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East Midlands Ambulance Service NHS Trust Headquarters Requires improvement

The report and ratings on this page are for a previous inspection of the East Midlands Ambulance Service headquarters. The report and ratings for the latest inspection of the service are published on our profile page for East Midlands Ambulance Service NHS Trust. This inspection resulted in an overall rating of Good.
We are carrying out a review of quality at East Midlands Ambulance Service NHS Trust Headquarters. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 10 May 2016

The East Midlands Ambulance Service NHS Trust (EMAS) is one of 10 ambulance trusts in England providing emergency medical services to Derbyshire, Nottinghamshire, Lincolnshire, Leicestershire, Rutland and Northamptonshire, an area which has a population of around 4.8 million people. The trust employs around 2,900 staff who are based at more than 70 locations including ambulance stations, an air ambulance station, emergency operations centres (EOCS) and support offices across the East Midlands.

The main role of EMAS is to respond to emergency 999 calls, 24 hours a day, 365 days a year. 999 calls are received by the emergency operation centres (EOC), where clinical advice is provided and emergency vehicles are dispatched if required. Other services provided by EMAS include patient transport services (PTS) for non-emergency patients between community provider locations or their home address and resilience services which includes the Hazardous Area Response Team (HART).

Every day EMAS receives around 2,000 calls from members of the public dialling 999. In 2014-15 they provided a face to face response to 649, 625 emergency calls. The service provided by EMAS is commissioned by 22 separate Clinical Commissioning Groups with one of these taking the role as co-ordinating commissioner.

Our announced inspection of EMAS took place between 16 to 20 November 2015 with unannounced inspections on 3 December 2015. We carried out this inspection as part of the CQC’s comprehensive inspection programme.

We inspected three core services:

• Emergency Operations Centres

• Urgent and Emergency Care including the Hazardous Area Response Team (HART) and the air ambulance.

• Patient Transport Services

Overall, the trust was rated as requires improvement. Caring and Responsive were rated as good. Effective and Well Led were rated as requires improvement and Safety as inadequate. We have taken enforcement action against the provider in this respect.

Our key findings were as follows:

  • The trust was working hard to improve response times for emergency calls but these were consistently below the national target.

  • There were insufficient staff and a lack of appropriate skill mix to meet the needs of patients in a timely manner.

  • Standards of cleanliness and infection control, although inconsistent in some trust buildings were generally good on ambulances.

  • All staff, especially those at the frontline were passionate about and committed to providing high quality, safe care for patients. At the same time they were open and honest about the challenges they were facing.

  • Whilst the trust were working hard to recruit staff, they were finding it a challenge to retain staff and overall numbers were only increasing minimally.

  • Staff morale was low and they often did not feel valued. There was an unrelenting demand for emergency services combined with a lack of staff and resources to meet the need.

  • Frontline leaders did not have the capacity or in some cases the skills to support teams and individuals and fulfil the requirements of their roles.

  • Many staff were not receiving performance development reviews (appraisals), clinical supervision (where appropriate) or mandatory training.

  • There was a clear statement of vision and values driven by quality and safety. The trust board functioned effectively.

  • Without exception the Chief Executive was held in high regard by staff for her visible, open approach.

We saw several areas of outstanding practice including:

  • We observed many examples of non-clinical staff supporting patients and saving lives in what were extremely difficult and stressful situations. Staff remained calm and gave callers confidence to deliver life-saving treatment.

  • The trust had introduced ‘change Wednesdays’ in the emergency operations centre (EOC) to avoid daily contact with staff about minor changes to policies and systems. Staff were confident any changes to policies or procedures would take place on the same day every week.

  • The trust were the best performing ambulance trust in England for the number of calls abandoned before answered.

  • A mental health triage car was available in Lincolnshire between 4pm and midnight, staffed by a paramedic and a registered mental health nurse from a mental health trust. They could assess the needs of the patient and provide appropriate care which in some cases avoided hospital admission or the use of a Section 136 detention under the Mental Health Act 1983.

  • The trust had a joint ambulance conveyance project working with six fire and rescue services in their region. This was the first service of its kind for an ambulance service nationally.

  • The trust, in partnership with six fire and rescue services across the region, had introduced a regional emergency first responder (EFR) scheme. This was the first regional service of its kind of an ambulance service nationally.

  • A project was in place to improve treatment for patients in acute heart failure. Crews had been issued with continuous positive airway pressure (CPAP) machines. The CPAP machine improves oxygen saturation levels in these patients.

  • Staff in patient transport services (PTS) had direct access to electronic information held by community services including GPs. This meant they could access up to date information about patients including their current medication.

  • The patient advice and liaison service had recruited existing patients to report to them about their planned journeys and experiences of patient transport services (PTS). They called this a ‘secret shopper’ programme.

  • Staff name badges included their name in braille to assist patients with visual impairment. Guide dogs were allowed to accompany visually impaired patients.

  • The Chief Executive was praised by all staff for her visible, open approach and her commitment to engaging staff face to face.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure staff report all appropriate incidents which are then appropriately and consistently investigated.

  • Ensure learning from incidents, investigations and complaints is shared with all staff.

  • Ensure all staff receive statutory and mandatory training.

  • Ensure all domestic, clinical and hazardous materials are managed in line with current legislation and guidance.

  • Ensure vehicle and equipment checks are carried out to the determined frequency.

  • Ensure there are sufficient emergency vehicles to safely meet demand.

  • Ensure medicines, including controlled drugs are stored and managed safely.

  • Ensure paper patient report forms are stored appropriately and securely in trust premises and in such a way on trust vehicles as to maintain patient confidentiality

  • Ensure there are sufficient numbers of staff with an appropriate skill mix to meet safety standards and national response targets.

  • Ensure arrangements to respond to emergencies and major incidents are practised and reviewed in line with current guidance and legislation.

  • Ensure response times meet the needs of patients by reaching national target times.

  • Ensure all staff receive appropriate non-mandatory training to enable them to carry out the duties they are employed for.

  • Ensure all staff receive an annual appraisal.

  • Ensure service level agreements are in place to monitor the quality of taxi service provision for patient transport services.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Inspection areas

Safe

Requires improvement

Updated 13 June 2017

Effective

Requires improvement

Updated 13 June 2017

Caring

Good

Updated 10 May 2016

Responsive

Good

Updated 10 May 2016

Well-led

Requires improvement

Updated 13 June 2017

Checks on specific services

Emergency operations centre (EOC)

Requires improvement

Updated 13 June 2017

Patient transport services

Requires improvement

Updated 10 May 2016

The patient transport service (PTS) serving north and north east Lincolnshire and the emergency department (ED) in Nottingham was considered to be good for effective, caring and responsive, and

requires improvement for safe and well led.

The PTS ambulance and control teams worked well together to provide an effective and responsive patient transport service to meet the needs of the population it served. The service was supported by a team of 42 volunteer drivers. Volunteer drivers’ used their own vehicles to transport patients. Vehicle documentation for MOTs and insurance had not been consistently checked and recorded. Communication between the control staff and drivers demonstrated an embedded respect for each other and good working relationships.

Staff demonstrated safety awareness and ensured each patient journey was as safe and comfortable as possible. This was reflected in the positive comments received from patients, carers and staff from local hospitals and care homes.

Staff knew how to report incidents and understood their responsibility to submit reports in a timely way. However, there was little evidence of sharing and learning and staff were unable to identify changes made following a reported patient safety incident.

Staff attended a comprehensive induction when joining the service but attendance to mandatory training did not meet the trust target of 95% with some key topics such as resuscitation and moving and handling showing minimal attendance.

Staff did not consistently receive annual appraisals to monitor competency and support professional development. Dates for appraisals were set for all staff but frequently cancelled at short notice.

Emergency and urgent care

Requires improvement

Updated 13 June 2017

Other CQC inspections of services

Community & mental health inspection reports for East Midlands Ambulance Service NHS Trust Headquarters can be found at East Midlands Ambulance Service NHS Trust.