Marches Ambulance Service

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Patient areas which included ambulances were clean well equipped, well maintained and fit for purpose. However, we found out of date consumable items such as airway equipment and dressings out of date on both ambulances. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.

This is the first inspection for this newly registered service. This key question has been rated good.

We have not awarded this service a score for Safe.

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

Staff knew what incidents to report and how to report them. They raised concerns and reported incidents and near misses in line with service policy. The service had an electronic incident reporting system which enabled staff to report incidents without having at the main base. Staff received feedback from incidents they reported. Learning from incidents was shared across the service using technology platforms, emails and newsletters and staff meetings. We saw information about learning from recent incidents both within and more widely across other services.

There had been no serious incidents within the service. All incidents and patient records were reviewed by an event team manager and when necessary, these were escalated to the medical director. This ensured us that patient management was proactively reviewed and when necessary, action was taken. The Management then shared any learning to the staff. There were systems in place to support staff following distressing incidents.

Staff told us national alerts were shared with them. For example, recent alerts included a requirement for children of certain ages needing to be reviewed by health care professionals following an incident. Another alert was the recall of an identified piece of equipment and for staff to ensure they escalated to management if they found anything had been missed.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Patient records management followed national Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines. Patient records reviewed for patients who had been transported to hospital were clear and complete and dated, timed with a staff signature. Patient record forms included information about the patient, and their treatment. The information was shared with staff at the emergency department they were was transferred to.

Patients were assessed against relevant protocols for example JRCALC. If staff had concerns about a patient, they were able to contact the service doctor who was able to access the patients records and make recommendations for treatment.

All staff received annual life support training. Information provided by the service identified all but 1 staff member had both basic and intermediate life support training ILS). In addition, all relevant staff who had up to date airway management competencies received enhanced ILS.

Paramedics completed advanced life support training which included airway management training usually with their primary employer and provided evidence to managers when completed. All staff were required and had completed paediatric first aid and basic paediatric life support training.

The service used the National Early Warning Score system (NEWS) and the sepsis screening pathway for detecting early signs of deteriorating patients. Early warning scores are systems for early identification of a deteriorating patient.

There were systems and support in place for staff to assess and manage risks when transporting patients experiencing a mental health crisis and manage disturbed behaviour.

The service worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that.

Staff had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They always shared concerns quickly and appropriately.

Safeguarding policies were in place for children and adults. Staff had completed level 2 and level 3 safeguarding adults and also level 2 and level 3 safeguarding children training. Staff gave examples of when they had or when they would raise a safeguarding referral and felt able to ask the safeguarding team for advice.

Learning from safeguarding referrals, near misses, and external reviews was captured through team briefings, clinical supervision, and continuous practice development sessions. Key themes were shared in monthly internal communications and documented in the Marches Ambulance Service-learning log to ensure consistent service-wide learning. Where safeguarding lessons indicated the need for change, policies or procedures were amended and staff were briefed at the earliest opportunity.

The registered manager was the organisational lead and was accountable for safeguarding to the senior management team.

The safeguarding adults and children leads were both appropriately qualified to be the safeguarding leads and held safeguarding level 4. Staff received training in the Mental Capacity Act (MCA). They were confident in its use to ensure they respected patients’ human and legal rights.

There was robust staff recruitment practice to ensure all required checks were completed before the staff member commenced employment and this included a Disclosure and Barring Service checks.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The registered manager had oversight of all risk assessments and updated them as required. At each event the risk assessment was reviewed by the on-site team to ensure this was accurate and covered all risks relevant to the event. We reviewed some examples of event risk assessments, where the service was contracted to convey patients if required and found them to be thorough.

Patients were assessed against relevant protocols (for example. JRCALC 2016 and 2017). Patient records were electronic and included risk assessments for sepsis, pain scoring and safeguarding. Patient records showed staff had discussed risks such as drug and excess alcohol intake with patients. Risk assessments clearly identified any risk and mitigating actions.

Marches Ambulance staff could get specialist advice both when on scene and in transit from paramedics or the medical director. There was a safe and effective escalation process for deteriorating or seriously ill patients. We saw evidence of escalation and medical review when a patient’s condition had deteriorated. Staff appropriately escalated any concerns.

The ambulance service had mechanisms in place to give antibiotics for people with high-risk criteria in pre-hospital settings in locations where transfer time was more than 1 hour. There were appropriate policies and procedures in place to manage disturbed patient behaviour. Patient records we looked at showed staff followed the policies and procedures to safely support the patient.

The service mostly identified and controlled potential risks in the care environment. However, they did not always make sure equipment was suitable to support the delivery of
safe care.

The service had enough equipment to help staff safely care for patients. However, on the day of our onsite assessment we found sealed equipment bags on both vehicles with 29 out of date consumables. The consumables included items required in emergency situations such as suction tubing (use by 07/2022). Without opening the bags staff would be unaware items were out of date when needed in an emergency. All the out of date consumables were disposed of during our onsite assessment; The registered manager told us they were reviewing all consumable items. They were setting up a new process to list all items contained within the bag with the expiry date for the staff to check when they were dispensed. There was a separate secure unit within the vehicle storage compound for storing consumables

The design, maintenance and use of facilities, premises, and vehicles kept people safe.

The site included offices and the vehicle storage was secure with an access control system to the main building with a monitored fob key system. There was gated access to the premises which was locked out-of-hours, CCTV monitoring and a monitored alarm system. Vehicles were stored within a further secured, lockable gate.

The service had 3 vehicles in total (2 ambulances and 1 car). Ambulances appeared well maintained and had in date vehicle tax, services and MOT tests. Vehicle fault forms were in the vehicles for staff to complete if required. A local company was contracted to maintain and service vehicles; Vehicle keys were securely stored.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service had employed staff, but most staff were on “zero-hour contracts” which meant they were only paid for the hours they worked. Most staff were employed in other services and worked around their shifts for their main employer. Staff included ambulance technicians, paramedics, nurses, first responder’s emergency care level 3 and 4, including 2 staff with blue light training.

The medical director was available remotely and could review patient records to advise staff when needed on patient management.

The service used an electronic staffing tool application for all future events. All staff had access to the electronic tool, so they could roster themselves on to cover an event. [LS1] [AH2] [AH3] The staffing system had controls in place so only staff who were qualified for the role could roster themselves into roles they were qualified for, to ensure the correct skill mix for an event. The service also had a working chat group, for those staff that required sickness cover. They could swap shifts or pick up extra shifts if they wanted to and it was a means of team communication.

Information provided by the service showed all staff had received all required mandatory training and role specific training. The registered manager said they identified a 60 day window before the updated training was required and if staff did not complete the training, they were suspended from the duty rota until the training was completed. The training was appropriate for the patient group using the service.

All staff completed a structured online induction which ensured consistent understanding of policies, governance, and clinical expectations from day one. In addition to their induction training all staff attended an annual face-to-face continuing practice development day. This included:

• Airway management appropriate to their clinical grade
• Life support skills assessment
• Scenario-based training
• Updates on clinical governance, documentation, safeguarding, and incident reporting

Mandatory training included training to make them aware of the potential needs of people with mental health conditions, a learning disability, autism and dementia.

In addition to mandatory training the service had invested in continuing professional development (CPD) programmes. The CPD included minor illness and injury, wound closure, and responding to drug incidents at events. The registered manager told us this ensured staff practice remains current and evidence based.

There were 2 staff members who had completed training in driving under ‘blue lights’ and were allocated for events that may require an urgent transfer to hospital.

All staff received a formal annual appraisal, completed by the end of March each year. Each staff member was assigned a dedicated medical manager, who provided ongoing mentorship, support, and guidance throughout the year.

Medical managers undertook appraisals for their allocated staff, while the operations director completed appraisals for the medical managers and operations managers. This ensured appropriate clinical oversight at every level. Staff who started working for Marches Ambulance within the last year their first appraisal would take place in March 2026.

The service assessed and managed the risk of infection. There was a comprehensive system for assessing and managing infection control risks, incorporating policies, procedures, roles and responsibilities, training and monitoring.

Vehicles were visibly clean and well maintained. Cleaning records were up to date and demonstrated that vehicles were cleaned regularly. Managers oversaw infection prevention and control (IPC) and cleaning audits (both onsite and vehicles) which were carried out monthly. Managers took immediate action if infection prevention and control procedures fell below expected standards.

All staff had received infection prevention and control training in the last 12 months. Monthly hand hygiene audits were undertaken monthly and, during events as part of the infection control audit this confirmed staff met the required hand hygiene standards.

Hand hygiene facilities (hand gel or a handwash station) were available on vehicles, for use when handwashing sinks were not available on scene.

Staff maintained equipment well and kept it clean. Vehicles were visibly clean, had required furnishings which were easily cleanable and were well-maintained. Cleaning records were up to date and demonstrated that vehicles were cleaned regularly.

There were monthly infection control audits of the service (sites and vehicles) which provided assurance of cleanliness, this showed that the required standards were met to minimise the risk of cross infection.

There were adequate amounts of personal protective equipment (PPE) for staff to use when treating for patients. PPE was also available on each vehicle. The service had a contract with a commercial laundry for all linen used during the conveyance of a patient to hospital and provided evidence regular launder of linen.

There were appropriate arrangements in place for the management and disposal of clinical waste safely. Clinical waste items were returned within clinical waste bags with the vehicle to the base and put into a clinical waste disposal bin. The service had a contract for clinical waste disposal.

The service made sure that medicines and treatments were safe and met people’s needs. Medicines were appropriately prescribed and administered in line with the relevant legislation and current national guidance. Staff maintained accurate and clear records of medicines given to patients. Staff recorded any medicine allergies within patient treatment records. When patients moved between health and care settings staff shared information about their medicines and medicines administered by the service, in line with current national guidance.

A full range of complete, up to date patient group directions (PGDs) were in place, providing a legal framework for the administration of specified medicines to certain groups of patients by registered health professionals. The PGDs were easily accessible to the trained, named and authorised staff working under them. The PGD directives were put together and agreed by a multidisciplinary group which included the clinical lead, medical director and pharmacist. All PGDs were reviewed annually as part of the medicines and clinical governance group. There were appropriate policies, systems and processes in place to ensure safe and appropriate antibiotic prescribing.

The service used a safe process for staff signing any medicines out of the safe at the start of their shift and signing any unused medicines back in afterwards. There were safe and secure storage arrangements for medicines both on ambulances and on the main site. The registered manager told us they now employed a pharmacist who had oversight of medicines management. The medical director and pharmacist completed monthly medicines audits which checked medicines available against medicines used and checked all medicine expiry dates.

The service did not store, administer or use controlled drugs. The registered manager told us they had applied for a Home Office Drugs License to enable them to use controlled drugs in the future under the supervision of both the medical director and pharmacist.

There were appropriate arrangements in place to safely and securely store medical gases (oxygen and Entonox) on site.