first4care

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• 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 that patients had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care.

Our rating of this assessment service group remained the same. At the last inspection this assessment service group was rated good. At this assessment the rating is good. This meant people’s outcomes were consistently good, and people’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.

Score: 3

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

The transport and care provided aligned with other services care plans which were provided to staff. Any important patient information for the journey was provided by the other providers. Staff assessed the needs of people throughout the journey. If staff could not meet patients’ needs or did not have sufficient training, they would not carry out the patient journey.

Staff at the service had access to aids to support with additional communication needs and translation services were in place if required.

Score: 3

Staff planned and delivered patients’ journeys with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff had access to a policy list which was kept up to date and reviewed bi-annually. The service kept up-to-date with both the National Institute for Health and Care Excellence (NICE) and the Resuscitation Council. All patient care we observed was in line with current evidence based practice, for example, we observed correct moving and handling technique.

The service had clear governance processes in place to evidence good quality assurance and management oversight of areas through audits. For example, vehicle checklists were audited, and we saw actions had been taken when information was missing from records. Mentors carried out regular checks of staff practice.

Score: 3

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

Whilst on assessment we observed staff worked well together and worked well with staff from other services that were receiving patients. In staff feedback we received following the on-site assessment staff also told us they worked well together.

All staff were aware of the need to provide an effective transfer of patients care and treatment to the receiving provider or family member. They ensured that they passed on the information from the discharging hospital to carers or family in a way that they could understand.

Leaders and staff told us they had worked with local ambulance teams for a long time and felt embedded within the teams.

Score: 3

The service supported people to live healthier lives where possible.

As a patient transport service, the service was not involved in any care beyond the transfer of the patient. Where possible, staff ensured that people were going to be comfortable on the journey and were happy at the location they arrived at. This included access to water on the journey and following peoples care plans. Staff would also stop for food and toilet breaks on longer journeys.

Staff carried 'welfare packs' on ambulances which included tea, coffee, sugar and long-life milk which could be provided to patients if required.

Score: 3

The service routinely monitored patient journeys to continuously improve it. Patient report forms were monitored as they came through the on the office system.

Each trust had its own key performance indicators (KPIs) regarding timeliness, the service had regular meetings with trusts to discuss KPIs. The service had performance reports for each of its service providers.

Score: 3

Staff explained to patients about consent and respected these when providing patient transport.

Staff gained consent prior to transporting patients. Whilst on the inspection we observed staff obtain verbal consent appropriately. Leaders assured themselves that staff appropriately sought and recorded patient consent by auditing patient record forms.

Staff had mandatory training in the Mental Health Act (MHA), Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff would not transport patients if they did not consent to the journey.

Staff checked and carried Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) paperwork when transporting patients. This enabled staff to respect patients’ wishes, should patients deteriorate on a journey. If these were not completed appropriately staff and leaders told us they would raise this with the hospital or care home and they would not be considered valid unless appropriately completed.