• 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

All Inspections

31 August 2021

During an inspection looking at part of the service

We carried out a focussed responsive inspection at ShowMed on 31 August 2021 as a follow up to the issue of a warning notice for breaches in Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) which was issued on 26 November 2019 following our previous inspection of this service on 11 November 2019.

We also followed up on actions taken following the issue of requirement notices for breaches in Regulations 13, 15 and 19 from the previous inspection of this service on 11 November 2019.

During this inspection we found there had been improvements since the last inspection and the provider had addressed the concerns raised in the warning notice and requirement actions from the previous inspection.

We did not rate the service as part of this inspection because the service had not carried out any regulated activities.

We found the following areas of good practice:

  • The service used systems and processes to safely prescribe, administer, record and store medicines.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events.
  • The design, maintenance and use of facilities, premises, vehicles and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration. staff carried out clinical observations and repeated these at regular intervals.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
  • The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.


  • The frequency of clinical observations was not formally specified in the provider’s policies for managing deteriorating patients.
  • The provider did not have a standardised process for documenting capacity assessments and best interest decision-making discussions.

11, 12 November 2019 and 7 January 2020

During a routine inspection

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