Criticare UK 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

At our last assessment this key question was rated Good. At this assessment the rating has remained 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.

The service had a proactive and positive culture of safety, based on openness and honesty. Staff and leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Learning was shared with staff.

The learning culture described within the PTS assessment also applied to EUC activity. Staff used the same incident reporting systems, governance processes and learning mechanisms. Leaders promoted an open culture and shared learning from incidents, complaints and operational events across the organisation.

The provider had a positive learning culture that supported the safe delivery of patient transport services. Staff understood how to report incidents, near misses and safety concerns and felt encouraged to do so. Incident reporting processes were well established, and records showed concerns were reviewed, investigated and used to identify learning opportunities.

Learning from incidents, complaints and feedback was routinely shared with staff through team meetings, briefings and organisational communications. The provider had systems to identify, review and learn from incidents. Although only two incidents had been reported in the three months prior to inspection, inspectors saw evidence each had been reviewed in detail by senior leaders. Reviews were documented, thorough and considered potential learning opportunities, despite neither incident being directly attributable to the provider.

The service worked with patients and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when responsibility for patient care moved between different areas of a service and between providers.

The provider primarily undertook urgent and high-dependency transfers commissioned by NHS organisations under its EUC registration. The did not fulfil any frontline emergency work.

The provider had effective systems and processes to support the safe transport of patients throughout their journey. Staff had access to information before transport and communicated effectively with commissioning organisations, healthcare providers and receiving services to ensure continuity of care.

There were clear procedures were for accepting, planning and undertaking patient transport journeys. Risks associated with patients' needs were assessed and managed, with relevant information shared between staff to support safe transfers. Handover arrangements were effective and helped ensure patients arrived at their destination safely and with the necessary information available to receiving services.

Staff understood their roles and responsibilities in maintaining patient safety during transfers and were able to respond to changes in patients’ needs.

Governance processes provided oversight of transport activities, incidents and operational risks, enabling the provider to identify improvements and maintain safe systems and pathways.

The service worked with patients and healthcare partners where required, to understand how best to keep people safe, what it meant for individuals and the best way to achieve that. The service shared concerns quickly and appropriately.

The provider had effective safeguarding systems and processes to protect patients from abuse, neglect and avoidable harm. Staff received safeguarding training required for their role and demonstrated a good understanding of how to recognise, respond to and report safeguarding concerns.

Clear safeguarding policies and reporting procedures were available, and staff knew how to escalate concerns internally and to external agencies when required. Records showed safeguarding concerns were managed effectively, with timely referrals made and actions taken to support patient safety.

Leaders promoted a culture where safeguarding was everyone’s responsibility, and staff told us they felt confident raising concerns.

The service worked with patients to understand and manage risks. Staff provided care to meet patient’s needs which was safe and supportive.

Staff involved patients, and where appropriate their relatives or carers, in decisions relating to transport and care. Patients were encouraged to communicate concerns and staff considered individual risks, preferences and support needs when planning and delivering transfers.

Staff monitored patients throughout transport and escalated concerns as required. Where risks or additional support needs were identified, crews communicated relevant information to healthcare professionals and receiving services.

The provider demonstrated staff took opportunities to identify potential risks to patients' health, wellbeing and safety. Where concerns were identified, staff could raise safeguarding referrals or communicate relevant information to healthcare professionals and other agencies to ensure patients received support.

The provider involved patients, and where required their relatives or carers, in managing risks associated with their transport. Staff communicated clearly with patients before and during journeys, ensuring they understood the arrangements for their transport and had opportunities to raise any concerns about their safety, comfort or individual needs.

Information about patients' mobility, medical conditions and specific support requirements was obtained and considered when planning transport, enabling risks to be identified and managed safely. Staff took account of patient preferences where possible and encouraged patients to share relevant information that could affect their safety during transit.

The service detected and controlled potential risks in the care environment. Leaders and staff took steps to make sure equipment, facilities and technology supported the delivery of safe care. Where they were unable to do so, they mitigated the risks.

Vehicles used for EUC activity formed part of the operational fleet reviewed during the inspection.

The provider had processes to identify, assess and manage environmental risks associated with patient transport activities. Staff understood their responsibilities for reporting defects, hazards and safety concerns, and action was taken promptly when issues were identified.

The provider maintained safe environments for patients, staff and others using the patient transport service. Vehicles were visibly clean, well-maintained and equipped for the type of transport provided. There were systems to ensure routine vehicle checks, servicing and maintenance were completed, helping to reduce risks to patient safety.

Since the last inspection, the provider had relocated its ambulance parking area and base unit within the existing grounds of the operational site. The new location provided enhanced security for vehicles, equipment and staff, increased space for the ambulance fleet, and improved facilities for staff. Staff told us the new arrangements had created a more organised and efficient working environment, supporting the safe delivery of patient transport services.

Cleaning schedules and vehicle inspections were completed regularly, and records demonstrated compliance with organisational requirements.

We inspected 3 of operational vehicles and found they were available for service and well equipped for their purpose. Emergency equipment, communications equipment and medical gases were present and maintained. Patient records were stored securely and arrangements for clinical waste disposal were satisfactory.

Inspectors identified several defects affecting vehicle condition, including damaged interior trim, torn upholstery, debris within patient areas and a missing wheelchair restraint harness within one patient transport vehicle. The provider was informed during the inspection and identified defects were rectified promptly. Evidence received after inspection confirmed that defects had been resolved.

The service made sure there were adequate numbers of qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care, which met patient’s individual needs.

The staffing arrangements described within the PTS assessment were also used to support EUC activity. Staff were trained, received mandatory training and had access to clinical support and supervision. Some staff were registered paramedics and worked within their scope of practice when undertaking EUC transfers.

The provider had effective systems to ensure enough suitably skilled, qualified and experienced staff were available to safely deliver patient transport services. Staffing levels were planned according to operational demand, and the provider reported 99% staffing coverage over the previous three months. Shortfalls were managed by bank staff, with minimal reliance on bank workers and no use of agency staff.

Recruitment and workforce management processes supported service continuity. At the time of inspection, the provider had no staff vacancies and reported an annual staff turnover rate of 10%, in line with organisational expectations. Staff sickness levels were low and well managed, with an actual sickness rate of 2.94% against a planned rate of 3%.

Recruitment and workforce assurance processes were established and supported by appropriate pre-employment checks. Staff had undergone enhanced Disclosure and Barring Service (DBS) checks for both adults and children where required. Leaders also maintained annual driving licence assurance processes, including DVLA checks, which were undertaken in line with organisational policy. This was particularly important given the nature of the service and the requirement for staff to drive patient transport vehicles safely.

Staff received training to support them in their roles. The provider reported 100% compliance with its mandatory training programme, which had 13 modules. Training records and certificates confirmed staff had completed training relevant to patient transport services, including modules covering mental health conditions, learning disabilities, autism and dementia. While additional training in end-of-life care and the transport of dialysis patients was not mandatory, staff were able to access further learning through nationally recognised e-learning resources.

The provider had a structured induction programme for new starters. We reviewed the induction policy and saw completed induction records that demonstrated staff were supported to become competent in their roles.

Ongoing oversight of staff performance was maintained through career conversations, vehicle and crew monitoring processes, and other managerial supervision arrangements. Staff received support from clinical team leaders through regular shift meetings and supervision arrangements. Records demonstrated that staff had access to clinical guidance, support and advice, helping them maintain safe and effective practice.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading by following policies. Infection and prevention and control data was collected and reviewed. Where required, actions were taken to improve shortcomings.

The provider had effective infection prevention and control (IPC) systems to protect patients, staff and others from the risk of infection. Staff received IPC training and demonstrated a good understanding of infection prevention measures, including hand hygiene, the use of personal protective equipment (PPE), and the cleaning and decontamination of vehicles and equipment.

The provider had clear IPC policies, standard operating procedures and ambulance cleaning standards guidance available. These documents outlined the processes for routine cleaning, decontamination and maintaining vehicle cleanliness standards. Staff followed infection prevention and control procedures and had access to the equipment and resources needed to undertake their roles safely. Staff followed established cleaning routines, and evidence reviewed included shift routine procedures detailing vehicle cleaning requirements at the start and end of each shift.

Vehicles were visibly clean and well maintained. Records from the provider's electronic systems confirmed that scheduled deep cleans had been completed over the previous three months. Staff had access to appropriate cleaning materials and PPE and told us these were readily available when required.

However, inspectors identified a damaged stretcher mattress cover on one vehicle. Whilst cleaning systems and IPC processes were otherwise effective, damaged patient-contact surfaces can limit effective decontamination and required remedial action. The provider was informed during the inspection and identified defects were rectified promptly. Evidence received after inspection confirms defects have been resolved.

The provider did not undertake separate hand hygiene audits. Compliance was monitored through the crew appraisal process, during which hand hygiene practices formed part of staff observation and assessment. This provided management with assurance that staff were following expected IPC standards.

The service made sure that medicines were safe and met patient’s needs.

The provider had systems and processes to ensure the safe management of medicines used within the EUC service.

EUC activity required the provider to carry a limited range of additional medicines. During the inspection, concerns were identified relating to medicines storage arrangements, including cold-chain monitoring and a small number of expired medicines. Leaders took immediate action to address the issues identified and provided evidence following the inspection that affected medicines had been removed, storage processes strengthened and additional assurance measures implemented. Leaders could demonstrate action had been taken to mitigate risk and improve medicines governance.

We reviewed the provider's standard operating procedure (SOP) for the management and use of medical gases and found it was current, comprehensive and aligned with relevant national guidance and recognised best practice. The SOP clearly outlined arrangements for the safe storage, handling, transportation and checking of medical gas cylinders. This included staff responsibilities and actions to be taken in the event of defects or concerns.

Staff demonstrated an understanding of the requirements for the safe use of medical gases and had access to the policies and guidance needed to support their practice.