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Provider: South East Coast Ambulance Service NHS Foundation Trust Good

Reports


Inspection carried out on 4 June to 10 July 2019

During a routine inspection

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

  • Safe, effective, caring, responsive and well led were good.
  • Emergency and urgent care services were rated as outstanding overall. The service was rated as good for safe, effective, responsive and outstanding for caring and well led. This was an improvement from our last inspection.
  • The emergency operations centre was rated as good overall. It was rated good for safe, effective, caring, responsive and outstanding for well led. This was an improvement from our last inspection.
  • The 111 service was rated as good overall. It was rated as good for safe, caring, responsive, well led and requires improvement for effective. This was the same as the last inspection.
  • In rating the trust, we took into account the current ratings of the service not inspected this time.


CQC inspections of services

Service reports published 15 August 2019
Inspection carried out on 4 June to 10 July 2019 During an inspection of Emergency and urgent care Download report PDF | 340.58 KB (opens in a new tab)Download report PDF | 1.97 MB (opens in a new tab)
Inspection carried out on 4 June to 10 July 2019 During an inspection of Emergency operations centre (EOC) Download report PDF | 340.58 KB (opens in a new tab)Download report PDF | 1.97 MB (opens in a new tab)
Service reports published 8 November 2018
Inspection carried out on 18th to 20th July 2018 During an inspection of Resilience Download report PDF | 451.58 KB (opens in a new tab)Download report PDF | 2.25 MB (opens in a new tab)
Inspection carried out on 18th to 20th July 2018 During an inspection of Emergency and urgent care Download report PDF | 451.58 KB (opens in a new tab)Download report PDF | 2.25 MB (opens in a new tab)
Inspection carried out on 18th to 20th July 2018 During an inspection of Emergency operations centre (EOC) Download report PDF | 451.58 KB (opens in a new tab)Download report PDF | 2.25 MB (opens in a new tab)
See more service reports published 8 November 2018
Inspection carried out on 18th to 20th July 2018

During a routine inspection

  • In both the emergency operations centre (EOC) and emergency and urgent care (EUC) we rated safe, effective, responsive and well-led as requires improvement and rated well-led in resilience as requires improvement.
  • We rated safe, effective and responsive in the trust’s resilience core service as good. We rated caring as good across all three core services.
  • In rating the trust, we took into account the current ratings of the 111 service, which was not inspected this time.
  • We rated well-led for the trust, overall, as requires improvement.

Inspection carried out on 15-18 May 2017

During a routine inspection

South East Coast Ambulance Service NHS Foundation Trust (SECAmb) is part of the National Health Service (NHS). The trust came into being on 1 July 2006, with the merger of the former Kent Ambulance Service, Surrey Ambulance Service and Sussex Ambulance Service. On 1 March 2011 SECAmb became a Foundation Trust. The trust employs approximately 3,300 staff working across 110 sites in Kent, Surrey and Sussex. This area covers 3,600 square miles which includes densely populated urban areas, sparsely populated rural areas and some of the busiest stretches of motorway in the country. It has a population of over 4.5 million people. There are 12 acute trusts within this area and 22 Clinical Commissioning Groups (CCGs). The trust responds to 999 calls from the public and urgent calls from healthcare professional across Brighton and Hove, East Sussex, West Sussex, Kent and Medway, Surrey, and parts of North East Hampshire. It also provides NHS 111 services across the region.

The emergency operations centre (EOC) receives and triages 999 calls from members of the public and other emergency services. It provides advice and dispatches ambulances as appropriate. The EOC also provides assessment and treatment advice to callers who do not need an ambulance response, a service known as “hear and treat”. Callers receive advice on how to care for themselves, or staff direct them to other services that could be of assistance. The EOC also manages requests from health care professionals to convey people either between hospitals or from community services into hospital. The emergency operations centre received 1,016,944 emergency calls between April 2016 and March 2017. The total call volume had increased by 8.6% since 2014-15, when the trust received 929,822 calls. At the time of our inspection, the trust had three emergency operations centres at Coxheath, Banstead and Lewes. Staff at Lewes EOC were preparing to move into a new, purpose-built EOC in Crawley the week after our visit. The trust planned to move staff from Banstead EOC to the new facility in Crawley in September 2017.

The trust had previously been inspected in May 2016, when we rated the trust overall as inadequate. We had rated Emergency and Urgent Care (EUC) as inadequate and both the Emergency Operations Centre and Patient Transport Services were rated as requires improvement. As a result of the inspection, we issued a warning notice detailing the areas where the trust needed to make improvements. Following the inspection, the trust was placed in special measures.

We inspected this location as part of our planned comprehensive inspection programme to review progress against the requirements of the warning notice. Our inspection took place on 15 to 18 May 2017. We looked at two core services: emergency operations centres and emergency and urgent care, including resilience and the hazardous area response team. The trust no longer provides patient transport services across the region. The 111 service provided by the trust was inspected separately and the ratings are included here to contribute to the overall rating.

We rated South East Coast Ambulance Service NHS Foundation Trust as inadequate overall.

We rated the trust as inadequate for safety and the well led domain. We rated the trust as requires improvement for delivering an effective and responsive service. However, we rated the trust as good for caring.

Our key findings were as follows:

Safety:

  • The voice recording system had failed to consistently record all 999 calls since January 2017. This meant the trust failed to keep complete records for all patients to ensure safe care.

  • The trust did not protect service users against the risks associated with the inappropriate use and management of medicines. The trust did not always make appropriate arrangements for obtaining, storing, recording, dispensing, administering and disposing of medicines. We observed poor practice in medicine management, which did not meet best practice guidelines.

  • We found paper patient clinical records were not always fully or appropriately completed or stored securely, and the trust did not consistently audit these.

  • New systems to manage the risk of infection prevention and control had not been embedded. We observed varied standards of cleanliness. The national standards of infection control and environmental cleanliness were not being achieved or consistently audited across the trust. This meant the trust was not fully assured that patients and staff were protected from health care associated infections.

  • We found emergency equipment without asset numbers displayed and equipment that was overdue for servicing. This meant the trust could not be assured equipment had been adequately maintained and was safe to use.

  • There was a poor culture of reporting incidents, with some staff having never reported an incident and lacking knowledge of the trust’s incident reporting processes. There was limited sharing of learning from incidents. This meant the service might have missed opportunities to learn from incidents and improve patient safety. A backlog of incident forms meant the service did not always address safety concerns quickly enough.

  • There were times of insufficient staffing relating to clinicians in the EOC. At times, there were insufficient numbers of clinical supervisors at the individual sites to ensure patient safety.

  • Clinicians in the EOC and the EUC service did not all hold an appropriate level of safeguarding children training in line with national guidance. The trust had failed to address this risk, identified at our previous inspection in 2016, in a timely way.

  • The computer aided dispatch (CAD) system was unstable and this had resulted in two serious business continuity incidents between April 2016 and March 2017.

However:

  • A successful recruitment drive meant the EOC had more than the full complement of call handlers. Call handler staffing levels had improved since our last inspection, when there was a 22.2% call handler vacancy rate.

  • The introduction of a tactical command suite at Coxheath EOC had improved the deployment of critical care paramedics.

  • The EOC had appropriate measures to ensure service continuity in the event of a business continuity incident such as CAD failure.

  • The trust had recently purchased a new CAD system, which was due to go live at Coxheath EOC in July 2017.

  • The health and well-being of employees had improved with the introduction of protected meal breaks and staff finishing their shifts on time.

  • We found the trust had begun to engage with local safeguarding teams across Kent, Surrey and Sussex, and had started to roll out level three safeguarding children training to all registered clinical staff.

  • We saw assessments of patients followed the Joint Royal Colleges' Ambulance Liaison Committee (JRCALC) and Health and Care Professions Council (HCPC) standards. There were pathways for assessing and responding to the risk of deteriorating patients. This included trauma cases, suspected stroke and patients suffering from chest pain. We saw adult and paediatric patients treated correctly and referral pathways followed.

Effective:

  • National benchmarking data showed patient outcomes and response times were worse than most other English ambulance services. The trust’s call abandonment rates had worsened since our last inspection in 2016.

  • Appraisal rates were worse than the trust target and had worsened since our last inspection in 2016.

  • Most EOC policies in use at the time of our visit were outside their review date. Not all policies reflected current working practices or national guidance.

  • The trust failed to achieve national performance targets for the highest priority calls. Whilst this was similar to other ambulance trusts nationally, patients were put at risk through delays in treatment or taking them to hospital. The outcome data for the trust was worse than the national average for the majority of clinical outcomes measured.

  • Not all ambulance crews followed best practice guidelines and we observed poorly completed records and incomplete patient assessments.

However:

  • We saw improvements in multi-disciplinary working since our last inspection. The service had close links with local police and fire services.

  • The trust worked well with GPs, in community settings and the patient’s own home. Patients were supported to manage their own health by using non-emergency services such as their GP, local urgent care centres or alternative care pathways when it was appropriate to do so.

  • The trust’s call answering performance had improved since our last inspection in May 2016 although this was still worse than the AQI target of five seconds.

  • Trust wide guidance and training provided on the management of mental health patients were more in-depth and had been included in the key skills training programme. The process for assessing a patient’s capacity was more comprehensive than what was previously just a tick box exercise. This meant the assessment now considered the person’s ability to give consent to a specific act in a specific circumstance. This meant that the trust ensured persons providing care or treatment to service users had the competence and skills to do so safely.

Caring:

  • All EOC staff we met and observed consistently demonstrated compassion, kindness and respect towards callers and patients, including those in mental health crisis.

  • We observed examples of patients in distressing situations being supported by staff over the telephone. Staff displayed empathy and helped the patients cope emotionally, often by staying on the telephone until an ambulance crew arrived.

  • There were systems to support patients to manage their own health and to signpost them to alternative services where they could access more appropriate care and treatment, for example GP surgeries and walk-in centres.

  • Between May 2016 and April 2017 the trust’s Friends and Family Test performance was better than the England average in ten out of the 12 months.

  • We observed the majority of EUC staff treating patients with kindness and compassion. Staff and patients told us ambulance crews had delivered care and treatment above and beyond what was expected of them.

Responsive:

  • Complainants experienced lengthy delays waiting for a response to their complaint. There was limited evidence of learning from complaints to help improve services.

  • Dispatchers did not have access to information about the maximum weights that different vehicles could transport. This meant the EOC sometimes dispatched a vehicle that could not accommodate a patient’s relatives or escorts.

  • The three EOCs escalated to different levels of the demand management plan (DMP) independent of each other. This meant patients received a different response depending on which EOC answered their call at times of DMP at one EOC.

  • Access, flow and demand were some of the concerns from the 2016 inspection. ‘Immediate handovers’ have reduced the time some ambulance crews wait for handovers in some areas. However, the application of the immediate handover system was inconsistent. There were still significant problems with ambulance waiting times at hospitals across the South East.

  • Communication of changes to policies, particularly the policy about transporting bariatric patients, was inconsistent.

However:

  • Overall, the service made reasonable adjustments and took action to remove barriers to enable people to access services easily. These measures included an SMS emergency service system for people who were unable to talk on the telephone and a language line for people who did not speak English as a first language. However, there was inconsistent bariatric service provision and processes for accessing translation services were not always effective.

  • The service’s four-stage management plan for frequent callers was helping meet the individual needs of these patients.

  • When staff received training in areas such as end-of-life care, mental health and dementia, they reported that the training was valuable and they were able to apply it in their roles.

Well led:

  • The executive team did not have sufficient understanding of the scale and severity of the risk relating to call recording failure.

  • The culture of the EOC did not always encourage openness and candour.

  • Staff satisfaction was inconsistent, and morale at Banstead EOC was low.

  • We found insufficient or no progress with making improvements in the majority of the concerns for EUC reported in the previous May 2016 inspection, particularly around medicines management.

  • The trust’s governance processes remained inadequate. Whilst there had been changes to ensure improvements were made at a strategic level, monitoring of risks and quality in front line services had not always been implemented. Where it had been, practices had not been embedded. The trust could not fully provide adequate assurance of clinical and operational oversight.

  • Overall communication with staff was still poor, in particular changes of policies, processes and practices in areas such as medicines and transportation / vehicles. This meant the trust could not be fully assured that communication was effective and that practice was consistent across the trust.

  • Trust strategy and core values were not recognised by front line staff and staff did not feel engaged with the trust’s vision. Staff generally felt supported by their immediate managers but told us there remained a disconnection between front line staff and senior managers.

  • There were still no local risks identified and there was limited knowledge of the trust wide risk register.

  • There was some inconsistency in the way staff were treated with regard to accessing mandatory training and the implementation of the sickness absence management policy.

However:

  • We observed positive examples of local leadership from the operating unit managers (OUMs) at all three EOC. We saw that the EOC listened to staff and worked to address concerns raised in the local “Pulse” staff survey. All staff we spoke with felt supported and valued by their OUM.

  • We saw improvements in staff and public engagement since our last inspection. These included reward and recognition badges and the introduction of a patient experience group.

  • Staff were proud of the work they did and the support they and their colleagues offered one another. They felt positive about the organisation and that they were ‘heading in the right direction’.

  • There was a medicines improvement strategy and associated annual plan in development.

  • Managers had put a number of processes in place to deal with bullying and no longer tolerated it. In addition, staff felt bullying was a problem that was “dying out”.

We saw several areas of outstanding practice including:

  • We found the trust’s mental health street triage service to be an area of outstanding practice.

  • The Hazardous Area Response Team (HART) was an approved training centre of excellence and offered training to external agencies.

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

Importantly, the trust must:

  • The trust must take action to ensure they keep a complete and accurate recording of all 999 calls.

  • The trust must protect patients from the risks associated with the unsafe use and management of medicines in line with best practice and relevant medicines licences. This should include the appropriate administration, supply, security and storage of all medicines, appropriate use of patient group directions and the management of medical gas cylinders.

  • The trust must take action to ensure there are a sufficient number of clinicians in each EOC at all times in line with evidence-based guidelines.

  • The trust must take action to ensure all staff receive an annual appraisal in a timely way so that they can be supported with training, professional development and supervision.

  • The trust must take action to ensure all staff understand their responsibilities to report incidents.

  • The trust must ensure improvements are made on reporting of low harm and near miss incidents.

  • The trust must investigate incidents in a timely way and share learning with all relevant staff.

  • The trust must ensure all staff working with children, young people and/or their parents/carers, who could potentially contribute to assessing, planning, intervening and evaluating the needs of a child or young person and parenting capacity where there are safeguarding/child protection concerns, receive an appropriate level of safeguarding training.

  • The trust must ensure patient records are completed, accurate and fit for purpose, kept confidential and stored securely.

  • The trust must ensure the CAD system is effectively maintained.

  • The trust must ensure national performance targets are met.

  • The trust must improve outcomes for patients who receive care and treatment.

  • The trust must ensure the risk of infection prevention and control are adequately managed. This includes ensuring consistent standards of cleanliness in ambulance stations and vehicles, and hand hygiene practices and uniform procedure are followed.

  • The trust must ensure that governance systems are effective and fit for purpose. This includes systems to assess, monitor and improve the quality and safety of services.

  • The trust must ensure all medical equipment is adequately serviced and maintained.

  • The trust must continue to ensure there are adequate resources available to undertake regular audits and robust monitoring of the services provided.

  • The trust must ensure the systems and processes in place to manage, investigate and respond to complaints, and learn from complaints are robust.

In addition the trust should:

  • The trust should take action to audit 999 calls at a frequency that meets evidence-based guidelines.

  • The trust should ensure 100% of frequent callers have an Intelligence Based Information System (IBIS) or other personalised record to allow staff taking calls to meet their individual needs.

  • The trust should take action to ensure all patients with an IBIS record are immediately flagged to staff taking calls 24 hours a day, seven days a week.

  • The trust should consider reviewing the arrangements for escalation under the demand management plan (DMP) so that patients across the trust receive equal access to services at times of DMP.

  • The trust should consider how to improve communications about any changes to ensure that they are effective and timely, including the methods used.

  • The trust should review all out of date policies and standard operating procedures.

  • The trust should ensure all first aid bags have a consistent contents list and they are stored securely within the bags.

  • The trust should engage staff in the organisation’s strategy, vision and core values. This includes increasing the visibility and day to day involvement of the trust executive team and board, and the senior management level across all departments.

  • The trust should continue to sustain the action plan from the findings of staff surveys, including addressing the perceived culture of bullying and harassment.

  • The trust should continue to address the handover delays at acute hospitals.

  • The trust should ensure there are systems and resources available to monitor and assess the competency of staff.

  • The trust should ensure that patients are always involved in their care and treatment.

  • The trust should ensure that patients are always treated with dignity and respect.

  • The trust should ensure all ambulance stations and vehicles are kept secured.

  • The trust should ensure all vehicle crews have sufficient time to undertake daily vehicle checks within their allocated shifts.

  • The trust should ensure individual needs of patients and service users are met. This includes bariatric and service translation provisions for those who need access.

On the basis of this inspection, I have recommended the trust remains in special measures.

Professor Edward Baker

Chief Inspector of Hospitals

Inspection carried out on 03-06 May 2016

During a routine inspection

South East Coast Ambulance Service NHS Foundation Trust (SECAmb) is part of the National Health Service (NHS). The trust came into being on 1 July 2006, with the merger of the former Kent Ambulance Service, Surrey Ambulance Service and Sussex Ambulance Service. On 1 March 2011 SECAmb became a Foundation Trust. The trust employs over 3,660 staff working across 110 sites in Kent, Surrey and Sussex. This area covers 3,600 square miles which includes densely populated urban areas, sparsely populated rural areas and some of the busiest stretches of motorway in the country. It has a population of over 4.5 million people. There are 12 acute trusts within this area and 22 Care Commissioning Groups (CCGs).

The trust responds to 999 calls from the public and urgent calls from healthcare professional across Brighton and Hove, East Sussex, West Sussex, Kent and Medway, Surrey, and parts of North East Hampshire.It also provides NHS 111 services across the region and in Surrey provides non-emergency patient transport services (pre-booked patient journeys to and from healthcare facilities).

The emergency operations centre (EOC) receives and triages 999 calls from members of the public and other emergency services. It provides advice and dispatches ambulances as appropriate.The EOC also provides assessment and treatment advice to callers who do not need an ambulance response, a service known as “hear and treat”. Callers receive advice on how to care for themselves, or staff direct them to other services that could be of assistance.The EOC also manages requests from health care professionals to convey people either between hospitals or from community services into hospital.

The emergency operations centre received 929,822 emergency calls in 2014-15. The call volume had increased by 7.24% compared with the previous year.The trust had three emergency operations centres: Coxheath, Banstead and Lewes. The trust plans to move services from Banstead and Lewes EOCs to a new, purpose-built facility in Crawley in February 2017.

Patient Transport Services (PTS) for SECAmb provides a service for people who meet the eligibility criteria within Surrey and a small part of North East Hampshire. PTS headquarters is based in Dorking, Surrey and there are six bases across the area, located at or near the major hospitals. Figures provided show that PTS handles between 1800 and 1950 journeys per week and currently employs 126 staff.

We inspected this location as part of our planned comprehensive inspection programme. Our inspection took place on 3 to 6 May 2016. We looked at three core services: emergency operations centres, patient transport services and emergency and urgent care, including resilience and the hazardous area response team. The 111 service provided by the trust was inspected separately. During the inspection, we visited both ambulance premises and hospital locations in order to speak to patients and staff about the ambulance service.

Overall, we rated this service as inadequate. We rated emergency and urgent care as inadequate and the emergency operations centre and patient transport services as requires improvement.

Overall we rated the service as good for caring, requiresimprovement for effective and responsiveand inadequate for safe and well led.

Our key findings were as follows:

Are services safe?

  • The incident reporting culture, the processes for reporting and investigating incidents and the lack of learning from incidents did not support the safe provision of service.
  • Safeguarding arrangements within the trust were exceptionally weak. A lack of accountability, understanding and appropriate investigation was prevalent throughout the trust.
  • There was low attendance at infection control training leading to inconsistent hand hygiene practices.
  • The trust CAD system had not been appropriately updated.
  • The trust medicines management process had allowed staff to develop practice outside national guidance and best practice.
  • Low staffing levels were having an impact on both performance and fatigue of staff. The trust did not have access to information to review the mix of staff or safe staffing levels.

Are services effective?

  • The trust was not meeting national performance targets for response times.
  • The trust was benchmarked as the worst performing trust nationally for answering 999 calls within 5 seconds. Trust performance was as low as 95% within 80 seconds during March 2016.
  • Policies and procedures had not been updated in a timely manner or in line with national guidelines.
  • There was no tracking system for appraisals leading to inconsistencies in approach.
  • There was no competency framework in place against which to assess staff.
  • There was a lack of Mental Capacity Act training leading to a variable understanding within the trust.
  • There were protocols and guidance for pain relief and patients reported that pain relief had been offered and managed effectively.
  • The trust had well developed links with the police, fire brigade and GPs.

Are services caring?

  • Our observation of staff interacting with patients demonstrated patient empathy and focus.
  • We saw kindness and understanding from staff even when faced by volatile patients and members of the public.
  • We saw examples of staff providing patients, relatives and colleagues emotional support.
  • Call handlers in the 111 service communicated with callers in a non-judgemental way and treated patients as individuals.
  • Ambulance crews largely provided clear explanations to patients adopting a sensitive tone and posture during discussions.
  • PTS staff sensitively supported patients to find alternative modes of transport when they did not meet the criteria for accessing PTS.
  • There were processes to ensure that staff could access support following traumatic or difficult calls or attendances. Staff were observed providing immediate support to colleagues.

Are services responsive?

  • The processes for complaint response failed to meet expected targets. Complaints did not fully acknowledge organisational responsibility and there was little evidence of learning from complaints across the whole trust.
  • Organisational planning had not facilitated equal distribution of resources across the geographical area served.
  • A ‘tethering’ system resulted in some patients waiting longer than necessary for emergency attendances.
  • Handover delays at emergency departments often significantly exceeded the 15 minutes target and led to a major loss of productive ambulance capacity.
  • The trust was working closely with commissioners to plan services against the background of significant increases in demand.
  • The trust worked with strategic clinical networks, operational delivery networks and the trauma network to plan for complex care.

Are services well-led?

  • Roles and accountability within the executive team lacked clarity.
  • There was a lack of clarity regarding the respective roles of the three clinical directors within the executive team.
  • The board had numerous interim post holders and we saw evidence of inter-executive grievance.
  • Although there was a comprehensive clinical strategy, there was no form of measurement to monitor the attainment of the strategy pledges by the board.
  • Risk management was not structured in a way that allowed active identification and escalation to the board. Risks managed at board level did not have robust and monitored action plans.
  • Staff reported a culture of bullying and harassment.
  • The trust had actively sought to engage with the public, notably with the development of community first responders.
  • The trust was utilising social media in an attempt to inform and influence the use of trust services.
  • The trust had a positive culture of encouraging innovation, notably in the development of the paramedic workforce and the introduction of critical care and advanced paramedics.

We saw several areas of outstanding practice including:

  • The trust encouraged staff to take on additional roles and responsibilities and provided training and support to enhance the paramedic roles. The specialist paramedics’ roles such as the critical care paramedic had expanded and developed.

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

Importantly, the trust must:

  • take action to ensure all staff working with children, young people and/or their parents/carers and who could potentially contribute to assessing, planning, intervening and evaluating the needs of a child or young person and parenting capacity where there are safeguarding/child protection concerns receive an appropriate level of safeguarding training.
  • take action to ensure all Emergency Operations Centre premises containing confidential data and critical equipment are secure.
  • take action to ensure the CAD system is properly maintained.
  • take action to provide every operational Hazardous Area Response Team (HART) operative with no less than 37.5 hours protected training time every seven weeks.
  • formulate a contingency plan to mitigate the loss of the Patient Transport Services control room in Dorking that will allow the service to continue.
  • take action to ensure that governance systems are effective and fit for purpose. This includes systems to assess, monitor and improve the quality and safety of services.
  • take action to improve the reporting of low harm and near miss incidents.
  • take action to ensure that national performance targets are met.
  • take action to improve outcomes for patients who receive care and treatment.
  • take action to adequately manage the risk of infection prevention and control. This includes ensuring consistent standards of cleanliness in the ambulance stations, vehicles and staff hand hygiene practices.
  • take action to ensure there are always sufficient numbers of staff and managers to meet patient safety and operational standards requirements. This should include ensuring there are adequate resources for staff to usually take their meal breaks, finish on time, undertake administrative and training.
  • take action to recruit to the required level of HART paramedics in order to meet its requirements under the National Ambulance Resilience (NARU) specification.
  • ensure that ambulance crews qualifications, experience and capabilities are taken into account when allocating crews to ensure that patients are not put at risk from inexperienced and unqualified crews working together.
  • take action to protect patients from the risks associated with the unsafe use and management of medicines. This should include: appropriate use of patient group directives; the security and safe storage of both medicines and controlled drugs; the management of medical gas cylinders.
  • take action to ensure that patient records are completed appropriately, kept confidential and stored securely.

In addition the trust should:

  • take action to review all out-of-date policies and standard operating procedures.
  • develop procedures to ensure HART rapid response vehicles (RRVs) are relieved to attend HART incidents within the timescales set out in standards 08-11 of appendix three of the NHS service specification 2015-16: Hazardous area response teams.
  • take action to audit 999 calls at a frequency that meets evidence-based guidelines.
  • take action to put in place an effective and consistent process for feedback to be given to those who report incidents and develop a robust system for sharing lessons learned from incidents.
  • take action to ensure all staff receive an annual appraisal in a timely fashion in order that they can be supported with training, professional development and supervision.
  • take action to address discrepancies in the number of funded ambulance hours with activity across the trust.
  • ensure all first aid bags have a consistent list of contents, stored securely within the bags.
  • devise a system that will accurately track the whereabouts of the PTS defibrillators.
  • include a question regarding the patient’s DNACPR status at the point of each transport booking.
  • provide Mental Capacity Act and Deprivation of Liberty Safeguards training to all operational staff.
  • take action to engage staff in the organisations strategy, vision and core values.This includes increasing the visibility and day to day involvement of the trust executive team and board across all departments.
  • develop a detailed and sustained action plan to address the findings of the staff survey including addressing the perceived culture of bullying and harassment.
  • continue to take action to address the handover delays at the acute hospitals.
  • ensure there are adequate resources available to undertake regular audits and robust monitoring of the services it provided.
  • ensure that there is adequate access to computers at ambulance stations to facilitate e-learning, incident reporting and learning from incidents.
  • ensure there is a robust system in place to manage, investigate and respond and learn from complaints.This includes ensuring that all staff understand the Duty of Candour and their responsibilities under it.
  • ensure that there is appropriate trust wide guidance and training provided regarding attending patients with mental health problems. This should include reviewing the current arrangements for assessing capacity and consent.
  • ensure that there are structured plans in place for all frequent callers as per national guidance. The information regarding this should be collected and monitored as per national guidelines.
  • ensure that there are systems and resources available to monitor and assess the competency of staff. This includes ensuring they always involve patients in the care and treatment and treat them with dignity and respect.
  • ensure there are robust systems in place to ensure all medical equipment is adequately serviced and maintained.
  • ensure that vehicles and ambulance stations are kept secure.
  • ensure that there is sufficient time for vehicle crews to undertake their daily vehicle checks within their allocated shift pattern.

Professor Sir Mike Richards

Chief Inspector of Hospitals