Cornwall & The Isles of Scilly – Plymouth

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence patients and communities had the best possible outcomes because their needs were assessed.

At this first assessment the rating was good. This meant patient’s outcomes were consistently good, and patient’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service usually made sure patient’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff shared key information to keep patients safe when handing over their care to others. They knew what journeys they were to undertake and which patients they would be picking up and taking onwards to appointments or returning home. Shift changes and handovers included all necessary key information to keep patients safe. As a result, we saw patients were generally calm and they were comfortable during journeys and transfer.

Staff took account of patient’s communication needs, particularly those with disabilities and with a sensory loss. We observed staff using skills to engage with patients and to assess their needs.

The service usually planned and delivered patient’s care, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff followed up-to-date policies to plan and deliver high quality. All policies we looked at contained a creation and review date, and clear references to current national guidelines. There were systems to communicate changes in guidance through meetings and management newsletters. Staff said they received information by email and on staff noticeboards.

We looked at the pathway for people who were attendees of outpatient departments who relied on the ambulance service to get to and from appointments. The provider was achieving the internal and external Key Performance Indicators (KPIs) for delivering and collecting these patients.

On longer journeys, staff made sure patients had access to drinks, food and rest stops, if necessary.

The service usually worked well across teams and services to support patients. Staff made sure patients only needed to tell their story once by sharing their assessment of needs when patient moved between different services.

Staff worked together as a team to benefit patients. They supported each other to provide good care and deliver a quality service, ensuring for example, they started their shifts on time and planned the route of patient collection to maximise efficiency. The provider had a dedicated renal liaison/co-ordinator for renal patients to ensure they received their transport and treatment in a timely manner. The renal liaison officer also visited patients in the renal units for feedback on experience of transfers. The provider also employed a discharge co-ordinator, based at a local NHS hospital to coordinate discharge transfers.

Discharge and transport arrangements considered people’s individual needs, circumstances and ongoing care arrangements. Information was shared between teams and services to ensure continuity of care.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control.

The service planned for long journeys with rest stops and food and drink.

The service monitored patient’s care and treatment to continuously improve it. Staff ensured outcomes were positive and consistent.

The service had systems to monitor and improve outcomes related to getting patients to their treatment on time. The service had internal and external key indicators (KPIs) to monitor performance. The service had processes to monitor cancellation and delays of planned transfers as well as collection times.

The provider met with the ICB monthly to discuss the KPIs. There were KPIs for the service to achieve. For example, for renal patients the KPI was an hour. This meant patients knew they would be conveyed to the dialysis unit within an hour of their treatment starting and picked up, up to an hour after treatment finished. The provider met the KPIs at 79.9%.

However, staff told us some patients had been left at hospital appointments without transport due to errors with the control centre and overbooking. One patient had to arrange a taxi home as patient transport did not attend.

The provider considered health inequalities and took steps to ensure outcomes across people with protected characteristics were in line with the wider community.

The service told patients about their rights around consent and respected these when delivering person-centred care and treatment.

All staff had completed mental capacity act (MCA) and deprivation of liberty safeguards (DoLS) training modules as part of their ongoing mandatory and statutory training.

Staff took all practicable steps to give people information, support and time to make an informed decision in a way they could understand, including use of accessible communication formats. Staff followed national guidance to gain patients’ consent. Staff knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff followed the services policies related to consent, mental capacity and deprivation of liberty as relevant.

Patients reported being involved in decision making about their care. For example, we observed staff seeking verbal consent before assisting a patient to transfer from a chair onto a wheelchair prior to taking to an ambulance.

Interpreters were used to support patients to give informed consent, including for British Sign Language (BSL) and face to face interpreting when necessary.