Transcare Secure Services - Birmingham

On this page

• 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 looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

This key questions have been rated as good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service always made sure patients’ care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them. Patients and relatives were involved in the assessment of their needs, and support was provided where appropriate to maximise their involvement. Staff told us about the comprehensive approach to assessing the needs of the patients. Staff were passionate about providing the best and most up to date evidence-based practice in line with national guidance to make sure patients had the best outcomes.

Risk assessments were carried out for each patient before, during and at the end of the journey. Information on patients' needs was collected at the booking stage as well as from staff on site when they arrived to collect a patient.

The service had an up to date restraint policy that included information on types of restraint, action to take and how to use handcuffs safely. Any restraint would be discussed with the patient and staff involved and documented in the patients notes. Staff told us that during the debrief they would discuss the restraint techniques used.

We reviewed 4 patient records and found each had a risk assessment completed prior to the journey, during the journey and upon arrival at the destination. These included staffing requirements, journey times, risks, specific requirements such as restraint, accessibility, mobility, communication needs and patient assessment upon arrival. Patients mental health status was recorded as well as those detained under the Mental Capacity Act 2005. We saw evidence these were in line with best practice.

The service planned and delivered people’s care and treatment with them and the referring provider, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance.

Policies we reviewed were up to date, relevant to the service and had been approved by the appropriate governance processes. This was an improvement since our last assessment.

It was unclear how the service accessed and documented actions of alerts from The Medicines and Healthcare products Regulatory Agency (MHRA) and The Central Alerting System (CAS) for information on patient safety alerts and to notify healthcare organizations of safety-critical issues requiring immediate action. We were not assured relevant actions were known or actions taken if required. We raised this at the time of the assessment. Following our assessment the registered manager provided evidence that service had registered to receive relevant alerts from both the MHRA and CAS systems.

Staff told us they had an annual appraisal and bank staff had supervision and could raise any issues or learning needs or opportunities with the registered manager. In the last 12 months, 100% of staff had received an appraisal or supervision. There were a variety of online learning platforms that staff could use to develop their skills and experience to enhance their development.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

There was good teamwork and communication within the team and with providers that used the services.

Staff had access to the information they needed to appropriately assess, plan and deliver patients’ care, treatment and support.

The service collected feedback from all providers following a transportation of a patient this included information about how staff interacted with the service and the patient. We saw this was positive and shared with the staff who were part of the transfer team.

The service supported people to manage their health and wellbeing during journeys from one location to another. The service provided secure transportation from one location to another and did not involve themselves with advising patients on aspects of their care and treatments.

Staff told us they would discuss any restraints required with patients and providers to ensure they were fully informed and this could help when patients that were distressed or confused.

There was bottled water available on the ambulance, that patients were offered during the journey.

The service routinely monitored people’s care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both providers and peoples expectations. However, they did not monitor the outcomes of audits or always share this information with staff. This was also identified at the last assessment.

Although audits were completed, there was no plan for monitoring the effectiveness of the service. There was evidence of regular audits being completed monthly, bimonthly and quarterly. These included patients reported outcomes, care records, staff files, cleaning and fire. We reviewed examples of audits which had been completed. However, we did not identify that audit results were always captured when they did not meet a 100% compliance, discussed or actioned. This meant that opportunities to improve may have been missed

Minutes from the governance meeting showed that audits were completed but did not always indicate the actual results or any required actions were discussed. Following our assessment the registered manager told us that they would include results from audits in meetings and share the results with staff.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. There were systems and practices to ensure patients understood the care and treatment being recommended. This helped them make an informed decision.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. Although the provider did not have a specific consent policy, consent was documented in a variety of policies including the transfer policy and mental capacity policy. Following our assessment the service provided an up to date consent policy relevant for their organisation, which included information on capacity for consent, staff responsibilities and information for patients.

The transport request form completed by providers included the patients capacity information including patients that had a Deprivation of Liberty Safeguards (DOLs) in place and those detained under the Mental Capacity Act 2005 (MCA).

When patients lacked the capacity to make decisions about their care and treatment 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 information within the mental capacity policy which related to consent when a patient was detained under the Mental Capacity Act 2005 and the legal rights of patients and staff as part of treating patients with or without consent.

We saw that patient consent to be transported was obtained from patients prior to them being collected and this would normally be done by the service requesting the journey. On arrival to collect the patient, consent was obtained again from the patient to ensure they were aware of the journey and destination.

Consent to search the patient would be obtained in some instances. Staff were able to explain the process and the consent process. The service provided MCA and DOLs training for all staff.