Archived: Inter-County Paramedic - Riverside Park

Updated 12 April 2017

Inter-County Paramedic is an independent ambulance provider which was incorporated as a private limited company in 2005. The primary purpose of the organisation is to provide dedicated and bespoke ambulance services to private events, which predominantly are related to motor sports. Other services provided by the organisation are ambulance services for county and country shows, football clubs and occasional non-emergency transfer of patients from acute hospitals.

On all occasions, the purpose of the provider is to provide treatment onsite and where necessary transfer patients to local acute hospitals for definitive care. The care and treatment provided during conveyance to hospital is the regulated activity which was the focus of our inspection.

The provider operates from a single location, an ambulance station and has 12 vehicles in total with two vehicles permanently located at sites which they regularly provide services for.

The service has had a registered manager in post since September 2011 when the service was first registered with the Care Quality Commission.

Updated 12 April 2017

Inter-County Paramedic Riverside Park is operated by Inter-County Paramedic Ltd. The independent ambulance service provides bespoke medical cover to sporting events which included medical care and treatment on the event site (this activity is not regulated and therefore is not included in this report) and conveyance to hospital for patients that required more definitive care. The care and treatment provided during conveyance to hospital is regulated and is the focus of this inspection. The service was inspected under the patient transport service framework.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 1 February 2017 along with two unannounced visits to the service on 8 and 14 February 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

The only service provided by Inter-County Paramedic Ltd was patient transport services.

Services we do not rate

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• The service had a system in place for reporting, recording and learning from incidents.

• There were robust systems in place to maintain patient safety which included medicines management, infection prevention and control and vehicle maintenance.

• There was a lead for safeguarding and staff knew who this was. Staff knowledge around safeguarding vulnerable adults and children from abuse was evident.

• The service stored patient record forms (PRFs) appropriately and audited to ensure good completion by staff.

• Staff followed evidence-based care and treatment and nationally recognised best practice guidance, which included the Joint Royal College Ambulance Liaison Committee (JRCALC) guidelines from 2016.

• The service had processes in place to ensure all staff who were employed were suitably qualified, medically fit and experienced in their roles.

• There was good coordination with other members of the multidisciplinary team and staff from the organisations medical cover was provided for.

• Staff had a strong focus on providing a caring, compassionate and professional service.

• Measures were taken to meet the individual needs of patients treated.

• There was a system for handling, managing and monitoring complaints and concerns. The service had not received any complaints from January 2016 to January 2017.

• Staff felt valued by the manager and proud to work for the service.

• The service had taken steps to improve and innovate their systems for stock management and maintaining a responsive service at events they are providing a medical cover for.

However, we also found areas that the service provider needs to improve:

• The service did not have a Home Office licence in place for the management of controlled drugs.

• The service did not have a system in place to regularly receive medicine and medical device alerts.

• There was no risk register in place to give an overview of all known risks.

• Staff were unaware whether there was a vision and strategy for the service.

• There were limited systems in place to measure quality and service improvement.

• There was an appraisal process in place, however at the time of our inspection, only 39% of staff had received one.

• Not all staff had completed mandatory training. At the time of our inspection, compliance with mandatory training was between 54% and 88%.

Ellen Armistead

Deputy Chief Inspector of Hospitals

Updated 12 April 2017

Are services safe?

We do not currently have a legal duty to rate independent ambulance services.

We found the following areas of good practice:

• We found staff were knowledgeable about the incident reporting system and received feedback when they submitted an incident.
• All vehicles were visibly clean and tidy and we saw evidence of regular deep cleans of the vehicles.
• All vehicles were serviced, an up to date MOT and the service maintained a database which highlighted when these were next due.
• There were comprehensive records to demonstrate medicine management which provided an auditable trail for where all medicines were located. Medicines were regularly checked and we saw evidence of these checks.
• All patient record forms (PRFs) were stored in accordance with policies and procedures, and were not kept on the vehicles.

However, we also found the following issues that the service provider needs to improve:

• The service did not have a Home Office licence for the management of controlled drugs, although they had previously tried to seek advice on whether this was required or not.
• There was no process in place for the service to receive alerts from the central alerting system (CAS), to alert them to any medicine or medical device safety alerts.
• Information provided by the service at the time of the inspection showed mandatory training compliance was between 54% and 88%.

Are services effective?

We do not currently have a legal duty to rate independent ambulance services.

We found the following areas of good practice:

• Staff followed evidence-based care and treatment and nationally recognised best practice guidance. All staff had access to the Joint Royal College Ambulance Liaison Committee (JRCALC) guidelines from 2016.
• All staff worked well with members of the multi-disciplinary team as well as working well with each other.
• All 14 staff files we reviewed contained the relevant documentation including Disclosure and Barring Service (DBS) checks, photo identification, references and health checks.
• Staff were aware of the requirements for consent to treatment and recorded consent on patient record forms. The service had forms available for patients who refused treatment.
• The service conducted regular six monthly reviews of all staff with a driving licence.

However, we also found the following issues that the service provider needs to improve:

• Appraisal rates were low at the time of inspection with only 39% of staff having an up-to-date appraisal. However, all staff permanently employed by the service were included in those who had received an appraisal.
• The service did not benchmark their performance internally or against other providers of a similar service.
• Only one staff file contained evidence of immunisations and immunity against infections.

Are services caring?

We do not currently have a legal duty to rate independent ambulance services.

• During our announced and unannounced inspections, we did not observe any patients being treated during regulated activity.

However:

• We spoke with staff and conducted a telephone interview with a patient about the care and treatment they received whilst they were conveyed to a local acute hospital.

Are services responsive?

We do not currently have a legal duty to rate independent ambulance services.

We found the following areas of good practice:

• The service had access to translation and interpretation services through a recognised translation service.
• The service were able to meet the individual needs of patients with hearing deficiencies.
• The booking system was straightforward and co-ordinated by the manager. The main events for which they were contracted to were prioritised and any additional work would only be accepted if the service could meet the requirements.
• The service had not received any complaints from January 2016 to January 2017.

However, we also found the following issues that the service provider needs to improve:

• There were no additional aids for communication for patients with sight deficiencies.
• The service had not provided training for meeting the needs of patients with learning disabilities or people living with dementia.

Are services well-led?

We do not currently have a legal duty to rate independent ambulance services.

We found the following issues that the service provider needs to improve:

• The service did not have a clear vision or strategy which was shared with staff members.
• There was no risk register available which provided an over-sight of the risks to the service.
• There were no formalised meetings between staff for governance purposes where risk management and quality measurement was discussed.
• There was no formalised audit programme for the service, although there was evidence of clinical auditing happening.

However, we also found the following areas of good practice:

• All staff spoke highly of the manager of the service and the professional and well organised service they ran.
• All staff told us the manager was supportive and had an open door policy. All staff told us they would feel comfortable approaching the manager if they needed to.
• The service had implemented an inventory system to improve their stock rotation and minimise unnecessary waste.