 2018 and extended the compliance date due to extenuating circumstances, because there had been significant changes in the management and governance structures.

We had also issued requirement notices in relation to Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment; Regulation 16 HSCA (RA) Regulations 2014 Receiving and acting on complaints; Regulation 18 HSCA (RA) Regulations 2014 Staffing.

The service was last inspected on 15 May 2018 where we carried out a focused inspection to follow up a warning notice we had issued to the provider in October 2017 under Regulation 17: Good governance.

In April 2018 we issued and published details of two fixed penalty notices for breaches of Care Quality Commission (Registration) Regulations 2009: Regulation 12 Statement of Purpose and Regulation 15: Notice of changes. These were paid in full by the service in May 2018.

Over 2018, Thames Ambulance Service Limited has been attending regular risk review meetings with CQC, NHS England and clinical commissioning groups, due to the level of concern. Given our level of concern at this service we contacted NHSE and they commenced risk review meetings to oversee the actions the provider was taking.

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 (MCA).

The main service provided by this service was non-emergency patient transport services (PTS).

  • Generally, staff we spoke with during our inspection of the ambulance stations said they had not completed safeguarding or mandatory training and station managers told us they had no access to training data. At the time of our inspection, the provider was unable to tell us staff compliance rates with safeguarding or mandatory training.

  • Generally, ambulance staff we spoke with during our inspection said they had no training on the MCA or meeting the needs of bariatric patients. Staff said they had not received handling and moving training and felt unsafe transferring bariatric (morbidly obese) patients. However, we could not corroborate this

  • At the Grimsby ambulance station, managers told us they had no access to staff contact information and didn’t know how to contact staff if they needed them to cover shifts or inform them of any changes.

  • We found infection control issues at the ambulance stations we visited, this included staff not having access to running water at the Spalding location and staff were unable to clean vehicles, and records of deep cleaning were unavailable. At the time of our inspection, the Grimsby ambulance station had ongoing issues with cleanliness and bird control. Following our inspection, the provider took action to install pest control equipment to eliminate this. We found visibly unclean vehicles at the Spalding and Lincoln ambulance stations.

  • Generally, ambulance staff and managers we spoke with during our inspection did not understand risk at the stations we visited, we found out of date policies in use and some of the ambulance staff had no personal digital assistants (PDA) to support their day to day activities limiting their access to information. This was particularly evident at Grimsby, where nine PDA were out of use.

  • Ambulance staff we spoke with during our inspection told us they had no access to equipment for transporting children, despite the provider offering this service and we found limited equipment for this purpose during our inspection.

  • Medical gasses at Spalding site were not being stored safely, there were environmental issues with the base being on a second level and staff access to equipment provided.

  • Generally, ambulance staff told us they had not received appraisals or supervision, and data supplied by the provider showed appraisal rates below the providers compliance target.

  • Generally, ambulance staff we spoke with during our inspection told us of their concerns regarding the safe transport of patients with mental health needs or dementia and questioned how the provider was assessing patient needs and if staff were competent to transfer these patients.

  • Generally, ambulance staff told us they did not receive feedback from complaints or incidents, unless they were directly involved. Information sharing was not routine and we found staff lacking in information about the new organisational structure and proposals for the business going forward.

  • Managers and ambulance staff were not using key performance data at ambulance station level, generally staff we spoke with were unaware of how this was used or how it impacted on the business or quality of the service.

  • The provider monitored call centre handling times and at the time of our inspection we saw compliance against call handling targets was not being achieved. Some ambulance staff we spoke with questioned how work was allocated to the ambulance teams as they often felt patients were not assessed correctly.

  • Generally, staff we spoke with at the ambulance stations didn’t know the providers vision or strategy, staff did say they wanted to provide good care, but they were not aware of the providers vision or strategy.

  • We found limited records of team meetings at the stations we visited, staff told us they have had very few meetings, if any, in the last six to 12 months.

  • Leadership was not embedded throughout the service, staff described a culture of significant change, consistent changes in management and a lack of senior management presence throughout the organisation.

  • Generally, ambulance staff we spoke with told us that relationships with the transport booking and call handling teams was fractious and there were difficult relationships between front line and office staff. Ambulance staff said that workloads often led to them not getting breaks or correct information about patients.

  • Generally, staff told us that staff morale was low at the ambulance stations we visited. Staff said they had no contact with the senior team and that managerial posts had changed so much they were unsure who was in managerial roles.

However, we also found:

  • The provider had recruited a fleet manager, we noted an improvement from our last inspection in terms of fleet management and the provider had detailed records of vehicle maintenance and scheduling.

  • Staff we spoke with across the providers teams, demonstrated caring attitudes towards patients and a will to provide them with the right level of care and support.

  • The complaints team had increased in size and the provider now had a system to log and respond to complaints formally.

  • The provider had implemented a corporate risk register, strategic plan, vision and business plan.

  • The provider had introduced a quality team and was beginning to review some areas of performance data.

  • The provider had increased the number of staff trained to safeguarding level 3 and 4.

Following this inspection, we told the provider that it must make other improvements, to help the service improve.

Amanda Stanford

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

Inspection areas

Safe

Inadequate

Updated 13 February 2019

Effective

Inadequate

Updated 13 February 2019

Caring

Good

Updated 13 February 2019

Responsive

Inadequate

Updated 13 February 2019

Well-led

Inadequate

Updated 13 February 2019

Checks on specific services

Patient transport services

Inadequate

Updated 13 February 2019

The main service provided was non-emergency patient transport.

We rated caring as good. We rated the service as inadequate for being safe, effective, responsive and well-led because staff were not trained or appraised to ensure their competency. Safeguarding training was inadequate. We found infection control issues at the ambulance stations we visited, staff not having access to running water, not able to clean vehicles, and records of deep cleaning unavailable. We found out of date policies in use and some of the ambulance staff had no personal digital assistant (PDA) to support their day to day activities limiting their access to information. During inspection ambulance staff raised concerns with us regarding the transport of patients with mental health needs or dementia and questioned how the provider was assessing patient needs and if staff were competent to transfer these patients. Ambulance staff told us they did not receive feedback from complaints or incidents, unless they were directly involved. Information sharing was not routine and we found staff lacking in information about the new organisational structure and proposals for the business going forward. Managers and ambulance staff did not understand risk at the stations we visited, and not using key performance data at ambulance station level, staff we spoke with were unaware of how this was used or how it impacted on the business or quality of the service. Staff we spoke with at the ambulance stations didn’t know the providers vision or strategy. Leadership was not embedded throughout the service, staff described a culture of significant change, consistent changes in management and a lack of senior management presence throughout the organisation. Ambulance staff told us that relationships with the transport booking and call handling teams was fractious and there were difficult relationships between front line and office staff. Ambulance staff said that workloads often led to them not getting breaks or correct information about patients. The staff morale was low at the ambulance stations we visited. Staff said they had no contact with the senior team and that managerial posts had changed so much they were unsure who was in managerial roles.

However, we also found the provider had recruited a fleet manager, we noted an improvement from our last inspection in terms of fleet management and the provider had detailed records of vehicle maintenance and scheduling. Staff we spoke with across the providers teams, demonstrated caring attitudes towards patients and a will to provide them with the right level of care and support. The complaints team had increased in size and the provider now had a system to log and respond to complaints formally. The provider had implemented a corporate risk register, strategic plan, vision and business plan. The provider had introduced a quality team and was beginning to review some areas of performance data. The provider had increased the number of staff trained to safeguarding level 3 and 4.

Ambulance 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.