UK Event Medical Services Limited

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• 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

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. Leaders had systems for identifying and responding to safety risks. The service had safety processes for the preparation of vehicles, equipment and for the patient journey between locations. Patients were safe from neglect, abuse and discrimination. Patient’s gave informed consent prior to any physical support required of staff. Where they were unable to consent, those close to them were involved in decisions made in their best interests.
This is the first assessment of the provider under the current registration.

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 managed patient safety incidents well. The service had an incident reporting policy, which outlined incident reporting procedures, levels and timescales of investigation. There was a risk assessment matrix applied to each incident, according to severity. Staff told us how they raised concerns and reported incidents and near misses, which was in line with this policy.

Managers investigated incidents and shared lessons learned with the whole team and the wider service, including external and contracted partner organisations, we saw incidents being reviewed as part of key stakeholder meetings. Wider learning was shared with the service’s contracted NHS ambulance services. Service leaders ensured staff’s welfare, offered them downtime and psychological support.

When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured actions from patient safety alerts were addressed and progress was monitored.

We saw evidence of incidents having been investigated, and sufficient action taken to reduce the risk of recurrence. We looked at the system for managing incidents which was on electronic devices when work was undertaken for the NHS ambulance trusts. If the incident occurred at other times, there were paper incident forms available on vehicles for staff to complete and then to upload once back at base. The computer system also alerted managers to the incident being recorded which prompted a quick response.

Incidents were analysed to identify trends or themes and potential links to individual practitioners. Where additional training or support was required to ensure competence, this was arranged.

Staff were able to identify and report risks, secure in the knowledge these would be addressed. For example, when concerns around worker safety were raised the service introduced lone-worker alarms following an increase in near misses and incidents involving violence towards staff.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if and when things went wrong. Staff received feedback from investigation of incidents, both internal and external to the service, we saw no themes or trends that had been identified. Managers debriefed and supported staff after any serious incident.

The service provided mandatory training in key skills to all staff. Managers monitored mandatory training and alerted staff when they needed to complete updates. The data showed a mandatory training completion rate of 89% against a service target of 85%.

The service’s recruitment policy outlined expectations around staff’s statutory and mandatory training. Staff had to complete this during their induction as part of the core skills training framework.

Clinical staff completed training on recognising and responding to patients with for example, patients with mental health needs, learning disabilities and dementia. Staff also completed and refreshed all their training and were reminded before any expired.

Safety and continuity of care was a priority throughout people’s care pathway. Patients were assessed prior to arranging their transport needs. There was a clear criterion for accepting patients as suitable for the available vehicles and resources.

There were systems and processes to ensure the correct patients were collected and transferred between locations. All staff we spoke with were able to describe how they would check patient identification and pass on information to the receiving location, as well as obtaining information from staff prior to taking the patient home.

The transfer of patients between locations was done so safely. Staff had appropriate driving skills and experience. Suitably skilled staff accompanied patients during the journey and safety equipment was used throughout.
When overall responsibility for the care and treatment of a patient moved to a different service provider, such as transfer to the NHS, there was effective communication, which allowed for seamless transfer.

The service had a policy to support the recognition and management of deteriorating patients. Staff demonstrated a clear understanding of their responsibilities and were able to describe the actions they would take to recognise deterioration, escalate concerns appropriately and ensure patients received timely clinical support.

Care and support was planned and organised with people, together with partners and communities in ways which ensured continuity after transfer to the destination.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. They understood their responsibilities for notification of safeguarding incidents to the contractor of services. The service had well established partner working and contacts around safeguarding with their contractors and local authorities. Most of their safeguarding cases were passed onto the relevant teams of their contracted NHS ambulance trusts. This meant staff did not report to the local authority directly.

The service received feedback from the contract provider about safeguarding concerns they had raised, to enable learning which was discussed and shared during staff meetings.

Staff received adult and children's safeguarding training. Training data showed 91% of staff had completed the required level of safeguarding for their role. There were current safeguarding policies, and these reflected the national guidance for adults and children.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. Expert safeguarding advice was available to support staff from Monday to Friday and staff knew how to contact them. In the out of hours period staff could contact designated safeguarding contacts within the NHS ambulance trusts. The general manager was the safeguarding lead and had been trained to the level recommended from national guidance for both adults and children.

Safeguarding concerns were considered when an incident occurred and a referral or further advice sought, when necessary. There were links to external agencies and staff knew what happened when they raised concerns.

Staff knew how to identify adults and children at risk of, or suffering, significant harm and worked with other agencies to protect them. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff used the least restrictive option when managing patients whose behaviour challenged. Incidents involving restraint were recorded, reviewed and used to identify learning. We reviewed 2 incident reports regarding the use of restraint and saw no errors or omissions.

The service used transfer report forms (TRFs), which were completed by the NHS ambulance trust and then passed onto the ambulance crew undertaking that patient journey. We reviewed 10 TRFs and found them complete and without error or omission.

The service worked with patients to understand and manage risks. patients' needs were met in ways which were safe and supportive and enabled them to do the things that mattered to them. This included for example, getting to appointments on time.

We reviewed all feedback which demonstrated that most patients felt listened to, risks had been explained, and they were involved in decisions about their care and treatment. Patients knew what to expect and when they would be next collected by staff.

Staff we spoke with said they could access advice and support from senior leaders in a prompt manner, in cases where unexpected risks were identified. Staff used a dynamic risk assessment for any patients with specialist needs. They gave examples of requesting additional resources, including female staff to accompany female patients where appropriate, to help ensure transfers were undertaken safely and in line with patients' individual needs.

Staff could accommodate bariatric patients under the maximum limit of their heavily weighted stretcher. They could assign an extra crew member, or a second crew to these jobs if needed.

Staff completed basic life support and resuscitation as part of their statutory and mandatory training.

Staff followed the service’s health and safety policy which outlined the risk assessment process, including for manual handling.

Oxygen cylinders were not stored correctly; they were stored lying flat on metal shelving units or stood up attached to the shelves with ambulance straps. We also noted inadequate separation of full and empty oxygen cylinders which increased the risk of staff taking empty cylinders which posed a risk to patients

Staff failed to dispose of clinical waste safely, the waste was separated appropriately but the designated clinical waste bins were not locked and were situated in an open car park which members of the public had direct access to.

We inspected 4 ambulance vehicles and found that they were clean and fit for purpose

Vehicles were equipped for the type of services provided, this included safety seatbelt straps and child seats. Records of equipment maintenance and schedules were available. Vehicles were stored in a safe area and could not be accessed by unauthorised persons, all keys to vehicles were securely stored.

Staff carried out daily safety checks of specialist equipment. There was a system for staff to report faulty equipment and vehicles. A formal record was made of action taken to address the fault/s. Vehicles used for the transport of patients who were detained under the MHA were appropriate and safe.

Leaders maintained oversight of equipment to ensure it was safe and ready to use. Equipment audits were completed and outcomes shared with staff. Staff told us they had enough equipment to carry out their work safely and to support the treatment and care needs of patients.

Fire safety equipment was available on vehicles and had been serviced. Fire exits were clear and free from obstruction in office areas.

Hazardous substances were stored safely and information about the products was available to staff.

We identified inconsistencies in recruitment practices and non-compliance with the provider's recruitment policy when employing staff with positive DBS disclosures. Although the provider's policy required a three-person senior management panel to review positive DBS disclosures, records for five DBS risk assessments showed decisions had been made individually, with no evidence of panel oversight. We also found the provider had not consistently applied its DBS risk matrix. In one case, an applicant assessed as unsuitable for employment under the matrix was appointed without a risk assessment being completed in accordance with policy.

We also saw other inconsistencies in risk assessments following employment of staff with a positive DBS disclosure, we were told that these members of staff had additional supervision on commencement of employment but when we asked the service for evidence of this being completed, none were available for review which did not provide assurance that they were suitable for their role.

We were told that driving assessments were undertaken by an external company, but we saw examples of driving assessments being undertaken by staff within the service. We requested copies of qualifications for these members of staff but nothing was provided that would provide assurance that they had the required qualification for assessing driver competence.

Managers supported staff to develop through constructive recorded, annual appraisals and constructive clinical supervision of their work. Appraisal rates were 87% at the time of our assessment.

Managers reviewed the number of staff needed for each shift based on planned activity. Managers could adjust staffing levels daily according to the needs of patients and changes in activities.

We saw duty rotas for the last 3 months, which showed no unfilled shifts due to sickness or other absence. The service had low sickness rate at 4% and low vacancy rates.

The service supported the learning and development needs of staff and made sure staff received any specialist training for their role. Managers identified any training needs their staff had and gave them the time and opportunity to develop their skills and knowledge. For example, we saw that additional training had been introduced following staff requests in managing patients at the end of life.

Managers made sure staff attended team meetings or had access to the information shared when they could not attend. We saw notes from team meetings and other general information was shared via email and contact with team leaders.

Managers supported staff to develop through constructive recorded, annual appraisals of their work and regular clinical supervision. If poor staff performance was identified, this was dealt with in a supportive way, with a view to improvement. Leaders were able to describe using performance management but there were no current staff on performance management at the time of inspection.

The service managed infection risks well. Staff used equipment and controlled measures to protect patients, themselves, and others from infection. They kept equipment and the premises visibly clean.

There was access to a local infection, prevention and control policy (IPC) and supporting guidance was accessible to staff. Staff received training on IPC.

There was a programme of infection and prevention and control audits including for example, hand hygiene. The service performed well in local IPC audits. In the most recent audits, the scores showed compliance with infection prevention and control measuresin all clinical areas.

There was guidance to support staff to respond to infection prevention and control risks such as transmittable infections. We saw staff were following infection control principles including compliant handwashing and all staff were able to articulate how they would use personal protective equipment (PPE) as outlined in the services PPE standard operating procedure.

Staff understood the process for managing spillage of body fluids.

Staff supported infection prevention and control measures by following the uniform policy. We saw that uniform audits were regularly undertaken and remedial action was completed to address those non-compliant.

Staff cleaned the interior of vehicles and equipment routinely. A record of cleaning was retained within the vehicles. We also noted that all vehicles were deep cleaned as per the policy schedule.

Oxygen was used onboard vehicles, and staff were appropriately trained in medical gas administration.