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CQC finds improvement at London Ambulance Service NHS Trust but calls for further progress
The Care Quality Commission (CQC) has found that London Ambulance Service NHS Trust has made improvements to the safety of its services.
The trust was issued with a warning notice by CQC in October 2015 requiring it to take action to ensure that there were sufficient numbers of appropriately trained paramedics, risks were managed more effectively and medicine management was following recommended guidelines. At the time the trust was given a rating of Inadequate.
Inspectors carried out a focussed follow up inspection in August 2016 to check on the trust’s progress in meeting the requirements of the warning notice. A full report detailing the findings of that inspection has been published today and highlights a number of improvements.
Professor Sir Mike Richards, CQC’s Chief Inspector of Hospitals, said:
“It is a credit to the staff and leadership of London Ambulance Service that they have responded so positively to the findings of our previous inspection. The Trust has managed to recruit over 700 new members of staff in the space of a year. Action has also been taken to improve staff training and to tackle bullying and harassment. The support provided by NHS England and NHS Improvement as part of the special measures process has been of clear benefit.
“We still have some concerns about medicines management and have called for further work to address these issues. The Trust leadership has also recognised that there is more to do to fully embed the new risk management and reporting systems that they have introduced in order to demonstrate sustained improvement in the long term.
“The trust has taken sufficient action to meet the requirements set out in the warning notice, but we have made it clear where they must continue to focus efforts to drive further improvements as a priority.
“We are aware of the recent concerns in relation to the trust's performance in response to emergency calls and we are in contact with the trust regarding the outcome of their investigations. We continue to monitor the service closely and will be returning to carry out a comprehensive trust wide inspection next month where we expect to see further progress. Any change to the trust’s current ratings or recommendation regarding special measures will be determined by what we find on that visit.”
At the time of the inspection the trust had recruited over 700 new staff including a number of front line paramedics and technicians to the Hazardous Area Response Team (HART) where concerns about staff cover had been significant at the time of the previous inspection. Further trust wide recruitment initiatives were also underway.
A new electronic reporting system had been set up to make it easier for staff to report incidents and staff had responded positively, with a marked increase in the number of incidents being reported and greater awareness as to the correct procedures for doing so.
However, there remained variation in the extent to which staff were being encouraged by their managers to report incidents or adverse situations and some staff told inspectors that they still did not always have time to complete incident reports meaning that the opportunities to identify learning would be lost.
Improvements had been made to staff training and the trust had been proactive in tackling bullying and harassment. Over 490 staff had attended bullying and harassment workshops, and specialist training had been rolled out for 39 staff appointed as bullying and harassment investigators, with further training sessions planned.
Although the management of medicines had improved, and controlled drugs were now being stored securely, the monitoring of drugs removed from paramedic drug packs was not formally managed so it was not always clear whether medicines had been administered or moved elsewhere.
As a result the report identifies the following two areas for further improvement:
The trust must implement an effective system that checks or monitors medicines removed from paramedic or general drug packs in order to assess if these were given to patients or otherwise used.
The trust must ensure a robust system of checks and audits are set up to trace, and track transactions of medicines removed from paramedic drug packs, which have been administered to patients.
The inspection team, which included a pharmacy specialist and a specialist advisor in emergency planning with paramedic experience, visited the trust over two days during which they spent time at the trust’s headquarters in Waterloo, London, ambulance stations in Fulham, Newham and Waterloo, and the Hazardous Area Response Team (HART) based in Cody Road, East London.
A report detailing the findings from CQC’s separate inspection of the trust’s NHS 111 service has also published today. That inspection took place in September 2016 and overall NHS 111 services provided by the trust have been rated as Good.
Inspectors found that patients were receiving a safe, effective and responsive service from competent and caring staff. Senior leaders had a visible presence and there was a strong focus on learning where incidents or complaints identified any areas for improvement. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times and clinical advice and support was readily available to call handlers when needed.
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- Last updated:
- 29 May 2017
Notes to editors