ERS Medical Midlands

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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

This means we looked for evidence that patients’ care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant patients’ outcomes were consistently good, and patients’ feedback confirmed this.

The service assessed patients’ needs to ensure transport arrangements reflected their mobility, health, communication and support requirements. Staff used structured assessment processes and dynamic risk assessments to help ensure patients received transport appropriate to their individual needs. 

The service delivered care and treatment in line with legislation, recognised standards and evidence-based guidance. Staff worked collaboratively with healthcare providers, commissioners and other stakeholders to support continuity of care and positive outcomes for patients using the service.

Leaders monitored performance, patient experience and service outcomes through governance and contract management arrangements. Information from performance monitoring, patient feedback, incidents, complaints and service reviews was used to make the service safer and more helpful for patients.

Although some performance indicators were below contractual targets during the assessment period, leaders demonstrated a clear understanding of the factors affecting performance and maintained improvement plans to support better outcomes. Performance was regularly reviewed with commissioners and healthcare partners, and actions were adjusted where further improvement was required.

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.

We scored the service as 3. The evidence showed a good standard. The service made sure patients' care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service maximised the effectiveness of patients’ transport. Staff assessed needs before transport was arranged. They also reviewed information when circumstances changed. Patients were assessed against Integrated Care Board eligibility criteria to make sure patients got the right transport for their needs. Staff recorded patients’ needs for communication, whether the patient needed an escort and any other additional needs. Where patients needed additional support, staff recorded this and planned for it. Staff also identified any need for specialist equipment or if patients required assistance with their mobility Staff could arrange specific seating arrangements where required. 

Transport staff were expected to verify information where appropriate. They escalated concerns when information differed from the original booking. This included changes to a patient's condition, mobility or changes to their infection status. Staff could change journeys when necessary.  This helped ensure patients received transport appropriate to their needs.

Staff understood the importance of reviewing available information and told us they would escalate concerns if a patient's needs differed from booking information. Staff worked closely with operational teams and control staff. They also worked with healthcare providers where appropriate. This helped ensure suitable arrangements were in place.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered patients' care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. 

The service delivered care in line with current legislation and recognised standards. The service used nationally recognised guidance to support care delivery. The policy for deteriorating patients referenced National Institute for Health and Care Excellence (NICE) and Resuscitation Council UK guidance. The policy also included Joint Royal Colleges Ambulance Liaison Committee guidance. Staff followed a policy for patients attending renal services such as dialysis. The policy was based evidence-based practice and recognised standards.

Staff we spoke with told us they used the policies to guide patient bookings and collections. They also guided patient transportation, monitoring, and handover. Policies required staff to assess a patient’s mobility before transport commenced. They also covered the assessment of cognitive needs and infection risks. Staff considered oxygen requirements and access arrangements. They also identified any additional support needs and patient monitoring and consent. There was guidance for staff on their safeguarding responsibilities. Policies also described how to respond to changes in a patient's condition and provided guidance on clinical escalation.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support patients. They made sure patients only needed to tell their story once by sharing their assessment of needs when patients moved between different services.

The provider had clear arrangements for transferring information between services. Staff worked with health and care providers to get relevant information before transport.  Crews were required to complete accurate handovers when collecting and dropping patients off.  These arrangements meant patients did not have to repeat themselves each time they arrived at a new location.

Leaders at the service worked with commissioners, healthcare providers, and partner organisations. Leaders told us they held monthly engagement meetings with partners. month. They reviewed service delivery, performance, and operational issues. The provider also employed relationship managers and patient liaison officers. These staff acted as points of contact for partner organisations. They enabled communication and collaboration between services which supported service improvement.

The service had a dedicated renal support coordinator for patients who regularly used transport to access renal appointments, such as dialysis. Healthcare staff working at dialysis units could contact the renal support coordinator directly to resolve any concerns about individual patients or their transport arrangements. The support was available Monday to Friday from 7am to 7pm through the relationship team. Outside these hours, concerns were escalated through the 24-hour control room, which had access to on call leaders.

Leaders promoted collaborative working between internal teams. Control room staff, planners, dispatchers, operational teams, and crews shared information. They used electronic systems and established communication processes. Frontline crew told us they worked closely with control room teams. They also worked closely with operational managers. if patient needs changed or when concerns were identified.

Most staff told us communication between teams was effective and said this supported safe and coordinated care. However, some crew members identified communication challenges. Frontline crew said information did not always match updates given to patients. This was particularly evident when delays occurred. They described delays in receiving operational updates from control room. These included changes to journey allocations and collection times. Leaders acknowledged this was an area for improvement. They explained that operational priorities could change rapidly which sometimes required  journeys to be changed at short notice. Leaders said these changes could affect communication with frontline crews. However, they continued working to minimise impacts on patients. They also worked to minimise impacts on staff.

We scored the service as 3. The evidence showed a good standard. The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduced their future needs for care and support.

The service supported patients to access healthcare services which promoted their health and wellbeing. The service enabled patients to attend planned healthcare appointments and treatments, including regular renal dialysis sessions. 

The service promoted patients' wellbeing during transport. Staff considered patients' comfort, dignity, hydration, and mobility needs. This was particularly important during longer journeys. Staff monitored patients throughout transport. They responded when patients' needs changed. Staff told us they routinely undertook informal welfare checks. These checks took place when collecting or returning patients home. Staff checked whether people could access essential items at home. This included medicines and drinks. They also identified concerns about home security and considered potential fire safety risks. They escalated any concerns where necessary. This helped ensure patients remained safe and supported at home.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored patients' care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of patients themselves.

Local leaders used provider wide systems and processes to monitor performance and quality. Leaders routinely reviewed performance information through contract management boards and quality meetings. They also developed service improvement plans.  Leaders monitored activity levels and journey delays. They also checked complaints, incidents, and safeguarding concerns. Patient feedback was reviewed regularly. Leaders also monitored cancellations and aborted journeys. Contractual key performance indicators were also routinely reviewed.

Leaders monitored service performance through a range of key performance indicators. Most patient transport journeys were completed as planned and the number of aborted journeys remained relatively low. However, the service did not consistently achieve some transport timeliness and call handling targets. This meant some patients experienced delays in being collected or had difficulty contacting the service. Leaders recognised these issues and implemented actions to improve performance, including recruiting additional call handling staff, introducing alternative booking routes and working with healthcare partners to improve booking processes and manage demand. Leaders monitored the impact of these actions through governance processes, and performance improved over the reporting period, with more calls being answered and fewer calls being abandoned.

Leaders used patient experience data, including complaints, compliments and survey results, to monitor service quality and identify opportunities for improvement. They reviewed trends, took action to address concerns and monitored the effectiveness of improvements through regular governance processes

We scored the service as 3. The evidence showed a good standard. The service told patients about their rights around consent and respected these when delivering person-centered care and treatment.

The service had arrangements to ensure patients' consent rights were understood and respected. Staff followed policies which reflected the principles of the Mental Capacity Act 2005.  Policies also supported people to make their own decisions. This was applied wherever possible. Staff were expected to presume patients had capacity. This remained the case unless evidence suggested otherwise. Staff were required to act in patients' best interests if people lacked capacity for specific decisions.

Staff obtained consent before undertaking any tasks with patients such as entering a patient’s home or transferring a patient to and from a vehicle. Staff involved patients in decisions about their journeys where possible. Staff demonstrated an understanding of the Mental Capacity Act. They described how they would identify and respond to concerns about a person's capacity. Staff told us they completed mental capacity assessments when required and understood the importance of supporting people to make their own decisions wherever possible. This helped ensure decisions were made appropriately and in accordance with legal requirements.

Patient feedback indicated staff involved them in discussions about their transport arrangements.