East of England Ambulance Service NHS Trust

Updated 13 July 2022

We plan our inspections based on everything we know about services, including whether they appear to be getting better or worse.

We rated well led (leadership) from our inspection of trust management, taking into account what we found in relation to leadership within the individual core services. We rated other key questions by combining the service ratings and using our professional judgement.

We conducted this comprehensive short notice announced inspection of the emergency and urgent care and emergency operations centre core services between 5 April and 6 April 2022. We also inspected the well-led key question for the trust overall between 4 May and 5 May 2022.

We did not inspect the core services of resilience or patient transport services because this inspection was focused on services where we had concerns. However, we continue to monitor the progress of improvements to these services and will re-inspect them as appropriate.

Our rating of this trust improved. We rated it as requires improvement, however the chief inspector of hospitals has recommended to NHS England and NHS Improvement (NHSEI) that it remain in the Recovery Support Programme to ensure the trust continues to receive relevant support to continue to make the changes required.

• The trust has made marked improvement on those issues that led to it being placed in the Recovery Support Programme (which was then called Special Measures).
• We rated caring as good, safe, effective and responsive as requires improvement. Well-led is the overall trust-wide rating, not an aggregation of services ratings.
• We rated both services we inspected as requires improvement overall. In rating the trust, we took into account the current ratings of the two services we did not inspect this time.
• Mandatory training, including safeguarding compliance was consistently low throughout the organisation.
• Staff did not routinely appraise staff’s work performance or hold supervision meetings with them to provide support and development.
• Leaders did not always understand or manage the priorities and issues the service faced. They were not always visible and approachable in the service for staff.
• Staff did not always feel respected, supported or valued and there was a lack of professional standards being adhered to and a lack of urgency and ownership of responsibilities within the service.
• For concerns requiring action from senior leaders in the organisation there were often delays in getting a response impacting on the ability of local leaders to deal with issues and concerns at a local level in a timely way.

However:

• Staff provided care and treatment based on national guidance and evidence-based practice. The trust monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved outcomes for patients.
• Staff treated patients with compassion and kindness, they provided emotional support to patients, families and carers to minimise their distress. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• All those responsible for delivering clinical care worked together as a team to benefit patients and staff gave patients practical support and advice to access appropriate services. Staff kept detailed records of patients’ care and treatment. Records were clear, stored securely and easily available to all staff providing care.
• 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.
• Leaders operated effective governance processes, throughout the trust and with partner organisations.

East of England Ambulance Service NHS Trust (EEAST) provides an emergency ambulance service 24 hours, 365 days a year across Bedfordshire, Hertfordshire, Essex, Norfolk, Suffolk, Cambridgeshire and Peterborough. This area is made up of:

• More than 6.2 million people
• 7,500 square miles
• 15 Clinical Commissioning Groups
• Six integrated care systems
• 17 acute hospital trusts

The trust also provides hear and treat and see and treat services. In some areas, the trust provides non-urgent patient transport for patients requiring non-emergency transport to and from hospital and treatment centres.

In 2020/21 the trust:

• received 1,195,670 emergency 999 calls
• treated 82,015 people through their Emergency Clinical Advice and Triage Centre
• made 426,500 non-emergency (patient transport service) journeys

The trust’s resources and teams include:

• more than 4,000 staff and more than 800 volunteers
• three ambulance operations centres (AOCs) located in Bedford, Chelmsford and Norwich
• 387 front line ambulances
• 178 rapid response vehicles
• 175 non-emergency ambulances (patient transport service and health care and HCRTs vehicles)
• 46 HART/major incident/resilience vehicles
• more than 120 sites.

Total income in 2020/21 was more than £402 million.

(Source: Trust website)

The trust serves an ethnically and geographically diverse population including rural, coastal and urban environments. There are areas of high deprivation in Essex, Bedfordshire and Norfolk.

We previously inspected EEAST under our current methodology and published the report in September 2020 and rated the trust as requires improvement overall, with well led being rated as inadequate.

How we carried out the inspection

We carried out this inspection on various days throughout April and May 2022. We visited areas relevant to each of the core services. We inspected and spoke with a number of staff groups. During the inspection we visited two emergency operation centres and six ambulance stations. We spoke with 124 staff members of various speciality and profession including, emergency call handlers, emergency medical dispatchers, clinicians (including paramedics and nurses), student paramedics, emergency medical technicians, team leaders, duty managers local operations managers, and senior managers.. We spoke with 18 patients throughout the departments and observed patient care.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 13 July 2022

Updated 31 July 2019

This is our first time inspecting the core service and rating this service. We rated it as good because:

We rated safe, effective, responsive as good and well led as outstanding. Due to the nature of the service we did not see any patient care and have not rated caring on this occasion.

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment to patients and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients.
• We did not rate ‘caring’ as we were unable to observe caring interactions between staff and patients and gather enough evidence to make a judgement. Although we were able to review a number of extremely positive feedback comments from patients and external partners.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
• Leaders ran services well using reliable information systems and supported all staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Leaders were visible, all staff felt respected, supported and valued. They were focused on the needs of patients receiving high quality standards of care. Staff were clear about their roles and accountabilities. The service engaged well with patients, external agencies and the community to plan and manage services. All staff were committed to improving services continually.

However:

• The service did not receive feedback from the trust electronic patient records audit.

Updated 31 July 2019

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

We rated safe, effective and well-led as requires improvement. We rated responsive and caring as good.

• Mandatory and safeguarding training rates still remained significantly below the trust targets. Compliance rates varied across regions and ranged from 26% to 76%.

• Appraisal rates and access to comprehensive frontline induction continued to be inconsistent across the service.

• The service took approximately 22 additional days to investigate and close complaints than the trust’s policy on complaints management set. This meant that patients were waiting excessive times for resolutions to any complaints they had raised.

• Whilst culture and morale had improved from our previous inspection, many staff were unsure that the present changes would last. Staff also told us that whilst they felt supported and valued by their local leaders, they did not believe their opinions mattered to senior leaders within PTS.

• Whilst we saw good local oversight of performance, governance and risk management, we did not see adequate scrutiny, management and representation of these factors at corporate or senior level.

• Whilst performance for collection and drop-off times for patients had improved since our last inspection, the service was still not meeting performance standards set by their commissioners.

However,

• Staff knowledge of safeguarding and incidents

• Infection prevention and control was well understood, complied to and audited throughout the service. Ambulances, cars and ambulance stations were well equipped and properly maintained. The design, maintenance, and use of facilities, premises, and equipment kept people safe.

• Staff understood consent and we saw examples of staff ensuring they gained consent throughout patient journeys by informing them and respecting their choices.

• Staff consistently provided care and treatment for patients in a way that was compassionate, supportive, informative, respectful, maintained their dignity and involved them in their own care.

• Oversight of the service demand and capacity was present at both senior and local levels. The service planned resources in advance and worked with other professionals such as private ambulance services and volunteers to cover all geographic areas they were commissioned for.

Updated 13 July 2022