Archived: Transsecure NW Ltd

TransSecure NW Ltd opened in August 2019. It is an independent ambulance service based in Blackburn. The service provides patient transport services for local, regional and national acute NHS hospital trusts, local authorities and independent hospitals, 24 hours a day, 365 days a year.

The service provides patient transport services for adults; the service does not transport children. The service transports patients with mental health needs and those detained under the Mental Health Act 1983. The majority of work undertaken by the service is inter hospital transfers; however, the service also transports patients with mental health needs to and from home addresses when required.

We carried out a short notice announced focused inspection of the service on 19 October 2020. We inspected the providers services to check on the progress towards addressing the concerns and action we took following our previous inspection in July 2020. We did not rate the service.

We found the found the following areas that still required improvement:

• We were not assured that there were systems or processes in place to safeguard service users from abuse and neglect. The safeguarding policy did not guide staff in relation to safeguarding children and it was unclear when a concern would be reported to the local authority. The provider was unable to evidence the skills and competencies of its safeguarding lead.
• We were not assured there were robust systems and processes in place to ensure the safe management, prevention and control the spread of infection. The provider’s infection prevention and control policy did not include information about how to manage risks related to the COVID pandemic. The policy included information about preparing food which would not be expected in the service delivered by the provider.
• We were not assured that effective systems were in place to ensure the safety of the care and support provided was regularly assessed and monitored to ensure it was being delivered safely. There were no completed risk assessments of the ambulance vehicle. The ambulance risk assessment policy did not define how the levels of risk used were derived, nor did it set out the need for a formal risk assessment and how these should be reviewed. Adaptations of the spare ambulance vehicle had not been completed and there were exposed metal parts that could pose a risk to patient safety.
• We were not assured that care was provided in a way to reduce the risk of avoidable harm to service users. The deteriorating patient procedure did not outline clear processes to manage service users in the event their condition deteriorated and they needed additional support. The provider did not have equipment to monitor oxygen saturations or blood pressure required to undertake vital observations.
• There was no clear policy or process to determine how many staff were needed to safely care for service users during transportation.
• Although staff had undertaken training in the management of epilepsy, it was unclear if staff understood the emergency management of other conditions. Further, although staff had completed first aid modules as part of their food and hygiene training and the management of seizures and epilepsy training, without the additional training there was an increased risk that early signs of a deteriorating patient would not be recognised. The provider informed us that plans had been made for staff to complete additional first aid training.
• We were not assured there were systems and process in place to support service users to safely manage their medicines, and to safely manage the risks to patients being transported while sedated. Contrary to the provider’s overarching medication policy which indicated staff could support a patient to administer non-prescribed medicines, the nominated individual told us staff would not administer medicines in any circumstances and there was no risk assessment form on how to safely store patients’ own medicines during transport. The policy included information that was not reflective of the service provided.
• The provider had a recruitment policy and had reviewed staff driving licences. However, the policy was not robust, included information not reflective of the service provided, and there was no evidence that driving assessments had been undertaken. The policy did not include information on how the provider would assess against the fit and proper persons requirements for all staff and there was no other policy outlining these.
• We were not assured the provider had robust processes to ensure that directors who had responsibility for the quality and safety of care and for meeting the fundamental standards of care were fit and proper to carry out the role. The provider had not undertaken important checks such as an enhanced disclosure barring service check, bankruptcy and insolvency checks on the appointment of its new director. The fit and proper person requirements for directors had not been included in the provider’s recruitment policy and there was no other policy outlining these requirements.
• We were not assured that restraint would only be used as the least restrictive option or that there were sufficient policies and procedures to support staff in the application of the Mental Capacity Act. The provider did not always recognise when restraint had been used and could potentially use restraint when not needed. The provider did not have a clear policy and procedure to support staff in seeking patients’ consent, to act in their best interests, or when undertaking a mental capacity assessment.
• We were not assured there were effective systems for governance and risk management to ensure service users received safe care and treatment. There were no audit programmes in place to undertake and record any patient quality monitoring or audits in relation to key processes. There was no policy and procedure to support staff in correctly applying and completing the new risk assessment process. The provider’s training policy was still being developed and it was not clear which elements of staff training were mandatory. A number of the provider’s policies and procedures contained information that was not reflective of the service provided. The provider did not have policies for some key areas such as mental capacity and health and safety.

However, the provider had made the following improvements since our last inspection:

• Although we were not assured the provider always recognised when restraint was used, most staff had completed additional accredited training which included, prevention and management of violence and aggression by patients; use of mechanical restraint; and, training and handling.
• Further online training completed by staff included but was not limited to safeguarding level two adults and children; first aid; fire safety; infection prevention and control; medicines management; and, information governance. All of these modules were completed in October 2020 and were valid for a period of 12 months.
• The provider had begun the implementation of a staff induction guide, which outlined training that was to be delivered at the start of employment of all staff. This was to be delivered by the operations manager and covered several important topics such as incident management, safeguarding, mental capacity and mental health. However, it was unclear if this had been fully completed at the time of the inspection.
• The provider had improved patient documentation to support staff in capturing all parts of patient journeys.
• The provider had implemented registers that provided evidence that staff had read all appropriate policies and procedures.
• All policies now have version controls and owners (role titles).

We will add full information about our regulatory response to the concerns we have described to a final version of this report, which we will publish in due course.