ERS Medical North East

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care.

We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This was the first rated assessment for this service. This key question has been rated good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We spoke with staff who booked service users for transport. The initial contact at the time of booking was used to determine essential information such as confirmation of the collection and destination addresses, for example home, ward, discharge or outpatient department. During this process details of any escort for the service user were also noted.

In line with service policies details of access or egress issues at the collection and destination locations were taken. These may be due to physical issues at the location, but the service also recognised the service user’s mobility at the time of booking could have an impact and recorded these details, such as walking with a stick or frame, history of falls.

Further individual needs were also recorded, for example infection protection and control precautions, on-going medical treatments such as oxygen therapy, communication and cognitive issues, and any additional, relevant information known. We saw these details were passed to other agencies when needed.

Plans were in place for nutrition and hydration needs on long journeys which were always prebooked. All vehicles carried water for all patients as required regardless of journey time and distance. Discharging hospitals were encouraged to provide nutrition and accompanying carers provided required support. Protocols were in place to maintain the tissue viability and hydration needs of service users.

We plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff followed clinical guidelines and quality standards appropriate to the service, including protocols for children and other service user groups which reflected their cultural needs, updated through reference to dispatch control and/or the service clinical lead. Staff understood the culture and assessed the nutrition and hydration needs of service users appropriately. A pain assessment tool was used by staff throughout the service user’s journey.

Staff were trained in their roles and supported to maintain and update their skills. All training was aligned with guidelines set out by National Institute for Health and Clinical Excellence (NICE), the Resuscitation Council UK (RCUK) and the Joint Royal Colleges Ambulance Liaison Committee (JRCALC). These standards were reviewed and approved by the service medical director and executive management team ensuring clinical accuracy, safety, and regulatory compliance. The service empowered staff to report any concerns and to share good practice.

Service user feedback showed they were very satisfied with the care and support provided. A feedback procedure was completed for each call to the service with consistently positive feedback from service users, confirming the appropriateness of the service provided.

The service monitored key performance indicators for the actual time to service user pick-up and the time service users spent on the vehicle. These showed the service was meeting and exceeding expected targets.

We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service demonstrated effective teamwork, both internally and with external partners, particularly the local NHS ambulance service and NHS trusts. We saw effective communication between the service and local NHS trusts.

An example given was the transport of a bariatric patient to their home following discharge from hospital involving gaining access to the service user’s home by the fire service. Before accepting the service user for transport, the service requested details of the needs of the individual, such as weight and constraints at the property.

On this occasion we saw the service had been informed there were difficulties accessing the property and prior to discharge the property was assessed by the service. Once details had been confirmed the service then confirmed the date and time for transport; the transport was ‘…prioritised due to the complexities and number of other teams involved.’

A further example given was the care given to a service user of no fixed abode discharged from hospital who was advised to go to their GP for treatment. This was noted on the service user’s discharge documentation, and they were transported directly to the GP.

We support people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

We scored the service as 3. The evidence showed a good standard. The service always supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

The service provided a range of examples of how it supported the health and wellbeing of patients and the local community. These ranged from introducing school children to the work of an ambulance delivering patient transport and basic resuscitation techniques to organizing fundraising events and foodbank collections. The service also introduced pupils to the work of ambulance care assistants through career days.

We saw feedback that showed a high level of service user satisfaction and evidence of its links with the local community. All journeys were triaged against strict eligibility criteria within the service’s booking system designed to prevent inappropriate transport. This ensured the service was reserved for clinically appropriate service users, supported independence and reduced reliance on NHS resources where possible. We saw booking forms recorded mobility, clinical needs, anxiety, pain, and social factors (for example childcare, return time, support at home). Control staff and crews viewed this information in real time, ensuring tailored support and patient-centred journeys.

Staff had been trained to identify and escalate health changes, deterioration, or safeguarding concerns, enabling service user escalation pathways supporting early intervention and timely clinical handover. Crews promoted independence by encouraging self-mobilisation where clinically safe, and by assisting service users to maintain routine attendance for outpatient appointments. All ambulance care assistants completed annual refresher training in person centred care, dementia awareness, and communication skills.

The company had worked with the Alzheimer’s Society and local dementia networks to understand service user experience in more depth and adapt communications, crew training and service design accordingly. Workshops had been held with service users, carers and partner organisations to identify service improvements and share learning, such as engagement teams to review themes, share learning and implement changes to improve outcomes.

We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service continuously monitored and supported the care and treatment it provided to service users and families. Clinical deterioration in a service user’s health was closely monitored and the service effectively supported and improved outcomes for service users.

Key performance indicators were monitored, and the service benchmarked its performance with other organisations. Key performance indicators were routinely audited and the service presented performance against its expected standards, including how it performed against expected response times.

We saw responders completed clinical diagnoses and functional assessments of the service user on arrival to determine whether they had capacity to consent. Following service users consenting, the service respected their wishes, provided advice where necessary and obtained feedback which demonstrated the service achieved very positive outcomes for service users which met and exceeded expectations.,

We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights as to consent and respected these when delivering person-centred care and treatment.

The service had policies in place to ensure service users had the capacity and competence to consent by making an informed decision, or by a representative with authority to do so. The service consistently explained their rights to service users and obtained their consent, which was recorded on the patient record form.

Consent was required for all plans that affected service users’ care or treatment, including before any medical observations being taken, any manual handling that is required in assisting the service user and entering a service user’s home address.

We spoke to staff who were all aware and understood consent requirements. Staff understood and obtained consent in line with legislation and guidance including the Mental Health Act, Mental Capacity Act 2005, and knew who to contact for advice, which was recorded in the patient record form.

Staff received and kept up to date with training in the application of the Mental Capacity Act as part of human rights training and understood when to assess whether a service user had the capacity to make decisions about their care. The service did not transport service users who were detained under the Mental Health Act or were experiencing a mental health crisis.

As part of the booking process discharging hospitals were required to advise if a do not attempt cardiopulmonary resuscitation (DNACPR) was in place. This was also recorded on the booking form for telephone requests. Staff also confirmed this on wards at the time of collecting a patient.