ERS Medical North East

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

This means we looked for evidence that people were protected from abuse and avoidable harm.

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

This meant people were safe and protected from avoidable harm.

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 have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had developed a patient safety incident response plan to ‘…define actions, responsibilities, and standards that … our patient’s, require and have an expectation of when receiving care, treatment, and transportation.’ The plan identified how staff and the service were expected to respond to an incident encouraging learning and improvement.

Staff were encouraged to report all incidents on a care hotline available 24 hours a day. In the last 12 months staff had reported 11 health & safety incidents and 21 safeguarding events across the company. Each had been investigated, discussed within governance processes and learning identified. Training had been designed for staff to involve service users and family in identifying learning from incidents.

An example of the process was the conveyance of an elderly service user to attend regular treatment. On arrival the service user was transferred from the ambulance into a hospital porter’s chair which struck a lowered kerb, stopped abruptly causing the service user to fall from the chair.

Learning identified was that porter chairs are not designed or intended to be used outside of a hospital premises, under no circumstances are hospital porter chairs to be used to transfer a service user to a vehicle, the importance of adherence to a service user’s booked mobility criteria is critical. Also, decisions to change mobility criteria must be done only following the correct procedure and by contacting the control team.

Staff we spoke with knew how to report serious incidents and adverse events, they were aware of their responsibilities regarding Duty of Candour requirements.

We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between different services.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service received calls for transport within existing contracts and occasionally on an individual basis. All calls were taken by experienced staff who followed the service’s referral and admission processes ensuring all essential information about the service user was recorded. This meant all the needs of service users were safely met.

Staff involved all necessary healthcare services to ensure service users had continuity of safe care. Procedures were in place to ensure there were pathways in place for requesting local NHS ambulance assistance when responders identified a higher category on attendance than initially reported.

We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, and we make sure we share concerns quickly and appropriately.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

All staff had received safeguarding adults and children level 2 training during their induction and through annual refreshers. Staff knew how to make a safeguarding referral when necessary.

Staff were able to discuss situations where they had identified issues which may lead to safeguarding issues and reported these to the designated safeguarding lead (registered manager). The training staff had received included how to protect service users from harassment and discrimination, and how to identify adults and children at risk of significant harm. This included working in partnership with other agencies.

The designated safeguarding lead was trained to Safeguarding Children Level 3 and Safeguarding Adults level 3.

We work with people to understand and manage risks by thinking holistically so that care meets their needs in a way that is safe and supportive and enables them to do the things that matter to them.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Initial calls to the service were received by call handlers who fully identified the care and treatment needs of service users, completed a patient referral form which included their location, presenting complaint, medical history and medication, and any support or advocacy needs.

Responders then identified further care and treatment needs ‘on arrival’ at the service user’s location, such as medical history, condition and treatment needs in consultation with the service user or next of kin.

These details were recorded and used to make appropriate judgements for the transport of the service user, for example treatment and equipment needs where necessary. These details were recorded and further advice given to the service user where necessary. Any concerns were also recorded and an overall risk level assessed; staff applied deteriorating patient policies and procedures and accessed clinical advice where applicable.

We detect and control potential risks in the care environment and make sure that the equipment, facilities and technology support the delivery of safe care.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service used fully equipped ambulances at two sites providing transport services within two geographic locations, near the service catchment areas and within easy access to local hospitals and care services.

All ambulance were kept within secure and monitored compounds at the two locations. Daily ambulance checks were carried out confirming the road worthiness and maintenance of the vehicles. Checks of the physical condition of ambulances, all equipment utilised on vehicles, gases such as oxygen, medication, defibrillator, carry chair for children, mobile phone and radios were carried out. All equipment was within date and well maintained; vehicles had been serviced regularly and all had current MoT certificates. Schedules for deep cleaning of ambulances were in place and complied with.

Daily checklists of the ambulance were uploaded to the service systems and audited through checks of ambulance daily records.

We make sure there are enough qualified, skilled and experienced people, who receive effective support, supervision and development and work together effectively to provide safe care that meets people’s individual needs.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service was staffed by teams of qualified responders located at the two sites. and we saw there was a comprehensive induction and training programme for all new staff and refresher training for staff already employed.

Induction training included for example equality, diversity and human rights, moving and handling, safeguarding adults and children, and Oliver McGowan training on learning disabilities. Annual refresher training was presented on areas such as health, safety and welfare, infection prevention and control. Further refresher training was available every three years for conflict resolution, data security, living with dementia, and Mental Capacity Act as part of human rights, for example.

The service identified and displayed in advance staff for each shift and rota to cover anticipated demand and had processes in place to cover any shortfall in staffing due to absence or sickness – sickness and turnover rates of staff were low. Staff confirmed shift patterns allowed for adequate breaks.

We reviewed staff files which confirmed all recruitment processes, including references and Disclosure and Barring Service checks had been carried out.

We saw the service had developed comprehensive supervision systems and undertook regular appraisals of staff performance. Staff engagement processes were in place as well as mechanisms for staff to raise suggestions or concerns.

We assess and manage the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service had an infection prevention and control policy in place which identified training available for all staff to undertake at induction and on an annual basis. Training and awareness were available to identify direct and indirect methods of spreading infection and ways to manage and minimise its impact. The service had patient safety committees in place to ‘…define, support and review all matters relating to IPC.’ The company medical director was the lead for infection prevention and control.

We saw the service had identified standard infection control precautions (SICPs) to be used by ‘… all staff, in all care settings, at all times, for all patients whether infection is known to be present or not’, to ensure the safety of those being cared for, staff and visitors. These were:

• Patient placement/assessment of infection risk;
• Hand Hygiene;
• Respiratory and cough hygiene;
• Personal Protective Equipment use - (gloves, aprons, facemasks, goggles);
• Safe management of the care environment, such as vehicles;
• Safe management of equipment;
• Safe management of healthcare linen;
• Safe management of blood and body fluids;
• Safe disposal of waste (including sharps); and
• Occupational safety and managing the prevention of exposure (including sharps).

We saw SICPs were reported and audited showed good compliance, any issues were raised with individuals when necessary. All cleaning records were up to date, and confirmed cleaning was completed daily.

Records showed an in-house deep clean was carried out on ambulances every 13 weeks and additionally when needed. Daily and monthly audits of infection prevention and control measures were carried out on ambulance bay areas, equipment stores and general purpose areas.

We make sure that medicines and treatments are safe and meet people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Standard operating procedures had been developed for the use of medications, such as oxygen, the only medication carried on vehicles. These included required professional qualifications and confirmation of specialist competences required for safe administration, such as training in the use and administration of the specific medication.

Crews were able to transport patients on oxygen on any dosage if that patient had already been prescribed, continuation of care already being administered. All administration of oxygen was documented on the patient report form or incident report form.

Further safeguards included referral arrangements to a supervising doctor, receiving facility or the company’s clinical support desk. Any administration was recorded, subject to audit, and documented method of administration, dosage and indications. Specific inclusion and exclusion criteria, requirements for further advice and potential side effects were identified.

We saw medicines were administered in accordance with SOPs developed and covered the correct storage on the ambulance and within the service premises, administration, documentation and waste management. Regular medication audits had been completed showing full compliance, including temperature checks of the storeroom.