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Provider: Yorkshire Ambulance Service NHS Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 14 October 2019

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

The emergency operations centre was rated as good; this rating was the same as the previous inspections.

Patient transport services were rated as good. This was an improvement from the previous inspection.

Well led at trust level was rated as good. This was the first time the trust had received a well led inspection.

Inspection areas

Safe

Good

Updated 14 October 2019

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

  • The core services in the emergency operation centre and patient transport services were rated as good for safety.

Effective

Good

Updated 14 October 2019

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

  • The core services in the emergency operation centre and patient transport services were rated as good for effectiveness.

Caring

Good

Updated 14 October 2019

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

  • The core services in the emergency operation centre and patient transport services were rated as good for caring.

Responsive

Good

Updated 14 October 2019

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

  • The core services in the emergency operation centre and patient transport services were rated as good for responsiveness.

Well-led

Good

Updated 14 October 2019

Our rating of well-led stayed the same. We rated it as good because:

  • The core services in the emergency operation centre and patient transport services were rated as good for being well led.
Checks on specific services

Emergency operations centre (EOC)

Good

Updated 14 October 2019

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

  • The service had enough staff to meet patient demand and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety. The service controlled infection risks. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
  • Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care and had access to good information. The service was available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people and took account of patients’ individual needs. People could access the service when they needed it and did not have to wait too long for emergency triage.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.
  • The service received positive feedback from patients and members of the public which showed they were compassionate and caring to patients.

However:

  • The service did not always have enough mental health nurses and lessons learned from incidents were not routinely shared outside the department.
  • Training in mental health crisis was limited and appraisal rates did not meet the trust target.
  • Learning from complaints and concerns was not always shared effectively in the EOC.
  • There was limited risk awareness at middle manager level. The service was taking action to mitigate this.

Patient transport services

Good

Updated 14 October 2019

Our rating of this service improved. We rated it as good because:

  • People’s needs were central to the delivery of the service and there was a proactive approach to meeting patient’s needs. Technology was used innovatively to ensure patients received a timely response from the service.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Patients we spoke with were consistently positive in their comments about the service.
  • People could access the service when they needed it, in line with national standards, and received the right care in a timely way. Staff supported patients to make informed decisions about their care and treatment. Patient flow coordinators based in hospitals supported bed management and discharge arrangements so that response times were met.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Escalation processes for deteriorating or seriously ill patients were in place and patient safety incidents were managed well.
  • The service engaged with patients, staff, and equality groups, the public and local organisations to plan and manage services. It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned.
  • The design, maintenance and use of facilities, premises, vehicles and equipment kept people safe. Ambulance vehicles fitted with specialised equipment were available to support the needs of bariatric and other patients with complex needs.
  • The service had sufficient staff and made sure they were competent for their roles. Managers appraised staff work performance and held supervision meetings with staff to support their development.
  • Infection risk was controlled well and premises and equipment were visibly clean. The service used systems and processes to safely prescribe, administer record and store medicines.
  • A positive culture was evident in patient transport services. The service had an open culture where patients, their families and staff could raise concerns and promoted equality and diversity.
  • Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders.
  • Clear governance procedures were in place in patient transport services. Managers and staff were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service. Leaders and teams used systems to manage performance effectively.
  • Records were clear, up-to-date, stored securely and easily available to all staff providing care. The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements.
  • Patient transport services encouraged innovation and participation in research. Staff were committed to continually learning and improving services. Managers and senior staff understood and applied the concept of quality improvement.

However:

  • Some staff did not have the confidence to report and escalate safeguarding concerns despite having been trained to do so.
  • Some risk to premises and vehicle security was encountered at more than one ambulance station; we discussed this with the service at the time and immediate action was taken to meet our concerns.
  • Some staff required the support of their manager in completing mandatory training, including e-learning. Managers were taking action regarding training support.
  • The service’s achievement for patients picked up at short notice remained below the trusts own planned achievement level. We acknowledged the trust was working to manage the challenges for short notice requests.