Ambulance & Medical Support Services - Ambulance Station Sandhurst

We found the following issues that the service provider needs to improve:

The premises were not clutter-free and there had been no fire safety or environmental assessment completed for the premises.

Information contained in the service policies and procedures did not always match current working practices.

There were gaps in the service’s systems and processes that supported staff in assessing if a patient had the capacity to make decisions about their care.

The governance framework was still in its infancy, some aspects required further development and change needed to be embedded into the service.

However, we found the following areas of good practice:

The service provided mandatory training in key skills to all staff and made sure everyone completed it.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment, vehicles and premises visibly clean.

The service had suitable premises and equipment and mostly looked after them well. Staff managed clinical waste well.

Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.

The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment for events it was contracted to provide medical assistance for.

Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.

The service used systems and processes to safely prescribe, administer record and store medicines.

The service was beginning to manage patient safety incidents. Staff recognised incidents and near misses and were being encouraged to report them appropriately. Managers investigated incidents and shared lessons learned with the whole team. There was a Duty of Candour policy to follow if things went wrong.

The service provided care and treatment based on national guidance.

Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief advice in a timely way.

The service had started to monitor response times with the intention to use the findings to make improvements.

The service was putting in processes to monitor the effectiveness of care and treatment, with the intention of using the findings to make improvements and achieve good outcomes for patients.

The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.

Due to the nature of the service there was limited opportunities for staff to work with doctors, nurses and other healthcare professionals and support each other to provide good care.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.

The service planned and provided services in a way that met the needs of the event they were attending.

The service took account of patients’ individual needs.

People could access the service when they needed it and receive care in a timely way.

The service had systems and process in place for patients to give feedback and raise concerns about the care received. The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

Although the manager at the service had the right qualifications to run a service, they had acknowledged they lacked the necessary skills, knowledge or experience to effectively manage and develop a service. They had taken the necessary steps to get support and bridge the gap whilst they developed their own skills. The manager was visible and approachable in the service for staff.

The service had a vision for what it wanted to achieve. The vision and strategy were focused on developing the quality and sustainability of the service and having the formal strategy to turn it into action.

There were indications that the service promoted a positive culture that supported and valued staff and were focused on the needs of the patients receiving care.

Systems and processes were being developed to operate an effective governance framework and to improve service quality and safeguard high standards of care.

Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.

The service had started to collect, analyse and use information to support activities.

The service was taking steps to improve engagement with patients, staff and the public.

Ambulance & Medical Support Services – Ambulance Station Sandhurst is operated by Ambulance & Medical Support Services Ltd. The service provides an emergency and urgent care ambulance service by conveying patients from event sites to the local acute NHS trusts.

Ambulance & Medical Support Services - Ambulance Station Sandhurst is not commissioned by other organisations to deliver services on a regular basis. Work was undertaken for event organisers on an ad hoc basis and there was no formal contract issued. The service had three emergency ambulances it used to carry out the regulatory activities.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 20 March 2019. However, the service was not operating on that day. We therefore carried out an announced inspection on 01 May 2019.

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.

We rated it as Inadequate overall.

We found the following issues that the service provider needs to improve:

• There was not an effective incident reporting and management process in place.

• The service did not ensure all staff working for the service had the qualifications, competence, skills, experience and had completed appropriate mandatory and safeguarding training to keep people safe from avoidable harm and to provide the right care and treatment.

• The service put patients and staff at harm from the risk of cross infection.

• The service did not make sure there was safe management of medicines that complied with national guidelines and legislation.

• The service’s policies and procedures were not all relevant to the service being delivered, or accurately detail current legislation and national guidance.

• There was no assurance that patients would know how to make a complaint, or the service would treat concerns and complaints seriously.

• Senior staff had gaps in their skills, knowledge and experience to effectively manage and develop the service.

• Senior staff had a lack of understanding of governance. Systems and processes were not used effectively to improve the quality of the service and keep patients safe from harm.

However, we found the following areas of good practice:

• The service had suitable premises and equipment and mostly looked after them well.

• Staff keep detailed records of patient’ care and treatment.

• Staff assessed and monitored patients regularly to see if they were in pain.

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 one requirement notice, the details are at this are at the end of the report.

The service was rated as inadequate overall. I am placing the service into special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.’

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South), on behalf of the Chief Inspector of Hospitals