Archived: Western Medical Ambulance Services

Western Medical (U.K.) Limited provides patient transport services.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 7 and 8 November 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services; are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• The provider’s stated aim was that the patient always came first. Staff were clear about the focus being the patient.

• The service was proactive in ensuring the vehicles were well maintained and equipment and consumable supplies were stored appropriately and available for use.

• Staff were employed and worked solely for the service. A sufficient number of staff were deployed in order to care for patients safely.

• The need to arrange food and drink for the patient in transit was considered. Staff completed an assessment of pain experienced by the patient and a pain score.

• Patient transport services (PTS) crew maintained the patient's privacy and dignity and demonstrated empathy and compassion. Staff were passionate about their roles and dedicated in providing excellent care to patients.

• For particularly vulnerable patients, such as those living with dementia or a disability, the service arranged for a relative or carer to accompany them while being transported. After transporting a patient home the crew frequently waited with a patient until the carer arrived.

• Emotional support was an integral part of the service provided by the PTS staff, particularly for end of life care patients.

• The patient's individual needs were taken into consideration when each request for patient transport was made. The requirements of patients with complex needs, including those with dementia, learning disabilities physical disabilities or mental health needs were assessed.

• Staff understood the reporting arrangements in this small service. The leadership operated through direct communication with staff. Staff told us that the leadership was very positive, supportive and approachable.

• Staff worked in a culture that was friendly and supportive. Staff felt valued and respected. Staff told us they were consulted about changes to the service and that managers were open to listen to any comments.

However, we found the following issues that the service provider needs to improve:

• No system was in place to manage risk which enables identifying, mitigating and controlling risks appropriately.

• Reported incidents were not graded, to determine the level of patient harm. In addition, investigation of incidents was not robust and did not include learning to reduce the risk of similar incidents happening again.

• Staff were not aware of their responsibilities in relation to the duty of candour.

• Appropriate actions were not taken to identify, assess and minimise the risks associated with infection prevention and control.

• Training and competency records were not kept for each staff member who was responsible for providing care and treatment to patients.

• The required employment checks were not always undertaken or records kept of these, which would ensure compliance with the fit and proper person’s employed requirement in full.

• Safeguarding training for adults was not evidenced in line with the Intercollegiate Document, 2016. This includes staff providing direct care and treatment to patients as well as the safeguarding lead.

• A policy and procedure for use of mental capacity, gaining consent, best interest and deprivation of liberty safeguards was not in place to support staff in complying with the requirements of these.

• A procedure for identifying, receiving, handling and responding to complaints from patients was not in place.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with seven requirement notices that affected patient transport services. Details of these are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region), on behalf of the Chief Inspector of Hospitals