• Ambulance service

Archived: Town Travel Limited

Office 6 Anchor Business Centre, Frankland Road, Blagrove, Swindon, Wiltshire, SN5 8YZ (01793) 778130

Provided and run by:
Tri-Medical Services Limited

All Inspections

19 Jul 2018

During an inspection looking at part of the service

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

9 January 2018

During a routine inspection

Town Travel Limited became registered as an ambulance service in May 2016, and provides patient transport services to the local communities of Swindon.

We inspected this service using our comprehensive inspection methodology. We carried this announced inspection on 9 January 2018.

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 concern:

  • Neither the registered manager nor the director were able to clearly define the duty of candour or their responsibilities around this regulation.
  • The mandatory training system was unclear and did not provide the oversight of training compliance.
  • There was no formalised policy or guidance to support the management of a medically deteriorating patient.
  • There was evidence infection control issues were taken into consideration for every patient journey, however, we did not evidence of management plans to safely manage the risk of infection when risks were identified.
  • There was no service level agreement setting out procedures for the management of linen or disposal of clinical waste.
  • Journey forms were incomplete due to missing information.
  • Risk assessments and associated management plans were not always documented to give an account of the decision making process to safely manage risks.
  • The service was not compliant with Revised Code of Practice for Disclosure and Barring Service Registered Persons 2015. However this issue had been rectified before we left site on the day of the inspection.
  • Performance data was only collected for the contracted work and there was no evidence as to how this was scrutinised to identify current performance and areas which required improvement.
  • The complaints policy did not identify a timeframe in which complaints should be investigated and responded to.
  • There were no systems or processes to enable the registered manager to monitor the safety, quality or performance of the service against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
  • There was no formal governance framework to evidence and support the delivery of good quality care.
  • There were no processes to assess, monitor and mitigate risks relating to the service.
  • There was no audit programme to identify the strengths of the service and where improvements were required.

However, we also found the following areas of good practice:

  • There was a comprehensive system to report and respond to incidents.
  • Systems and processes reflecting relevant safeguarding legislation were effective to safeguard adults from avoidable harm and abuse.
  • The maintenance and servicing of equipment ensured the safety of patients.
  • Daily and weekly safety checks carried out on the vehicles.
  • The storage of oxygen was in line with national guidance.
  • Staff completed driving competencies when commencing employment with the service.
  • The service communicated and worked well with other organisations. We received positive feedback about the service from other organisations.
  • Staff understood their role and responsibilities with regards to consent to care and treatment.
  • Staff spoke in an insightful way about patient care and how comfort and dignity was integral to the way they provided the service.
  • All of the comment cards we received from patients provided consistently positive feedback about the service.
  • Staff demonstrated a passion to ensure good patient care.
  • Patients were well informed during journeys.
  • The service was able meet the needs of the patients who travelled with them.
  • The service was flexible to the needs of the demands and organisations they worked for.
  • Staff spoke positively about management, their leadership and the culture of the organisation

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 one warning notice and one requirement notice which affected Town Travel Limited. Details are at the end of the report.

Amanda Stanford

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