Archived: Town Travel Limited

Updated 13 September 2018

Town Travel Limited registered as a provider of patient transport services in May 2016 and is an independent ambulance service in Swindon, Wiltshire. The service has had a registered manager, in post since May 2016.

The service primarily serves the communities of the Swindon area under contract with the local clinical commissioning group and healthcare providers. It is registered to provide the following activity:

• Transport services, triage and medical advice provided remotely

We first inspected this service on 9 January 2018 when we undertook a comprehensive inspection. We identified some concerns and told the provider urgent improvement action was required. We issued a Section 29 Warning Notice, which we served on 5 February 2018. The service provided an action plan describing what actions they planned to take to meet the regulatory requirements.

Updated 13 September 2018

Town Travel Limited provided a non-emergency patient transport service in the Swindon area for patients with a range of health and mobility difficulties.

We inspected this service in January 2018 using our comprehensive inspection methodology.

Following that inspection, we served a Section 29 Warning Notice under the Health and Social Care Act (2008), which set out our areas of concern. These are summarised below:

• There was no governance framework to evidence and support the delivery of good quality care. The provider could not tell us how they assured themselves of the quality and performance of the service.
• The provider did not review performance data to identify ways in which the service could be improved.
• There was no programme of internal audit to identify the service’s areas of strength and areas for development. There was no oversight of risk, performance, outcomes or safety.
• There was no risk register or similar process to assess, monitor and mitigate the risks to service provision or the health, safety and welfare of patients.
• There was no documentation to support how the provider had assessed the risks identified at the booking stage. There were no management plans to safely manage risk to individual patients using the service.

We conducted this focused follow-inspection on 19 July 2018 to see what progress had been made to address the concerns laid out in the warning notice.

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:

• There was a new governance framework outlining how the provider would ensure the delivery of safe and high-quality care. This included a quality policy and an annual programme outlining how they would measure performance in each area of the service.
• A programme of audit had been developed and the service had undertaken two audits. This ensured they had oversight over the quality and safety of care provided and a system for identifying where action was needed.
• There were new systems for measuring and recording risks within the organisation. Five organisational risk assessments had been completed and there was a plan for those which would be completed over the coming year.
• The service had improved how it recorded their assessment of the risks of transporting individual patients. The booking form had been updated to include more information. We saw risk assessment forms had been completed for individual patients and we were given examples where visits had been made to premises to establish the safest way to transfer the patient.
• To address a possible shortfall in skill and experience around governance, the registered manager had sought external advice regarding its arrangements and planned to arrange an independent review once improvements had been completed.

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

• There were no formal arrangements for the regular review of quality and performance outcomes. Discussions about governance activity happened informally and were not recorded, and there was no process for the review and improvement of the assurance systems.
• Although risks had been assessed and documented, there was process for the regular review of risks to ensure controls were sufficient.

Amanda Stanford

Deputy Chief Inspector of Hospitals (South) on behalf of Chief Inspector of Hospitals

Updated 13 September 2018

Town Travel Limited provided non-emergency patient transport services so patients in need of assistance could reach healthcare appointments, or to support admission and discharge from healthcare providers. It provided these services to the local communities of Swindon.

Since our last inspection, we saw the provider had made several improvements in response to our warning notice. These improvements made the service safer.  They also ensured the quality of the service would be monitored in accordance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We were not yet assured there was an adequate framework for the review of audit outcomes and risks to ensure safety would be maintained and continually improved.