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Provider: West Midlands Ambulance Service University NHS Foundation Trust Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 22 August 2019

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

  • Emergency and urgent care services and resilience were rated as outstanding.
  • Emergency operations centre and patient transport services were rated as good.
  • We rated well-led at the trust as outstanding.
Inspection areas

Safe

Good

Updated 22 August 2019

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

  • All core services of emergency and urgent care, emergency operation centres, patient transport and resilience were all rate as good.

Effective

Outstanding

Updated 22 August 2019

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

  • Emergency and urgent care services and resilience were rated as outstanding
  • Emergency operations centre and patient transport services were rated as good.

Caring

Outstanding

Updated 22 August 2019

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

  • Emergency and urgent care services were rated as outstanding.
  • Emergency operations centres and patient transport service were rated as good.
  • Resilience is not rated for caring.

Responsive

Outstanding

Updated 22 August 2019

Our rating of responsive improved. We rated it as outstanding because:

  • Emergency and urgent care services and resilience were rated as outstanding
  • Emergency operations centre and patient transport services were rated as good.

Well-led

Outstanding

Updated 22 August 2019

Our rating of well-led improved. We rated it as outstanding because:

  • Emergency operations centre, emergency and urgent care services and resilience were rated as outstanding
  • Patient transport services were rated as good.
  • We rated well-led at the trust as requires improvement outstanding.
Checks on specific services

Emergency and urgent care

Outstanding

Updated 22 August 2019

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

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it. The trust target for mandatory training compliance was met for all clinical staff in all subjects. The trust had set a target of 85% for completion of mandatory training courses.

  • Staff understood how to protect patients from abuse and the service 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 service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.

  • The design, maintenance and use of facilities, premises, vehicles and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.

  • 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.

  • The service had 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. Managers regularly reviewed staffing levels and skill mix and gave bank and agency staff a full induction.

  • Staff kept detailed records of patients’ care and treatment. Electronic patient record forms (EPRF) were clear, up-to-date, and easily available to all staff providing care.

  • The service used systems and processes to safely prescribe and administer medicines.

  • The service used monitoring results well to improve safety. Staff collected safety information and made it publicly available.
  • The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team, the wider service and partner organisations. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients’ subject to the Mental Health Act 1983.
  • Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • The service monitored, and met, agreed response times so that they could facilitate good outcomes for patients. They used the findings to make improvements.
  • The service monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • 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 gave patients practical support and advice to lead healthier lives. Health promotion materials were available throughout the services and staff knew which services to signpost patients to. Health promotion was available and suitable for both patients and staff.
  • Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. They used to agree personalised measures that limit patients' liberty.
  • Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. All staff had access to an electronic records system that they could all update.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.

  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • The service was inclusive and took account of patients’ individual needs and preferences. The service made reasonable adjustments to help patients access services.
  • People could access the service when they needed it, in line with national standards, and received the right care in a timely way.
  • 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 with all staff, including those in partner organisations.
  • Managers of all levels within the ambulance services had the right skills and abilities to run a service providing quality and sustainable care.

  • The service had a vision of what it wanted to achieve and plans to turn it to action. Not all staff were able to recite trust values but staff we spoke with were able to demonstrate the values within their role.

  • Managers across the service promoted a positive culture that supported and valued their staff with shared values on patient care and improving the quality of care within the trust and their own hubs.

  • The governance arrangements within the ambulance service, were clear and operated effectively and staff understood their roles and accountabilities. However, investigations to some incidents raised were not always investigated thoroughly and robustly.

  • The service had a system in place for identifying risks, planning to eliminate and reduce risks and the ability to cope with expected and unexpected challenges within the ambulance services
  • Management collected, analysed, managed, and used information to support individual hubs activities using secure systems with security to safeguard all processes in use.

  • Staff engaged well with patients, staff, and the public and local organisations to plan and manage appropriate services and collaborated with partners’ organisations effectively.

  • Ambulance service was committed in improving services by learning from things that have gone well and when things go wrong, promoting training, research, and innovation.

However:

  • Documentation around medications was variable and temperatures for the storage of medicines was inconsistent at some hubs. The trust was aware of the concerns and plans to address these issues were being actioned.

  • In some instances, investigations into incidents relating to staff misconduct were not investigated thoroughly.

Patient transport services

Good

Updated 22 August 2019

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

  • During our last inspection we found that mandatory training compliance was in breach of the Health and Social Care Act regulations. During this inspection we found that the service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • During our last inspection we found the storage of medicines was in breach of the Health and Social Care Act regulations. Systems and processes to safely administer, record and store medicines were in place. During this inspection we found that the service used medical gases only.
  • Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service mostly controlled infection risk well. Staff used equipment to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. However not all vehicles we saw during inspection were visibly clean and this was not consistently monitored. This was rectified post inspection.
  • The design and use of facilities, premises, vehicles and equipment kept people safe. Staff managed clinical waste well.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks.
  • The service had 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. Managers regularly reviewed staffing levels and skill mix.
  • Staff kept records of patients’ care and treatment. Records were clear, up-to-date, stored securely and available to all staff providing care.
  • The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team, the wider service and partner organisations. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
  • The service mostly provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients subject to the Mental Health Act 1983.
  • The service did not routinely carry or use any pain-relieving medication. However, some high dependency vehicles were equipped with medical gases used to relieve pain.
  • The service monitored response times. They used the findings to make improvements and achieved good outcomes for patients.
  • The service made sure staff were competent for their roles. Managers appraised staffs’ work performance. This was an improvement noted since our last inspection.
  • 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 supported patients to lead healthier lives. Staff encouraged patients to attend important medical appointments.
  • Staff supported patients to make informed decisions about their transport. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress.
  • Staff supported and involved patients, families and carers to decisions about their care during transport.
  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
  • The service was inclusive and took account of patients’ individual needs and preferences. The service made reasonable adjustments to help patients access services.
  • People could access the service when they needed it, in line with key performance indicators.
  • The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff, including those in partner organisations.
  • Managers at all levels in the service had the right skills and abilities to run a service providing sustainable care.
  • The service 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 service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in care would flourish.
  • The service had good systems to identify risks, plan to eliminate or reduce them.
  • The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • The service engaged well with patients, staff and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.
  • The service was committed to improving services by learning from when things went well or wrong, promoting training and better ways of working.
  • Following our inspection, we highlighted areas of improvement to the trust. The trust responded positively and developed action plans to rectify concerns.

However, we also found areas for improvement:

  • We found that staff did not receive any feedback or confirmation following the report of a safeguarding concern.
  • We found some equipment had incorrect servicing dates on it. This was rectified post inspection.
  • Not all vehicles we saw during inspection were visibly clean and this was not consistently monitored. This was rectified post inspection.
  • Staff told us risk assessments undertaken by booking staff did not always provide sufficient information to keep patients safe. We saw this was a concern raised in the previous inspection; particularly in relation to working with patients who had mental health diagnoses.
  • New trust guidance issued to staff regarding patients with an active ‘do not attempt cardio pulmonary resuscitation’ was not fully compliant to national best practice guidelines.
  • A small number of staff told us they had received some training on sepsis, but they would not know how to identify this in a patient.
  • Following our inspection, we found that the trust had recorded five incidents involving taxi drivers. Only one of these had been directly reported by the taxi driver or firm involved. A protocol was in place for taxi firms to use to report incidents; however, we were concerned that not all drivers and firms were adhering to this. However, we did see some shared learning following one incident about ensuring all incidents are reported to WMAS. In addition, we noted an incident that occurred post our inspection was directly reported by the taxi driver; and was investigated thoroughly.
  • A small number of staff within a specific team did not feel supported.
  • We saw team meetings were recorded and information was disseminated inconsistently between teams.
  • Not all identified risks were formally recorded on the risk register.