All inspections: Alliance-Pioneer Group

Alliance Pioneer Groupis operated by Mr Matthew Davey. The main service provided by Alliance-Pioneer Group is events medical cover, which is outside the scope of regulation. However, they transport patients from event sites to local hospitals, which is in scope of our regulation. The provider was also providing patient transport services to transport patients between hospitals.

We carried out this focused follow-up inspection in response to a number of concerns which were identified at our previous comprehensive inspection in August 2017. We carried out our inspection on 6 and 8 February 2018.

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?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

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.

This inspection focused solely on the issues identified at our previous inspection where significant improvement was required.

The service had made some progress in addressing some of our concerns.

We found the following areas where the provider needed to make improvements:

There was no evidence of robust incident investigation processes or any learning from incidents.
Incidents, complaints and concerns were dealt with in the same policy and it was not clear if the service understood the difference between a concern and an incident.
A training spread sheet had been introduced however some key evidence for safeguarding and resuscitation training was missing for some staff.
Patient Group Directions (PGDs) and Medicines Administration Protocols (MAPs) needed further development, including appropriate authorisation before use.
Two operational staff did not have evidence to show competence in emergency driving.
Not all staff had provided evidence of DBS checks and one member of staff’s file did not contain this information.
There was no evidence of any action planning following the staff risk survey or evidence of any other staff engagement.
There was no evidence of any audit or scrutiny of recent care records at the time of the inspection.
There was an outline audit schedule for 2018 but there was limited evidence of current audit and no evidence of any actions taken a result.
There was no formal induction process or standardised induction programme for new staff joining the service.
Not all policies had been updated and the infection prevention control policy was not service-specific.
There was no system in place for the spot-checking of vehicles.
There was no formal assessment of staff competencies, although some training and assessments were being planned.
Terms of reference had not been established for the newly formed governance group and it was unclear how frequently the team were intending to meet.

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

There was a live spreadsheet for the recording and documenting of reported incidents.
The provider had a comprehensive medicines policy that provided governance and guidance for staff.
A medicines management training and competence package had been developed.
Medicines and medical gases were ordered, stored, recorded and disposed of safely.
Staff completed an infection prevention and control competence-based training booklet in the absence of training from their primary employer.
Vehicle cleaning checklists had been modified to allow staff to record their initials against checks, but this had not been assessed yet to see if it was working.
Managers had created a shared platform for key documents, but this was not yet accessible to remote staff.
All permanent and contracted staff were to be offered appraisals, although this had not yet been implemented.
The service held valid Disclosure and Barring Service (DBS) checks for most eligible staff and where cautions or convictions had been identified comprehensive risk assessments had been carried out.
Professional registrations had been checked for all paramedics employed; however, no risk assessment was present for one paramedic with conditions against their registration.
There was a new comprehensive risk register which contained details of current risks, reviews and actions and was to be reviewed as part of the new clinical governance group.
Two senior managers had undertaken additional complaints training.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with five requirement notices that affected urgent and emergency services. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (South), on behalf of the Chief Inspector of Hospitals

Alliance-Pioneer Group is operated by Mr Matthew Davey.

The main service provided by Alliance-Pioneer Group is events medical cover, which is outside the scope of regulation. However, they transport patients from event sites to local hospitals, which is in scope of our regulation.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 24 August 2017 along with an additional visit to the office on 1 September 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?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

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.

During our inspection we identified a number of areas of serious concern. In particular there was lack of assurance the provider had or could evidence regarding the safe working practice and competency of their staff.

We found the following areas of concern:

The governance arrangements did not assure Alliance-Pioneer Group it was providing a high quality and safe service. Performance was not monitored and there was limited internal or clinical audit. Therefore learning and improvements were not encouraged.
Provider risks were not being identified and recorded. We were not confident Alliance-Pioneer Group were aware of the risks to enable them to manage and mitigate the risks effectively.
The provider was unable to demonstrate they employed ‘fit and proper’ staff who were able to provide care and treatment appropriate to their role.
Safe recruitment processes were not in place to ensure patients were safeguarded against unsuitable staff. Recruitment procedures were not robust to ensure required checks were completed.
The provider was unable to evidence staff had the skills, knowledge and experience to deliver safe and effective care and treatment. There were no systems in place to demonstrate staff competence at recruitment and on an on-going basis. There was no formalised process for induction, regular appraisals or clinical supervision.
Staff did not receive mandatory training in safe systems, processes and practices. For staff employed by other healthcare providers there was an assumption this had been completed, but no evidence of this was obtained.
There was no evidence of the level of safeguarding training staff had received. Therefore the provider could not show us staff were kept up to date with how to recognise different types of abuse and ways they can report concerns.
There was no evidence to confirm staff responsible for the administration of medicines were suitably trained and competent. The provider did not have in place patient group directions, a document permitting the supply and administration of prescription only medicines, and could not evidence staff training.
The storage of medical gases was not safe and did not comply with the Department of Health HTM02 guidance or British Compressed Gas Association code of practice.
The arrangements for storing and transporting morphine (a controlled drug) had not been risk assessed and the processes were not clearly documented within the provider’s policy.
There was a risk staff were not reporting incidents. The provider told us there had been no incidents in the last year. Policies did not include how staff should report incidents, or the type of incidents to report.
There was a lack of evidence of compliance with infection control standards. Although systems were in place, there was no audit of infection control practice and no evidence of training. We identified torn seat coverings, arm rests and mattresses in ambulances which posed an infection control risk.
Vehicles were not cleaned immediately after use. During our announced inspection we observed three vehicles, which were all waiting to be cleaned. The crew for the vehicle following an event had not taken the responsibility to remove clinical waste and clean the interior to reduce the risk of the spread of infection.
Policies, procedures and checklist documents were not available centrally to ensure all senior management team had access. This also meant some policies and procedures were not readily available to staff.
There was limited engagement with the public and staff to formally seek feedback on the service to enable improvements to be made.

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

Patient observations were completed frequently and there was an awareness of sepsis tools. This ensured early identification of a deteriorating patient so they could be transferred to hospital quickly.
Clinical records for patients who had been transported to hospital were well-completed. They were clear and concise.
There was evidence of good event planning and risk assessing. Hospitals to which patients would be transferred to were identified and contact numbers made available. This reduced the chance of delays when transferring patients to the appropriate healthcare provider.
Records of equipment maintenance and schedules were available, including vehicles and medical devices.
Staff spoke of good relationships and co-ordination with other healthcare providers to enable the delivery of effective care and treatment.
Staff understood the relevant consent and decision making requirements and this was evidenced in patient care records when patients had been transferred to hospital.
During the inspection we were not able to observe any direct patient care but noted staff spoke in a thoughtful way about caring for patients. Staff provided accounts of events and situations which demonstrated either themselves or their colleagues “going the extra mile” to provide kind and compassionate care.
A dedicated crew and ambulance were identified as the primary resource for transporting a patient off-site if needed. This ensured access to care and treatment was timely and delays were minimised.
The Alliance-Pioneer Group were responsive to the needs of patients who were under the influence of drugs and were able to provide support through qualified counsellors to meet their needs.
Managers were described as supportive and responsive to concerns. The feedback received from staff about working for the provider was consistently positive.
The senior management team had a shared vision of future aspirations for the Alliance-Pioneer Group and were keen to make improvements. They spoke of their aim to evidence the quality and safety of the service.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with six requirement notices that affected emergency and urgent care. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (South)

The service provided by Alliance-Pioneer Group was medical cover at events and transferring patients between hospitals. It was, therefore, not possible to ask patients their opinion of the service. We saw letters from event organisers who commissioned Alliance-Pioneer Group services. The comments included "Thank you for your support and cooperation in achieving another successful event"; "A big thank you for the wonderful medical coverage...not only were the staff extremely professional and friendly but they were often seen to be helping (people) in other ways" and "We would be pleased to use your medical services again".

We found that all Alliance-Pioneer Group work was organised in detail, carried out in a professional way and the results closely monitored so that any improvement required could be identified and made.

We spoke to four staff during our visit and two ambulance crew following our visit. We were told, "(The registered provider) provides a professional service and business second to none" and "(The registered provider) is very keen to get things right and expects extremely high standards. Any staff who do not pull their weight do not continue in employment". The staff said they had 'never been let down' by the standard of ambulance or equipment. We saw that the premises, including the ambulance vehicles, were kept in a safe, well organised and well equipped state.

Alliance-Pioneer Group understood and complied with their responsibilities to ensure people consented to any care and treatment, that they understood and carried out their duty of care to protect people who might refuse treatment, or be vulnerable in other ways. There were robust arrangements to make sure ambulance crew were very well informed.

We conducted a visit to the office of Alliance-Pioneer Group on 12 March 2013 as part of a planned inspection. We gave short notice of our visit to ensure that somebody from the organisation would be available to meet with us.

We were unable to talk with any people who used the services because the ambulance service is provided at events, such as displays and sport. However, we saw that people's care and welfare needs were met through meticulous planning and risk management to ensure that any potential risk is mitigated. This included the number and skills required of the staff, back up equipment and vehicles suitable for different terrains.

The premises, including the vehicles, were clean and very orderly with good security in place. Vehicles and equipment was maintained in good order, with regular servicing and monitoring.

Medicines stored at the premises and in use on the vehicles were stored and administered in a safe way. A full audit of their use was in place to ensure no mishandling or mistakes and to ensure that medicines required would be available.

The service had a core staff group which attended the majority of events, supported by management, usually the provider. This meant that no staff worked alone. There were some gaps in recruitment checks prior to people working at an event but people were not put at risk by recruitment arrangements.

We conducted a visit to the office of Alliance-Pioneer Group private ambulance service on 23 July 2012 following information we received about the service. A pharmacist inspector accompanied us and we gave short notice of our visit to ensure that somebody from the organisation would be there.

We spent three hours looking at how medicines were handled and recruitment records. The provider and staff provided information. We did not speak with any people who used the service on this occasion because the service was only provided at events.

We looked at the arrangements for managing medicines including policies and procedures. We looked at the controlling and disposal of stock and how medicines were obtained, stored, administered and audited.

We found that there were appropriate arrangements for obtaining medicines and that those medicines were kept safely in that they were securely stored with separate storage for those needing additional security.

There were records of medicines that had been given to a patient. We were told that there was regular stock control of medicines, including controlled drugs, but those stock control checks were not recorded.

We saw that appropriate arrangements had been made for the disposal of unused, out of date controlled drugs and that there were policies on medicine handling, although these policies did not cover every aspect of medicine use.

However, the provider did not have appropriate arrangements in place for the recording and disposal of some medicines and so there was not a clear audit trail to show that they had been looked after safely. The reasons included: the provider not always recording that there had been stock checks, not recording medicines in and out of the ambulances, and part used ampoules of controlled drugs not recorded in the controlled drugs register.

We looked at 14 staff files. We found that the provider had undertaken thorough checks of the registration of paramedic staff. A tick and date list was used to record when a check, such as with the Criminal Records Bureau (CRB), was completed. However documents to evidence safe recruitment had not been kept and so we could not confirm that the checks had been adequately robust to protect people.

Archived: Alliance-Pioneer Group

All Inspections

6 and 8 February 2018

During a routine inspection

24 August and 1 September 2017

During a routine inspection

Amanda Stanford

Deputy Chief Inspector of Hospitals (South)

23 December 2013

During a routine inspection

12 March 2013

During an inspection looking at part of the service

23 July 2012

During an inspection in response to concerns