• Ambulance service


Overall: Requires improvement read more about inspection ratings

Unit 3, Tonge Bridge Industrial Estate, Tonge Bridge Way, Bolton, BL2 6BD (01604) 781722

Provided and run by:
ShowMed Limited

Important: This service was previously registered at a different address - see old profile

Latest inspection summary

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Background to this inspection

Updated 4 October 2021

ShowMed is located in Bolton, Greater Manchester and operated by the Risk Practice Ltd. The service supplies doctors, nurses, paramedics, emergency medical technicians and first aiders to sporting and public events.

CQC does not regulate activities that are undertaken on an event site. However, CQC do regulate activities involving patients being transported from an event to hospital, which was an activity that was carried out by the service.

The service has been registered since 16 September 2011 and the current registered manager has been in post since October 2019.

The service is registered to provide the following regulated activities:

  • Transport services, triage and medical advice provided remotely
  • Treatment of disease, disorder or injury

We previously inspected the service on 11-12 November 2019 and 7 January 2020. Following the inspection in November 2019 we issued a warning notice for breaches in Regulation 12 (safe care and treatment) and Regulation 17 (good governance). We also issued requirement notices for breaches in Regulations 13 (safeguarding), 15 (premises and equipment) and 19 (fit and proper persons employed) following this inspection.

The inspection report was published in March 2020 and we rated the service as requires improvement overall, with a rating of requires improvement for safe, effective and well-led and a rating of good for responsive. We did not rate caring as part of this inspection.

Overall inspection

Requires improvement

Updated 4 October 2021

ShowMed is operated by the Risk Practice Ltd and supplies doctors, nurses, paramedics, emergency medical technicians and first aiders to sporting and public events.

CQC do not regulate activities that are undertaken on an event site. However, CQC do regulate activities involving patients being transported from an event to hospital, which was an activity that was carried out by the service.

We inspected this service using our comprehensive inspection methodology. We carried out the short notice announced part of the inspection on 11 and 12 November 2019. Following this, further concerns about the service were raised with CQC and a further unannounced visit to the service took place on the 7 January 2020.

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?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

We rated the service as Requires improvement overall.

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

  • The service did not operate a system that protected people from abuse. This was because there was an increased risk that safeguarding referrals would not always be made in a timely manner.

  • The maintenance and use of equipment did not keep people safe. The service had not maintained oversight of all equipment and staff had reported a high number of incidents when equipment had not been available or had been faulty.

  • Staff did not use the system to help identify deteriorating patients. Staff had not documented a national early warning score for patients on any occasion.

  • The service had not recorded whether there had been enough staff with the right qualifications, skills and experience to keep people safe from avoidable harm and to provide the right care and treatment. This was because records did not indicate which members of staff had been responsible for transporting patients to hospital.

  • Staff had not always kept detailed records of patients’ care and treatment. We reviewed 11 patient records, finding that none had been fully completed.

  • The service did not use safe systems to safely store, record and prescribe medicines. The service had not maintained oversight and we found a large number of medicines discrepancies against what was recorded. In addition, the service had not used Patient Group Directives, which was not in line with the Human Medicines Regulations 2012.

  • The service had not always managed incidents well. Managers had not always investigated incidents or learnt lessons. We found that there was not always documented evidence of an investigation into incidents that had been reported or actions taken to reduce the risk of a similar incident happening again.

  • Managers had not checked whether care and treatment had been given in line with national guidance and evidence-based practice.

  • The service did not always make sure that staff were competent for their roles. On checking personnel files, evidence of competencies had not always been checked at the start of their employment.

  • Staff had not always documented why patients had lacked Mental Capacity on occasions when they had acted in their best interest. On two occasions, staff had not fully documented the reasons why they had lacked Mental Capacity to make their own decision about care and treatment.

  • Although the service had workable plans to turn their vision and strategy into action, there was an increased risk that this would not be achieved in a timely manner.

  • Leaders had not always operated effective governance processes. We found that the service held patient safety group meetings, however, it was unclear how the service was planning to take action to make improvements where needed.

  • Leaders had not always used systems to manage performance effectively. The service was not aware of all areas that we identified as requiring improvement during the inspection. In addition, risks had not always been minimised in a timely manner.

However, we found the following areas of good practice;

  • The service provided mandatory training in key skills to all staff and made sure that everyone completed it.

  • The service controlled infection risk well. Staff used equipment and control measures to protect themselves, patients and others from infection. They kept the premises and equipment visibly clean.

  • On most occasions, staff assessed and monitored patients regularly, and gave pain relief in a timely way.

  • Staff within the service communicated effectively and the service worked well with other agencies.

  • Staff understood the need to treat patients with compassion and kindness as well as to respect their privacy and dignity.

  • The service worked with others in the wider system and local organisations to plan care.

  • The service was inclusive and took account of individuals needs and preferences. Staff made reasonable adjustments to help patients access services.

  • The service had planned to treat concerns and complaints seriously, investigate them and share lessons with all staff.

  • Leaders were visible and approachable.

  • Staff who we spoke with felt supported, respected and valued.

Following this inspection, we told the provider that it must take some actions to comply with the regulations. Due to the concerns that we had following the inspection, we issued enforcement action, telling the service that it had to make significant improvements. This is detailed at the end of the report.

Ann Ford

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

Patient transport services

Updated 2 July 2018

The main service provided was urgent patient transport. Therefore we have reported findings in the patient transport section.

We do not currently have a legal duty to rate independent ambulance services, but we highlight good practice and issues that service providers need to improve.

The leaders of the service had a clear vision and strategy. Management appeared open and inclusive. This was evident in the morale of the staff and in their comments, which were overwhelmingly positive. They spoke with enthusiasm and passion about the service and its culture. Staff also spoke of a commitment to providing the best possible care and treatment to patients.

A collaborative multi agency approach was evident in the pre-planning for urgent patient transport services during events. Pre-planning incorporated risk assessments and addressed relevant patient safety issues.

The service had developed numerous ways to engage with their staff and provide information to a workforce that was casual by nature. They had also invested in new team management software.

We found the online staff booking system to be effective. This enabled the service to utilise the right levels of skilled staff and resources to meet the needs of the urgent patient transfer service safely.

The service had established policies and processes to identify, assess and monitor risks and to improve quality and safety. Staff knew how to record incidents and had ready access to incident reporting forms. We saw evidence and examples of incident reporting, reviews.

We found that the service had an effective recruitment system. Skills assessments, qualification and Disclosure and Barring Service (DBS) checks were performed. This ensured that they had sufficient numbers of suitably skilled staff and accurately monitored whether all staff had the qualifications and skills needed to provide safe and high quality care.

The service worked hard to establish a good relationship with its existing and potential clients. We spoke to one client who was very satisfied with the service and described how they always met their expectations and requirements.

We found evidence of service innovation, improvement and sustainability. The service was developing a clinical competency framework for staff to ensure that they were working within the boundaries of their role. A new alternative to controlled drugs for pain relief was introduced into the medicines formulary. The service had in place a business continuity policy.

However, we found the following issues that the service provider needs to improve:

The service did not have effective systems in place to ensure that medical gases were available in the necessary quantities and at all times. We found that oxygen cylinders had not been stored appropriately and there was no system in place to identify and segregate full, part used and empty cylinders.

The service could not ensure itself that medical gases and other equipment on the ambulance were in date and functioning before the point of use.

There was no formal process for checking that the contents of paramedic bags were correct and in date. The paramedic bags were also not identifiable as being ready for use or requiring restocking.

The service did not have a robust system to identify that ambulance vehicles had been cleaned prior to transportation, in between conveyances, or as and when required. Since routine cleaning was not recorded there was no means to identify if vehicles had been cleaned and were ready for use.

The service had performed audits which highlighted issues with completion of the patient report forms. Information was not always recorded to a sufficiently high standard, particularly surrounding the lack of documenting and witnessing consent.

Staff had completed mandatory training in safeguarding children and adults; however this was not always to a sufficiently high and skilled level for their roles.

The service was registered to provide urgent patient transport services from events to the whole population; however we did not see specific policies, skills assessments, competencies or equipment relating to the needs of children and young people. We were not assured that staff had the right competencies and training to provide urgent transport services to this population group.

The service did not currently check that relevant staff had been vaccinated for infectious diseases such as Hepatitis B and that they had achieved immune status.