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Inter-County Ambulance Services Limited Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 27 August 2019

Inter- County Ambulance Service 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. Repatriation services are not registered with the CQC, 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 inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11 June 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.

The main service provided by this service was patient transport service. The management and leadership of the service is the same for both the emergency and urgent care service and the patient transport service. All staff deliver both the emergency and urgent care service and the patient transport service. Where our findings on patient transport service – for example, management arrangements – also apply to the emergency and urgent care service, we have not repeated the information but cross-referred to the patient transport service core service.

We rated it as Requires improvement overall.

  • The delivery of high-quality care was not assured by the leadership, governance or culture.

  • Leaders did not demonstrate they fully understood and managed the priorities and issues the service faced. They were not always aware of the risks, issues and challenges in the service. For example, they did not have a process to identify and manage operational risks of the service.

  • Leaders did not show they were clear about their accountability for quality. The service did not carry out audits to evaluate the quality of the service they provided.The service did not carry out audits of the quality patient record forms. The service did not review or audit information that had been collected about patient journeys, including time of arrival of pick-up of the patient compared to the booked time for pick up, the length of time the crew had to wait for the patient to be made ready for the journey and time the patient arrived at their destination compared to the planned time. Records of meetings held by the leadership team did not include review of the quality of the service provided.

  • The management of medicines was not safe.The process for recording stock management and disposal of medicines was inaccurate and did not provide an audit trail to accurately detail the amount of medicines held at the service.The service had no formal approval of the patient group directions.The management of medicines policy did not support safe administration of medicines.The policy gave incorrect information about which staff could administer medicines.

  • Leaders did not operate an effective governance process or use systems to manage performance and risk effectively and support improvements to the service. We identified risks to the environment and running of the service that had either not been identified, or if identified processes had not been put in place for staff to follow to lessen the risk.There was no effective process to ensure policies and procedures were reviewed to provide clear guidance. Some policies did not relate to the service provided, describing roles and staff groups that did not exist. The service did not evaluate and use feedback from people who used the service to support improvement of the service.

  • There were gaps in the management and support arrangements for staff, such as appraisal and supervision.


  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills and understood how to protect patients from abuse. Staff assessed risks to patients, acted on them and kept good care records. Staff worked well together for the benefit of patients. Staff assessed risks to patients, acted on them. Staff worked well together for the benefit of patients.

  • The service controlled infection risk well.

  • The service planned care to meet the needs of local people and took account of patients’ individual needs. People could access the service when they needed it. The service was available seven days a week.

  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.

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 two requirement notices 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.

Inspection areas


Requires improvement

Updated 27 August 2019


Requires improvement

Updated 27 August 2019


Not sufficient evidence to rate

Updated 27 August 2019



Updated 27 August 2019



Updated 27 August 2019

Checks on specific services

Patient transport services

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

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.