Hardcore Medical & Ambulance Service

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed evidence and found positive feedback on care from patients and patients representatives evidenced in emails, cards and HMAS formal feedback on care. Staff and leaders told us they have a proactive learning culture, underpinned by HMASs own professional and reputational values.

The staff and leaders were able to demonstrate, explain and evidence the HMAS values which included patient-centric focus, open communication, ethical conduct, teamwork, continuous improvement and positive attitude throughout the organisation.

Staff and leaders told us concerns were listed, and safety events are investigated, reported and lessons are learned.

The service had established processes in place to learn from feedback, compliments and complaints. The service had a process in place to share feedback and communications with staff. We saw significant evidence of responsive actions and processes from both staff and leaders’ perspectives following feedback on the service. We found evidence of ongoing service wide learning and improvements to maintain good practice and meet HMAS own service values following feedback from staff, leaders, patients experience and NHS feedback.

We saw evidence of peer-to-peer service user feedback shared to staff from HMAS management in letters of appreciation. Examples of compliments included thank you emails from professionals, service users family members which described kindness, compassion and individual care planning to meeting their needs.

Service user and family feedback seen showed HMAS staff caring for a vulnerable person were friendly, polite, professional and the had given information about everything that they were doing to help the person. The staff were described as kind and caring throughout. The service user was transported to hospital staying until the service users care was handed. Feedback described HMAS as “a really good service”.

Safe
This service is safe

We rated this key question as good because the service used effective systems and processes to store medicines, and managed cleanliness infection prevention well. Vehicles and equipment were well-maintained, the service demonstrated they had effective arrangements and processes in place to monitor the safety and upkeep of consumables, equipment and vehicles.

We rated this key question as good because staff followed effective systems and processes to store medicines. Staff managed cleanliness and infection prevention well. Leaders ensured vehicles and equipment were well-maintained. Staff followed arrangements and processes in place to monitor the safety and upkeep of consumables, equipment and vehicles. The service managed patient safety incidents well. Staff were competent and trained to undertake their role.
 

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We rated this as ‘good’ as This service maximises the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

People's Experience
We reviewed evidence and found positive feedback on care from patients and patients representatives evidenced in emails, cards and HMAS formal feedback on care.

Staff and leaders told us they have a proactive learning culture, underpinned by the providers own professional and reputational values. The staff and leaders were able to demonstrate, explain and evidence the underpinning HMAS values which included patient-centric focus, open communication, ethical conduct, teamwork, continuous improvement and positive attitude throughout the organisation. Staff and leaders told us concerns are listed too, and safety events are investigated, reported and lessons are learned.

Staff and leaders told us concerns were listened to.

The service had established processes in place to learn from feedback, compliments and complaints. The service had a process in place to share feedback and communications with staff. We saw significant evidence of responsive actions and processes from both staff and leaders’ perspectives following feedback on the service. We found evidence of ongoing service wide learning and improvements to maintain good practice and meet HMAS own service values following feedback from staff, leaders, patients experience and NHS feedback.

We found managers and staff had made changes to how they did tasks following patient feedback. For example, when transporting service users, staff ensure they monitor of the risks in moving people and the potential impact on service users’ skin. This showed a learning culture of being open to use feedback to improve care and treatment.

We saw evidence of learning from patient safety evidence, incidents being reported, reviewed, investigated and any learning shared. Learning from incidents were shared in the HMAS newsletters, staff emails, team briefing and posters to enable a learning culture.

Good – This service maximises the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

Leaders and staff were able to describe and show us HMAS systems, and pathways that were used and introduced into the service.

The service had feedback from an NHS ambulance provider following an audit and action plans were created and completed by HMAS.

The service worked with the local NHS ambulance trust to see more patients as part of the urgent and emergency services.

Leaders engaged with local NHS trusts and integrated care systems to support the delivery of care.

The service had effective processes and systems in place. HMAS had a robust safeguarding process which included the local authority, local NHS ambulance service and hospitals.
 

HMAS had agreements with local AEs to telephone ahead if they had a very unwell patient, and they had pathways for AE avoidance where they refer to other community services rather than covey to hospital where appropriate.

HMAS had good electronic handover documents which shared relevant info when handing over care to care providers which were audited by managers.

Good - This service maximises the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff and leaders told us they worked to local and district safeguarding policies. Staff received feedback from the NHS services they worked with. Staff had senior leadership on call to support if they wanted to discuss specific concerns. Staff showed us they work effectively to safeguard. The leaders and staff showed us audits, and incidents reported with outcomes.

Feedback from staff and leaders told us HMAS staff worked to their HMAS policies which were aligned to those of the local authorities providers they engaged with.

Partner agencies provide feedback from the local authorities and outcomes of referrals.

We found staff engaged with partner agencies such as the local authorities and NHS trust managers on call when safeguarding concerns were raised. Evidence seen showed us that staff made clear safeguarding referrals as required. These local partners provided evidence on feedback received on safeguarding referrals made to the local authorities which HMAS leaders reviewed.

Hardcore had involved in the local community at attending village events, school visits and community sporting events, and working with Leicester council by attending schools, colleges and universities to provide volunteer talks. We found all HMAS staff are invited to take part in the local community HMAS actives.

The service had embedded processes, policies, guidelines and support in place to ensure the service safeguarded patients, staff and volunteers.
HMAS staff were compliant with the intercollegiate guidance for training relating to safeguarding children and adults which included appropriate staff being trained to level 3 safeguarding for ambulance service staff providing urgent and emergency medical care. HMAS had a level 4 safeguarding lead.

All HMAS staff had disclosure and baring service (DBS) checks completed prior to employment with HMAS to ensure they were safe to be employed to do their role.
 

Good – This service maximises the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s experience was gathered from complaints, compliments and feedback provided to the service. People shared they felt the service was a safe environment.

We reviewed service user feedback which showed us that HMAS staff were able to talk to service users to understand their medical problem, so the staff provided the best care. the Staff completed service user risk assessments considering their patients clinical and social needs, including stroke and mental health conditions.

Staff and leaders showed the service learnt from incidents and risks to improve the service. The service had a risk register in place and staff were aware of their risks, how to escalate and manage the identified risks.

Staff did risk assessments with patients such as assessments for strokes and mental health conditions. Where possible, staff fully involved the patient or people with the patient when assessing them, which meant staff better understood the patient's needs and health risks.

Audit and governance processes were used by the service to gain assurance in relation to the safety of the service and environments.

HMAS has processes for the Reporting of Incidents, Diseases and Dangerous Occurrences Regulations (RIDDOR), complaints, accident and incident reporting, safeguarding and major incidents.

Good – This service maximises the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We found evidence from service users feedback showing that HMAS staff consider and manage the risks including when some service users may have been unconscious or unable to communicate.

Leaders and staff emphasised continual service improvements and developments to staff and equipment, ensuring the environment was safe. We observed staff openly discussing how the service had encouraged staff to bring forward initiatives, develop the service and environment, alongside their own professional development with the focus on ensuring the environment is safe.

Leaders and staff told us about upgrades to equipment and facilities to make the service safer for patients.

Staff told us they were encouraged to share ideas to improve the environment with the focus on ensuring the service is safe.

We saw how the service had previously changed its storage of medical gasses to ensure a safe environment was maintained following a move to new premises and feedback for other agencies.

Managers completed audits of patient records to ensure staff had completed holistic risk assessments with patients and people with the patient. Where areas of improvements were identified through these audits, managers shared this with staff for learning.

Audit and governance processes were used by the service to gain assurance in relation to the safety of the service and environments.
 

Good – This service maximises the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

People's Experience
People’s experience was gathered from complaints, compliments and feedback provided to the service.

Feedback from service users showed they found staff to be caring and competent when providing care and treatment.

Staff told us that HMAS managers give feedback to individual staff and people they have worked with on the shift. They have a “buddying” system in place with mentors being trained to an appropriate relevant peer competence level to ensure appropriate feedback to staff. Staff and leaders told us staff complete “peer to peer” shifts and discussion. Team leaders and managers place the “peer to peer” staff considering both clinical and social skills are undertaken, and feedback is given.

Team leaders told us they allocate shifts to staff considering both clinical and social skills.

The service told us they had a process to complete the annual appraisal for all employed staff. As subcontractors are not employed by HMAS, the service holds an annual business meeting to discuss contractual arrangements which we identified was not an appraisal or clinical competence review. Service leaders have since reviewed and amended their process to ensure clinical competence review is included in the annual subcontractor meetings. HMAS have a process for archiving staff that have not worked more than 12 months.

Managers had introduced a new 360 review process that managers or team leaders complete, plus staff are expected to have completed 2 peer to peer reviews, 2 patients feedback a month all of which is looked at in appraisals. Managers ensured all employed staff working for their service had an annual appraisal which reviewed competency to undertake their role.

Managers had a live training data spreadsheet showing all of their employees training compliance which included dates of what training was due. Managers scheduled

Leaders completed audits and followed governance processes to gain assurance about the safety of the environment including the ambulance vehicles and the base location.

The service had a system to ensure all vehicles were in date with MOTs and servicing; and clinical equipment was serviced in line with manufacture guidelines.

We reviewed records and found all vehicles and equipment checked were in date and safe for use. Training had oversight of which training was due to ensure staff maintained their competences.

HMAS had a flexible workforce with 18 staff employed on a flexible or zero hour contract and 31 subcontracting staff used to enable them to ensure they had sufficient numbers of appropriately trained staff to provide safe care and treatment.

Professional registration checks are completed when employed however we found no formal process to routinely check paramedics pin numbers.

Good – This service maximises the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s experience was gathered from complaints, compliments and feedback provided to the service. People shared they felt the service was a safe environment.

Staff and leaders told us they audit the vehicle cleaning and deep cleaning. Supplies of gloves, sleeve protectors, anti-bacterial wipes, hand sanitiser, face masks, aprons and moisturising cream all stored in vehicles. At the end of each shift a summary is completed by staff which includes confirmation of cleaning.

The service evidenced they complete daily cleaning checks and the evidenced that the appropriate products for cleaning were available, including specialist cleaning equipment for spills.

Staff cleaned equipment and vehicles in between each patient and knew about how to deal with body fluid spills, such as blood or vomit, using specialist products.

Staff completed daily cleaning including the use of specialist cleaning tablets for floors and alcohol wipes, and specialist spill kits.

Staff completed end of shift summary which included confirmation of cleaning.

We had only onsite observations and we reviewed the services cleaning data and audits in addition to looking at the vehicles on site. We found vehicles were visibly clean and tidy.

We observed staff using hand sanitiser and PPE appropriately in between patients. Staff disposed of used PPE in line with the service's IPC policy. Staff had access to PPE and cleaning equipment such as gloves, sleeve protectors, anti-bacterial wipes, hand sanitiser, face masks, aprons and moisturising cream on board vehicles.

At the end of each shift a summary is completed by staff which includes confirmation of cleaning. Infection prevention control (IPC) audits were completed monthly, hand hygiene audits completed bi-monthly and used clinical waste bags were appropriately stored in locked cages and audited. We reviewed the services vehicle IPC data and established that vehicles have a deep clean 6 weekly and there was a written certificate to demonstrate this cleaning. Additional details are kept on the electronic portal which includes Adenosine Triphosphate (ATP) swab results, which are used to measure the cleanliness levels of a service. The service evidenced they complete daily cleaning checks and the evidenced that the appropriate products for cleaning were available, including specialist cleaning equipment for spills. The HMAS audit planner is a dashboard which rated their risks by colour with the greatest risk rated as red, amber as medium and green as low (RAG) on an electronic system. A communication bulletin was sent out to all staff, and a targeted approach together with the introduction of an additional new patient records form training was being developed by the service. Results from patient record form (PRF) audit in August 2024 showed the service as being green and compliant without any specific issues related to the compliance of completing PRF. Audits included clear desk audit, safe storage of patient record forms, the International Organization for Standardization (ISO), fire safety, business continuity, medical waste disposal, reporting of injuries, Reporting of Incidents, Diseases and Dangerous Occurrences Regulations (RIDDOR), complaints, accident and incident reporting, safeguarding and major incidents.

We saw the vehicle cleaning bay was in line with national guidance such as different coloured cleaning equipment for different areas, and appropriate cleaning chemicals available.

Vehicles had a deep clean every 6 weeks and had written certificates seen and HMAS kept records on the electronic portal.

Good – This service maximises the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We were unable to evidence peoples experience relevant to medicines optimisation due to no patients being spoken with during the onsite inspection.

People's Experience was gained from service user feedback, compliments and complaints.

A Patient Group Direction (PGD) is a legal document that lets certain health professionals give medicines to a group of patients without a prescription. Staff told us they worked to patient group directions (PGD) of which technicians working did so on the same strict criteria as if they were contracted by an NHS provider.

National guidelines set out what each grade is allowed to give in accordance with the PGD. Leaders told us that the NHS ambulance service they were contracted to was for as an service emergency staff at a technician level only.

Staff and leaders had confidence in their new stock ordering policy and process and demonstrated to the inspection team an understanding of the need to appropriately monitor stock usage. The NHS ambulance who had a contract with HMAS completed a service audit. Actions completed following this service audit included the safe storage of gasses.

HMAS staff and leaders told us following on from this audit they had put effective procedures in place to ensure the safe and appropriate management of medicines and included the appropriate storage gasses. At the time of inspection, HMAS had implemented the actions, and we found oxygen and entonox stored in a secure locked area within the ambulance garage.

Leaders showed us they had security measure in place regarding medicines management which included a camera inside the medicine cupboard. The medicines cupboard also was seen to have a combination code locked door entry and a medicine fridge monitoring system alerts managers staff if the fridge temperature goes out of range.

Staff and leaders told us they had a new stock control process whereby stock levels and reordering were monitored, reviewed and ordered to prevent overstocking or shortages. We found that the emergency medicine packs/ technician drug packs were all tagged. The service had an effective process for monitoring and checking expiry dates of consumables.

We checked 15 medicines, and all were found to be in date to use. HMAS had applied for the storage of controlled drugs licence prior to the move to new premises, however under the requirement of the licence they were now required to reapply for this licence, so no controlled drugs were held by HMAS. We identified that appropriately trained paramedics and doctors working for HMAS were on a self-employed subcontractor basis. Under their professional registration, staff were permitted to store, provide and administer controlled drugs. However, we found at the time of the on-site assessment that HMAS did not have a process to monitor or audit the use of these controlled drugs being brought into the service, although all medicines should be documented in the patient record form. Leaders of HMAS accepted this feedback constructively and within 24 hours had developed a process and standard operating procedure. Medicine management processes included auditing securely stored medication, completing spot checks, actions completed from last audit sign in and out, and fridge temperatures.