- Ambulance service
South East Coast Ambulance Service NHS Trust Headquarters
All Inspections
28 February and 1 March 2022
During a routine inspection
This service is rated as Good overall. (Previous inspection 02 2019 – Good)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Requires Improvement
Are services well-led? – Good
We carried out an announced comprehensive inspection at South East Coast Ambulance Service NHS 111 service on 28 February and 1 March 2022. This was to follow up on a breach of regulation 12 identified in the July 2019 inspection. The visit was also part of a Trust wide inspection. Action taken had resulted in improvements to meet the essential standards although call response times continued to be a challenge.
At this inspection we found:
- The service had systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
- The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
- Staff involved and treated people with compassion, kindness, dignity and respect.
- Patients were able to access care and treatment from an integrated service with specialisms to meet their needs.
- Commissioned targets were not being met for call response times and abandonment rates.
- There was a focus on continuous learning and improvement at all levels of the organisation.
We found the following areas of outstanding practice:
- Having worked with the commissioners and other external organisation to establish a Direct Appointment Booking (DAB) service, approximately 30% of all triaged patients received a DAB into an external provider. This service improvement had resulted in a Health Service Journal improvement Award for ‘Best Acute Sector Partnership with the NHS’.
The areas where the provider should make improvements are:
- Continue to work towards meeting the key performance indicators on clinical call back times, call abandonment rates and call response times.
- Continue working towards supporting the workforce in order to reduce the pressure and improve staff morale.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
02 July to 03 July 2019
During a routine inspection
This service is rated as Good overall. (Previous inspection May 2017 – Good)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Requires Improvement
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Good
We carried out an announced comprehensive inspection at South East Coast Ambulance Service NHS Trust Headquarters (SECAmb) on 2 and 3 July 2019 as part of our inspection programme. At this inspection we found:
- The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
- The service reviewed the appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
- There were processes to audit the quality of care being delivered according to evidence- based guidelines. However, the required number of clinical call audits was not being met.
- Staff involved and treated people with compassion, kindness, dignity and respect.
- Patients were not always able to access care and treatment from the service within an appropriate timescale for their needs as performance fell below target in relation to abandoned calls and call answering times.
- Staff felt supported and valued, and spoke highly of the leadership team.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
The areas where the provider must make improvements are:
- Ensure care and treatment is provided in a safe way to patients
The areas where the provider should make improvements are:
Take action to ensure patient feedback mechanisms are fully established.
Dr Rosie Benneyworth BM BS BMedSci MRCGP Chief Inspector of Primary Medical Services and Integrated Care
17 and 18 May 2017
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out a comprehensive inspection of the NHS 111 service provided by South East Coast Ambulance Service NHS Foundation Trust (SECAmb) on 4 and 5 May 2016. At this time SECAmb were contracted to deliver the NHS 111 service to Kent, Medway, Surrey, Sussex and the North Hampshire area with the NHS 111 service provided by SECAmb from their base in Ashford, Kent. There was a shared management structure in place with Care UK Surrey, with whom they sub-contracted to provide the NHS 111 service across the same geographical area as SECAmb. At this inspection we rated the service as Requires Improvement as performance was not at the expected standard, with a lack of strategic leadership. Most importantly patients were not always being dealt with in a timely manner, with many calls remaining unanswered at some peak periods of usage.
We re-visited the service on 17 and 18 May 2017 and found that there had been many improvements in the service that was being provided. In particular our key findings were as follows:
- The complaints procedure was comprehensive with all complaints dealt with by the service in a thorough and timely manner.
- Risk management was embedded and the risk register was up to date and completed with relevant action points.
- There was a culture of transparency and communication between all staff.
- Significant events and staff concerns were embraced as opportunities for learning and development.
- Staff were encouraged in their career and working life and supported in their wellbeing.
- Feedback from staff, providers and patients was encouraged and acted upon when necessary.
- High standards were promoted and owned by all provider staff.
- Team working was encouraged and embedded.
- Safeguarding was a priority for learning and training was implemented to a high level.
- There were effective systems in place to monitor and improve service.
- Response times for calls answered at peak times had improved and was an ongoing priority for all management.
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Daily, weekly and monthly monitoring and analysis of the service achievements was measured against key performance targets. This information was shared with the Lead Commissioner for the County clusters in Surrey, Sussex and for Kent and Medway. Account was also taken of the ranges in performance in any one time period.
- The system of working with other providers was systematic and professional.
- There was good collaborative working with the partner organisation.
- Senior management understood the governance structures and there was oversight at local and trust level.
- The service had long and short-term plans in place to ensure staffing levels were sufficient to meet anticipated demand for the service.
- There was evidence of innovation and a continuous assessment for future planning and improvement.
We saw one area of outstanding practice:
There was a well-developed leadership structure that had supported innovative practice and the implementation of new systems, which were becoming embedded across the service. For example the diamond pod training structure, where staff had instant access to supervisory help on the floor. This allowed new staff to be nurtured and valued without pressure of call targets, with more experienced staff able to give their time appropriately. There were initiatives to increase safety and welfare in the call centre for staff and patients, such as bright orange cards that could be used by call handlers to easily signal that immediate help was required. There was also a focus on continuously improving working relationships within the service management with Care UK and the wider health and care service. SECAmb management was striving to find more efficient and responsive ways of sharing and utilising knowledge from the acute and primary health providers, social care providers and voluntary agencies in order to improve service to patients and the working environment for all staff.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
4 and 5 May 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out a comprehensive inspection of the NHS 111 service provided by South East Coast Ambulance Service NHS Foundation Trust (SECAmb) on 4 and 5 May 2016, as part of the wider Ambulance Trust Inspection. This report should be read in conjunction with the South East Coast Ambulance Service NHS Foundation Trust report, which can be found on our website at: http://www.cqc.org.uk/.
SECAmb are contracted to deliver the NHS 111 service to Kent, Medway, Surrey, Sussex and the North Hampshire area. The NHS 111 service is provided by SECAmb from their base in Ashford, Kent. There is a shared management structure in place with Care UK Surrey, with whom they sub-contract to provide the NHS111 service across the same geographical area as SECAmb.
Our key findings were as follows:
- SECAmb recognised that their performance in achieving the expected standards for the NHS 111 service (the national minimum data set) was not good enough. Since the inspection the provider has informed us that they have introduced plans that have improved performance. However they did not provide us with evidence to demonstrate this.
- Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
- All opportunities for learning from internal incidents were used to promote learning and improvement.
- Staff took action to safeguard patients and were aware of the process to make safeguarding referrals. Safeguarding systems and processes were in place to safeguard both children and adults at risk of harm or abuse, including frequent callers to the service.
- Staff were trained to ensure they used the NHS Pathways safely and effectively.
- Regular audits of calls to the service monitored quality and supported improvement and where issues were identified remedial action was taken and the employee was supported to improve.
- There was an overarching governance framework across the NHS 111 service, which supported the delivery of the strategy and good quality care. This included arrangements to monitor quality and identify risk.
- Patients using the service were supported effectively during the telephone triage process. Consent to triage was sought and their decisions were respected. We saw that staff treated patients with compassion, and responded appropriately to their feedback.
- Clinical advice and support was readily available to call handlers when needed. Care and treatment was coordinated with other services and other providers.
- The SECAmb NHS 111 management team had agreed local operating policies and procedures to govern the NHS 111 activity and held regular governance meetings.
- SECAmb was aware of and complied with the requirements of the Duty of Candour. The managers encouraged a culture of openness and honesty.
- There was a strong focus on continuous learning at all levels.
- During our inspection we found groups of staff, notably health advisors, clinicians and first line managers to be highly dedicated to and proud of the important work they were undertaking.
We saw an area of outstanding practice:
The service used innovative approaches to developing pathways in response to specific needs resulting in improved outcomes for people, for example the service identified factors that were impacting on the quality of end of life care and sexual assault pathways. They analysed the factors, engaged the clinical commissioning group and other providers, and developed tailored pathways and reviewed the implementation, they recorded a positive impact for nine referrals for end of life care and four referrals for sexual assault in the first month.
Importantly, the provider must:
- Ensure patients can access timely care and treatment when first contacting the service.
The areas where the provider should make improvements:
- Ensure that all the governance processes have been reviewed through the SECAmb governance structures and signed off by the Trust Board.
- Review how it communicates with the population is serves by providing feedback on themes identified in annual reports such as the annual complaint report.
The provider has been issued with a Warning Notice under section 29A of the Health and Social Care Act 2008 in relation to the findings of the inspections.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
During a check to make sure that the improvements required had been made
2, 3, 4, 6, 8 December 2013
During a routine inspection
People who used the service told us they felt they received the care and support they needed. They said ambulances arrived promptly and that staff were caring. Comments included, 'They took such care of X". 'They reassured me'. Everyone we spoke with confirmed that staff protected their dignity and sought their consent.
Staff we spoke with understood their individual roles and accountabilities. All staff demonstrated their commitment to ensuring that patient care was the focus. All staff displayed a pride in their role.
There were effective systems in place to reduce the risk and spread of infection.
Medication procedures safeguarded the people who used the service.
Improvements in training meant that people were cared for by staff who were supported to deliver care and treatment safely.
There were systems in place to monitor quality and identify risks. However we found that some of these systems did not address issues in a timely manner. There were inconsistencies in practices in different areas.
4, 5, 6, 7 February 2013
During a routine inspection
We spoke with over fifty members of staff who worked for the Trust. Staff showed pride in working for the Trust. Staff had a positive attitude and patient care was their primary goal and the focus of the service. They said, 'It's outcomes for patients that really matter' and 'Everything we do is in the best interests of the patients'.
People who used the ambulance service told us that they had received the help they needed. They told us they felt safe and that ambulance staff had explained everything to them. Comments included, 'They were brilliant, concerned, kind and efficient', 'They involved me and listened to what I had to say'. 'The ambulance staff were first class, very good indeed and they asked for my consent to do tests' and, 'Overall the experience was extremely good'. I am highly complementary of them'.
Staff knew how to safeguard people from abuse and how to report any concerns about people's welfare.
Clear and detailed procedures were in place for the management of medicines. The ordering of controlled drugs was not compliant with the Misuse of Drugs Act 2001.
Not all staff had received training and supervision appropriate to their role.
We found that there were systems in place to monitor quality and identify risks to ensure people's needs were met and promoted.
12 January 2012
During a routine inspection
There are other ambulance stations across the three counties which do not yet have this specialist facility and ambulances are cleaned and re-stocked by the ambulance crews.
We visited two Accident and Emergency departments (A&E) so that we could observe ambulances arriving at A&E and speak to people, relatives, front line ambulance staff and staff employed at the hospitals.
People who had used the service told us that the ambulance crews were polite and treated them with respect. People commented: "they spoke to me the same as they spoke to each other".
"Yes they were respectful, they were calm and reassuring."
People told us that ambulance crew asked for their consent before giving any treatment.
The Patient Transport Service (PTS) is operated by the trust and provides non urgent patient transport. PTS services transport people between their home or place of residence to where they need to go to for treatment. For example to a hospital or day care centre and home again after treatment. We spoke to people who use this service.
They told us:
'They don't discuss anything about me in front of anyone else'.
'I know roughly what time they're coming. Sometimes I have to wait a little, but it is not a problem'. 'They always put me at ease'. Someone else said 'They are very lovely staff, they all chat to me'.
We carried out telephone and face to face interviews with managers of care and nursing homes and people across the area who had reasons to use the ambulance service.
They told us ,
'The PTS is much better now. It used to be dreadful. I would have to phone two or three times and patients would be late and miss their treatment. Over the past six months to a year it is much better. They are on time so it is much better for the patient now as they do get anxious. It works much better now'.
'When we call the emergency services they are always here promptly. They are very nice as well. They always ask questions and yes they are respectful'.
'I had to call an ambulance for a person when I had taken them for walk on the beach. We were not easy to reach but the ambulance crew got to us very quickly. The crew were very polite to the person using the service (who has communication difficulties) and efficient. They carried out a variety of medical checks but could not find any evidence of anything indicating ill health. I was confident that they had been thorough in their observations and investigations and I was given a written report to refer to'.
As part of the review we visited the Emergency Dispatch Centre (EDC) to see how 999 calls are dealt with. We spoke to a range of staff who worked there.