Criticare UK Ambulance Service

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant patient’s needs were met through good organisation and delivery.

We have not awarded this service a score for Responsive.

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

The service made usually sure patients were at the centre of their care and they decided, in partnership with patients, how to respond to any relevant changes in patient’s needs.

The provider usually ensured patients were placed at the centre of decisions relating to their transport and support needs. Information gathered during the booking process enabled staff to understand patients' individual requirements, preferences and any adjustments needed to ensure safe and comfortable transport.

Staff used the information available to tailor their approach to each patient and were responsive to changes in needs that arose before or during transport. Where circumstances differed from those originally recorded, staff were supported by established processes, including dynamic risk assessment arrangements. This meant staff could review the situation and take action in partnership with patients and other relevant professionals.

Patients were encouraged to express their views and preferences, and staff took these into account when planning and delivering transport services. Information relating to individual needs was shared effectively between booking staff and transport crews, helping to ensure a consistent and person-centred approach throughout the patient journey.

Patients were usually supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The provider had processes to support patients whose care needs required consideration of future planning, including patients receiving end-of-life care. Staff were aware of the importance of respecting patients' wishes and ensuring relevant documentation accompanied patients during transport.

The provider had a policy that provided clear guidance for staff on the management of patients with Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders, ReSPECT forms and other end-of-life care documentation.

ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. The ReSPECT process creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they are not able to make decisions or to express wishes.

Staff were expected to confirm the presence of relevant documentation before transport and ensure it accompanied the patient throughout their journey where required.

Leaders gained assurance staff understood their responsibilities through established policies, procedures and operational guidance. This helped support continuity of care and ensured important decisions relating to patients' future care and treatment were available to receiving healthcare providers.

The service understood the diverse health and care needs of patients and their local communities.

The provider understood the needs of the patients using the service and worked with healthcare providers and commissioners to ensure transport was coordinated, flexible and supported continuity of care. Information relating to patients' transport requirements and individual needs was shared between booking staff, operational crews and relevant partner organisations, helping to ensure journeys were planned and delivered effectively.

The provider had systems to monitor transport activity, including cancelled journeys. Records demonstrated cancellations were captured, reviewed and categorised to support service oversight and planning. The provider reported 85 cancelled journeys during the previous six-month period. The reasons for cancellation were often outside of the provider's control and included circumstances such as transport no longer being required, patients becoming unwell, or hospital beds no longer being available.

Leaders used operational information to understand demand and support the effective delivery of patient transport services. This helped ensure resources could be deployed while maintaining continuity for patients whose transport needs remained unchanged.

The service usually supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider usually supplied patients with relevant information in a way that supported their individual communication needs. Staff understood the importance of ensuring patients received information they could understand and had processes to support effective communication throughout the transport journey.

The provider demonstrated awareness of the needs of patients whose first language was not English. Translation support was available through bilingual staff where required, with additional support provided through translation applications when required. Given the size and nature of the service and the population served, these arrangements were proportionate and enabled staff to communicate effectively with patients.

Information gathered during the booking process helped identify any additional support requirements in advance of transport, allowing crews to make adjustments to their approach.

Patients were provided with information on how to give feedback, raise concerns or report changes in their needs. Feedback was reviewed and used to improve service delivery and patient safety.

The provider was aware of its responsibilities under the Accessible Information Standard (AIS) and was reviewing its compliance arrangements. Evidence reviewed demonstrated staff considered patients' communication needs and took reasonable steps to ensure information was provided in an accessible format wherever possible.

The service made it easy for patients to share feedback and ideas, or raise complaints about their care and support.

The provider made it easy for patients to share feedback, raise concerns or make complaints about the service they received. Information about how to provide feedback was available to patients, and the provider had systems to receive, investigate and respond to complaints in a timely manner.

We reviewed examples of recent complaints and found these had been acknowledged, investigated and responded to. The provider reported receiving a low number of complaints, which was consistent with the size and nature of the service. Of the two complaints received during the reporting period, neither were upheld following investigation.

Leaders maintained oversight of complaints through governance processes and used complaint reviews to identify any recurring themes or opportunities for learning. Although no service changes had been made because of complaints during the period reviewed, this reflected the fact investigations had not identified failings requiring corrective action. Records demonstrated complaints were taken seriously and patients' concerns were considered appropriately.

Staff involved patients in discussions about their transport arrangements and responded to questions or concerns where these arose.

The service usually made sure patients could access the care and support treatment they needed when they needed it.

The provider usually ensured patients could access the transport services they needed and took reasonable steps to reduce barriers to access. Staff understood the importance of recognising and responding to the diverse needs of patients and used information gathered during the booking process to identify any additional support requirements.

The provider demonstrated a practical and proportionate approach to supporting patients with a wide range of needs. Evidence reviewed showed transport arrangements were adapted where necessary to ensure patients could access and use the service safely and comfortably. Staff considered factors such as mobility, communication needs and other individual requirements when planning and delivering transport.

Crews had access to a range of equipment and resources to support equitable access to the service. This included mobility and communication aids, together with other equipment designed to meet patients' individual needs during transport. Information relating to these requirements was shared with staff in advance where required, supporting a personalised approach to care.

Staff and leaders listened to information about patients who were most likely to experience inequality in experience or outcomes and tailored their care and support in response to this.

The provider demonstrated an awareness of the need to understand and respond to the experiences of patients who may be at greater risk of experiencing inequalities in care or outcomes. Information about patients' individual needs was captured through the booking process and shared with crews to help ensure support was tailored effectively during transport.

The service sought feedback from patients through an online feedback system, providing opportunities for people to share their experiences and identify areas for improvement. Although the provider did not use separate feedback mechanisms for specific patient groups, the approach was proportionate to the size and nature of the service and enabled leaders to gather information about patient experience across the population served.

Staff were trained to recognise and respond to differing needs, including those relating to communication, mobility, learning disabilities, autism and dementia. Information about these needs was considered when planning and delivering transport services, helping to reduce potential barriers and support positive experiences for patients.