CQC's Chief Inspector of Hospitals has published his first report on the quality of care provided by South Central Ambulance Service NHS Foundation Trust.

England's Chief Inspector of Hospitals has published his first report on the quality of care provided by South Central Ambulance Service NHS Foundation Trust.

Overall, the CQC inspection found that the trust provided safe and effective services which were well-led with a clear focus on patient care.

South Central Ambulance Service NHS Foundation Trust is the second ambulance trust to be inspected under radical changes which have been introduced by CQC to provide a more detailed picture of healthcare than ever before.

Click here for the full report from the inspection.

Inspectors examined the care and treatment provided by the trust, reporting in detail on access to the service through emergency operations centres, emergency and urgent care and patient transport services.

Patients who met inspectors were positive about the quality of their care, and inspectors saw staff treating patients with compassion, dignity and respect. Staff showed a caring, committed and compassionate manner.

In comparison with England’s other regional ambulance services, inspectors found that the performance of SCAS varied in some areas of quality.

Overall, during 2014, the trust was meeting the national emergency response to respond to calls within 8 minutes for 75% of patients who had had a cardiac arrest, had stopped breathing or had other life threatening emergencies.

The trust was ranked as the best in the country for dealing with patients who had had a cardiac arrest and stopped breathing, who were then resuscitated and taken to hospital. However the trust needed to ensure that patients who had had a heart attack had appropriate pain relief and that stroke patients had timely access to hospital

The trust had the highest percentage of patients who were treated at the scene without the need for ambulance transfer to hospital. The re-contact rate within 24 hours of this treatment was higher than the national average but was decreasing.

The trust was affected by the national shortage of paramedics and staff worked long hours and some reported stress and fatigue. The trust was working with staff to manage peaks in demand and improve working hours to improve their work life balance.

The emergency operation centres had a high number of staff vacancies and staffing levels were, at times, not adequate to meet the demand. Staff worked long hours, sometimes without breaks, to deliver the service. The service had an escalation plan for when calls exceeded capacity and action was taken to shorten calls if safe to do so or to divert calls to other operation centres. At the time of our inspection, however, calls were not being answered within target times.

The patient transport service, which deals with non-urgent transport, was not meeting performance targets and this was having an impact on patients’ care and treatment. Some patients were experiencing delayed or missed appointments and some were choosing to curtail their treatment rather than risk missing their transport home.

The inspection team found several areas of good practice:

• Representatives of the trust attended local youth organisation meetings, village fetes and school assemblies. The trust had developed a child-friendly first-aid book printed specially for schools and the wider local community.
• The trust had a clinical lead in mental health and learning disability. This role was unique among ambulance trusts. The lead had established a national mental health group for ambulance trusts, and worked with partner agencies such as the Royal College of Psychiatrists and the College of Policing. The introduction of mental health practitioners into the emergency operation centre was supporting operational practice and care to mental health patients.
• The introduction of a midwife to the clinical support desk in the Southern House emergency operation centre had improved the outcomes for expectant mothers and their new babies. The 24-hour labour line started as a pilot in May 2014. It gave women in labour access to advice and support, whereas the ‘professional’s line’ enabled medical professionals to speak to a midwife 24 hours a day during a woman’s labour and birth. The service had over 1,600 calls in the first eight weeks.
• The trust provided a service on Friday and Saturday nights in the city centres of Portsmouth (Safe Place) and Southampton (ICE Bus) to provide support, first aid and transfer to hospital. This had been set up in partnership with other organisations such as the Hampshire Police, the local council, volunteers and the local street pastors.
• The Helicopter Emergency Medical Services adopted innovative practices and learning taken from combat zones. The team had the equipment and skills to give blood transfusions and perform ultrasound and blood gas tests. In some circumstances, this bypassed or reduced the time a patient had to spend in the accident and emergency department, and meant they could receive treatment immediately on arrival at the hospital. HEMS was also planning to introduce a night service, so it would operate 24 hours every day.

The report identifies a number of areas for improvement:

• All staff must meet statutory and mandatory training trust targets. 
• Staff in the emergency and urgent care service had good knowledge of the Mental Capacity Act 2005, but staff in the Emergency Operation Centre and Patient Transport Services needed to have better knowledge to ensure the best interest of patients.
• Emergency call takers must answer calls and dispatch an ambulance within target times
• Patient transport services must improve to prevent delays and missed appointments, and to reduce the impact on the clinical care, treatment and welfare of patients
• There should be better coordination of care, in particular for mental health patients

Professor Sir Mike Richards, Chief Inspector of Hospitals, said:

“We rely on our ambulance services to be there whenever we need them. The key to providing an excellent ambulance service is in first ensuring there are enough trained staff managing all the calls that come in to ensure that patients in need get the best possible service – whether it is from a paramedic at the scene, or in being advised to attend a walk in centre, if that’s appropriate.

“Overall, we found services provided by South Central Ambulance Service NHS Foundation Trust were safe, well led with a focus on care and quality. Our inspectors came away with many examples where staff demonstrated exceptional care and compassion to patients, especially when working in very difficult and pressured conditions.”

“It is reassuring that the front-line 999 services have been meeting their emergency response times to people with life threatening emergency or urgent conditions. Not everyone who calls an ambulance needs to go to hospital, and we saw that the service was working well with local hospitals to meet their needs and decrease the pressure on these services.

“However - the less urgent patient transport service does need attention. Patients told us how they had become worried waiting for transport, and had missed appointments for outpatient consultations or other treatment and checks. Call handlers were overwhelmed with calls about service delays.

“While I can commend the staff for their dedication and effort, particularly for 999 emergency services, I will continue to watch progress with the Patient Transport Services to ensure that there are real improvements ”

The inspection team included CQC inspectors, doctors, nurses, paramedics, patient experts by experience and senior managers. The team spent five days visiting the trust’s emergency operations centres in Oxfordshire and Hampshire covering Hampshire, Berkshire, Buckinghamshire and Oxford, and shadowing ambulance crews and paramedics on 10, 11 and 30 September and 1 October 2014. They visited 10 of the 27 ambulance stations within the trust. They also visited 10 of the local A&E and Outpatient departments to talk to patients and staff about their experience of the ambulance service.

Ends

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