Archived: Air Alliance Medflight UK

Updated 19 November 2018

Air Alliance is operated by Air Alliance Medflight UK Limited. The service opened in 2016. It is an independent air ambulance service based at Birmingham Airport.

They are a 24/7 multilingual operation and leader in aircraft technology. They employ 150 staff pool of senior doctors and nurses on an adhoc basis. They are accredited by the European Aeromedical Institute and Commission on Accreditation and carry out over 950 air ambulance missions per year. For their paediatric and neonatal services they have 14 of their own aircraft based across Germany, Austria and UK. The service has had a registered manager in post since 2016.

The aircraft are a combination of short, mid and long range. The configurations are two to three stretchers. The long-range aircraft can accommodate up to 10 people. Air Alliance Medflight has a team of health workers on standby to help in case of emergency: using aircraft with medical equipment to transfer patients quickly and reliably to the desired hospital. The repartition service includes collecting patient anywhere in the world and cared for them until the handover at the destination hospital. Whether dealing with accident victims who require monitoring or critically ill intensive care patients, complex transport requirements can also be met.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Air Alliance Medflight UK Limited provides repatriation services to patients who have privately funded (or part privately funded) and this is regulated by CQC. However, they also provide treatment under arrangements of an insurance policy not primarily or solely intended for diagnosis and treatment (e.g. travel insurance), which is exempt by law from CQC regulation. CQC’s remit is also limited to services provided within England. Air Alliance were unable to record for each patient how their treatment was funded, but were able to confirm that the same process, policies and procedures are in place for all patients.

The service is registered to provide the following regulated activities:

• Diagnostic and screening procedures

• Transport services, triage and medical advice provided remotely

• Treatment of disease, disorder and injury

While on inspection we spoke with the chief flight nurse who has a background in critical care and is the infection prevention control lead. We spoke with the registered manager, who is a registered nurse with a background in critical care, the director for the UK with a background in flight crew, the medical director, a consultant anaesthetist/intensivist, who had clinical oversight, a paramedic and senior flight nurse.

During the inspection, we visited the UK base at Birmingham Airport. We spoke with six members of staff including; a registered paramedic, a medical director, the registered manager, the general manager and two senior nurses, all staff we spoke with also worked within the NHS.

During our inspection, we reviewed nine sets of patient records.

There were no special reviews or investigations of the service ongoing by the CQC at any time during the 12 months before this inspection. This was the service’s first inspection since registration with CQC, which found that the service was meeting all standards of quality and safety it was inspected against.

Activity from 2 January 2018 to 21 May 2018 was 131 flights from various destinations.

The staff were registered paramedics and nurses, consultants, general managers, and a bank of subcontracted staff that could be utilised by the provider. The accountable officer for controlled drugs (CDs) was the registered manager.

Track record on safety

• There were no never events

• There were no clinical incidents that met the threshold for CQC notification.

• There were no reportable serious injuries.

Updated 19 November 2018

Air Alliance is operated by Air Alliance Medflight UK Limited. The service provides a planned and emergency patient transport service for adults and children abroad.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 3 July 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 good practice:

• There was a good incident reporting culture which resulted in improvements in practice.

• Staff were up to date with mandatory training, all of which had evidence of reviews and updates. Staff had completed safeguarding children and adults training to the required level. The registered manager was trained to a level 4 qualification in safeguarding adults and children.

• There was a strong focus on infection prevention and control measures to ensure ongoing compliance, including regular audit.

• The equipment and environment used by the provider were appropriate and well maintained. There were effective systems to ensure ongoing safety.

• Staffing levels were appropriate to meet the needs of the patients. There were sufficient numbers of qualified staff on the sub-contractors register.

• Patients records were complete and up to date and accessible to those that needed them.

• There were safe medicines management policies/processes/practices which included a service level agreement with a local NHS trust for supply and audit.

• Patients had their nutrition and hydration needs met and staff used evidence based risk screening tools to assess and manage risks.

• The service operated a 24-hour, seven-day week service with operational staff who were multi-lingual carrying out assessments.

• Staff were employed based on their competency to ensure they were skilled to meet the needs of the individual patients. Staff were multi-disciplinary and worked well together to provide good quality care.

• People provided feedback about the care they received. The feedback about staff was overwhelming positive, for example staff were described as caring and experiences were good.

• The service met people’s individual needs. For example, they sourced aeroplanes that were the right size to accommodate patients with families. They had accessible translation services to communicate with patients using their own language. Staff were from diverse backgrounds and when assessing a job, staff could be employed based on their cultural or religious background, for example, employing a Muslim team member if that was a patient’s preference.

• The leadership and staff team were highly qualified. There were effective governance systems to ensure oversight and standards were being met.

• Staff worked alongside accredited bodies, were involved with other regulatory bodies and were involved in research.

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

• Sub-contracted patient transport services on the ground did not always have all the relevant checks in place to assure the provider that vehicles had up to date insurance certificates.

• Patient outcomes were not routinely monitored.

• The provider was in the process of writing a business strategy, however it was not available at the time of inspection.

• Documentation to confirm staff competency was not checked and verified by an experienced member of staff.

• Managers did not have a system in place to document and review annual appraisals and supervision.

Heidi Smoult

Deputy Chief Inspector of Hospitals), on behalf of the Chief Inspector of Hospitals

Updated 19 November 2018

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:

• There was a good incident reporting culture which resulted in improvements in practice.

• Staff were up to date with mandatory training, all of which had evidence of reviews and updates. Staff had completed safeguarding children and adults training to the required level. The registered manager was trained to a level four qualification in safeguarding adults and children.

• There was a strong focus on infection prevention and control measures to ensure ongoing compliance, including regular audit.

• The equipment and environment used by the provider were appropriate and well maintained. There were effective systems to ensure ongoing safety.

• Staffing levels were appropriate to meet the needs of the patients. There were sufficient numbers of qualified staff on the sub-contractors register.

• Patients records were complete and up to date and accessible to those that needed them.

• There were safe medicines management policies/processes/practices which included a service level agreement with a local NHS trust for supply and audit.

• Patients had their nutrition and hydration needs met and staff used evidence based risk screening tools to assess and manage risks.

• The service operated a 24-hour, seven day week service with operational staff who were multi-lingual carrying out assessments.

• Staff were employed based on their competency to ensure they were skilled to meet the needs of the individual patients. Staff were multi-disciplinary and worked well together to provide good quality care.

• People provided feedback about the care they received. The feedback about staff was overwhelming positive, for example staff were described as caring and experiences were good.

• The service met people’s individual needs. For example, they sourced aeroplanes that were the right size to accommodate patients with families. They had accessible translation services to communicate with patients using their own language. Staff were from diverse backgrounds and when assessing a job, staff could be employed based their cultural or religious background, for example, employing a Muslim team member if that was a patient’s preference.

• The leadership and staff team were highly qualified. There were effective governance systems to ensure oversight and standards were being met.

• Staff worked alongside accredited bodies, were involved with other regulatory bodies and were involved in research.

However,

• Sub-contracted patient transport services on the ground did not always have all the relevant checks in place to assure the provider that vehicles had up to date insurance certificates.

• Patient outcomes were not routinely monitored and there was no system to record outcomes.

• The provider was in the process of writing a business strategy, however it was not available at the time of inspection.

• Documentation to confirm staff competency was not checked and verified by an experienced member of staff.

• Managers did not have a system in place to document and review annual appraisals and supervision.