Archived: British Red Cross Mitcham

British Red Cross Mitcham is operated by British Red Cross Society. British Red Cross Mitcham provides emergency and urgent care.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 05 September 2019 and staff interviews on 11 October 2019, this was the first date following our initial inspection visit that managers were available.

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 was emergency and urgent care.

We rated it as Requires improvement overall.

We found the following issues that the service provider needs to improve:

• The safeguarding adult procedure referred to the previous adult safeguarding policy which had been replaced.
• We were not assured the contract for the removal of clinical waste met the needs of the service. Collections were not always pre-planned and were missed when staff were not onsite. Clinical bins removed by the contractor were not always replaced with empty bins ready for use.
• The deep cleaning record had not been completed in one of the eight ambulances we looked. We were not assured this deep clean had been done.
• There was a supraglottic airway device bag, however, there was no access to end-tidal carbon dioxide (ETCO2) monitoring if the equipment was used to provide an objective measure of airway patency and ventilation. Following our inspection, we were informed that the provider’s guidelines stated waveform capnography should be used for tracheal intubation but not for SGA insertion.
• There was an asset management system in place, but this did not include stock management and all equipment was logged in and out manually which was time consuming and not always effective.
• Keys to vehicles were not always securely stored and were left outside the key safe when the make ready centre was unattended.
• Only non-prescription medication was stored at this location. The medicines were stored in an unlocked cupboard, in an unlocked office. There were two bins full of out of date medicines. When we raised this with staff they told us there had been a problem contacting the contractor responsible for collecting the bins and they had been full for several months.
• Volunteer paramedics could store British Red Cross controlled drugs (CDs) at their home. The service could not provide details of which paramedics held stock at home and evidence that home audits of CDs had been carried out.
• The managers were not assured that treatment provided by staff was in line with best practice and followed national guidelines and the service did not monitor patient outcomes or produce patient outcome data. Following the inspection, the registered manager provided us with a copy of the clinical audit data spreadsheet. This was a record of the treatment provided on site and included an evaluation of patient report forms (PRF) following an internal review. However not all entries on the spreadsheet had a review logged and it did not list actions taken in response to the review where improvements could be made.
• Volunteers did not receive an appraisal or participate in supervision of their work.
• The service did not routinely collect data on the number of patients conveyed to hospital in an easily accessible format. To provide us with the data, staff had to check all patient record forms to identify who had been conveyed.Following the inspection we were advised the number of patients conveyed was included on the clinical audit data spreadsheet. However, we reviewed this and found the data included on the spreadsheet did not match the information given to us during the course of the inspection and it was not clear which figure was correct.
• The complaints, compliments and comments procedure was due for review in July 2017 and was now two years out of date.
• Staff told us national senior management were not visible and did not listen to the views of staff. The event first aid Mitcham pulse audit reported staff concerns in relation to the availability and presence of senior management.
• The provider’s corporate strategy 2015 to 2019 covered areas of the organisation nationally and internationally. But did not reference specific services provided by the location, such as event first aid including conveyance from events to hospital.
• There was no evidence the event first aid risk register, and the risk register for Mitcham were live documents and periodically reviewed. The event first aid risk register was not dated and most risks did not have a named individual as a risk owner. The risk register for the Mitcham had nine risks, all of which were added in December 2018 and seven risks did not have an assigned risk owner.
• Volunteer staff we spoke with were not aware of the results of the volunteer staff survey completed in October 2017. The results had been collated nationally but were not broken down to local level to identify specific local issues.

However, we found the following areas of good practice:

• The provider used an electronic incident reporting system. All staff were encouraged to report incidents and all staff had access to this. Staff could complete paper forms when they were unable to access the electronic form at an event site. However, staff were not always clear on what they should report as an incident and were not able to provide an example of learning following an incident.
• All staff were required to complete mandatory training in key skills. Staff who were not up to date with their mandatory training could not work until they were compliant.
• Volunteers responsible for emergency driving were required to undertake blue light driving training and an assessment with an external provider.
• The service had enough staff with the right qualifications, skills, training and experience to keep patients safe. All event first aiders were volunteers that could be accessed nationally when required.
• The service controlled infection risk well. The ambulances we saw were visibly clean and tidy with access to personal protective equipment.
• All essential emergency equipment was stored correctly and was ready to use. Consumables were in date and in undamaged packaging. The seats and stretchers in all ambulances we saw had harnesses and seatbelts to ensure patients could be safely conveyed.
• The service had access to a 4x4 vehicle which had been used to assist the NHS during heavy snow fall.
• The service had access to communication aids to assist staff communicate with patients. Each ambulance had a communication booklet of pictograms to use with people unable to verbalise their needs. Staff could access language line if required and each ambulance had a multi lingual phrase book in the document folder.
• Volunteers, staff, local and senior managers were passionate about working for the organisation and upholding its values.
• The service had a clear management reporting structure and the leadership team were able to give a clear account of how it worked.
• The service engaged well with volunteers. Weekly or fortnightly meetings were held locally, and volunteer coordinators attended to provide updates and discuss training.

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 one requirement notice that affected emergency and urgent care services. Details are at the end of the report.

Nigel Acheson

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