Archived: Oak Tree Reliance Head Office

Updated 2 July 2021

Oak Tree Reliance Head Office is operated by Oak Tree Reliance Ltd. The provider was registered in 2018. It is an independent ambulance service based in Stanmore, North West London. The service primarily serves the communities of North London. The provider is sub-contracted by another private ambulance provider to provide services to the NHS primarily for outpatient appointments for adults. The service does not transport patients under the age of 18 or those detained under the Mental Health Act 1983.

The location has had a registered manager in post since 19 February 2020 and is registered to provide the regulated activity, Transport Service, triage and medical advice provided remotely.

The service has been inspected twice before, in March 2020 and September 2020. Following the inspection in March 2020, the provider was rated inadequate and four warning notices were served. We inspected the service in September 2020 to review whether the provider was compliant with the warning notices. We found that the provider was compliant with one of the four warning notices. There were still areas of concern identified and the provider was not compliant with three warning notices.

This was the third inspection of the service. We found that improvements had been made and the provider was now compliant with all warning notices served following the first inspection.

Updated 2 July 2021

Oak Tree Reliance Head Office is operated by Oak Tree Reliance Ltd. The service provides a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out the short noticed announced part of the inspection on 10 March 2020 and telephone calls to staff on 23 to 25 March 2020. We were not able to return to the service and speak to staff and patients due to Covid-19 restrictions.

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.

The only service provided by this service was a patient transport service.

This was the first inspection of this provider. We rated it as Inadequate overall.

• Staff had training on how to recognise and report abuse, but training was not an accredited level mapped to the Adult Safeguarding: Roles and Competencies for Health Care Staff intercollegiate document and not all staff knew how to apply the learning in practice.

• Staff did not keep detailed records of patients’ care and treatment provided while being transported by the service.

• The service did not manage patient safety incidents well. Managers investigated incidents but did not share lessons learned with the whole team and partner organisations.

• The service did not provide care based on national guidance or evidence-based practice and did not check to make sure staff followed guidance.

• The service monitored and met agreed response times with the contractor. However, they did not use the findings to make improvements to the service.

• The service did not obtain references for staff from previous employers. Managers did not hold supervision meetings with staff to provide support and development.

• The service did not have a policy on consent, the Mental Capacity Act or Deprivation of Liberty Safeguards.

• The service did not always take into account patients’ individual needs and preferences. The service did not always make reasonable adjustments to help patients access services.

• We were not assured the service investigated complaints fully or that they shared lessons learned with all staff, including those in partner organisations.

• Leaders did not demonstrate they understood and managed the priorities and issues the service faced.

• Leaders did not operate effective governance processes throughout the service. There were limited opportunities for staff to meet, discuss and learn from the performance of the service.

• Leaders did not use systems to manage performance effectively. They did not have a process in place to identify risks and issues or identify actions to reduce their impact.

• The service collected data but did not analyse it. Data was accessible to office staff but was not used to understand performance or make decision and improvements.

• There was no formal process for quality improvement to the service or sharing learning.

However;

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

• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection.

• All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively.

• People could access the service when they needed it and received the right care in a timely way.

• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear.

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, even though a regulation had not been breached, to help the service improve. We also issued the provider with four requirement notice(s) that affected patient transport services. Details are at the end of the report.

I am placing the service into special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Nigel Acheson

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

Updated 5 June 2020

The only service was patient transport services, which included the transfer of patients between health care providers for patients who were unable to use public or other transport due to their medical condition. In the period 1 March 2019 to 29 February 2020, the service carried out 33,658 patient transport journeys.

We have rated this service as inadequate overall. The provider did not ensure that all governance and risk management processes and procedures were in place to meet the needs of patients.