Amvale Medical Transport - Ambulance Station

Updated 20 February 2018

Amvale Medical Transport – Ambulance Station is operated by Amvale Limited. Amvale Medical Transport Limited (AMTL) was established in 1991 as part of Amvale Limited which was established in 1985. The company expanded and introduced in 1998 non-clinical transport services with blood and organs for United Kingdom Transport for Transplants and the British Transplant Service. This provision is not regulated by the Care Quality Commission; therefore we did not inspect that part of the service.

The service provides a patient transport service and an urgent and emergency care service. In addition it provides specialist transport for patients with mental health needs across the United Kingdom. This service for patients with mental health needs is provided on an ad-hoc basis, using some staff who work as part of the non-clinical transport services with blood and organs, and some staff from the patient transport service. AMTL also sub-contracts some of the mental health work to other independent ambulance providers across the country.

The patient transport services serve the communities of Lincolnshire and Hull and East Yorkshire. The emergency and urgent care aspect of the service serves the communities within the East Midlands, although both services are able to undertake long distance journeys if required. AMTL have contracts from two NHS Hospitals and two NHS ambulance providers.

We previously undertook a focussed inspection of the emergency and urgent care service in January 2017. We inspected a hub location in Leicester which has since been closed due to the reduction in the contract. Following that inspection we served the company with a requirement notice against regulation 12 HSCA 2008 (Regulated Activities) Regulations 2014 Safe care and treatment. This was in relation to the proper and safe management of medicines.

The service is run from the headquarters based in Scunthorpe. The NHS contract for the urgent and emergency care service is due to finish at the end of October 2017.

The service has a registered manager in post since 1991. The current registered manager had taken over that role in December 2016.

Updated 20 February 2018

Amvale Medical Transport – Ambulance Station is operated by Amvale Limited. The service provides emergency and urgent care and a patient transport services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 17 October 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.

The main provision provided by this service was a patient transport service. Where our findings on the patient transport service for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the patient transport core service.

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 areas of good practice:

• The service had improved on the majority of the issues for action highlighted in the previous inspection in January 2017. During the last inspection, we found that clinical waste was not stored in line with infection prevention and control practices. During this inspection, we found improvements and the storage of waste was in line with infection prevention guidelines.
• Staff followed infection control policies that managers monitored to improve practice. Managers were able to respond to requests to provide the service in a timely manner and had the flexibility in the resources to meet the needs of commissioners.
• We found the environment clean and tidy and the vehicles and equipment were well maintained.
• Staff recognised incidents and knew how to report them. Managers investigated incidents quickly, and shared lessons learnt and changes in practice with staff. When things went wrong patients received an apology.
• Patients records were stored securely the patient record forms we checked were all completed fully.
• Staff had received training to enable them to care for patients effectively and staff were able to identify and respond appropriately to patients if they deteriorated.
• Staff kept patients safe from harm and abuse. They understood and followed procedures to protect vulnerable adults and children.
• Staff provided care and treatment based on national guidance and evidence, and used this to develop new policies and procedures.
• New staff received an induction programme and staff received annual appraisals.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.
• Patients were taken to the appropriate hospital, based on their needs.
• We saw good evidence of multi-disciplinary working between staff from the hospital and the ambulance crews.
• Staff cared for patients with compassion, treating them with dignity and respect.
• Patients, families and carers gave positive feedback about their care.

• Staff provided emotional support to patients to minimise their distress.
• The service treated concerns and complaints seriously, investigated them and learnt lessons from the results.
• Staff took into consideration the individual needs of patients when each booking was made to support the safe transport of patients.
• The service had a strategic plan and service values that were resonant across all groups of staff.
• Staff described the culture within the service as open to change and supportive. Staff could raise concerns and felt listened to. They said leaders were visible and approachable.
• The service had a clear leadership structure and each member of the leadership team had clear roles and responsibilities.
• The service had effective systems and processes in place regarding recruitment of staff.
• The service has gone through periods of uncertainty over the last year with the reduction and termination of the urgent and emergency care service contract, the service and its staff showed resilience in the process and continued to support the contract and show flexibility to the demand on their services.

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

• During the previous inspection in January 2017, we found that controlled drugs were not checked in and out of the safe at the beginning and end of each paramedic’s shift. During this inspection we found that this was still happening.
• We found a batch of a medicine that had passed the expiry date.
• We found that some hazardous substances were not stored in a locked cupboard. This did not comply with control of substances hazardous to health (COSHH) legislation.
• Not all staff we spoke with were aware of female genital mutilation (FGM) and had not received training regarding this. This is important, as reporting any recognised incidents of FGM is a legal requirement for all healthcare staff.
• A safeguarding lead had been appointed who had been trained to safeguarding level three. The intercollegiate document states that the identified safeguarding lead should be trained at level four for children.
• We found crews checked their vehicle daily, if a fault was found there was no audit trail as to whether this had been reported and resolved.
• Although a medicine policy was in place, there was no clear guidance for staff to follow or have consideration to when handling patients own medication, when administering patients own medication or when transferring a patient with a syringe driver (which is used to give patients medication continually over a period of time).
• An audit was in place of the patient report forms, which captured what care, and treatment had been provided in line with evidence-based practice, this audit had not taken place since August 2016.
• The service had a number of processes in place to monitor the quality and safety of the services that were provided. However, the service did not have oversight of other key areas, for example, the audit of the management and storage of controlled drugs was not robust.
• There was some duplication in the two management meetings that took place and some areas of clinical governance were not discussed within the meetings.
• The service did not have a fit and proper persons policy that all directors are required to comply with.

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 one requirement notice that affected both the emergency and urgent care and the patient transport service. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals Ellen Armistead, on behalf of the Chief Inspector of Hospitals

Updated 20 February 2018

We have not rated this service because we do not currently have the legal duty to rate this type of service or the regulated activities it provides.

The main service provided by this ambulance service was the patient transport service. Where our findings on the patient transport service, for example, management arrangements, also apply to other services, we do not repeat the information but cross-refer to the patient transport service section.

Updated 20 February 2018

We have not rated this service because we do not currently have the legal duty to rate this type of service or the regulated activities it provides.

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