Medisec Ambulance Service 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

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

Service vehicles and equipment met patient needs, and were generally clean, and well maintained. However, our assessment found evidence that policies and procedures for maintaining cleanliness and some equipment showed signs of limited hygiene standards.

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.

Description: We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.

We scored the service as 3. The service had a proactive and positive culture of safety, based on openness and honesty. Staff and leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service managed patient safety incidents well. It had a clear incident reporting policy that explained how to report issues, the timescales for investigation and how to assess each incident by severity. There had been 7 serious incidents reported in the past year prior to our inspection. Managers reviewed each of these and we saw that each had been formally documented and reviewed accordingly. We saw that each incident had been formally documented and reviewed accordingly, and actions taken to drive improvement. Managers shared lessons with the external stakeholders' External stakeholders made sure improvements were put in place during review meetings. Managers also monitored safety alerts, checked progress and ensured issues were resolved.

Staff used an internal electronic system to record and manage incidents. Staff told us they could report incidents and risks knowing managers would respond. Staff said they felt confident raising concerns and reporting both incidents and near misses which followed service policy.

Staff members understood their requirements of duty of candour legislation. They were open and transparent, explaining clearly to patients when things went wrong. Patient surveys highlighted that families were alerted when things went wrong. For example, when there were delays in attending an end of life patient, the family was given an apology and provided with a verbal explanation of what happened.

Managers did not always analyse incidents to spot patterns or trends. Staff told us they were not routinely given feedback on patterns emerging from incidence reviews However, when staff needed extra support or training as a result from an incident, this was arranged. An example of this included the retraining of moving and handling for a staff member when they had scraped the side of vehicles with equipment.

Description: We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between different services.

We scored the service a 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when responsibility for patient care moved between different areas of a service and between providers.

The service was contracted by a local mental health trust to provide secure patient transfers for both NHS and private patients. For secure patients, initial risk assessments were carried out by the mental health trust and shared with the service. The service was also subcontracted to support patient discharges from the local NHS acute hospital. In these cases, the NHS provider’s discharge planning team managed the booking process and provided the initial risk information for transfers. Staff told us they could raise concerns if they felt an assessment was inaccurate, although managers and stakeholders told us this “this rarely happened”.

Safety and continuity of care were a priority throughout each patient’s journey. Patients were assessed before transport to make sure they were suitable for the available vehicles and resources. The service had its own risk assessment for this to align with their contract This process reduced risks by identifying any additional needs, such as mobility aids or specialist equipment.

There were clear systems to ensure patients were correctly identified, collected, and transferred to the right locations. We observed staff accompanying patients on journeys from hospital to home, checking identification, passing on information to receiving teams, and confirming details before handing patients over.

Safe driving was monitored through an integrated system application, which also recorded any instances of vehicle idling. Patient transfers between locations were carried out safely. Experienced staff with the right driving skills and clinical knowledge accompanied patients, using appropriate equipment throughout the journey.

Staff completed risk assessments for every patient and recorded them, so information was available before transfer. The booking team consisted of the two operations managers and office manager. This team ensured the appropriate vehicles and support were available, for example providing a bariatric ambulance and additional staff if needed. For secure transfers, the initial risk assessment came from the referring service. When restraint was required, staff followed current legislation and used the least method in line with national guidelines. All restrictive transfers were audited for safety.

Description: We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, and we make sure we share concerns quickly and appropriately.

We scored the service a 3. The evidence showed a good standard. The service worked with patients and partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

All staff had up to date safeguarding training and could give examples of when they had made referrals. For instance, one team noticed that a patient may not be safe to be discharged home as they lived alone. They contacted the hospital safeguarding lead and arranged for the patient to return safely. This and other examples highlighted that staff were confident in raising safeguarding concerns and knew who to contact when issues arose. They acted quickly, making referrals or seeking advice whenever needed.

The Operations Manager, who was the Designated Safeguarding Lead, had Level 5 safeguarding lead certificate. Inspectors reviewed all staff records, which confirmed all staff had completed training in both adult and children’s safeguarding. These records also showed compliance with national safeguarding guidance and the provider’s policy expectations.

Staff used this knowledge well. They were able to describe when adults and children were at risk of, or already experiencing, significant harm. They also gave clear examples of safeguarding patients from harassment and discrimination, including those protected under the Equality Act. Staff gave an example of when a patient who lacked mental capacity was being targeted through social media, staff recognised the risk and intervened by escalating concerns to the appropriate safeguarding team.

Description: We work with people to understand and manage risks by thinking holistically so that care meets their needs in a way that is safe and supportive and enables them to do the things that matter to them.

We scored the service a 3. The service worked with patients to understand and manage risks by thinking holistically. Staff provided care to meet patient’s needs which was safe, supportive and enabled patient to do the things that mattered to them.

The service worked closely with patients to help them understand and manage risks. Staff ensured that patients’ needs were met in ways that were safe, supportive, and person-centred, enabling them to attend important appointments and maintain independence. For example, after the staff's shift had ended, staff accommodated a free transfer home so a patient could celebrate their birthday with family, and made sure the patient was on time for a hospice appointment.

Staff enabled patients to give feedback on the service through surveys. Patient surveys indicated that most people felt listened to, understood the risks explained to them, and were included in decisions about their care. Staff communicated effectively, adapting their approach for people with communication difficulties so that patients could understand their care and treatment. Where needed, staff helped patients access advocacy so their voices could be heard.

External stakeholders also reported positive feedback from patients, carers, and families, these praised the strength of staff communication. There were processes in place to safely accommodate bariatric patients within the weight limits of their specialist stretchers. Where needed, they could assign an additional crew member or a second team, in line with contractual requirements, to reduce risk during transfer. The dispatching office staff supported safe transfers by contacting wards in advance to confirm medicine readiness, ensuring patients received their treatment promptly upon arrival.

The service used an electronic system to record all patient data. The system flagged specific risks for patient groups. For example, on one of the journeys we observed- we saw moving and handling and IPC risks being flagged on the system. The system showed the moving and handling equipment required and the type of infection the patient had so the staff could respond appropriately. However, managers did not always use this data to monitor trends or carry out audits which limited opportunities for learning and improvement.

Description: We detect and control potential risks in the care environment and make sure that the equipment, facilities and technology support the delivery of safe care.

We scored the service a 3. The service detected and controlled potential risks in the care environment. Leaders and staff took steps to make sure equipment, facilities and technology supported the delivery of safe care.

We reviewed 8 vehicles to ensure they were safe, well maintained, and suitable for purpose. All service vehicles contained items for safe transport, such as seatbelt straps and child seats. Maintenance records and service schedules were available, up to date, and demonstrated compliance.

Vehicles were stored securely, with keys securely stored to prevent unauthorised access. While most vehicles were based at headquarters, 4 were held at a satellite site.

Staff carried out daily safety checks on specialist equipment and recorded results electronically through the ambulance check system. Leaders reviewed these records and monitored staff use of the reporting system to flag faults. Improvement actions were documented, ensuring that equipment remained safe and appropriate for transporting all patients, including those detained under the Mental Health Act.

Leaders maintained strong oversight of vehicle and equipment safety. They completed regular audits, shared results with staff, and ensured enough equipment was available to support safe care. Evidence included service records such as MOTs, service schedules, tail lift maintenance logs, and restraint checks, all of which were current. The service audited vehicle assessment records to monitor compliance with process and enable oversight.

Fire safety procedures had been established within the service. All vehicle equipment was serviced, and fire exits remained clear and accessible. Oxygen cylinders were securely stored in cages, positioned upright, and kept away from flammable or electrical items. Fire extinguishers were correctly fastened, regularly checked, and within expiry dates.

We noted one issue with staff facilities, where a bathroom located upstairs at the HQ site was not accessible to individuals with mobility needs, as there was no lift access. Additionally, it was reported to be unclean.

Description: We make sure there are enough qualified, skilled and experienced people, who receive effective support, supervision and development and work together effectively to provide safe care that meets people’s individual needs.

We scored the service a 3. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care, which met patient’s individual needs

The service employed 21 substantive clinical staff. The wider team included 2 managing directors,2 operations managers, 1 office manager, 1 finance manager, 1 finance officer, 2 team leaders, and 2 team mentors.

The service had taken on new contracts which increased recruitment demands to extend service capacity. Managers maintained continuous welfare contact with staff who had sickness absences, by carrying out regular checks, updating rota details, and ensuring payroll support was accurate. Staff returning from sickness were supported through return to work meetings, with referrals to occupational health where appropriate. Notes were recorded formally and stored on a HR platform.

New staff had complete mandatory training within the first month of induction. The service required all staff to complete mandatory training. Training covered a range of areas including the Mental Capacity Act, dementia, learning disability and other relevant topics. Managers monitored compliance using an online monitoring system. Managers monitored compliance and reminded staff when updates were due. Training completion rates included: Intermediate Life Support 90% and Basic Life Support 98%. Managers also gave new staff members a professional development folder to guide them through their first year. This was overseen by the office manager.

All new staff, including temporary workers, completed an induction that was relevant to their role when starting. Managers supported them through structured supervision, monthly appraisals, and weekly feedback. Clinical supervision formed part of this process to help staff develop confidence and skills. Evidence from the assessment showed appraisals were all up to date for all staff members.

There were robust and safe recruitment practices to make sure all staff were suitably experienced, competent and able to carry out their role. The service did not use bank or agency staff. All staff were substantively employed and managed by the service. Managers ensured that each shift was staffed to the appropriate level based on planned activity, and they adjusted numbers according to patient needs. Staff confirmed they felt shifts were safely staffed, with adequate breaks during the working day.

Patients’ journeys were not cancelled due to staffing shortages, and we saw no evidence of breaks in service. Managers discussed training with staff at supervision and appraisal sessions, ensuring a clear understanding of requirements. Completion of training was monitored through an electronic system, which provided oversight and accountability.

Managers regularly reviewed development needs and ensured staff accessed training relevant to their roles and gave them the time and support needed to apply this learning. Staff valued this approach and reported feeling supported to carry out their responsibilities effectively.

There was evidence that managers used incidents and appraisals to spot training gaps, although they did not provide evidence of using national guidance to identify staff and the services learning needs.

Description: We assess and manage the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

We scored the service a 2. The evidence showed some shortfalls. The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

While IPC systems and policies were in place and staff demonstrated knowledge of safe practice, gaps in oversight and the absence of structured cleaning schedules increased the risk of inconsistent infection control

The operations manager carried out monthly IPC audits, which showed generally good compliance. Vehicles and equipment were routinely cleaned, and staff logged this electronically. However, we found no evidence of an annual infection prevention and control (IPC) risk review, as required by national standards. Cleaning schedules for base and yard areas were not documented, and one member of staff was unsure how often mop heads should be changed. Deep cleaning records were completed weekly, but there was no policy that determined how often cleaning should be undertaken. Crews told us that some cleaning was carried out on an ad hoc basis “when quiet”. This meant we there was no consistent practice in IPC methods and effective oversight by leaders.

A cupboard that had previously been used solely to store substances Hazardous to Health was now also being used as a general storeroom for equipment no longer in use, such as defibrillators, stretchers and splints. We noted that some chemicals were still stored in this area, but there was no clear system to demonstrate how these were being managed safely by staff. However, risk assessment information for Substances Hazardous to Health was available, and we reviewed this onsite to confirm it was appropriate.

Staff understood infection control principles and had access to appropriate handwashing facilities. Personal protective equipment (PPE) was available and used correctly. When PPE was used during patient transport, the staff disposed of the used items in designated clinical waste bags, which were securely tied and placed in the nearest hospital’s approved clinical waste bin. Because all clinical waste was disposed of on-site at hospital facilities, the service did not hold a separate clinical waste bag contract.

Staff had access to an IPC policy, related procedures, and supporting guidance. Training covered hand hygiene, PPE use, spill management, and the handling of body fluids. Staff we spoke to understand these requirements and followed the service’s uniform policy. Records confirmed that staff had completed ultraviolet (UV) hand-cleaning training, overseen by managers.

Description: We make sure that medicines and treatments are safe and meet people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

We scored the service a 3. The service made sure that medicines and treatments were safe and met patient’s needs, capacities and preferences. Staff are involved in planning, including when changes happen.

The service operated as a Patient Transport Service (PTS) and did not store or administer medicines. Medicines provided to a patient when discharged from a service were transported along with the patient they were prescribed to and not administered during conveyance. The service ensured these were securely stored during transport and given directly to the receiving service clinicians. Staff received training on how to safely transport and store medicines.

Staff confirmed that no medicines were kept on site or within vehicles. Where patients required time critical medicines, transport was planned to ensure that staff did not need to administer these.

Vehicles carried oxygen cylinders, which were stored securely. Some senior staff were trained in medical gas administration as part of their First Response Emergency Care Level 3 (FREC3) qualification. The staff told us that previously, oxygen tubing and masks were carried on the PTS vehicles, but these were removed because some staff had not received the necessary training to use them safely. If a patient required oxygen, clinical teams could provide tubing and masks before transport.

The service had an oxygen use policy, which aligned to national best practice guidance which set out the hazards of oxygen use, including fire and explosion risks, the importance of correct storage, and the need to avoid non-compatible materials.