ERS Medical North

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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

At our last assessment we rated this key question good. At this assessment the rating has remained good. 

Staff had the skills and knowledge to deliver effective care and described receiving appropriate training, including safeguarding, first aid and moving and handling. Risk assessment and handover processes supported effective decision‑making during transport. However, the effectiveness of organisational systems was undermined by inconsistent governance oversight, including policies and standard operating procedures that were not always current.

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

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service usually made sure patient’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. 

Staff assessed people’s needs before and during transport. They completed pre‑transfer risk assessments and carried out dynamic risk assessments when people’s conditions changed. Inspectors observed staff recognising deterioration and escalating concerns appropriately, including aborting transfers and returning patients to hospital when required. Staff demonstrated awareness of frailty, mobility needs, and complex health conditions.

Staff shared key information to keep patients safe when handing over their care to others. They knew what journeys were to undertaken and which patients they would be picking up and taking onwards to appointments or returning home. Shift changes and handovers included all necessary key information to keep patients safe.

We saw patients were generally calm, their faces appeared relaxed, and they were comfortable during journeys and transfer.

Staff took account of patient’s communication needs, particularly those with disabilities and with a sensory loss, however we did not see any evidence of dementia friendly boxes on vehicles. We observed staff using appropriate skills to engage with patients and to assess their needs. They also took account of cultural and social needs when planning patient related transport activities. 

The service usually planned and delivered patient’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards. 

Staff used guidance on patient transport safety and scope of practice to inform their decisions.  Polices and processes reflected updates to professional guidelines and staff described how changes were communicated through meetings and management newsletter. Care was delivered in line with organisational policies, which were aligned to National Institute Care Excellence (NICE) guidance where appropriate.

Staff followed guidance for moving and handling, oxygen administration, safeguarding, end of life and managing deteriorating patients. Policies and procedures were available electronically, and staff described how these informed their practice. Current policies and procedures were available electronically; however, some outdated printed copies remained displayed in the staff room. This was escalated during the assessment.

The service ensured staff were trained in relevant standards, including consent, mental capacity, learning disability, autism, and dementia awareness. Patient feedback was used to inform care and monitor performance through internal dashboards. 

All vehicles carried water for patients regardless of journey time and distance. Discharging hospitals were encouraged to provide nutrition and accompanying carers where required. 

Suitable protocols were available for children of all ages and other patient groups.

We reviewed 6 patient transport records and found the initial contact at the time of booking was used to gather essential information including confirmation of collection and destination addresses, for example home, ward, discharge or outpatient department. Staff identified whether an escort was required and recorded individual needs including infection protection and control measures, on-going medical treatments such as oxygen therapy and any communication or cognitive issues. When necessary, this information was shared with other agencies to support safe and co-ordinated care.

The service usually worked well across teams and services to support patients. Staff told us they worked well together. Information was shared between teams and services to ensure continuity of care. 

Assessments of patients’ needs were communicated when they moved between services, which reduces the need for people to repeat information, so patients only needed to tell their story once.

Staff supported each other to provide good care and deliver a quality service.

Managers and staff described positive working relationships with external organisations including the local NHS ambulance service and NHS trusts. We saw effective communication between the service and local NHS trusts.

Staff described positive relationships with managers, both internal and external partners. We saw examples where crews and leaders had to adjust planning to meet people’s needs safely.

Managers considered staff welfare. For example, they advised and encouraged drivers not to work second jobs and to rest in between shifts. There was a health and safety policy, which set out responsibilities at all levels.

Discharge and transport arrangements considered people’s individual needs, circumstances and ongoing care arrangements. Information was shared between teams and services to ensure continuity of care. 

The service 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, reduced their future needs for care and support.

People were involved in reviewing their health and wellbeing needs where necessary. The booking form included areas to complete to ensure patients’ individual needs were identified and planned for, including requirements relating to nutrition, hydration, and toileting. For longer journeys, comfort breaks were planned, and appropriate nutrition and hydration were provided.

Staff ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of patient themselves. 

Crews monitored patients’ health for signs of clinical deterioration during journeys, and the service supported achieving good outcomes through safe and timely transfers.

The service monitored performance using electronic systems, including journey data and key performance indicators (KPIs) to support continuous improvement.  Managers used these findings to make changes and achieved good outcomes related to getting patients to their treatment on time.  

Managers reviewed incidents and complaints, and commissioners received regular quality and performance reports.

We saw crews receiving patient details on their personal digital assistant (PDA) device and staff completed dynamic risk assessments on arrival to determine whether people were safe to transfer. Once patients had consented, staff respected their wishes, provided advice where necessary and obtained feedback. Feedback demonstrated that the service achieved very positive outcomes for patients which met and often exceeded expectations.

The service told patient about their rights around consent and respected these when delivering person-centred care and treatment. 

Staff understood consent and capacity and described how they gained consent before transport. They explained how they supported people who were anxious or reluctant to travel and how they escalated concerns when people refused transport. Training in the Mental Capacity Act had been completed, and inspectors observed staff communicating clearly and respectfully with people on the two journeys we accompanied them on.

Staff took all practicable steps to give people the appropriate information, support and time to make an informed decision in a way they could understand, including use of accessible communication formats. Staff followed national guidance to gain patients’ consent. Staff knew how to support patients who lacked capacity to make their own decisions.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff followed the services policies related to consent, mental capacity and deprivation of liberty safeguards as relevant. 

Patients reported being involved in decision making about their care. For example, we observed staff seeking verbal consent before a safe moving and handling transfer was carried out.

Where specific requests had been made by patients, for a same sex health care professional this was discussed and provided whenever possible. 

Interpreters were used to support patients to give informed consent, including for BSL and face to face interpreting when necessary.   

Staff sought permission before sharing patient information with family or friends. 

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.