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St John Ambulance South East Region Good

Reports


Inspection carried out on 10 to 11 December 2019

During a routine inspection

St John Ambulance South East is operated by St John Ambulance. St John Ambulance South East region provides emergency and urgent care services and a patient transport service. The South East region is part of the London and South region within St John Ambulance which covers 9 counties. This inspection and report covered the South East region only.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 10 to 11 December 2019.

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.

The main service provided was emergency and urgent services. Where our findings on emergency and urgent services – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the emergency and urgent services core service.

We rated it as Good overall.

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.

  • Staff provided good care and treatment, gave patients enough to drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key emergency services were available seven days a week.

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.

  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

    However:

  • The service did not monitor the temperature storage of medicines which would not assure them of the efficacy of the medicines.

  • The service did not provide training for all staff on the use of child restraints.

  • Not all policies had been recently reviewed and therefore the provider could not be assured staff were using up to date policies.

  • Not all ambulances contained information for patients on how to make a complaint or compliment.

    Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Nigel Acheson

Deputy Chief inspector of Hospitals (London and South East) on behalf of the Chief Inspector of Hospitals.

Inspection carried out on 6 and 12 October 2016

During a routine inspection

St John Ambulance South East Region is part of St John Ambulance, a national first aid charity. St John Ambulance provides a number of services including first aid at events, emergency and non-emergency patient transport services and first aid training. The objective of the organisation nationally is the relief of sickness and the protection and preservation of public health. Both volunteers and employed staff are involved with the services provided by St John Ambulance.

St John Ambulance South East Region provides an ambulance service across a number of counties in the south east region through a contract with two local ambulance trusts and a local NHS hospital. There is also an events service that provides first aid support, at public events. St John Ambulance South East Region has contracts with a number of organisations, which hold events in the local area and provides first aid at these events including the provision of an ambulance.

We inspected St John Ambulance South East Regions on 6 and 12 October 2016. This was an announced comprehensive inspection. We visited five different locations during the visits but were unable to visit any events where St John Ambulance South East Region were providing cover during this inspection.

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and issues that service providers need to improve.

We found the following areas of good practice:

  • We saw staff provided compassionate care for patients. They ensured patients’ privacy and dignity was maintained. Patients and their families were involved in decisions about their care. Staff understood the importance of respecting and responding to patients’ specific and individual needs.

  • Staff followed infection prevention and control procedures to reduce the spread of infection to patients. They kept vehicles clean, tidy and well stocked. The system for servicing vehicles was effective, with accurate records kept.

  • We saw good multi-disciplinary team working with other emergency services and during handovers at hospital. Staff working for the service were competent in their role and followed national guidance when providing care and treatment to patients. They knew when to escalate concerns so patients’ needs were responded to promptly.

  • The service only provided cover for contract or event work if it had sufficient staff to do so safely. Managers worked with contract providers and commissioners for events to enable services to be delivered which meet the needs of local people. Debriefs were held to identify changes which could be made.

  • All staff, both employed and volunteers, had an induction and could access further training for their role.

  • The service had systems in place for reporting and investigating incidents and complaints. Staff could describe changes to practice after managers had investigated these.

  • There was a national vision and strategy in place, which the service had implemented locally. Additional key performance indicators were being used regionally and nationally to support the quality monitoring of the service. Some of these had not been fully adopted at the time of our inspection.

  • Staff felt able to make suggestions on how the service could be improved and developed. They felt the leadership of the service were supportive and accessible.

However, we also found the following issues that the service provider needs to improve:

  • The provider’s safeguarding children training for staff did not show how it met and was in line with key national documents and recommendations on safeguarding children. Therefore, we were not able to confirm staff had completed the correct level safeguarding children training for their role.
  • We found one of the two ambulances used for the neonatal transfer and retrieval service did not lock. Staff had reported the vehicle defect but the service had taken no action until after our inspection. The processes to keep patients safe had not been followed.
  • The majority of volunteers had outstanding mandatory training to complete. Also, there was no performance review for staff who worked for the service on a casual basis to ensure they remained competent in their role.
  • On ambulances responding to emergency calls, there were no suitable restraints to secure children during transfer to hospital. The service recognised this as a risk and a review was taking place. There were also no paediatric defibrillator pads so staff could use the defibrillator safely on children.

  • There was limited provision on vehicles to support people who were unable to communicate verbally or who did not speak English.

Information on the actions we have asked the provider to take are listed at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection carried out on 16, 20 May 2013

During a routine inspection

We spoke with two NHS ambulance trusts, one private international medical repatriation service provider and three significant public event organisers, all of whom have regularly used St John Ambulance South East Region. We visited an ambulance station at Bicester and the regional headquarters at Aylesbury.

People told us the service provided by St John Ambulance South East Region was reliable, responsive and effective. They said the staff were efficient and professional.

We saw there were policies, procedures and guidance for staff about obtaining consent from people about their treatment and support options. We spoke with five front-line ambulance staff and with training and support managers. They confirmed all staff received infection control training, both at induction and periodically updated thereafter. We saw St John Ambulance had policies and procedures in place and readily accessible on infection control. We spoke with ambulance staff including one who had recently been recruited. They told us they had been subject to a rigorous recruitment process.

We saw copies of the comments, compliments and complaints literature provided for people who used the service. We were shown how these were recorded and analysed. The very few examples of complaints we saw had been appropriately responded to.

We saw evidence of routine periodic audits and checks carried out on vehicles. These highlighted any defects or issues which were then addressed.