Archived: Event City

A&E Life Support Ltd is an independent ambulance service that mainly provides patient transport services across the North West region. This includes transport of patients detained under the Mental Health Act (1983).

The service also provides emergency services for patients that may require transport from events to a hospital. This is only a small part of overall activities.

We carried out a focussed responsive inspection at the provider’s premises in Blackburn, Lancashire on 17 January 2020.

We carried out a focussed responsive inspection because of concerns that we identified during our previous inspections of the service on 04 and 05 November 2019 as well as on 25 November 2019.

We inspected specific key lines of enquiry for safe, effective and well-led. We did not inspect caring and responsive as part of this inspection.

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 rate

We did not rate the service because this was a focussed responsive inspection. We found the following issues that the service provider needs to improve:

• The service did not provide mandatory training in key skills to all staff and did not make sure everyone completed it. Although the service had listed mandatory training modules that staff were required to complete, it was unclear how these would be delivered.

• Patients were not always protected from potential abuse because not all staff had been trained on how to recognise and report abuse. This was because the service had not completed appropriate Disclosure and Barring service checks for all staff.

• The service controlled some infection risks. The policies and procedures for infection control did not always reflect the service that was provided. We found that the infection and prevention control policy contained several inappropriate references, meaning that staff would not always have the correct information to support them to reduce the risk of infection being spread.

• We were not assured that all equipment used by the service for providing care or treatment was safe for such use. We had concerns that not all equipment was immediately available. We did not see evidence that all equipment had been serviced in line with manufacturers guidance.

• The service did not have clear processes in place to remove or minimise risks to patients. Although the service implemented guidance for staff to follow when managing the deteriorating patient following the inspection, it was still unclear how patients would be assessed to make sure that they received the most appropriate care. Additionally, policies and processes were not always in place to support staff in the use of mechanical restraint.

• We were not assured that improvements that had been made to patient records would be effective, sustained or monitored. Although the service had made improvements to patient records, we found that the service had not updated their policies and procedures regarding this or had planned to monitor compliance against the changes that had been made.

• The service did not have systems in place to make sure all staff were competent for their roles. We were informed that staff had received mental health training. However, we did not see evidence of what this training had included.

• The service had not planned to seek the consent of patients before providing care and treatment, in line with national guidance. Although the service had made amendments to patient documentation, it was unclear how staff were supported to seek and document consent before providing care and treatment.

• The service did not have a formal strategy to turn what they wanted to achieve into action. We found that the service had a vision of what they wanted to achieve but it was unclear how this would be achieved in a timely manner.

• The service did not operate effective governance processes. The service did not have processes outlining how policies and procedures would be reviewed to make sure that they were reflective of up to date best practice guidance and legislation.

• The service did not have systems to manage performance effectively. We had concerns that the process in place to manage risk would not be effective. The service had not planned to monitor the services provided so that improvements could be made when needed.

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 took urgent enforcement action against the provider and issued an urgent suspension notice because we identified significant concerns that posed a potential risk of harm to patients. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (North Region), on behalf of the Chief Inspector of Hospitals

A&E Life Support Ltd is an independent ambulance service that mainly provides patient transport services across the North West region. This includes transport of patients detained under the Mental Health Act (1983).

The service also provides emergency services for patients that may require transport from events to a hospital. This is only a small part of overall activities.

We carried out a focussed responsive inspection at the provider’s premises in Blackburn, Lancashire on 4 and 5 November 2019. We took enforcement action and issued the provider with an urgent suspension notice on 8 November 2019. We also carried out a follow up inspection on 25 November 2019.

We carried out a focussed responsive inspection because of concerns identified following a registration inspection of the service in September 2019. We also received concerns about the service through our routine monitoring of enquiries and concerns from members of the public and other stakeholders.

We inspected specific key lines of enquiry for safe, effective and well-led. We did not inspect caring and responsive as part of this inspection.

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 rate

We did not rate the service because this was a focussed responsive inspection. We found the following issues that the service provider needs to improve:

• The service did not provide mandatory training in key skills to all staff and did not make sure everyone completed it.
• Patients were not always protected from potential abuse because not all staff had been trained on how to recognise and report abuse.
• The service controlled some infection risks. Whilst staff kept equipment and the premises visibly clean, staff did not receive formal training in infection prevention and control and the service did not carry out audits to monitor infection control processes.
• We were not assured that all equipment used by the service for providing care or treatment was safe for such use. The service had not carried out suitable assessments of the premises to ensure they were safe. Compressed gas cylinders were not securely stored, or risk assessed to ensure they were safe.
• Staff did not complete and update risk assessments for each patient to remove or minimise risks.
• The service did not have enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
• Staff did not keep detailed records of patients’ care and treatment. Patient care was not planned to take into account patient’s individual needs.
• The service did not make sure all staff were competent for their roles. Managers did not appraise staff’s work performance or hold supervision meetings with them to provide support and development.
• Staff did not always support patients to make informed decisions about their care and treatment. National guidance to gain patients’ consent was not always followed because there were no records to demonstrate if consent had been sought. The service had no records to show whether staff knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
• Whilst leaders had the skills and abilities to run the service, we were not assured they managed the priorities and issues the service faced effectively.
• The service did not have a formal documented vision for what it wanted to achieve or a formal strategy to turn it into action.
• Leaders did not operate effective governance processes. Staff did not have regular opportunities to meet, discuss and learn from the performance of the service. The service did not have effective processes in place for assessing the suitability of company directors.
• The service did not have systems to manage performance effectively. There was no process in place to manage risk. Staff did not identify and escalate relevant risks and issues or identify actions to reduce their impact.

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 took urgent enforcement action against the provider and issued an urgent suspension notice on 8 November 2019 because we identified significant concerns that posed a potential risk of harm to patients. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (North Region), on behalf of the Chief Inspector of Hospitals