F.A.S.T. Ambulance Services

F.A.S.T. Ambulance Services is operated by F.A.S.T. Ambulance Service Limited. The service provides a patient transport service, commissioned by and on behalf of NHS and independent ambulance services, NHS trusts and primary care providers.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 16 and 17 April 2019.

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 rated the service as Good overall. We had not previously rated this service using our new methodology.

We found the following areas of good practice:

• The service had improved systems to provide assurance of safety. There were improved and effective monitoring systems to provide assurance that premises, vehicles and equipment were well maintained and clean and that medicines were safely stored and their use recorded.

• Staff received comprehensive training in safety systems on employment and this was regularly refreshed. All staff were up to date with mandatory training and there were effective systems to monitor this.

• Staff undertook dynamic risk assessments and took sensible precautions to protect patients and themselves from harm.

• The service investigated incidents, including complaints, and took appropriate remedial action.

• Managers were visible, approachable and respected by staff. Staff felt valued and well supported.

• Feedback from patients and commissioners was unanimously very positive. We observed friendly and attentive staff.

• Staff and managers demonstrated allegiance to the service’s mission statement: “Treat as you wish to be treated....” and their vision “to put compassionate care, safety and quality at the heart of everything we do”.

• People could access the service when they needed it.

• The service took steps to support patients with complex needs and those in vulnerable circumstances.

• Staff completed accurate records of patients’ care and treatment and kept them securely.

• Staff had been trained and understood their responsibilities to report safeguarding concerns.

• Staff respected their managers and felt supported and valued by the organisation.

However, we also found the following areas where the provider needed to improve:

• There was not an effective governance framework which provided a holistic understanding and assurance of safety, quality and patient experience.

• There was a range of policies but these were often merely statements of good practice. Some policies had been plagiarised from other services and had not been adapted to meet the needs of the service. This meant they were not always fit for purpose and did not clearly set out local standards and how those standards would be met and monitored.

• The service did not measure its performance against standards agreed with commissioners.

• There were not effective arrangements to manage risk. The risk register did not identify operational risks or describe safeguards in place to manage those risks, and it was not regularly discussed and updated. The service did not analyse incident and complaints data to identify themes and learning.

• The service did not audit patient records to provide assurance that care and treatment provided were appropriate and in accordance with national guidance and best practice.

• Recruitment procedures were not operated consistently or in accordance with the Recruitment and Retention Policy, so that the service could be assured of the competence and suitability of applicants for employment.

• Performance appraisal had recently been introduced without a guiding policy or training for senior staff. As a result, records were poorly completed and did not provide evidence of a meaningful process to ensure staff’s ongoing training learning and development needs were identified and supported. There was no provision for health care professionals (paramedics) to access clinical or professional supervision.

• There remained some lack of understanding of regulations and legislation surrounding the supply and administration of medicines, which meant emergency medical technicians had been able to administer some medicines without the legal authority to do so. The registered manager took immediate action during our inspection to suspend some medicines.

• Senior staff (those in supervisory and managerial roles) had not received suitable training to ensure they were suitably skilled to undertake those roles.

• There was a lack of clarity about onward reporting of safeguarding concerns and there was no mechanism in place to feed back to staff.

Following this inspection, we told the provider 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 two requirement notices. Details are at the end of the report.

 Nigel Acheson

Deputy Chief Inspector of Hospitals