Archived: Arriva Transport Solutions - South West

Arriva Transport Solutions South West is part of Arriva Transport Solutions Limited, a nationwide provider of independent, non-emergency patient transport services. Arriva Transport Solutions Limited is part of an international transport group.

We did not rate Arriva Transport Solutions - South West as they have not yet had an announced comprehensive inspection. We carried out an unannounced focussed inspection on 19, 20 and 21 July 2016 to review the service’s arrangements for the safe transport of patients. We did this following concerns raised by a number of patient organisations and hospital trusts after an increase in delays to travel times affecting both transport to appointments and return home.

Our key findings were as follows:

• We saw evidence of learning that directly benefited patients such as reviewing and developing patient feedback processes. There were plans for 2016/17 to continue working with commissioners on learning from the level of harm, as well as distress, caused by incidents of delayed transport, to ensure quality improvements improved patient experience
• Staff were aware of their responsibilities to report incidents to managers. We saw incident reporting that covered what staff did to manage resuscitation if patients needed it, safeguarding regarding staff, and patients, and injuries during transport.
• Staff we spoke with were aware of their responsibilities regarding duty of candour and understood the importance of being open and transparent with patients when things go wrong.
• Mandatory training for the coming months had been planned as mandatory training records showed that not all staff had received the yearly training. However targets and completion of mandatory training overall was high compared to other organisations.
• There were reliable systems, processes and practices in place to protect adults, children and young people from avoidable harm. The patients we spoke with during this inspection told us they felt safe with the staff and in the vehicles.
• There was an infection prevention and control policy and system that described decontamination of medical devices, vehicles and workwear. Overall we found stations we visited to be visibly clean and tidy. We saw evidence of when vehicles and equipment were last cleaned and when it was next due.
• People’s needs were assessed and transport provided to patients in line with national and local guidelines. The eligibility criteria required call takers to ask prompted questions about the patient’s condition, health and mobility status, which determined the most appropriate type of transport required.
• We saw that people were treated with kindness, dignity, respect and compassion while they received care. We received positive comments about ambulance crew from patients, patient’s relatives and from staff working at local hospitals we spoke with. Crew were described as 'wonderful' and 'brilliant.' Another patient described crew as ‘lovely’ and said they could not do enough to help.
• Crew encouraged patients to be as independent as possible and provided support where required. We observed crew members enabling and encouraging patients to move independently, providing support and advice where appropriate
• The service ensured that lessons were learnt when things went wrong and actions taken as result of complaints. Learning included, reflection on attitude even when complaints not upheld, acknowledging that increases in demand affected journeys and journey times.
• There was a clear vision and credible strategy to support quality care. We saw evidence that the key to good non-emergency patient transport was understood by the relevant staff. There were governance frameworks in place to support staff to know their responsibilities and that quality, performance and risks were understood and informed action plans. However, senior managers acknowledged that there was some way to go in a number of areas. For example, achieving key performance indicators, reducing the number of complaints related to delays.
• Patients and others who used the service and staff were engaged and involved in several ways. Patients were engaged in a survey run by an external company and fed back to the service. The number of returns was small and the result of the patient feedback survey was mixed and reflected both positive and negative comments.
• Managers and others told us of a culture that encouraged candour, openness and honesty. We saw evidence of this and senior managers spoke broadly about the duty of candour and how it applied to service delivery.
• Patient records were created at the control centre and received by ambulance crew on the electronic tablet associated with each particular vehicle. Control staff collected relevant information during the booking process so that they recorded the information regarding patient’s health and circumstances. Several of the provider’s ambulance crews reported that the information provided on the patient record was sometimes incorrect, out of date or very limited which had been raised with the organisations that had supplied the information.

However

• Staff level was at 85% for road based staff and there was a recruitment plan in place. The service used bank and volunteer staff when necessary.
• Not all lessons were learned when things went wrong. Staff told us that it was difficult to report incidents on the electronic system. They said they frequently experienced long waits when calling the control room to report incidents so some potential for improvements were not identified when things went wrong.
• There was not a robust system in place to make sure defects in the vehicles were recorded and always actioned in a timely way and vehicles were not always taken off the road for repair.
• Delays and long waiting times for patient outbound journeys from clinics were a recurring theme amongst staff we spoke with at the local hospital and patients. We saw that the service had investigated all incidents or were in process of doing so. Themes included, the service arriving late and other organisations moving patients to a different location and not letting the service know or providing incorrect mobility information.
• Staff were not supported to be able to communicate with patients who were significantly hearing or vision impaired.
• Service delivery did not always meet people’s needs. We saw evidence of mixed patient experience and missed key performance indicators in reports from external stakeholders such as Healthwatch Gloucestershire and clinical commissioning group reports. The service was working with stakeholders to improve the service and had recently undergone a management recruitment and restructure in order to deliver the requirements of their contract in 2016 and beyond.

We saw several areas of outstanding practice including:

• Control and road based staff recognised where they could help patients. Staff went out of their way to assist patients we were told by a patient of an example of staff amending their journey to help a patient who was delayed by another provider. There were other examples that we saw in the incident recording, where staff had identified issues that patients needed assistance with at home and had completed tasks before leaving to ensure the patient was safe as well as emotionally supported.

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

Importantly, the location must:

• Ensure that mandatory training observations, appraisals and yearly updates for all staff are carried out and up to date including the high dependency ambulance vehicle staff.
• Ensure that the process in place to record defects in vehicles was recorded and actioned in a timely way was followed.

The location should:

• Ensure that the process for staff to be informed of updated policies, procedures and quality and governance updates is followed and records kept
• Ensure that all equipment and particularly those used to take measurements of patients’ blood pressure and oxygen saturation levels are listed on equipment servicing records and serviced and maintained within specified dates.
• Ensure that systems for control to communicate between operational or road based staff enable timely communication via telephone calls and text messaging so that messages about patient’s condition or incidents were able to be shared.
• Ensure that policies and procedures for disposal of clinical waste are followed.
• Ensure that battery life for equipment used for text and voice communication is fit for purpose and is reliable
• Ensure that the process for identifying poor performance that needed to be addressed and managed formally was followed.

In addition the location should:

• Consider how staff receive feedback from any incidents they report.
• Consider whether Mental Capacity Act 2005 and deprivation of liberty safeguards training meet staff needs.
• Consider aids for staff to be able to communicate with patients with significant sight or hearing impairment are available.
• Consider reviewing the process and questions for call taking for identifying mental health and other support needs a patient may have once scripted prompts are exhausted.
• Consider carrying out a review of patients comfort in vehicles.
• Consider whether electronic alerts that the planning and control room staff used on patient records that included the word complaint complies with records keeping best practice.
• Consider the method for journey time allocations and whether post code allocation is detailed enough.
• Consider increasing the opportunity for road based staff and control based staff to understand each other’s role better.

Professor Sir Mike Richards

Chief Inspector of Hospitals