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Inter-County Ambulance Services Limited Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 7 April 2020

Inter-County Ambulance Services Limited is operated by Inter-County Ambulance Service Ltd . The service primarily provides a patient transport service. However, as part of the service, they provide transfers of patients who required critical care or high dependency care and transfers of patients who were receiving end of life care which is reported on in the emergency and urgent care core service.

The service also provides a repatriation service. The Care Quality Commission does not regulate repatriation services, and so this part of the service was not assessed during this inspection. The service is staffed by trained paramedics, ambulance technicians, ambulance care assistants and first responders

We previously carried out a comprehensive inspection in June 2019. Following that inspection, we issued the provider with a warning notice under Section 29 of the Health and Social Care Act 2008. The warning notice set out areas of concern, where significant improvement was required.

We carried out a focused follow up inspection on 13 January 2020. During this focused inspection, we looked at all the issues raised in the warning notice which ranged across the well led domain. We gave the service 48 hours’ notice of our inspection to ensure everyone we needed to speak with was available.

The ratings remain the same as for the inspection undertaken in June 2019. We have not re-rated the service because we did not look at a complete domain. Therefore, the rating for the service remains at requires improvement.

We found the service had made some improvements since the inspection in June 2019;

Policies had been reviewed, which included content and guidance, and they now had a published and review date.

A process to audit patient report forms was now in place.

Staff appraisals had been progressed and undertaken except for two bank staff who worked infrequently for the service.

Following this inspection, the provider took immediate action to ensure the patient group directions were reviewed by a pharmacist. This was completed 30 January 2020.

The provider had introduced an audit schedule to monitor compliance with the medicine management policy.

A plan had been developed to support business continuity if there should be unexpected events.

Patient feedback was now analysed by the service, and discussions held by the leadership team to improve the volume of feedback received.

However further improvements were still required;

Not all staff involved in the management and administration of medicines were suitably trained and competent.

Standard operating processes were not in place, as per the provider policy, to support ambulance technicians and emergency care assistants administer relevant medicines on formulary at Inter-County Ambulance Services Limited.

The governance of the service, including the agenda for the leadership meetings was not structured to ensure quality reviewed, risk management and information systematically discussed.

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 that affected emergency and urgent services and patient transport services. Details are at the end of the report.

Nigel Acheson

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

Inspection areas


Requires improvement

Updated 7 April 2020


Requires improvement

Updated 7 April 2020


Insufficient evidence to rate

Updated 7 April 2020



Updated 7 April 2020



Updated 7 April 2020

Checks on specific services

Patient transport services

Requires improvement

Updated 7 April 2020

We did not re-rate this service as part of this focused inspection.

There had been improvements in relation to the management of policies, audit, evaluation of patient feedback and management of business continuity risks. Further work was required to ensure effective governance systems and processes.

Emergency and urgent care

Requires improvement

Updated 7 April 2020

We did not re-rate this service as part of this focused inspection.

Further improvement was required in the management and administration of medicines. There had been improvement in the safe management of stock medicines.