Elite EMS Headquarters

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• 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

We assessed a total of 2 quality statements from this key question. We combined the score for this area with scores based on the rating from the last inspection, which was good. Our rating for this key question remains good.

During our site visit we did not have any significant concerns about the vehicles that we inspected and did not have to ask the provider to take any action. All vehicles were insured, taxed and had a valid MoT certificate and the vehicles were maintained by suitably qualified personnel. There were good service records kept, and all faults were recorded on a computer system where it could be demonstrated that the issue had been dealt with.

Medical devices were effectively managed and maintained by suitably qualified personnel or manufacturer’s service agents. Faults were logged electronically and there was a record of all work carried out. There was an effective system of responding to manufacturer safety alerts and again these were recorded.

Vehicles were all equipped to the requirements of the commissioning NHS ambulance service through an effective make ready system and logistics chain.

We had been told that there was a lack of some consumables and that vehicles were going out without stock. When we spoke to staff, they told us that this had been the case, but that changes to the delivery schedules meant that this was no longer an issue.

There was an effective medicines governance system in place with effective management and oversight of medicines including controlled drugs (CDs). The medicines management system was computerised, and the usage and stock could be readily reported on. Incidents involving medicines were effectively reported, investigated and necessary action taken including feedback to staff.

Although there had been reports of medicine shortages which resulted in ambulances being on the road with low stocks this had been addressed. Medicines shortages we saw at the time of the inspection were because of national scarcity.

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 did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We spoke with senior leaders including the Registered Manager, the Chief Executive and managers responsible for logistics, fleet and medical devices.

We discussed strategy for the rationalisation of MRCs in the south which included closures as well as a new superhub. The provider had implemented a logistics system with a central stores and distribution to MRCs using delivery vehicles. These approaches were similar to ongoing initiatives by some NHS ambulance service providers, and we were shown that they had learned from their experiences. It was essentially a “push” model, with the ability to “pull” when necessary.

We discussed that we had been told of problems with stock and were told this had been the case, but that it was resolved with moving from fortnightly to weekly deliveries. When we spoke to crews they corroborated this and make ready and delivery staff agreed that the system was now working. One person told us that some staff thought that a good stock system was having lots of consumables on the shelves and on the vehicles, while in reality that was wasteful and the risked use of out of date items.

Several staff expressed concerns that they did not always have access to Airwave radio sets for communication with the control room on two of the NHS contracts. While they had access to the electronic dispatch system, voice communication was through mobile ‘phones and staff did not have access to the “man down” function of the radios. On one of the contracts there was separate system which provided a “man down” function. On the other there were never any radios and no separate “man down” system. We understood that access to radios was in the gift of the NHS provider and the provider had raised the problem as a safety concern to no avail. As the Ambulance Radio Programme is rolled out these issues are likely to resolve.

Vehicles were equipped to an equipment and consumables loadout specification which was defined by the commissioning NHS ambulance service. We made checks of vehicles and bags and found they were correctly stocked.

The fleet consisted of vehicles of different ages from several manufacturers and had either been purchased new or obtained through the purchase of other ambulance companies. Some ambulances were very new, others older and some were ex NHS vehicles that were up to 7 years old. A few of these, while safe, were described by members of staff as “tired”. In some cases there were worn seats and facias repaired with tape, although because these were all in the cab and not the saloon they did not present a risk to patient safety. Staff told us that they were not pressured to take vehicles they were not happy with and that faulty vehicles could be recovered rather than driven to the MRC. Staff also told us that attention was paid to tyres with them being changed at the recommended rather than legal wear limit and the summer and winter tyres were used.

Most MRCs were being reconfigured, updated and in some cases closed following their acquisition. All were suitable for purpose and had separate areas for vehicle parking, charging, light maintenance and cleaning. Equipment and consumables were suitably stored and the areas were clean, tidy and well organised. At one site we noted that a clinical waste bin was not locked, and an oxygen store not labelled. These matters were pointed out to the provider and rectified immediately.

Some staff told us that if they reported vehicles with engine management lights lit the vehicle would be taken off the road but come back the next day with a note that the issue was not a concern. We examined vehicle records and saw that when this had been done it was a minor fault such as a problem with a diesel particulate filter. However, crews were not being informed of the details, and it caused them unnecessary worry.

Vehicle equipment and consumable loadouts were carried out to the individual specifications of the commissioning NHS ambulance trust. There were minimum levels to be maintained when stock was low which was done partly because of delivery issues within the provider but also because of national shortages of some items

Vehicles were “made ready” according to this specification using written processes that included checklists. There was strong document control with work instructions having version numbers and superseded documents were destroyed. The processes were subject to regular audit and when discrepancies were found the root cause was identified and action taken.

Rolling restocks where an ambulance could top-up supplies during a shift were allowed once before the ambulance had to return to an MRC for a full restock.

When we asked about any reported incidents of stock shortages and were shown the most recent, which was a lack of defibrillator pads. The root cause of this was a failure to act on a request for stock from one of the MRCs.

There were cleaning schedules and specifications for equipment, vehicles and buildings and we saw records and audits that showed these were adhered to. Vehicles were deep cleaned every 6 weeks, and this was monitored through the use of swabs.

The maintenance of vehicles and medical devices was carried out under a planned preventative maintenance programme by suitably qualifies and trained staff. Accurate records were kept and were readily available for us to view when we requested them.

Audits of safety critical processes took place, and this was done as part of a rolling audit schedule.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service operated a medicines governance system with senior member of staff acting as a Medicines Compliance Officer responsible for oversight. At MRC level station supervisors took responsibility. For CDs the CEO acted as an Accountable Officer for the purposes of governance as, although the law does not require this role for independent ambulance providers, the provider considered it good practice.

Prior to the inspection we had been told that there was a lack of some medicines and that vehicles were going out without stock. When we spoke to staff they told us that this had been the case, but that changes to the delivery schedules meant that this was no longer a serious issue although there were still some shortages of medicines such as which we knew were a national problem. There was a system in place for managing any shortage with a defined minimum stock for kit bags and instructions to make use of, in some cases, a patient’s own medicines.

All staff to whom we spoke confirmed that only medicines supplied by the provider were used and that paramedics never carried personal stocks of medicines while on duty.

Medicines were prescribed and administered according to the requirements of the commissioning NHS ambulance service, which in turn were based on the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines.

Vehicles were equipped to a medicines loadout specification which was defined by the commissioning NHS ambulance service. We made spot checks of vehicles and bags and found they were correctly stocked.

At all the MRCs we visited we found that medicines were stored correctly and that there were systems in place to rotate stock and to identify medicines that were at risk of being out of date. CDs were stored securely and access was restricted to only those staff who needed to use them.

Recent Home Office inspections of systems at selected sites as part of their oversight of the provider’s Controlled Drug Licence had not identified any problems.

Due to the circumstances of our inspection, we did not see any medicines being prescribed or administered to patients.

Vehicle medicines loadouts, including bags, were to the individual specifications of the commissioning NHS ambulance trust. There were minimum levels to be maintained when stock was low which was done partly because of delivery issues within the provider but also because of national shortages.

Vehicles were “made ready” according to this specification using written processes that included checklists. There was strong document control with work instructions having version numbers and superseded documents were destroyed. The processes were subject to regular audit and when discrepancies were found the root cause was identified and action taken.

Rolling restocks where an ambulance could top-up supplies during a shift were allowed once before the ambulance had to return to an MRC for a full restock.

There was a computerised medicines management system. Requisitions were made using a QR code scanned to a smartphone. When the medicines arrived at the MRC they were scanned into stock and then out to the individual bag. Records contained the name, expiry date, batch and dose and this ensured there was a full audit trail from who ordered it to who used it. This supported the audits and compliance checks as well as identifying medicines about to go out of date. We looked at the May 2024 expired medicines report against stock and found no discrepancies.

Any losses or spillages were recorded and controlled drugs were disposed of in line with legislation.

Senior staff and roadcrew openly discussed recent incidents and those they mentioned were referred to in various learning from incidents posters and reports we saw.

We asked staff for examples of medicines incidents, and several referenced an occurrence where a controlled drugs had been given through the wrong route. The leadership team showed us that this had been reported to the Home Office and how the investigation involved the service’s medical director as well as the commissioning NHS trust.