The Care Quality Commission
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Yorkshire Ambulance Service NHS Trust

This is an organisation that runs the health and social care services we inspect

Overall: Good read more about inspection ratings

All Inspections

26 April 2022

During an inspection of Emergency operations centre (EOC)

A summary of CQC findings on urgent and emergency care services in West Yorkshire.

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for West Yorkshire below:

West Yorkshire.

Provision of urgent and emergency care in West Yorkshire was supported by multiple provider services, stakeholders, commissioners and local authorities.

We spoke with staff in services across primary care, integrated urgent care, community, acute, mental health, ambulance services and adult social care. Staff continued to work under sustained pressure across health and social care and system leaders were working together to support their workforce and to identify opportunities to improve. System partners worked together to find new ways of working, linking with community services to meet the needs of their communities; however, people continued to experience delays in accessing care and treatment.

During our inspections, some staff and patients reported difficulties with providing and accessing telephone appointments in GP practices. Some of these issues were caused by telephony systems which were being resolved locally. We found inconsistencies with triage processes in primary care which could result in people being inappropriately signposted to urgent and emergency care services. However, a number of staff working in social care services reported good engagement with local GPs.

We visited some community services in West Yorkshire and found these were generally well run. Service leaders were working collaboratively to identify opportunities to improve patient pathways across urgent and emergency care. These improvements focused on meeting the needs of local communities and alleviating pressure on other services. There were strong partnerships with social care and community teams, so patients had the right support in place on discharge.

However, we inspected one intermediate care service and found it could only take referrals from an acute trust, which meant there were no step-up facilities for patients in the community. The service struggled for ward space to deliver therapeutic activities and there were no communal spaces for patients to meet together or engage in group therapy. Plans were in place to provide additional facilities and to reconfigure the existing layout to provide communal spaces.

The NHS111 service was experiencing significant staffing challenges and were in the process of recruiting a high number of new staff. Staff working in this service had experienced an increase in demand, particularly from people trying to access dental treatment although a system was in place to manage the need for dental advice and assessment. Due to demand and capacity issues, performance was poor in some key areas, such as providing a call back to patients from a clinician.

The ambulance service had an improvement programme in place focused on performance and staffing. Whilst we saw some improvement in ambulance response times and handover delays, performance remained below target. We identified impact on other services due to the availability of 999 responses; for example, a maternity service had to close temporarily to keep women safe, due to system escalation and because ambulance responses couldn’t be guaranteed in an emergency. Staff working in social care services also experienced lengthy delays in ambulance response times which further impacted on their ability to provide care to their residents.

We inspected some mental health services in Wakefield which were delivering person-centred care and responded to urgent needs in a timely way. Staff worked in multi-disciplinary teams and collaborated with system partners.

People’s experiences of Emergency Departments were varied depending on which service they accessed. Some Emergency Departments had long delays whilst others performed relatively well. In services struggling to meet demand, patient flow was a key factor. Poor patient flow was primarily caused by delays in discharge with a high number of people fit for discharge unable to access community or social care services.

Staff working in some social care services reported significant challenges in relation to unsafe discharge processes, this included a lack of information to support their transfer of care and we were told of examples when this resulted in people having to return to hospital. Local stakeholders had a good understanding of this problem and were looking to improve pathways and discharge planning.

Staffing and capacity issues in both care homes and domiciliary social care services have at times impacted on timely and safe discharge from hospital.

We found services were under continued pressure and people experienced difficulties accessing urgent and emergency care services in West Yorkshire. System and service leaders across West Yorkshire were working together to seek opportunities for improvement by providing services and pathways to meet people’s needs in the community; however, progress was needed to demonstrate significant improvement in people’s experience of accessing urgent and emergency care.

Due to the nature of the inspection we did not rate the service.

  • The service did not consistently have enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
  • The service monitored, but did not always meet, agreed response times so that they could facilitate good outcomes for patients.
  • People could not always access the service when they needed it which was not always in line with national standards.
  • The service generally controlled infection risk well. Staff used equipment and control measures to protect themselves and others from infection. They kept equipment and the premises visibly clean. The design, maintenance and use of facilities, premises and equipment kept people safe.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
  • All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies. Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles. Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.

26 April 2022

During an inspection of Emergency and urgent care

A summary of CQC findings on urgent and emergency care services in West Yorkshire.

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for West Yorkshire below:

West Yorkshire.

Provision of urgent and emergency care in West Yorkshire was supported by multiple provider services, stakeholders, commissioners and local authorities.

We spoke with staff in services across primary care, integrated urgent care, community, acute, mental health, ambulance services and adult social care. Staff continued to work under sustained pressure across health and social care and system leaders were working together to support their workforce and to identify opportunities to improve. System partners worked together to find new ways of working, linking with community services to meet the needs of their communities; however, people continued to experience delays in accessing care and treatment.

During our inspections, some staff and patients reported difficulties with providing and accessing telephone appointments in GP practices. Some of these issues were caused by telephony systems which were being resolved locally. We found inconsistencies with triage processes in primary care which could result in people being inappropriately signposted to urgent and emergency care services. However, a number of staff working in social care services reported good engagement with local GPs.

We visited some community services in West Yorkshire and found these were generally well run. Service leaders were working collaboratively to identify opportunities to improve patient pathways across urgent and emergency care. These improvements focused on meeting the needs of local communities and alleviating pressure on other services. There were strong partnerships with social care and community teams, so patients had the right support in place on discharge.

However, we inspected one intermediate care service and found it could only take referrals from an acute trust, which meant there were no step-up facilities for patients in the community. The service struggled for ward space to deliver therapeutic activities and there were no communal spaces for patients to meet together or engage in group therapy. Plans were in place to provide additional facilities and to reconfigure the existing layout to provide communal spaces.

The NHS111 service was experiencing significant staffing challenges and were in the process of recruiting a high number of new staff. Staff working in this service had experienced an increase in demand, particularly from people trying to access dental treatment although a system was in place to manage the need for dental advice and assessment. Due to demand and capacity issues, performance was poor in some key areas, such as providing a call back to patients from a clinician.

The ambulance service had an improvement programme in place focused on performance and staffing. Whilst we saw some improvement in ambulance response times and handover delays, performance remained below target. We identified impact on other services due to the availability of 999 responses; for example, a maternity service had to close temporarily to keep women safe, due to system escalation and because ambulance responses couldn’t be guaranteed in an emergency. Staff working in social care services also experienced lengthy delays in ambulance response times which further impacted on their ability to provide care to their residents.

We inspected some mental health services in Wakefield which were delivering person-centred care and responded to urgent needs in a timely way. Staff worked in multi-disciplinary teams and collaborated with system partners.

People’s experiences of Emergency Departments were varied depending on which service they accessed. Some Emergency Departments had long delays whilst others performed relatively well. In services struggling to meet demand, patient flow was a key factor. Poor patient flow was primarily caused by delays in discharge with a high number of people fit for discharge unable to access community or social care services.

Staff working in some social care services reported significant challenges in relation to unsafe discharge processes, this included a lack of information to support their transfer of care and we were told of examples when this resulted in people having to return to hospital. Local stakeholders had a good understanding of this problem and were looking to improve pathways and discharge planning.

Staffing and capacity issues in both care homes and domiciliary social care services have at times impacted on timely and safe discharge from hospital.

We found services were under continued pressure and people experienced difficulties accessing urgent and emergency care services in West Yorkshire. System and service leaders across West Yorkshire were working together to seek opportunities for improvement by providing services and pathways to meet people’s needs in the community; however, progress was needed to demonstrate significant improvement in people’s experience of accessing urgent and emergency care.

Due to the nature of the inspection we did not rate this service.

• The service did not consistently have enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

• The service monitored, but did not always meet, agreed response times so that they could facilitate good outcomes for patients.

• People could not always access the service when they needed it which was not always in line with national standards.

• The service generally controlled infection risk well. Staff used equipment and control measures to protect themselves and others from infection. They kept equipment and the premises visibly clean. The design, maintenance and use of facilities, premises and equipment kept people safe.

• Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.

• All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies. Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles. Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.

28 May to 28 June

During a routine inspection

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.

28 May to 28 June

During an inspection of Patient transport services

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.

28 May to 28 June

During an inspection of Emergency operations centre (EOC)

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.

13-16 September 2016, 6 October 2016, 10-12 October 2016

During an inspection looking at part of the service

Yorkshire Ambulance Service NHS Trust (YAS) was formed on1 July 2006 when the county's three former services merged. The trust covers North Yorkshire, South Yorkshire, West Yorkshire, Hull and East Yorkshire covering almost 6,000 square miles of varied terrain, from isolated moors and dales to urban areas, coastline and inner cities. The trust employsover 4,670 staff and provides 24-hour emergency and healthcare services to a population of more than five million.

The trust provides an accident and emergency (A&E) service to respond to 999 calls, an NHS 111 service for when medical help is needed fast but it is not a 999 emergency, patient transport services (PTS) and emergency operation centres (EOC) where 999 and NHS 111 calls are received, clinical advice is provided and from where emergency vehicles are dispatched if needed. There is also a resilience and hazardous area response team (HART).

We carried out a follow up inspection of the trust from 13-16 September 2016, in response to a previous inspection as part of our comprehensive inspection programme of Yorkshire Ambulance Service NHS Trust in January 2015. In addition, an announced comprehensive inspection of the NHS 111 service was carried out on 10-12 October 2016.

Focused inspections do not look across a whole service; they focus on the areas defined by the information that triggers the need for the focused inspection. We therefore did not inspect all of the five domains: safe, effective, caring, responsive and well led for each of the core services we inspected.

We inspected five core services:

  • Emergency operations centres
  • Urgent and emergency care
  • Patient transport services
  • Resilience services including the hazardous area response team
  • NHS 111 services.

Overall, we rated all of the five key domains as good which meant the overall rating for the trust was also good.

Our key findings were as follows:

  • The trust had undertaken a number of initiatives to improve staff engagement; the staff forum had become embedded since our previous inspection and was viewed positively by staff.
  • Relationships between the trust and trade unions had improved since the previous inspection but there still more work for the trust to do.
  • Staffing levels throughout the trust were planned and monitored. The trust had challenges due to national shortages however; it was addressing this through a range of initiatives.
  • From April 2016 the trust was participating in the national trial of the ambulance response programme (ARP) which helped the service to dispatch appropriate ambulance resources. There were no performance targets for the ARP pilot. The trust monitored its performance on response times.
  • At the previous inspection there had been concerns in relation to equipment checks, maintenance of equipment and consumable stock. At this inspection we found the trust had put in place a system to ensure equipment and stock was suitable to use.
  • In most of the core services we found infection control procedures were followed and the ambulance stations and vehicles we observed were generally clean. However there were still inconsistencies in the way staff maintained vehicle cleanliness across the PTS service.
  • There were systems in place to share learning from incidents and adverse events. Most staff we spoke with confirmed they received feedback by email after reporting an incident. A safety bulletin was produced and shared across the trust to share lessons learnt.
  • There were high levels of compliance with safeguarding training at levels one and two, and all staff who were determined by the trust to require level three training, had received this.
  • From April 2016 the trust had commenced a local review of mortality and morbidity, supported by local audits linked to the trust’s commissioning for quality and innovation (CQUIN) targets to explore all deaths in the care of the trust, where Recognition of Life Extinct (ROLE) had been invoked by YAS paramedics.
  • Within the NHS 111 service, call abandonment rate was 2%, compared to the national average of 3%. We saw that 89% of calls were answered within 60 seconds, compared to the national average of 87%.
  • Within the PTS service there was a clear lack of management oversight and lack of ownership of roles and responsibilities, and governance systems were not fully embedded throughout the service.

We saw several areas of outstanding practice including:

  • The red arrest team provided clinical leadership in the response to cardiac arrest patients, which had improved the success rate in the return of spontaneous circulation (ROSC).
  • The ‘restart a heart' team was commended for its CPR work with school children. More than 31,000 children were trained in hands-only CPR in conjunction with the British Heart Foundation.
  • Community first responders were trained volunteers who were available to attend emergency calls and to provide initial care before the arrival of an ambulance. More than 300 community first responder schemes worked closely with the ambulance service.
  • The service supported 670 public access defibrillators across the Yorkshire region which was available for use by members of the public. The scheme particularly helped people to access defibrillators in remote villages.
  • A member of the air ambulance crew had completed training in Crew Resource Management (CRM). The qualification enabled the member of staff to undertake critique and feedback of incidents whilst taking account of human factors.
  • HART staff presented evidence on the benefits of early antibiotic administration in open fractures. This treatment now has become standard practice within YAS.
  • The trust was part of the urgent and emergency care vanguard programme, to support the development of new approaches to the provision of urgent and emergency care. The West Yorkshire urgent and emergency care network aimed to develop an integrated urgent care model for the region, building on the services provided by existing urgent care services.
  • The trust had contributed to the development of a Pharmacy Urgent Repeat Medication Scheme (PURM) across the locality which enabled patients to access essential medicines from participating pharmacists out of hours. This scheme had won a ‘Pharmacy Innovation’ award.
  • The NHS 111 service had implemented access to palliative care nurses on weekends and bank holidays, who were able to provide support to patients approaching the end of life.
  • The trust had made use of a comprehensive workforce management tool to forecast anticipated call levels and deploy staff accordingly. The development of this tool and the transformation of planning within the organisation were recognised by a National Planning Award from the Professional Planning Forum.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • The trust must ensure at all times there are sufficient numbers of suitably skilled, qualified and experienced staff.
  • Within patient transport services (PTS) the trust must ensure that all ambulances and equipment are appropriately cleaned and infection control procedures are followed.
  • The trust must ensure secure seating for children is routinely available in ambulance vehicles.

In addition the trust should:

  • The trust should review the training requirements for operational staff in the PTS service for vulnerable groups such as patients living with dementia and patients experiencing mental health concerns.
  • The trust should review the arrangements for operational staff to check their vehicle and equipment at the start of the shift to ensure they have sufficient time to complete the checks.
  • The trust should review the audit procedures for reviewing the recording of controlled medicines.
  • The trust should continue to ensure that equipment and medical supplies are checked and are fit for purpose.

Professor Sir Mike Richards

Chief Inspector of Hospitals

13-16 January 2015,19 January 2015,9 February 2015

During a routine inspection

Yorkshire Ambulance Service NHS Trust (YAS) was formed on 1 July 2006 when the county's three former services merged. The trust covers North Yorkshire, South Yorkshire, West Yorkshire, Hull and East Yorkshire covering almost 6,000 square miles of varied terrain, from isolated moors and dales to urban areas, coastline and inner cities. The trust employs over 4,670 staff and provides 24-hour emergency and healthcare services to a population of more than five million.

The trust provides an accident and emergency (A&E) service to respond to 999 calls, a 111 service for when medical help is needed fast but it is not a 999 emergency, patient transport services (PTS) and Emergency Operation Centres (EOC) where 999 and NHS 111 calls are received, clinical advice is provided and from where emergency vehicles are dispatched if needed. There is also a Resilience and Hazardous Area Response Team (HART).

Our inspection of the ambulance service took place between 12 to 15 January 2015 with unannounced inspections on 19 January 2015 and 9 February 2015. We carried out this comprehensive inspection as part of the CQC’s comprehensive inspection programme.

We inspected four core services:

  • Emergency Operations Centres
  • Urgent and Emergency Care
  • Patient Transport Services
  • Resilience Services including the Hazardous Area Response Team:

Overall, the trust was rated as Requires Improvement. Safety, effectiveness, responsive and well-led were rated as requires improvement. Caring was rated as good.

Our key findings were as follows:

  • At the time of inspection four out of the six executives were in substantive positions however there had been a recent loss of the Chief Executive and a history of change at executive level within the trust.
  • There was below national average performance over Red 1 and 2 targets and an increased number of complaints which did not meet the trusts 25 day response times. The trust reported an increase in activity across all services during this period.
  • The trust were in the process of changing the culture in the organisation from performance target driven to one of professional/clinical culture.
  • There was a history of poor staff engagement and relationships between senior management and workforce. There was a recent introduction of new rotas and meal breaks which had a further negative impact on relationships.
  • We had significant concerns within the HART service about the checking of equipment ­ a large number had passed their expiry dates and assurance processes had not detected this. There were also inconsistencies with checking of breathing apparatus and the processes observed did not follow best practice guidance. We re-visited the HART base two days after the announced inspection and one month later to check that changes had been implemented in response to our concerns.
  • Development work had been undertaken to strengthen the assurance and risk management process and these showed improvement, but lacked maturity. Issues were found on inspection, for example; there were security issues at one station and cleanliness of ambulances was an issue across the region, but particularly at the HART unit, which demonstrated a lack of robustness with misleading results giving rise to false assurance.
  • The trust had major difficulties in recruiting staff; national shortages of paramedics contributed to the trust’s difficulty in recruiting paramedics which impacted on the ability to be responsive and also enable staff to attend training and other activities. The trust was working hard to be more outward facing, working in partnership with commissioners and improving consultation with patients and the public.

We saw several areas of outstanding practice including:

For the trust:

  • The trust’s ‘Restart a Heart’ campaign trained 12,000 pupils in 50 schools across Yorkshire.
  • The trust supported 1,055 volunteers within the Community First Responder and Volunteer Care service Scheme.
  • Green initiatives to reduce carbon in the atmosphere by 1,300 tonnes per year.
  • The emergency operations call centre was an accredited Advanced Medical Priority Dispatch System (AMPDS) centre of excellence.
  • Mental health nurses working in the emergency operations centre to give effective support to patients requiring crisis and mental health support. This included standardised protocols and 24 hour access to mental health pathways and crisis team.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • The trust must ensure all ambulances and equipment are appropriately cleaned and infection control procedures are followed.
  • The trust must ensure that equipment and medical supplies are checked and are fit for purpose.
  • The trust must ensure all staff are up to date with their mandatory training.

In addition the trust should:

  • The trust should ensure all staff receive an appraisal and are supported with their professional development. This should include support to maintain the skills and knowledge required for their job role.
  • The trust should ensure risk management and incident reporting processes are effectively embedded across all regions and the quality of identifying, reporting and learning from risks is consistent. The trust should also ensure staff are supported and encouraged to report incidents and provide feedback to staff on the outcomes of investigations.
  • The trust should ensure all ambulance stations are secure at all times.
  • The trust should review the provision and availability of equipment for use with bariatric patients and ensure staff are trained to use the equipment.
  • The trust should review the safe management of medication to ensure that there is clear system for the storage and disposal of out of date medication. The trust should also ensure oxygen cylinders are securely stored at all times.
  • The trust should ensure records are securely stored at all times.
  • The trust should ensure consistent processes are in place for the servicing and maintenance of equipment and vehicle fleet.
  • The trust should ensure performance targets in relation to patient journey times and access to booking systems continue to be monitored and improve.
  • The trust should ensure there are appropriate interpreting and translation services available for staff to use to meet the needs of people who use services.

In addition, the trust should consider other actions - these are listed at the end of the report.

Professor Sir Mike Richards Chief Inspector of Hospitals