Archived: Trust Medical Ambulance Services

Trust Medical Ambulance 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 20 and 21 July 2017 along with two unannounced visits to the service on 25 July 2017 and 2 August 2017.

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.

Urgent and emergency services were a small proportion of activity. The main service was patient transport services therefore we have reported findings in the patient transport section.

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 issues that the service provider needs to improve:

• There was no clear procedure for reporting incidents. The information collected about accidents, incidents and near misses was not used to identify trends and themes.
• Not all equipment in use for the bariatric ambulances was up to date with testing under the Lifting Operations and Lifting Equipment Regulations (LOLER, 1998).
• Patient records on the patient transport service were not always completed accurately.
• The systems in place to respond to concerns about patients did not ensure all potential risks of abuse or neglect were identified, acted upon and reported in a timely way. Action was taken by the provider during the inspection and improvements to the systems were made.
• Not all staff had been assessed for their competence to complete specific tasks for patients. This included staff that had completed a recognised health professional qualification, but had no ongoing assessment of their competence.
• Staff that provided care and treatment to children were not up to date with their paediatric life support training.
• Staff were not clear how to obtain or record consent to travel from patients especially those who may lack mental capacity to make their own decisions.
• Staff had not received training regarding their role and responsibilities in the assessment and support of patients who lacked mental capacity. There was no general mental health awareness included in the mandatory training.
• The staff were not all up to date with their annual appraisals.

However we found the following areas of good practice:

• The premises we visited and the ambulances we saw were clean, tidy and stocked with the items deemed necessary dependent on their level of response.
• Medicine management systems ensured the safe storage, administration, recording and disposal of medicines.
• Records were managed so as to protect the confidentiality of patients and meet data protection requirements.
• Most staff were up to date with mandatory training.
• There was a comprehensive induction process in place for new staff.
• Ambulance staff had pocket books which provided comprehensive information about how to assess a patient’s condition and actions to take.
• There were procedures in place to assess and respond to a patient whose condition deteriorated.
• Staff were very complimentary about the leadership of the service, including the visibility of managers at the remote sites. There was an open culture with common shared values.
• The provider and managers were responsive to concerns we raised during the inspection and worked to make improvements in a timely way.

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 also issued the provider with five requirement notices 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