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  • SERVICE PROVIDER

East of England Ambulance Service NHS Trust

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

Overall: Requires improvement read more about inspection ratings

All Inspections

25 to 26 June 2020

During a routine inspection

Our rating of the trust remains the same as the previous inspection because:

This was a focused inspection and we did not inspect any core services. We did not inspect all of the key lines of enquiry as our concerns were related to specific risks. This means that the previous ratings for our 2019 inspection remain.

Well-led rating remains as inadequate. The level of enforcement we undertook to ensure people’s safety means that the rating for well-led would have been limited to inadequate had we been rating on this occasion.

On the basis of this inspection, the Chief Inspector of Hospitals has recommended that the trust be placed into special measures.

10 Apr to 2 May 2019

During an inspection of Resilience

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.

6-8 March 2018, 27-29 March 2018

During an inspection of Patient transport services

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

  • Patient transport services remained as requires improvement overall. The questions of effectiveness, and well-led stayed the same as requires improvement. Caring remained good and responsive and safe improved from requires improvement to good. There were concerns with safety aspects relating to vehicle cleaning and staffing within the service. The performance against key performance indicators was variable but had improved. The service had governance processes in place for the oversight of risk, safety, and quality but we had concerns that this information was not shared effectively with staff.

Announced inspection: 4th to 8th April 2016. Unannounced inspection: 19th April 2016

During a routine inspection

The East of England Ambulance Service NHS Trust (EEAST) is one of 10 ambulance trusts in England providing emergency medical services to Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk; an area which has a population of around 6 million people over 7500 square miles. The trust employs around 4000 staff and 1500 volunteers who are based at more than 130 sites including ambulance stations, emergency operations centres (EOCS) and support offices across the East of England.

The main role of EEAST is to respond to emergency 999 calls, 24 hours a day, 365 days a year. 999 calls are received by the emergency operation centres (EOC), where clinical advice is provided and emergency vehicles are dispatched if required. Other services provided by EEAST include patient transport services (PTS) for non-emergency patients between community provider locations or their home address and resilience services which includes the Hazardous Area Response Team (HART).

Every day EEAST receives around 2600 calls from members of the public dialling 999. The service provided by EEAST is commissioned by 19 separate Clinical Commissioning Groups with one of these taking the role as co-ordinating commissioner.

Our announced inspection of EEAST took place between 4th and 8th April 2016 with unannounced inspections on 19th April 2016. We carried out this inspection as part of the CQC’s comprehensive inspection programme.

We inspected three core services:

• Emergency Operations Centres

• Urgent and Emergency Care including the Hazardous Area Response Team (HART).

• Patient Transport Services

Our key findings were as follows:

  • The trust was under significant pressure and was failing to meet performance standards and targets for response to emergency calls.
  • The chief executive had been in post for approximately 7 months and was developing new models of care and new strategies to address performance and recruitment concerns. These were yet to reach fruition.
  • Resources were frequently unavailable as they were unable to hand over patients to acute providers in a timely way. This occurred throughout or inspection.
  • There was ongoing significant issues in recruitment of paramedics across the trust with particular ‘hotspots’ in certain areas including Norfolk and Cambridgeshire.
  • The trust had identified new models of workforce development and new roles to support the service. This was in the process of consultation and implementation during our inspection.
  • There was variation across the trust in many areas including governance, medicines management and infection control.
  • The emergency operations centres were recruiting clinical staff into ‘clinical hubs’ to dramatically improve the number of patients treated over the telephone or signposted to more appropriate services.
  • All staff were passionate about providing the best possible service to patients. We consistently observed staff to be caring and compassionate and concerned for the welfare of patients.
  • There were low levels of mandatory training and many staff were not equipped with the skills to care for people living with dementia and mental health problems and a poor knowledge of the Mental Capacity Act 2005.

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

Importantly, the trust must:

  • Improve performance and response times for emergency calls.
  • Ensure that there are adequate numbers of suitable skilled and qualified staff to provide safe care and treatment
  • Ensure staff are appropriately mentored and supported to carry out their role including appraisals.
  • Ensure staff complete mandatory training (professional updates).
  • Ensure that incidents are reported consistently and learning fed back to staff.
  • Ensure that all staff are aware of safeguarding procedures and there is a consistent approach to reporting safeguarding.
  • Ensure that medicines management is consistent across the trust and that controlled medicines are stored and managed according to regulation and legislation.
  • Ensure that all vehicles and equipment are appropriately cleaned and maintained.
  • Ensure all staff are aware of their responsibilities under legislation including the Mental Capacity Act 2005.
  • Ensure all staff are aware of their responsibility under Duty of Candour requirements.
  • Ensure records are stored securely on vehicles.

In addition the trust should:

  • The trust should consider how all risks associated with PTS can be captured and reviewed on the risk register.
  • The trust should improve the numbers of patients offered hear and treat services.

Professor Sir Mike Richards

Chief Inspector of Hospitals