Archived: SNP Medical

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

Safe – this means we looked for evidence people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained as Good.

This meant people were safe and protected from avoidable harm.

This service scored 81 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The service had had two serious incidents in the previous 12 months. Leaders could describe both incidents and what they had learnt from these. One incident was a return to hospital for a patient that deteriorated on the way home. The second incident involved violence and aggression once the patient had been delivered home. The service supported staff and advised contacting the police for immediate help. Following the incident the service met with staff to get views on how they could learn and improve. They reviewed the use of equipment and emergency procedures and ensured all staff were involved in learning from this incident. Staff involved in the incident were debriefed by leaders and offered further support if necessary.

The registered manager ensured safety was at the centre of everything they did, and opportunities were taken to learn from incidents and audits. Staff knew how to report incidents and any learning that occurred from these. Staff and leaders were aware of their responsibilities under duty of candour regulations. When things went wrong the registered manager contacted the patient to fully understand the issue and to apologise and inform them of actions taken to address the issue.

The registered manager worked with patients and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. During patient journeys there was a strong awareness of the risks to people. Staff were trained and able to identify and manage these risks proactively and effectively. There was clear guidance for staff to identify specific conditions people may have which would make it unsafe for the service to transport. This included patients who may require restraint.

The service made sure there was continuity of care, including when people moved between different services. Where patients had carers, staff received a handover from them when collecting a patient to understand the needs of the individual. They also conducted risk assessments of each patient needs to ensure they could facilitate the transfer safely. When a patient was delivered to a different healthcare provider the service ensured they gave a full handover including the discharge or transfer information from the sending organisation. Leaders monitored the effectiveness of these processes to keep people safe.

When undertaking long journeys, routes were planned with two hourly stops as a minimum to ensure both driver and patient safety and comfort. In warm weather food and water was supplied so patients were hydrated and given appropriate nutrition for the duration of the journey.

The provider worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve this. 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. The provider always shared concerns quickly and appropriately.

Staff were trained to level three in safeguarding adults and children. One senior leader had a level 5 qualification in safeguarding. Leaders had considered several safeguarding scenarios which the service may face and provided guidance for each. The provider always shared concerns quickly and appropriately. Following an incident where the crew were concerned for the safety of a patient they reported this to their local authority. The service also referred the patient’s family member who they felt was also vulnerable of harm. The team interacted with the social service department to ensure the patient was safe and followed up to ensure the patient received additional support. Leaders conducted a debrief with the crew to reflect on the incident and support their wellbeing.

Staff at the service ensured patients felt safe within the ambulance. Each patient was assessed for their psychological safety as well as ensuring a safe environment. Where necessary a same sex crew member was provided to attend to patients.

The service did not regularly transport children, but the staff had the facilities and safeguarding knowledge to do this when necessary. Staff were able to describe what they would look for to identify someone who may need a referral to the safeguarding team and would consider any dependents. The staff used de-escalation techniques where patients living with dementia began to become upset eliminating the need to restrain this type of patient.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe and supportive. Staff communicated in different ways to involve patients and carers when planning journeys. Patients contributed to any assessments where possible. Staff were aware of the need to transport the original Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) document for use in the community. This is a document with contains a person wishes and preferences for clinical care and treatment if they become unable to make or express their choices. It is important to have the original document, so staff know people’s latest preferences and how they want to be supported.

Staff at the service detected and controlled potential risks in the ambulance. They made sure equipment, facilities and technology supported the delivery of safe care. Substances that were hazardous to health were stored in line with legislation. Clinical waste was disposed of via a contracted provider of this service. Staff had a vehicle checklist that was completed prior to any journey. The registered manager ensured the ambulances were safe to be on the road through regular servicing and an annual MOT. Each ambulance was insured and taxed in line with legislation. Stock was stored appropriately and checked regularly on shelves in the base room. Items were laid out in such a way that staff could readily access them. The keys, pertinent documents and relevant information was site together for each vehicle. This ensured that crews had the relevant information easily to hand. Paediatric stretcher harnesses were also stored onboard to accommodate patients of all ages. Staff were trained and demonstrated a good understanding of how to use this equipment to support patients safely.

The registered manager made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Due to the variation in business needs the service had several staff who were on a zero-hour contract. This allowed them to flex staffing to meet the needs of the service. Numbers of staff depended on the assessment of patient needs for any journey. Whilst there had been a small amount of turnover of staff the service had not needed to recruit any new staff since March 2025.

All staff received an induction and had up to date mandatory training required for their role. A senior manager ensured staff completed the online or face to face training and sent reminders out to staff. A record of training was kept by the organisation. Staff worked together well to provide safe care that met people’s individual needs. A member of staff said they felt part of a family and that everyone worked well together. Senior staff listened to issues from staff. Recruitment files were maintained in line with legislation apart from interview records. However, we reported this to the registered manager at feedback at the close of the inspection activity and they sent a suitably amended proforma to be used when next recruiting.

Appraisals were undertaken with staff, and these used to identify any development needs or wishes. However, leaders told us that they would not wait for an appraisal to address poor performance, and the member of staff would be approached as soon as possible.

There were systems and processes in place to assess and manage the risk of infection, which was in line with current relevant national guidance. There were clear roles and responsibilities around infection prevention and control. Staff cleaned ambulances pre and post journey. Vacated seats were cleaned after safe delivery of each patient. Staff detected and controlled the risk of infections spreading and shared concerns with appropriate agencies promptly. Where there were concerns about conveying a patient who may be infectious, the service had sufficient vehicles for staff to transport them individually. The service had a checklist of what to clean on the ambulances before and after each patient. There was a deep cleaning schedule for each ambulance. The deep clean involved taking all equipment off the vehicle and clean all surfaces with the appropriate solution. Equipment was cleaned and reinstated on the ambulance. The service used a system to check and track how well their cleaning worked by collecting and reviewing data after tests. Staff told us that they always had sufficient personal protective equipment such as gloves, aprons and masks available in the vehicle and at base. This enabled them to reduce the risk of cross infection.

As a patient transport service, the service did not store or administer medications. The service did not provide medicines to patients but assisted them with safe transport of any medications they were discharged with or needed to take to hospital with them. Staff made sure these medicines were safe and met people’s needs. The service carried oxygen cylinders which were regularly checked and stored in line with national guidance both on and off the ambulances. All staff were trained to First Response Emergency Care (FREC) level 3 and as such had the capabilities to administer medical gases. The service had an oxygen administration policy which reflected national guidance.