Archived: Immediate Care Medical Services

Immediate Care Medical Services (ICM) is a private, family-run ambulance service that provides patient transport services. They did not have any substantive contracts, but carried out various patient transport and transfer work for the NHS and other private ambulance providers on a sub-contracted ad-hoc basis. This work was tendered through a centralised clinical commissioning group (CCG).

We carried out an announced inspection of ICM on 6 December 2016. This was a comprehensive announced inspection as part of our inspection programme.

Our inspection covered four of the five domains to assess whether the patient transport services provided by ICM were safe, effective, responsive and well led. We were unable to inspect caring as there were no patient transfers scheduled on the day of our inspection. We were not able to contact any patients directly after our inspection as the provider did not hold contact details for service users. All patient transfers carried out by the provider were managed through the clinical commissioning group that the provider tendered their work through.

The provider operated from one location split between two premises. The office was based in an office block on an industrial estate in Birmingham. The vehicles were held in an industrial garage based in Smethwick. We inspected both premises as part of this inspection.

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and issues that service providers need to improve.

We found the following areas of good practice:

• There was a good incident reporting culture. The provider encouraged staff to report all concerns including patient safety, vehicle and equipment concerns.
• The provider understood their responsibilities under Duty of Candour. Staff were able to explain what this meant and when it should be used.
• The provider documented policies and standard operational procedures well and staff had access to these.
• Staff were able to describe what they would do if they had safeguarding concerns and this description was in line with ICM policy.
• There were good processes in place to prevent and control the spread of infection. All vehicles we saw were visibly clean internally and externally.
• Staff we spoke with understood what their responsibility was for prevention and control of infection.
• All vehicles had a valid ministry of transport roadworthiness test (MOT) certificates. They all had regular documented services and had valid road tax.
• The provider stored patient record forms securely on an electronic database and disposed of paper copies appropriately.
• There were good processes in place to check the registrations, disclosure and barring system (DBS) and qualifications of sub-contracted staff on appointment of contract.
• The provider was registered with an umbrella DBS organisation that allowed them to apply for DBS certificates directly.
• The service was flexible and was planned and delivered to meet the needs of their service users.
• There were sufficient resources to carry out patient transport services.
• The provider had a protocol for inclusion of patients and only accepted transfers they were equipped to assist.
• There was a good process in place to manage concerns and complaints.
• The culture of the service was open and transparent. The provider encouraged staff to give feedback in an open and transparent manner.
• Leaders had the necessary knowledge and capability to lead effectively. The registered manager had a good understanding of the Health and Social Care Act 2008.
• The leadership team were visible and accessible.
• Policies provided guidance for staff to use them and protocols were written down for staff to reference.
• All management staff were aware of their roles and responsibilities, and understood what they were accountable for.
• The provider had a private social media page to keep in touch and engage with sub-contracted staff members.
• The provider had an online booking system where patients could book directly with ICM through completing an online form, requesting a call back or calling the provider over the phone.

However, we also found areas where practice could be improved;

• There was a lack of assurance that all sub-contracted staff had completed, and were up to date with their mandatory training including safeguarding training.
• There was no documentation outlining mandatory training needs per role or to specify what level of training the provider expected staff to have as a minimum.
• The provider did not have a formal induction programme in place to assess and approve the competency of newly appointed staff.
• There was insufficient assurance in place to demonstrate people received effective care.
• There was no system in place for monitoring patients’ outcomes of care and treatment.
• There was no interaction with patients and organisations requesting tenders before the provider accepted transfers. This meant there was a risk of the provider accepting patient groups that were not in their inclusion criteria.
• At the time of the inspection, none of the permanent staff ICM employed had an appraisal.
• There was a lack of assurance that the sub-contracted staff were competent to perform their role.
• There were no formal processes in place to ensure patients’ needs were met for those patients living with hearing or sight difficulties and those patients where English was not their first language.
• There was no policy for staff on how to deal with violent or aggressive patients.
• The service did not appear to have a clear vision, strategy or set of values.
• There was a lack of engagement with service users, both patients and other organisations using ICM services for patient transport. The provider was not actively gaining feedback from relevant people.

Information on our key findings and action we have asked the provider to take are listed at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals