Starcross Trading Ltd T/A Bears

Updated 18 November 2021

Starcross Trading Ltd T/A BEARS (British Emergency Ambulance Response Service) is operated by Starcross Trading Limited. The service provides emergency and urgent care and a patient transport service. BEARS was founded in 2009 and is an independent ambulance service providing a range of different patient transport services based in north west London. This includes the transfer of high dependency patients, paediatric and neonatal intensive care transfers, patients receiving Extracorporeal Membrane Oxygenation (ECMO), non-emergency transfers secure/mental health patient transfers and a paramedic service. ECMO is a form of life support that provides both cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange to sustain life. The service provides transport for both adults and children and young people. Journeys are made to various locations within London and longer journeys occur on a regular basis. The service has vehicles operated by emergency care assistants, emergency medical technicians and paramedics. The service provides patient transport services (PTS) and emergency and urgent care (EUC) services. EUC patient transfers are between hospitals. The provider is registered for the regulated activities:

• Transport services, triage and medical advice provided remotely

• Treatment of disease, disorder and injury

The service performs contracted work with two London NHS Trusts and ad-hoc work for various other hospitals nationally. The service also does ad-hoc work for other independent ambulance providers based on agreed set rates. The service also subcontracts some work out to smaller independent ambulance services.

The main service provided by this ambulance service is Patient Transport Services (PTS). Although the service experienced fluctuations in activity during the COVID-19 pandemic over the last 12 months, PTS makes up 78% of the work the service undertakes. Emergency and Urgent Care (EUC) takes up 22% of the work the service undertakes. Where our findings on Emergency and Urgent Care (EUC) – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the PTS section.

The service was last inspected on 11 and 12 February 2020 and a report was published in March 2020. Following the 2020 inspection, the service was rated as good and was served with one Requirement Notice for failing to comply with Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 19 (Fit and proper persons employed).

Updated 18 November 2021

Starcross Trading Ltd T/A BEARS is operated by Starcross Trading Limited. The service provides emergency and urgent care and a patient transport service.

British Emergency Ambulance Response Service (BEARS) was founded in 2009 and is an independent ambulance service providing a range of different patient transport services based in north west London. This includes the transfer of high dependency patients, patients receiving Extracorporeal Membrane Oxygenation (ECMO), non-emergency transfers secure/mental health patient transfers and a paramedic service. ECMO stands for Extracorporeal Membrane Oxygenation and is a form of life support that provides both cardiac and respiratory support to persons who heart and lungs are unable to provide an adequate amount of gas exchange to sustain life. The service provides transport for both adults and children and young people. Journeys are made to various locations within London and longer journeys occur on a regular basis. The service has vehicles operated by emergency care assistants, emergency medical technicians and paramedics.

The service provides patient transport services (PTS) and emergency and urgent care (EUC) services. EUC patient transfers are between hospitals.

The provider is registered for the regulated activities:

• Transport services, triage and medical advice provided remotely
• Treatment of disease, disorder and injury

The service performs contracted work with two London NHS Trusts and ad-hoc work for various other hospitals within London. The service also does ad-hoc work for other independent ambulance providers based on agreed set rates. The service also subcontracts some work out to smaller independent ambulance services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11 and 12 February 2020.

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.

We last inspected this service in May 2018 but at the time we did not have the legal duty to rate independent ambulance services. However, following this inspection we rated the service good overall for both core services.

The main service provided by this service was PTS. Where our findings on PTS – for example, management arrangements – also apply to EUC, we do not repeat the information but cross-refer to the PTS core service.

We rated it as Good overall because:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.
• The provider had systems, processes, and practices to keep people safe and safeguard them from abuse. Staff were aware of and knowledgeable about these processes. The safeguarding lead was now trained to the recommended level.
• The service had improved their use of Patient Group Directives (PGDs) since the last inspection. These were now only in place for appropriate staff.
• The service had introduced training around information governance since the last inspection. Patient records were completed to a good standard and audited to ensure good compliance.
• The secure services division had improved the completion of patient record forms for patients who required restraint during transport. There was now evidence of risk assessment and decision making in patient notes. This included an incident report form being completed.
• The service had improved the way they recognised deteriorating patients.
• The service encouraged staff to report incidents and staff investigated incidents and took actions to improve services.
• The service’s had reviewed its policies and these were now in date. This had improved since the last inspection.
• The service had improved their service level agreements with subcontractors and procedures were in place for auditing services to ensure quality of care.
• We observed effective multidisciplinary working between BEARS staff and staff at the various hospitals they worked with.
• The service performed well against their key performance indicators and discussed these on a regular basis with hospital staff
• Staff treated patients and relatives with compassion, kindness, dignity and respect. We observed staff acting in a professional and courteous manner at all times. Patient feedback was positive.
• Staff reported a positive working culture within the service and found leadership supportive and caring.
• The provider had improved their processes for Disclosure and Barring Services (DBS) checks to ensure it was safe for staff to work with patients.
• The service had further developed its in-house electronic information system to include staff rota, audits and equipment checks. This allowed management to have good oversight of the services performance.

However;

• The safeguarding policy was not up to date with the most recent national guidance. The service updated the policy following our inspection.
• Incidents around restraints during secure service transfers were not included in the main incident report log. The service took immediate action to ensure this took place going forward.
• We found two occasions where sedated patients were transported without a registered professional. The service updated their booking process during our inspection to ensure this was completed going forward.
• We found staff records did not always show evidence of interview notes and reference checks were not always completed.
• Whilst we found good risk management within the service we found no evidence in the board minutes this was discussed at an executive level.

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, to help the service improve. We also issued the provider with one requirement notices. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

Updated 23 March 2020

The main service was patient transport services (PTS). The service had vehicles which could be used for PTS and/or high dependency services. The arrangements for PTS and urgent and emergency care were the same. Therefore, we have reported most of our findings in the PTS section of the report.

We rated PTS as good overall because staff treated patients and relatives with compassion, kindness, dignity and respect. There were systems, processes and practices to keep patients safe and safeguard them from abuse. Compliance with mandatory training was good and we found good multidisciplinary working between BEARS staff and hospitals. The service’s leadership had made improvements since we last inspected, around secure services and monitoring of disclosure, barring services (DBS) checks and service level agreements. However, we did find some inconsistencies in the quality of staff records such as reference checks and interview notes not always being completed.

Updated 23 March 2020

Urgent and Emergency services were a small proportion of activity. These services included high dependency transfers between hospitals.

Arrangements for patient transport services (PTS) and urgent and emergency care were mostly the same. Where arrangements were the same, we have reported findings in the PTS section.

We rated the urgent and emergency service as good overall for the same reasons set out in the PTS summary of findings below.