Transcare Secure Services - Birmingham

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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

We reviewed assessing needs; delivering evidence-based care and treatment; how staff, teams and services worked together; supporting people to live healthier lives; monitoring and improving outcomes and consent to care and treatment as part of the effective key question. We found effective had improved from the previous rating of inadequate to requires improvement. Although audits were completed, there was no plan for monitoring the effectiveness of the service and not all staff were identified as being competent to deliver all aspects of care. However, staff provided care and treatment, which was based on the needs of the patient.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from patients was positive about their experience with the service and they felt supported by staff and listened too.

Staff told us that information on patients' needs was collected at the booking stage of the process. For example, they would check if a translator was needed where the patient's first language was not English, the organisation booking the patient transfer journey would provide a translator, but service also had access to translation services. Flashcards were also available as a communication tool. Staff told us they would gather information about a patient's coping strategies and communication needs. They were able to give examples where they had supported patient's emotional and physical needs. This included a patient who became distressed about moving to a new service, the patient was pregnant and unable to speak English. The organisation requesting the transfer had not organised a translator. Staff were able to use a translation application to help understand the patients' needs and concerns. Once they were able to communicate the patient was calm and they were able commence the journey. Staff gave us examples of times where they had supported patients outside of the scope of their role, for example they told us of an occasion where they had helped a patient to get some food shopping prior to transfer as they would have not had any at home.

There were processes in place to ensure staff completed detailed risk assessments when patient bookings were completed. This included all key information including any accessibility and communication needs the patient had as well as other aspects of clinical care required, such as the requirement for restraint.

We could not collect the evidence about people’s experience of delivering evidenced based care and treatment as there were no patients journeys undertaken during the inspection.

Staff mostly followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. However, there was no evidence of training for staff on administering medication, medication transfer forms not been completed as per the service policy. Some staff members had specialist knowledge in areas such as dementia and learning disabilities and supporting people with mental health needs. Staff used information collected on the risk assessment at the time of booking the journey and information provided at handover when collecting the patient, to anticipate any additional or complex needs a patient may have to make their journey more comfortable. Staff told us that if a patient had a long journey, they would ensure snacks and drinks were offered. Staff told us learning from any incidents was used to improve patient’s experience.

The risk assessments and clinical assessment tools which staff used were evidence-based and widely used and recognised across healthcare. Policies,processes and other supporting documentation in relation to risk assessments and clinical assessment tools were mostly based upon national guidance and polices. However, we identified the safeguarding policy did not refer to which version of the intercollegiate guidance this was based on. We were therefore not assured the policy was based on the most recent version of the guidance.

We could not collect the evidence about people’s experience of of how staff and teams work together as there were no patients journeys undertaken during the inspection.

Staff told us they were able to attend one to one clinical supervision every 3 months and attended team meetings. Staff told us they had yearly appraisals. The service provided data after the assessment in relation to staff appraisals, and supervision. The service stated that 5 healthcare assistants (HCA’s) had received supervision in April 2024. The supervision record stated that 2 RMN’s staff had received supervision. However, this was a total of 7 staff, where the service had 36 staff working at the service. Staff told us that they felt there was good staff morale within the team and the staff team supported each other. Staff also told us that they feltsupported by their managers. They felt they could approach managers if they had any concerns, and these would be acted upon. We observed managers and the service leader working well together, good teamwork and a positive morale within the team. Staff were communicating effectively to meet the needs of the patients who were using the service. Staff told us that they received an induction when they started in the service.

We spoke to 2 partners who used the service, they told us the service completed patient journeys effectively and patient handovers were good.

We could not collect evidence by observing how staff and teams worked together as there were no patients journeys undertaken during the inspection and therefore no interactions to observe.

There were processes in place to ensure members of the multidisciplinary team (MDT) worked together to ensure the needs of the patients were met. Key governance meetings were attended by members of the MDT which demonstrated an effective and cohesive service. There was also evidence of the service working with external partnersas part of the wider MDT. Where staff transported patients to alternative locations, staff engaged and worked well with those involved in the patient's care and treatment throughout the journey.

We could not collect evidence on these aspects as this was not an area which the service was involved in due to the nature of their service. The service provides secure transportation from 1 location to another and does not involve themselves with advising patients on aspects of their lives.

We could not collect evidence on these aspects as this was not an area which the service was involved in due to the nature of their service. The service provides secure transportation from 1 location to another and does not involve themselves with advising patients on aspects of their lives.

We could not collect evidence on these aspects as this was not an area which the service was involved in due to the nature of their service. The service provides secure transportation from 1 location to another and does not involve themselves with advising patients on aspects of their lives

We could not collect evidence on these aspects as this was not an area which the service was involved in due to the nature of their service. The service provides secure transportation from 1 location to another and does not involve themselves with advising patients on aspects of their lives.

Staff told us they received information on the patient bookings daily and the booking system was effective. The service was completing a low number of journeys and as such had no cancellations. Staff we spoke to told us once they had completed their induction they would shadow another experienced member of staff, this was to embed new learning and ensure they were competent for the role. Staff told us the service completed audits including a transfer of care audit and a transfer performance audit. The transfer of care audit was to ensure records were of a good standard, key information was easy to access, and documentation was accurate. The transfer performance audit was to ensure patient safety standards were being met. Following the assessment, the service provided evidence of completed audits, if any concerns were identified, then actions were taken to improve outcomes for patients.

There were processes in place within the service to monitor and improve outcomes for patients who used the service. There was an audit policy in place which informed staff of the expectations in relation to audits which were conducted within the service. There was evidence of regular audits being conducted which included patient reported outcomes. We reviewed examples of audits which had been completed. However, we did not identify where the audit results were discussed. Minutes from the governance meeting only said that the audits were completed, and did not indicate whether the results or any required actions were discussed. The service had a key performance indicator (a performance target) in relation to their response times. Information within the Transfer Governance Summary Report identified a response time target for transfers as 2 hours. All transfers completed between January and April 2024 met this target. During the same period for 2023, there were 5 transfers which were recorded as outside of the key performance indicator. This was due to the distance which the staff needed to travel.

We were unable to observe staff gaining consent during the assessment as the service did not have any transfers booked. However, the service was able to provide patient feedback, which was positive. Also, in all transfer records we reviewed consent had been clearly documented.

Staff we spoke to told us that patient consent to be transported was obtained from patients prior to them being collected and this would normally be done by the team requesting the journey. The consent paperwork would be seen by the service prior to the patient accessing the vehicle. Consent to search the patient would be obtained in some instances. Staff were able to explain the process and the consent policy. The service provided Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards training for all staff. Staff also ensured that the patients' understood why they were moving and if they understood where they were transferring to. If patients were unable to understand there were discussions with the service, to gain the knowledge of the patient and their individual needs. Staff told us they completed a post transfer report, which identified consent of care and treatment and explained why the patient was unable to consent to treatment due to their capacity to understand.

There were processes in place to ensure staff supported patients to make informed decisions about their care and treatment. There were policies and processes in place which staff were aware of and followed to gain patient consent. Where patients lacked the capacity to make decisions about their care and treatment themselves, the policy provided clear information for staff to follow which was in line with national guidance and legislation to ensure consent was gained lawfully. There was also additional information within the policy which related to consent when a patient was detained under the Mental Health Act 1983 and the legal rights of patients and staff as part of treating patients with or without consent.