Inter-County Ambulance Services Limited

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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 people and communities 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. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support was not reviewed or monitored to improve outcomes.

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.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they could not demonstrate that potential risks had been assessed and documented. 

The service did not use appropriate tools to support the assessment of patients' health and care needs. It also did not have a process to record or evidence risk assessments, for example where access to a patient's home may be difficult when using a stretcher or wheelchair. As a result, the service could not demonstrate that all relevant risks had been consistently identified and assessed. However, people's individual needs were considered, and staff communicated key information when handing patients over to other services to help keep them safe. Crews were also clear about the journeys they were undertaking and which patients they were collecting, transporting to appointments, or returning home.

We received positive feedback relating to 5 patient transfers. This feedback confirmed that crews had access to relevant information about the patients they were transporting and were aware of each patient's planned journey.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The service did not always plan care in line with evidence-based good practice and standards. The service held paper copies of its policies within the service premises; however, these were not readily accessible to crews while undertaking journeys. Not all policies accurately reflected current practice, for example the infection prevention and control and safeguarding policies. Following the inspection, the service updated the relevant policies and provided evidence of the revised versions. Updated policies were placed in the crew base room for staff to review, and staff were required to sign to confirm they had read and understood them.

At the time of the inspection, the service did not have a Medical Director or Clinical Lead in post. This meant there was no evidence of clinical oversight or review of policies and practices.  However, following the inspection we were informed that the service recruited a Medical Director who has been in post since July 2026.  

For people requiring regular transfers, the service aimed to allocate at least one crew member who had previously supported the individual, helping to provide continuity of care and reassurance through familiarity.

Ambulance vehicles carried bottled water for people being transported. For longer journeys, comfort and refreshment breaks were planned into the journey where appropriate. Crews also carried funds to purchase food and drinks for people being transported if they were unable to obtain these items themselves.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people.

Staff worked together to support positive outcomes for patients. They supported one another to provide safe, effective care and deliver a high-quality service. Staff demonstrated a proactive approach to operational efficiency, including starting shifts on time and planning patient collection routes to maximise efficiency and minimise delays.

Staff described positive working relationships with external organisations with which they had regular contact, including local hospitals. They reported effective communication and cooperation to support patient care and service delivery. For example, we received a copy of an email from an occupational therapist which said, “The two paramedics were exceptionally patient, professional and respectful throughout the visit” and “What stood out most was their calm and understanding approach.”

Service leaders had considered staff wellbeing and welfare. For example, we reviewed staff meeting minutes, which noted a discussion relating to long-distance transfers. This discussion showed consideration of factors such as travel times, driver fatigue and appropriate rest arrangements.

Discharge and transport arrangements took account of people's individual needs, circumstances and ongoing care requirements. Information was shared appropriately between teams and services to support continuity of care and ensure patients received coordinated care throughout their journey. We received feedback from the spouse of a person who had been transported by the service. Prior to the journey, the person's care home identified that the planned transfer time could affect the timing of their next medication dose. Following discussions with the service, the journey was brought forward to an earlier time, ensuring the person received their medication as prescribed. This demonstrated a flexible approach and consideration of the person's individual needs.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control.

The service supported people to manage their health and wellbeing by providing a reliable service that enabled them to attend healthcare appointments. Staff also advocated for people to maximise their independence, choice, and control by accommodating their individual needs wherever possible.

We scored the service as 1. The evidence showed significant shortfalls. The service did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that they met both clinical expectations and the expectations of people themselves.

The service did not have an effective system in place to monitor and improve outcomes. While Patient Report Forms (PRFs) were audited to ensure they had been fully completed, the service did not audit the accuracy, relevance, or quality of the information recorded. In addition, people using the service were not informed about how they could provide feedback, and incidents were not routinely reported. As a result, the service was unable to effectively review the quality of care provided, identify areas for improvement, and implement service developments.

The service had not actively encouraged people to provide feedback, which meant opportunities to identify and drive improvements could have been missed. During the inspection, staff told us that people could leave feedback through an online customer review platform or by emailing the service, but these options had not been routinely communicated to people using the service.

Following the inspection, the service informed us that it had implemented an improved feedback process. QR code posters had been displayed in all ambulances, enabling people to provide feedback directly and immediately using their mobile devices. Paper feedback forms and envelopes were also available for those unable to access the QR code. The use of sealed envelopes meant people could submit feedback confidentially without it being visible to ambulance crew members.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service respected and understood patients’ rights and decisions around consent. Staff completed Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training modules. Office staff identified and flagged any mental capacity concerns for people requiring transport at the booking stage. For people being transported between hospitals, mental capacity assessments were undertaken by the hospital and the outcome was recorded on the Patient Report Form (PRF).

Staff took all practicable steps to provide people with information in a way they could understand. The service had access to an on-line translation service through the ambulance vehicle mobile phones, but they did not provide any written information about the service. Feedback received from 5 transfer journeys in June confirmed that ambulance crews communicated effectively with people being transported and responded appropriately to their individual needs and requests.