Archived: Jigsaw House Cheshire

Updated 18 April 2018

Jigsaw Medical Services is operated by Jigsaw Medical Service Ltd. The service opened in 2012 and is an independent ambulance service with the head office in Chester, Cheshire. The service has expanded since 2012 and has ambulance bases situated in Warrington, Buckingham and Basingstoke. The service serves a number of communities including, Greater Manchester, Cheshire, Merseyside, Yorkshire, East Midlands, Buckinghamshire, Oxfordshire, Berkshire and Hampshire. The urgent and emergency care vehicles are operated mainly from the Buckinghamshire base.

The service provides emergency and urgent care to a number of NHS ambulance trusts and is provided in specific emergency vehicles.

The patient transport service provides support to several ambulance trusts as well as NHS acute hospital trusts and individual patients. The service consists of both contract and ad hoc work.

Jigsaw Medical Services also provide an ad hoc events’ support service to sports events and festivals.

The provider is registered with the Care Quality Commission (CQC) to provide the following regulated activities:

Treatment for disease, disorder and injury

Transport services, triage and medical advice provided remotely.

The service has had a registered manager in post since 2012. In the months preceding the inspection the registered manager role had transferred from the chief executive officer (CEO) to the managing director.

We completed an announced inspection in the head office and the Buckingham base on 9 January 2018 and the Warrington ambulance base on 10 January 2018.

Updated 18 April 2018

Jigsaw Medical Services provides emergency and urgent care and a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 9 and 10 January 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.

The main service provided was emergency and urgent care with a smaller level of patient transport activity therefore we have reported findings in the emergency and urgent care 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 areas of good practice:

• The provider had strong leadership with a clear focus on high quality provision and care.
• We found all vehicles were in good condition and a comprehensive system was in place to ensure they were fit for purpose.
• An effective compliance process was in place to ensure operational staff had completed induction and mandatory training before commencing employment and also that staff remained compliant during the time they continued to work for the provider.
• Risk assessments were completed for any ad hoc patient transfers to ensure the correct vehicle, equipment and appropriately trained crew were assigned to meet the needs of the patient.
• Arrangements were in place for escalating issues with contracting trusts. A contract manager was identified within each trust and monthly contract meetings took place to monitor performance and provide feedback regarding incidents and referrals.
• Mental Capacity Act (2005) training compliance was 100% for operational staff at the time of our inspection.
• Staff were committed to providing the best quality care to patients and we observed staff demonstrating patience, kindness and respect.
• Staff had access to practitioners trained in Trauma Risk Management (TRiM) to support personnel following traumatic events. TRiM is a peer delivered psychological support system designed to allow organisations to proactively support personnel following traumatic events.

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

• The provider did not have a record of all incidents or safeguarding referrals reported through trust processes and relied on the contracting trust to feed the information back either by telephone or during monthly contract meetings. This meant the provider did not have oversight of all incidents and safeguarding situations operational staff had been involved in and relied on the NHS trust to identify any immediate learning.
• The provider did not have robust processes to ensure the safe disposal of out of date medicines.
• Not all staff had received an appraisal and documentation we reviewed did not indicate any standards or provide a clear scoring system.
• Patient feedback forms were not available on all vehicles we inspected. Staff were not always involved in complaints from the NHS trust and did not always receive feedback.

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 issued the provider with one requirement notice that affected both emergency and urgent care and patient transport services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North), on behalf of the Chief Inspector of Hospitals.

Updated 18 April 2018

We have not rated this service because we do not currently have a legal duty to rate this type of service or the regulated activities which it provides.

The main service provided was emergency and urgent care.

The service also provided patient transport services. As this was only a small part of overall activities, this has been reported under emergency and urgent care services.

The provider had strong leadership with a clear focus on high quality provision and care.

Arrangements were in place for escalating issues with contracting trusts.

Staff were committed to providing the best quality care to patients and we observed staff demonstrating patience, kindness and respect.

However, the provider did not have a record of all incidents or safeguarding referrals reported through trust processes therefore did not have oversight of all incidents and safeguarding situations operational staff had been involved in.

The provider did not have robust processes to ensure the safe disposal of out of date medicines.