Archived: Radmere HQ

Radmere HQ is operated by Radmere Medical Ltd. The service provides a patient transport service to local NHS hospitals. The service also provides a non-emergency patient transport service for high dependency patients, reported under the core service of urgent and emergency care.

We inspected the service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 6 December 2017, along with an unannounced visit to the provider 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.

The main service provided by this service was patient transport. Where our findings on patient transport – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the patient transport core service.

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 issues that the service provider needs to improve:

• Staff had not received the correct level of safeguarding training recommended in national guidance.
• We were not assured that staff had clear information on how to report and escalate safeguarding concerns.
• We found one cylinder containing medical nitrous oxide was past its expiry date and one cylinder of oxygen which did not have a clearly marked expiry date.
• Staff did not receive formal training on the Mental Capacity Act.
• The service did not have a formal complaints policy.
• The service did not have a formal policy on consent.
• The service did not provide translation services for patients who did not speak English.
• The managing director was unable to provide complete records of induction, pre-employment disclosure and barring service (DBS) checks and ongoing training and appraisal for all staff.
• Governance meeting minutes did not include discussion of quality outcomes or performance against the quality standards stated on the provider’s website.

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

• There was a process in place for staff to report incidents. Senior staff reviewed and investigated incidents to enable learning.
• Staff completed daily vehicle checks, which included cleaning of equipment.
• There were processes in place to ensure that electrical equipment was serviced and maintained in line with manufacturer’s guidance.
• Medical gases were stored securely in the vehicles we inspected.
• Patient transport booking forms contained relevant information relating to each transport request.
• Staff had access to equipment to treat deteriorating patients including ventilators, pacing equipment and suction equipment.
• There was an effective booking system in place to ensure the service was able to meet demands. Requests for patient transport were not accepted if there were not sufficient staff available to safely complete the journey.
• Staff had access to policies in paper or electronic format. We reviewed a selection of policies and found they were in date, version controlled and referenced relevant legislation and guidance.
• Written feedback from patients was positive. We reviewed a sample of five patient feedback forms, all of which rated the service 5 out of 5. Comments from patients included “Very pleasant and competent staff” and “Very good and careful with patients.”
• The service had specialist equipment for transport of bariatric patients. We saw equipment including a bariatric wheelchair, stretcher and ramps.
• Staff took account of patients’ nutrition and hydration needs. The patient transport booking form prompted staff to consider patients’ nutrition and hydration needs and staff made arrangements with hospitals to ensure adequate nutrition and hydration was provided.
• Information on how to make a complaint was available in the vehicles we inspected. The managing director gave us an example of learning and changes to policy following a complaint.
• Senior staff held quarterly governance meetings. Meeting minutes showed discussion of financial matters, risks, controls and actions, staffing, appraisals and complaints.
• Senior staff kept a risk register, which specified the level of risk and included actions to manage risks with timescales and risk owners.
• The managing director was visible and had regular contact with staff. Staff could contact the managing director directly if they had any concerns.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make some improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices that affected the patient transport service and urgent and emergency care service. Details are at the end of the report.

Heidi Smoult

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