Archived: SSG UK Specialist Ambulance Service - Corporate HQ

Updated 11 September 2019

SSG UK Specialist Ambulance Service Ltd – Corporate Headquarters is operated by SSG UK Specialist Ambulance Service Ltd. The service was registered with the CQC in July 2017. The service was previously registered with the CQC under a different name. It is an independent ambulance service in Rainham, Essex. The service provides emergency and urgent services and some patient transport service and 92% of services are commissioned by NHS ambulance trusts with the remaining 8% of services being commissioned by the police, prison service and independent healthcare providers.

The service has had a registered manager in post since August 2017. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage a service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how a service is managed.

The organisation is registered with the CQC to provide:

• Transport services, triage and medical advice provided remotely

• Treatment of disease, disorder or injury

The Rainham headquarters location was last inspected in November 2018. The CQC issued the provider with five warning notices, requirement notices and ‘should do’ actions following the inspection.

We carried out a comprehensive inspection of the Rainham Headquarters location on 8 and 9 May 2019.

During the inspection, we spoke with 18 staff including; registered paramedics, emergency care assistants (ECAs), ambulance care assistants (ACA), technicians, managers and service leadership. During our inspection, we reviewed staff and 12 patient records and looked at organisation policies, documents and management information.

There were no special reviews or investigations of the service ongoing by the CQC at any time during the 12 months before this inspection.

Updated 11 September 2019

SSG UK Specialist Ambulance Service Ltd – Corporate Headquarters is operated by SSG UK Specialist Ambulance Service Ltd. The service provides emergency and urgent services and some patient transport service. NHS Ambulance trusts commission 92% of services with the remaining 8% of services being commissioned by the police, prison service and independent healthcare providers. For the purposes of this inspection we focused on urgent and emergency services only as patient transport services made up less than 10% of activity.

We inspected this service using our comprehensive inspection methodology. We made an unannounced visit to the service’s headquarters in Rainham on 8 and 9 May 2019. Another inspection team, from the CQC’s South Central region visited the provider’s location in Fareham, Hampshire on 15 and 16 May 2019. We previously inspected the service in November 2018. At that inspection, we identified significant concerns with the service. Following that inspection, we issued five warning notices requiring the service to take immediate action to address certain concerns. In addition, we told the service that there were other actions they should take to improve the service.

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.

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

• The service did not have an effective process for sharing the learning from incidents. In addition, staff said they did not routinely receive feedback when reporting an incident.

• Although the service was in the process of updating all staff records, there remained gaps in records, meaning that that there was limited assurance that the relevant safety checks and mandatory training had been completed. As such, the service did not have sufficiently accurate records to provide assurance that there were enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.

• It was concerning that staff were not aware that a vehicle had been decommissioned. With the exception of this vehicle, however, all of the vehicles we inspected were clean and clutter free.

• Whilst there had been some improvements in the management of medicines since our last inspection, there were still some issues. For example, some staff kept controlled drugs (Controlled Drugs)s in their home, but there was no clear policy as to which staff were eligible to do so. There was no permanent independent witness to the destruction of Controlled Drugs.

• There was limited evidence of clinical audit activity and the service did not have a planned annual audit programme.

• Staff had variable knowledge of their roles and responsibilities under the Mental Capacity Act. The service’s ‘capacity to consent’ policy was out of date.

• There was a disconnect and a level of distrust between frontline staff and the management team at all levels. Whilst senior leaders told us they continued to work to build trust with frontline staff, there was little evidence of this. Staff continued to describe bullying and unprofessional behaviours from senior staff and there was a perception that promotions were not always made on merit.

• We were not assured of the integrity or validity of information presented to the board. This meant the board did not have a complete corporate understanding of the risks and challenges to service quality and sustainability.

• Risks, issues and performance was not managed effectively. Whilst progress had been made towards addressing the concerns identified by the CQC in November 2018, this progress had been slow and had, in many areas, yet to have demonstrable impact.

However, we found the following areas of good practice:

• The service was now following the Duty of Candour (DoC) and staff were aware of their responsibilities under the DoC.

• There had been some improvements in the management of medicines. For example, the service now routinely monitored drug fridge temperatures.

• The service had suitable premises and equipment.

• The service was meeting the national standards expected under its NHS contracts in respect of response and turnaround times.

• Since our last inspection, all the service’s policies had been updated in line with national guidance and best practice.

• The service had introduced a patient survey.

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.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 11 September 2019

We have rated safe and well led as inadequate. Effective and responsive were rated Requires Improvement. We received insufficient evidence to rate caring. Whilst there had been some improvements since the last inspection.

However, there remained significant concerns.