Archived: Hangar 68, Exeter International Airport

Updated 21 March 2018

Capital Air Ambulance opened in 1991. It is an independent air ambulance service in Exeter, Devon providing 24 hour service, seven days a week, 365 days a year. The service has a fleet of 11 aircraft.

The service carried out executive passenger flights from 1991 until 2011 when the scope of the business developed to include air ambulance work. At this time, a medical director with expertise in the aeromedical field was appointed to oversee the development of the service. The service has recently renewed its contract with a Healthcare provider, outside the regulatory authority of the CQC, to provide aeromedical transport to patients. Medical and commercial repatriation is also provided.

Capital Air Ambulance offers all levels of medical care for adults and children, including premature and neonatal babies, and has level three intensive care capability. The service specialises in providing aeromedical transport of the most ill and severely injured of patients, for example patients who are normally managed in an intensive care unit (ICU) or specialist high dependency unit (HDU), such as for coronary care. The service also provides transport to patients with other medical conditions requiring treatment by doctors and nurses.

The service has had a registered manager in post since 1991.

The provider is registered to provide the following regulated activities:

• Transport services, triage and medical advice provided remotely
• Diagnostic and screening procedures
• Treatment of disease, disorder or injury.

Capital Air Ambulance Limited was last inspected in January 2013. During this inspection, the service met all the standard requirements it was inspected against. There have been no previous requirement notices or enforcement actions associated with the service. We carried out an announced inspection of Capital Air Ambulance on 12 December 2017 and revisited the service on 18 December 2017.

The CQC only regulates services provided in England. Medical repatriation services are also within our scope of regulation if the patient pays privately for the service.

Updated 21 March 2018

Capital Air Ambulance is an aeromedical transport service providing emergency and urgent care, run by Capital Air Ambulance Limited.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 12 December 2017, along with a further visit on 18 December 2017.

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:

• Incidents were investigated and actions were taken where appropriate.
• Medical equipment and aircrafts were regularly serviced, maintained and safe for use.
• Thorough risk assessments were carried out prior to missions taking place.
• Infection risks associated with patients were actively assessed to prevent and control the spread of infection.
• Patients’ individual care records were written and managed in a way which kept them safe. They were up to date, identified individual patients’ needs, detailed the individuals’ care needs and the treatment provided during the mission.
• Staffing levels and skill mix were planned according to the needs of the individual. This ensured patients received safe care and treatment.
• Care and treatment was based on nationally recognised guidance which had been tailored to meet the requirements of the aeromedical environment.
• Patients’ individual needs were assessed and planned to ensure they received the correct care and treatment to maintain their safety and wellbeing during the mission.
• The service monitored the quality of its response times for commissioned contracted work, against specified key performance indicators.
• Staff had the skills, knowledge and experience to deliver effective care and treatment and underwent bespoke professional development in aeromedical care and treatment.
• The service coordinated care and treatment with other providers to ensure the effectiveness of the mission.
• Information needed to deliver effective care was accessible to relevant staff in a timely way.
• Staff gained consent before providing care and treatment. They also knew how to make decisions in patients’ best interests when required.
• Feedback from people who used the service was consistently positive. Comments written by service users praised the medical and aviation staff for the way they treated people with dignity and respect.
• The service understood the importance of communicating with a patient’s next of kin and keeping them informed.
• Staff provided emotional support for patients during a time of high anxiety and uncertainty.
• The service worked closely with the commissioners for the contracted work to ensure services were planned and delivered to meet the needs of the patients.
• The office was staffed and operational 24 hours a day, seven days a week to fulfil the terms and conditions of the commissioned work.
• Some of the clinical staff were able to support the care and treatment of patients whose first language was not English.
• The governance framework supported the delivery of good quality care, although some processes needed to be formalised and carried out more regularly to identify areas where quality could be improved.
• The service maintained risk registers which were reviewed regularly to effectively monitor and manage risks to the service.
• Leaders were supportive and approachable, and staff felt valued.
• The service engaged with patients and stakeholders to receive feedback and identify areas for improvement.

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

• A small number of policies we reviewed not always based on the most current legislation and guidance.
• There was no formal system or process to track which members of staff had received an appraisal and not all staff who had carried out a specified number of missions had received a recent appraisal.
• There was no formal process to ensure the quality of the service provided by the preferred ground ambulance providers used to support missions.
• There was no formal programme of clinical or internal audit used to provide a clear oversight of the service to monitor quality to identify areas for improvement.

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 two requirement notices. Details are at the end of the report.

Amanda Stanford

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

Updated 21 March 2018

Capital Air Ambulance Limited is an independent air ambulance service in Exeter, Devon providing 24 hour service, seven days a week, 365 days a year.

The service has recently renewed its contract with a healthcare provider outside the regulatory authority of the CQC to provide aeromedical transport to patients. Medical and commercial repatriation is also provided.

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and issues that service providers need to improve.

We found areas where the service performed well during our inspection. For example, medical equipment was well maintained and safe for use, thorough risk assessments were carried out and individual patient needs were carefully assessed and planned to ensure patients received the most effective care and treatment during the mission. The service understood the importance of keeping patients and their next of kin informed and supporting patients emotionally. All feedback we received about the service was consistently positive.

However, there was no formal programme of clinical or internal audit used to monitor quality or to identify areas for improvement, or formal process to ensure the quality of the service provided by the preferred ground ambulance providers used to support missions.

There were several other areas where improvement was required, however the service started to rectify the issues raised both on the day of and following the inspection. We were provided with an action plan following the inspection which included evidence of actions which had been taken and implemented to improve the service.