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Provider: North East Ambulance Service NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 10 January 2019

Our rating of the trust stayed the same. We rated it as good because:

  • We rated each domain of safe, effective, caring, responsive and well-led as good. Therefore, the overall rating of the trust remained the same as the last inspection.
  • At this inspection, we inspected two core services including the 111 service and emergency operations centre (EOC). We rated both of these core services as good which was an improvement from requires improvement overall for EOC at our last inspection.
  • In rating the trust, we took into account the current ratings of the services that we did not inspect during this inspection but that we had rated in our previous inspection.
  • We rated well-led for the trust overall as good. This was not an aggregation of the core service ratings for well-led.

Inspection areas

Safe

Good

Updated 10 January 2019

Our rating of safe stayed the same. We rated it as good because:

  • Staff understood how to protect patients from abuse and the trust worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The trust had suitable premises and equipment and looked after them well.
  • NEAS used a demand forecasting tool to identify which resources would be required on which shifts to meet demand. The forecasting was reviewed during inspection and seen to be accurate.
  • The organisational risk register was up to date and completed appropriately. It included a summary section showing changes to risk ratings and a detailed section where the risk, controls and actions taken to address the risk were recorded.
  • There were clear systems of report, audit and review in relation to serious incidents which included individual or organisational learning.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • Any patient safety incidents which were recorded as moderate harm and above had a high-level review, including the duty of candour requirements and the relevant information was updated live on a NEAS computer system.
  • There was a major incident response plan in place, which we reviewed. The plan identified command and control structures with defined roles and responsibilities for staff.
  • NEAS had put in place a contingency plan, which had been frequently tested, to move to another building which took on average seven minutes to set up to dispatch ambulances in the event of system failure at Bernicia house. This was an improvement on the 20 minutes to dispatch ambulances identified in the previous inspection report.

However:

  • There were differences in the working environment between Bernicia House and Russell House, where we found the noise levels were high during busy periods. Action had been taken to improve noise levels and several options had been tried but we found there was minimal positive impact to these actions and noise levels remain high.
  • There were calls where human error had resulted in an incorrect grading and a delayed dispatch culminating in patient harm and the recording of a serious incident.
  • The provider had reviewed their systems following incidents where call takers had been unable to obtain an interpreter. Before the review call takers had discretion as to how the call response was graded. Post review a memorandum was sent to all call handlers identifying changes in practice in terms of categorising calls, the default grading being Cat 2 when an interpreter could not be sourced. However, there was a significant delay in this information being given to staff.
  • The provider had failed to achieve six of the 11 mandatory training targets within EOC.
  • The provider had failed to achieve three of the four safeguarding training targets within EOC.
  • During this inspection there were 102 open incidents relating to EOC, of these 52 were overdue, 45 related to patient safety incidents and seven related to non-patient safety incidents. Although this was an improvement on the levels found in the previous inspection there was no effective system in place to immediately identify overdue incidents which could be serious matters requiring immediate action or were near misses.

Effective

Good

Updated 10 January 2019

Our rating of effective stayed the same. We rated it as good because:

  • The trust provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
  • NEAS had performed above average against other NHS ambulance trusts in five of the seven measures on the new Ambulance Response Programme that commenced November 2017 and is the best performing ambulance trust for response times for Category 1 calls (calls from people with life threatening illnesses or injuries).
  • We saw evidence of a flagging system which directed staff to certain actions dependent on the issues flagged and risk assessment including contacting the police, a community nurse, crisis team or community psychiatric nurse (CPN).
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
  • The trust was in the process of implementing a ‘Care Platform’ for frontline staff and managers. This enabled almost real-time feedback on key patient safety issues by enabling individual feedback on a range of areas such as compliance with care bundles, self-assessment of skills to support learning and development, performance relating to time on scene and turnaround times and reflective practice.

However:

  • The overall appraisal rate was 70.7% which was similar to our inspection in April 2016 where NEAS were given must do action in relation to Regulation 18 of the Health and Social Care Act to ensure all staff received an appraisal and were supported with their professional development. This remained significantly lower than the trust target of 95%. There was an action plan in place to improve this by April 2019.

Caring

Good

Updated 10 January 2019

  • Staff were caring and provided compassionate care. Accurate, timely and clear information was provided to patients and callers about their condition and followed the clinical pathways.
  • Staff understood the patients’ personal, cultural, social and religious needs. They displayed an understanding and non-judgemental attitude to all patients.
  • The results of the NHS Friends and Family test showed the majority of patients were satisfied with the service.
  • Staff understood the requirements of legislation and guidance when considering consent and decision making.
  • The trust won the ‘enhancing patient dignity’ category for its end of life services in the Nursing Times Awards 2017. The end of life service provided a responsive and timely patient transport across the north-east region for patients with palliative/end of life care needs, enabling them to be cared for and die in the place of their choice.

Responsive

Good

Updated 10 January 2019

Our rating of responsive stayed the same. We rated it as good because:

  • The trust planned and provided services in a way that met the needs of local people.
  • There was a system in place that alerted staff to any specific safety or clinical needs of a person using the service. The ‘special notes’ system meant that information was available to health advisors and clinical advisors at the time the patient or their carer contacted the service. This assisted staff to safely manage their needs.
  • Care pathways were appropriate for patients with specific needs, for example, those at the end of their life, babies, children and young people.
  • NEAS had a system called “Recite me” on their website which made all information more accessible. It allowed the website information to be changed into a range of languages and accessibility tools.
  • It had been identified that the two main reasons for complaints in EOC were timeliness responses and staff attitude. This information was shared with EOC staff and they were given a script to include at the end of each call to manage caller expectations. The result of using the script was a 30% drop in those type of complaints.
  • We saw evidence NEAS had engaged with local communities in a variety of ways to promote health and what the service provided, for example, staff had attended local events, such as Pride and the Mela and they had completed community based work on the text relay service and BSL relay service in local deaf communities.

However:

  • The trust treated concerns and complaints seriously, investigated them and learned lessons from the results and shared these with staff. Complaint responses were always completed within the specified agreed timelines.
  • Staff could access interpreter services, the trust had experienced challenges with gaining access, on occasion to specific interpreters which resulted in HM Coroner issuing a regulation 28 to prevent future deaths notification. The trust was reviewing its policy but this was still in process at the time of our inspection. A memorandum was sent to all call handlers following our inspection to identify changes in practice in terms of categorising calls when an interpreter could not be sourced.

Well-led

Good

Updated 10 January 2019

  • Managers at the trust had skills and abilities to run a service providing quality, sustainable care.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients and key groups representing the local community.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. NEAS had made improvements in this area since our previous inspection.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them and coping with both the expected and unexpected.
  • The trust collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
  • NEAS were awarded the most innovating NHS education provider award as part of the Bright Ideas in Healthcare Award for their falls training.

However:

  • The trust had a freedom to speak up policy in place which was in line with the recommended national policy, however there were challenges in terms of establishing a robust network of champions.
  • There was a lack of clinical advisors within the NHS 111 service due to the service being taken over by the trust on 1 October 2018. This had led to a number of staff remaining with their original organisation, leaving a staffing shortage within the service. There was not a robust contingency plan in place to manage this transfer over.

Checks on specific services

Reference: Emergency operations centre not found

Good

Updated 10 January 2019

  • NEAS had put in place a contingency plan, which had been frequently tested, to move to another building which took on average seven minutes to set up to dispatch ambulances in the event of system failure at Bernicia house. This was an improvement on the 20 minutes identified in the previous inspection report.
  • There were sufficient staff trained to deal with 999 and 111 calls and who could switch between calls dependent upon the demand and clinical need.
  • There were clear systems of report, audit and review in relation to serious incidents which included individual or organisational learning.
  • NEAS had performed above average against other NHS ambulance trusts in five of the seven measures on the new ambulance response programme which commenced November 2017.
  • NEAS had engaged with local communities in a variety of ways to promote health reducing demand on services.
  • EOC staff were subject to regular call audit which evidenced high levels of competence.
  • During the 65 live calls in the emergency operations centres listened to, all the staff involved were observed to be calm, professional and considerate of the patient’s needs.
  • NEAS had reviewed complaints linked to caller expectations. A script for call takers had been devised to be used to manage expectations which resulted in a 30% drop in those type of complaints.
  • There was a clear mission statement, vision and values which were displayed on notice boards in corridors and offices. They were included as part of the recruitment and appraisal systems.
  • There were clearly defined strategic priorities and three strategic aims supported by a quality strategy.
  • NEAS had a board assurance framework with six identified areas of risk, each issue had been risk assessed and managed appropriately with a clear audit trail of accountability.
  • NEAS had developed an action plan following the 2017 staff survey. The action plan had an overall aim to improve the overall staff engagement score.