Archived: QAS Ambulance Limited

QAS Ambulance Limited is operated by QAS Ambulance Limited. The service was first registered in April 2013. It is an independent ambulance service based in Manchester which serves several local and regional acute NHS hospital trusts and local authorities. The service provides patient transport services from one ambulance base location situated in Manchester. The service also provides event cover (unregulated activity) and is able to provide patient transportation services from event sites (regulated activity), as required.

We carried out an unannounced focussed inspection of the service on 4 March 2020 to follow up on enforcement action issued from the previous comprehensive inspection on 23 and 24 April 2019. We did not rate the service as this was a focussed inspection.

We found the following areas that required improvement:

• There was no procedure or guidance to support staff in making a decision as to whether the patient was suitable for transport or not, either for transportation from event sites or routine patient transport journeys. It was therefore unclear that the service was able to monitor the suitability of the patients effectively.

• Patient booking forms and patient journey records (including patient risk assessment information) were not always completed in full. Similar information remained incomplete at the previous inspection. It was therefore unclear that the service was effectively able to drive improvements in record keeping.

• Systems put into place to monitor the service provided were not always comprehensive or embedded appropriately. It was therefore unclear that the service provided was being monitored effectively or that improvements could be made easily.

We found the following areas of good practice:

• The service had made significant improvements to make sure that medicines were managed safely.

• The service had made significant improvements in relation to commencing a programme to review and update all policies and procedures and to implement a formal risk system.

• The service had implemented a formal five-year vision and strategy with milestone target dates and workable plans to achieve these.

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. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals North, on behalf of the Chief Inspector of Hospitals

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced inspection on 23 and 24 April 2019.

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?

QAS Ambulance Limited is operated by QAS Ambulance Limited. The service opened in April 2013. It is an independent ambulance service in Manchester that serves several local NHS hospital trusts and local authorities. However, the service also transports patients across the country when required.

We rated it as Inadequate overall.

We found the following issues that the service needs to improve:

• Although the service had a safeguarding policy for adults and children, it was unclear if there was an effective system to protect patients from abuse. This was because although the service had a designated safeguarding lead, it was unclear if they had completed the correct level of training and the service had not planned to access a suitably qualified professional when needed.
• The service undertook Disclosure and Barring Service checks for all new staff. However, we found that there was no documented evidence of how the service had assessed the suitability of staff who had previous criminal convictions to undertake their role.
• We did not see documented evidence that the service had completed basic risk assessments for each patient and removed or minimised risk. This was because this had not been documented as part of the booking process or patient record forms.
• Staff had not always kept detailed records of patient’s care and treatment. We reviewed 18 patient records, finding that they had not been fully completed on eight out of 18 occasions. In addition, the service had not kept patient records on occasions that patients had been transferred from an event to hospital.
• The service did not have processes to manage medicines safely. This was because they did not have a medicines management policy, despite staff regularly transporting patient’s own medicines as well as providing medical gasses to patients. Additionally, not all staff had received training to administer medical gasses.
• The service had not always managed patient safety incidents well. Although there was an incident reporting policy, not all staff knew about the process to report incidents. Records indicated that there had no reported clinical or non-clinical incidents between April 2018 and April 2019.
• The service did not have a policy or standard operating procedure covering mental capacity, consent or best interest. This was important as it meant that there was no clear process for staff to follow when documenting a best interest decision or if a patient had refused transport.
• Although managers informed us that the service took account of individual needs and preferences on reviewing patient records, there was no documented evidence that the service had considered other complex needs such as if patients were living with dementia or had learning disabilities.
• The service did not have a formal vision and strategy. However, managers could tell us about the service and what they were aiming to achieve moving forward.
• The service did not have a formal system to assess, mitigate and control both clinical and non-clinical risks. This meant that we were not assured that all risks had been identified or that controls were in place to reduce the level of risk when needed.
• The service had not always monitored compliance against national guidance or policies. We found areas of poor compliance, such as record keeping, which the service was not aware of.

However, we found the following areas of good practice:

• The service provided mandatory training in key skills and made sure that all staff completed it. This included important topics such as basic life support.
• The service had controlled infection risk well on most occasions. There were sufficient amounts of personal protective equipment available for staff to use and all ambulances were visibly clean.
• The design, maintenance and use of facilities, premises, vehicles and equipment kept people safe. Staff were trained to use them. The service had a system to report faults and had acted to fix faulty items when needed.
• The service had enough staff to provide the right care and treatment. Records between March and April 2019 indicated that there had been the planned number of staff available to undertake all patient journeys.
• We reviewed eight patient record forms when feedback had been received by patients, finding that all feedback had been positive, with comments such as ‘staff were great’ and that a ‘comfortable journey’ had been provided.

During the inspection, we visited the service at Unit 4, Cornishway Industrial Estate, Austell Road, Manchester, M22 0WT unannounced on 23 and 24 April 2019. Due to an incorrect registration, this location was not registered as a separate location with us. The provider has submitted an application for the service’s new location, under which this report is now published.

Following this inspection, we issued enforcement action, telling the provider that they must make significant improvement. We also 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. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (North Region), on behalf of the Chief Inspector of Hospitals