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SSG UK Specialist Ambulance Service - South Inadequate

The provider of this service changed - see old profile

We are carrying out checks at SSG UK Specialist Ambulance Service - South. We will publish a report when our check is complete.


Inspection carried out on 23 August &4 September 2018

During a routine inspection

SSG UK Ambulance – South is operated by SSG UKSAS. The service provides emergency and urgent services and some patient transport service and all services are commissioned by NHS trusts.

We carried out a responsive review of the service to follow up on some concerns we had received relating to medicines, staffing, overall management of the service and one of the provider’s ambulances being involved in a road traffic collision (RTC). This RTC is subject to a Police investigation and as a result this inspection did not examine the circumstances of the incident.

We carried out the unannounced part of the inspection on 23 August 2018 along with another unannounced inspection to the provider’s headquarters on 04 September 2018.

The service had a combination of patient transport, emergency response ambulances and five secure vehicles. The secure vehicles were used for the transport of mental health patients, these vehicles all had a secure area or cell.

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:

  • Medicines were not managed safely and securely which may impact on the safety of patients. This included receipt, storage and disposal of controlled medicines.

  • There was no evidence that paramedics and technicians had completed the appropriate training and competency to administer medicines safely.

  • The administration of medicines via patient group directions was not effectively managed which posed risks to patients’ safety.

  • Incidents which affected the health and welfare of patients were not reported in line with the Care Quality Commission’s requirement as part of the provider’s registration.

  • The staff who undertook the transfer of mental health patients did not follow national practice guidance and risk assessments were not completed. We were not assured that patients were adequately safeguarded from the risks of harm.

  • The use of mechanical restraints had not been risk assessed and procedures for their usage were not fully developed to ensure the least restrictive means were used on potentially very vulnerable patients.

  • The recruitment process did not ensure only suitable individuals were employed. Records of checks and fitness of staff were not available or incomplete.

  • There was a lack of an effective system to review fit and proper persons being employed. Pre- employment checks for directors were not all available to assess the fitness of the directors.

  • Not all staff had completed training appropriate to their role. Training such as practical intermediate life support, medicines management and safeguarding children had not been completed by all staff.

  • There was no competency framework to provide assurance that staff were competent to undertake their role in line with best practice.

  • There were limited clinical policies and guidelines to support staff and provide evidence based care and treatment. Those policies and guidelines that were in place included out of date information, referred to roles that were not in place.

  • There was no effective incident reporting system and process in place and limited evidence of learning from incidents to improve practices and minimise the risks of these re-occurring.

  • There was an ineffective governance process that did not provide assurance and leadership.

  • There were limited systems to monitor the safety and quality of the service. Audits were not undertaken and therefore learning did not take place from the review of practices and procedures.

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

  • There was a process that was followed to ensure vehicles were serviced regularly and they were roadworthy.

The service was rated as inadequate overall. I am placing the service into special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Following this inspection, we told the provider that they must take some actions to comply with the regulations and that they should make other improvements, even though a regulation had not been breached, to help the service improve.

We also issued the provider with two Warning Notices and four requirement notices that affected SSG UK Ambulance – South. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals