The Care Quality Commission (CQC) is calling on independent ambulance services in England to ensure they care for their patients safely after its inspections to date have found significant concerns.
CQC has carried out 70 comprehensive inspections of independent ambulance services since April 2015, which covers around a fifth of those registered.
From many of these inspections, CQC has identified common concerns around poor medicines management, cleanliness and infection control practices and a lack of appropriate recruitment checks.
CQC has published 39 reports on these inspections to date. Within these, CQC has taken enforcement action and issued ‘requirement notices’ to 25 different providers, ordering them to improve. This includes two cancellations.
In a letter sent to all independent ambulance providers in England today (Tuesday 21 March), CQC has highlighted its emerging concerns and it has reminded providers of their commitment to provide safe and effective care. Also, CQC has warned those that have not been inspected yet, that they will be scrutinised in the same level of detail so that CQC can be sure patients are being cared for safely and appropriately.
CQC's letter says: "We have found problems with the safety of the healthcare provided to people who use independent ambulance services. In these instances we have taken appropriate enforcement action against the providers to protect the people under their care. However, we are concerned that these might not be isolated findings. We will therefore pay particular attention to these issues at all future inspections and urge you to consider any actions you may need to take to address these issues in your service."
Prof Sir Mike Richards, Chief Inspector of Hospitals at the Care Quality Commission, said: “Providers have a responsibility to ensure the safety and appropriate treatment of the people within their care. Having inspected around 20 per cent of the independent ambulance providers registered in England so far, we are concerned that some may be putting patients at risk.
"Patient safety must be a priority at all times. Vehicles used to transport patients must be clean and fitted with the right equipment, staff must be appropriately trained and supported to carry out their roles effectively, and medicines must be stored securely and administered by staff trained to do so.
"We know that there are some independent ambulance services doing all these things and providing very good care, but unfortunately, our emerging findings suggest that this is not always the case. Where we have found concerns we have held those providers to account and have been clear where improvements must be made. We expect providers to deliver on their commitment to provide safe, high-quality and compassionate care and we will do everything within our powers to ensure this happens."
Independent ambulance providers (including charities and private businesses) mainly offer specialist patient transport services and non-emergency responses, often on behalf of the NHS. In addition, some provide 999 emergency responses during peak demand.
Specific concerns CQC identified during its inspections so far include:
- A lack of attention to fundamental safety processes and variable standards in relation to governance and risk management.
- Problems with the recruitment processes, including failures to ensure staff have had their DBS checks or that they hold the correct driving licence categories and expectations (e.g. to operate heavier vehicles or to have had blue-light training).
- Staff not always recognising or escalating safeguarding concerns and a lack of appropriate safeguarding training.
- Concerns around incident reporting including poor reporting systems and limited evidence of learning from incidents.
- Infection prevention and control standards not always been followed and concerns about vehicle and equipment maintenance.
- Concerns regarding medicines management, including their storage on the vehicles.
- Patients often finding it difficult to make a complaint about their care and a failure to use of complaints as a learning opportunity.
CQC plans to complete its inspection programme of all independent ambulance services by the end of March 2018. This will include follow up inspections of those providers where concerns have been identified already.
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