Archived: E-zec Medical - Norfolk

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

At the Great Yarmouth site there was a positive culture around safety, leaders encouraged staff to raise concerns and staff felt confident in their leadership. Safety events were investigated, but reports were not always comprehensive and lacked detail. This meant that areas of learning from incidents might have been missed. The service worked alongside its commissioner to address safety matters; however, the leadership did not always report incidents in a timely way and did not always recognise serious incidents.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us there was a positive learning culture and felt able to speak to managers if there was an incident or concern. Staff had notice boards that were kept up to date with learning outcomes from incidents that was shared across all the services locations. Staff told us they were kept up to date with required mandatory learning via emails. Leader told us they had a no blame culture and encourage staff to raise concerns and speak up.

The service had policies and procedures in place to support staff, volunteers, and service users in reporting and escalating any incidents or concerns. A centralised 24-hour telephone line was available for staff and volunteers to raise safeguarding alerts or report incidents, ensuring prompt action. Reports were then reviewed by the local operations manager and investigated in line with the provider’s policies.

At the time of assessment, the service was using a mix of old and new policies, some still referencing previous providers. This caused confusion among staff, highlighting the need for a more consistent and standardised approach.

People who use the service were mainly very satisfied with how their transport booking were managed. They felt staff were able to meet their care needs and had a good patient experience throughout their care journey.

Staff told us they had well-established processes in place for managing transport bookings for patient transport services. Patients could self-refer and book transport directly with the provider. Eligibility criteria, set by their commissioners, were clearly explained to those using the service.

As part of the booking process, staff carried out risk assessments to identify any potential risks. There were strong lines of communication with hospital teams, and staff worked closely with discharge coordinators daily to support patient discharges.

Leaders told us they conduct patient surveys each month and use the feedback to make ongoing improvements to the service.

At the Great Yarmouth site, a call centre handled referrals from both individuals and healthcare professionals. However, the provider was still using policies and standard operating procedures (SOPs) from previous providers, and governance processes around care pathways were not always fully embedded after the booking stage.

Staff told us they receive mandatory safeguarding training each year for both children and adults. They shared examples of safeguarding incidents and the actions they had taken in response. Clear referral pathways were in place, and staff consistently used the 24-hour phone line to report concerns.

They also felt supported by local managers when making referrals and received feedback, including any lessons learned. Staff demonstrated an understanding of how people could be vulnerable and recognised their role in safeguarding when necessary.

Partners told us the service was proactive in completing safeguarding referrals and were good at escalating concerns to commissioners and stakeholders. Partners felt staff and leaders had understanding and training around safeguarding processes and fulfilled their contractual obligations.

The service had clear safeguarding policies and procedures in place for staff to follow, with annual safeguarding training being mandatory. Staff had access to a 24-hour referral phone line to report any safeguarding concerns and submit the necessary referrals. These referrals were closely monitored by local managers and safeguarding leads to ensure appropriate action was taken.

People using the service had opportunities to discuss individual requirements at the booking stage. The service would discuss mobility and health needs and their requirements for patient transport journeys. People using the service who required a family member or carer to travel with them for additional support would be risk assessed on a case-by-case basis.

Staff told us they felt supported in escalating any risks or concerns to local management teams. Leaders explained that they maintained an internal risk register, which was regularly updated with reported incidents and safeguarding referrals. Local and regional managers had access to this register, ensuring oversight of risk management.

Leaders also stated that they engaged in open and transparent discussions with commissioners to address identified risks and agree on necessary actions and improvements. Investigations were handled by local operations managers in line with policies, with regional managers providing support in more complex cases.

The service had guidelines in place to assess risk during the booking and referral process for patient journeys. These risk assessments were conducted remotely and relied on information provided by the caller, which was not always accurate. However, the service had a dedicated staff member who could visit patient locations to carry out face-to-face risk assessments before booking.

This approach helped ensure that appropriate resources and any necessary specialist equipment were allocated for transport. Risk assessments were regularly reviewed in line with the service’s policy to maintain safety and effectiveness.

Overall, people felt safe during their transport journeys. However, there had beenincidents where individuals were injured during transit. These incidents were investigated in line with the service’s incident policy, and actions were taken to prevent similar occurrences in the future.

Staff told us they felt they had good facilities at the Great Yarmouth site to enable them to carry out their duties. They had access to kitchen and toilet facilities and seating areas, as well as a private room for meetings. Leaders aimed to make the workspace comfortable and practical for all their staff. Leaders felt the facilities and staff space needed to be bigger as they had more patient transport vehicles than they could accommodate and needed additional parking.

The facilities at this location met the needs of both staff and leaders. There was parking available for vehicles; however, there was no designated outdoor wash bay, so vehicles had to be taken to another location for external cleaning.

Staff had access to toilets, showers, and handwashing facilities, including an accessible toilet on the lower floor. The areas were clean and fit for purpose. A kitchen space was available, equipped with a fridge and microwave for staff use, along with adequate refuse bins and cleaning products. Staff had a designated area to sit and eat during meal breaks, as well as a quiet space if needed.

However, access to the control room required climbing a flight of stairs, which restricted accessibility for disabled staff. Fire exits and extinguishers were clearly signposted. Vehicles were visibly clean and free from damage, with staff having access to cleaning materials and spill kits.

The service had policies and procedures in place to ensure facilities and vehicles were clean and fit for purpose. Regular cleaning audits and monitoring were carried out, highlighting any defects and repairs needed. Allocated staff members kept comprehensive records of each vehicles infection prevention control compliance and carried out bacterial swab testing post deep cleans. Equipment was checked daily by staff and reported and replaced in line with policy. All records were shared with commissioner for assurance.

Staff told us they felt confident in their roles and clearly understood their responsibilities. They reported that leaders provided the necessary tools and resources to perform their jobs effectively. Staff also confirmed they received annual mandatory training updates, including assessments on medical theory and manual handling. However, while some incidents were addressed through the service’s incident policy, with actions taken to prevent recurrence, several incidents in the past year lacked a clear process for identifying and sharing key learning points with staff.

At the time of assessment, the provider was meeting mandatory training targets, including an annual programme covering medical theory, such as responding to patient deterioration, chest pain, shortness of breath, and seizures, as well as manual handling assessments. However, following an incident, it was identified that staff had not received adequate training on the newly introduced vehicles. Staff had begun using the adapted vehicles without prior instruction on the new equipment. As a result of the incident, one of the vehicles was withdrawn from service. A subsequent review highlighted that staff lacked sufficient knowledge and training to operate the new vehicles safely. In response, revised training was developed and delivered to ensure all relevant staff were appropriately equipped to use the vehiclesgoing forward. Additionally, the guidance on identifying and managing certain emergency medical situations was unclear. The reviewed guidance did not provide staff with a clear process for escalation or treatment within their individual scope of practice.

Staff told us they have regular cleaning schedules for the vehicles and equipment and carry out daily checks prior to their shifts. There was a designated member of staff who held responsibility for deep cleaning all vehicles and equipment. Staff had access to fresh linen for each shift and had clear processes in place to dispose of soiled linen.

During the assessment we visited the Great Yarmouth site which consisted of office space, kitchens, toilets, garage space and vehicles. All areas were clean and had cleaning records that were up to date. Daily vehicle checks were completed by staff and defects reported in line with policy. Staff wore appropriate clean uniform and all displayed identification badges. Kitchen areas were clean and ready for staff to use. Cleaning products were stored in line with policy and national guidelines.

The service had policies and procedures in place to maintain effective infection prevention and control processes. They monitored compliance closely, in line with national guidance, and shared all relevant data with commissioners and stakeholders. The provider had provisions in place to manage infection prevention and control incidents and had access to facilities for decontaminating vehicles when needed.

Staff working on the patient transport services told us they understood the procedures and risk assessments related to medical gases. They felt confident in supporting patients who were on home oxygen and facilitating oxygen therapy during transport. However, staff working on the high dependency unit (HDU) vehicles carried a grab bag of emergency medicines. They were unsure why these medicines were necessary, as the hospital transfers, they conducted were typically routine for cardiac procedures. Staff mentioned that these emergency medicines were rarely used and often discarded for being out of date.

Qualified HDU staff were responsible for checking the drug stock monthly but were unsure how these audits were being monitored by local leaders

Medicines were stored in accordance with legal requirements, with access restricted to certain qualified staff. The storage area was clean, and all medicines we checked were within their use-by dates. Out-of-date medicines were disposed of correctly. The provider maintained up-to-date records on stock levels and administration.

Medical gases were stored safely in a designated area and secured properly on vehicles. However, leaders had limited oversight of the medicines kept on the high-dependency vehicle and lacked a clear understanding of medicines management and audit processes.

The provider had policies and procedures in place for ordering, monitoring, and reviewing the use of medicines. Medicine audits were carried out by a single member of staff, with limited oversight from the on-site operations manager. There had been no medicine-related incidents in the past 12 months. However, it was unclear why the provider was carrying medicines, given the nature of the contract and the requirements of their commissioners. The contract had not been reviewed for several years, nor had the use of medicines been reassessed.