Heart Medical HQ

Heart Medical HQ is operated by Heart Medical Limited. The service is registered to provide a patient transport service and urgent and emergency care.

The service provided medical and first aid support at events and worked on behalf of insurance companies in relation to medical repatriations. Both these services are not activities regulated by CQC and were not inspected, however, the transfer of urgent and emergency care patients to hospital from events is regulated and this element was inspected.

At the time of the inspection Heart Medical HQ was not commissioned or contracted to provide patient transport services for any commissioners, NHS or private health providers. Patient transport services were provided on an as required basis for a local NHS hospital trust. The provider was also registered with an external company which was a digital market place where independent ambulance companies could bid for patient transport work.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 10 December 2019.

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.

We rated this service as Requires improvement overall because;

• The provider did not use patient record forms for patient transport patients.

• Staff did not complete and update risk assessments for each patient, removing or minimising risks because they were totally reliant upon the risk assessment carried out by the provider requesting the patient transport.

• Staff did not keep detailed records of patients’ care and treatment as they used patient booking forms which contained patient details supplied by the provider requesting the patient transport.

• The provider did not carry out any hand hygiene audits of staff.

• The provider did not have an audit process for reviewing patient record forms for patients transferred from an event to hospital.

• The providers safeguarding policy did not have any reference to the current 2018 intercollegiate guidance.

• The provider did not have a patient eligibility criteria policy, so we could not evidence if staff had the correct level of training to deal with the level of acuity of the patient transported.

• There were limited opportunities for staff to learn from the performance of the service or the standards of care provided because the service did not have key performance indicators or used patient record forms.

• It was not clear at which meeting the information from the risk register was discussed at or for how long the risks had been active.

• The risk register was not a standard agenda item on the provider’s monthly quality report.

• There was no evidence the business continuity had been tested either in response to an incident or by way of an exercise.

However, we did find the following good practice;

• All staff were up to date with statutory, mandatory and safeguarding training.

• There was evidence of regular vehicle deep cleans and infection prevention control audits.

• The provider adhered to the national patient safety (2016) colour coding systems.

• Medical gases were stored in accordance with health and safety executive legislation 1998.

• We saw evidence staff who had worked for the company for over a year had an annual appraisal and those who had not were booked to receive one in January 2020.

• We saw evidence of disclosure and barring service checks for staff and when DBS re-checks would be done.

• The provider published a quarterly quality report which was shared with staff which covered incidents, records, infection prevention control and any other business.

Following this inspection, we told the provider that it should make seven improvements and must make four other improvements to help the service improve. The provider was issued with one requirement notice. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (area of responsibility), on behalf of the Chief Inspector of Hospitals

Heart Medical HQ is an independent ambulance service operated by Heart Medical Limited. The service provides patient transport and emergency and urgent care service.

We first visited this provider in March 2019, due to a number of concerns raised with CQC about the cleanliness of vehicles and the culture within the service. Following this inspection, we carried out urgent enforcement action and served a notice under Section 31 of the Health and Social Care Act 2008 to suspend the registration of the service provider in respect of the regulated activities: Transport services, triage and medical advice provided remotely and Treatment of disease, disorder or injury. We took this action because we believed that a person will or may be exposed to the risk of harm if we did not take this action. Following this action, the service was not allowed to carry out any regulated activity until they had improved. We undertook two further visits to the location, in May and June 2019 which are covered in this report. At the May 2019 inspection, we did not receive assurance that services had improved sufficiently, and the provider agreed to voluntarily suspend regulated activity. At the June 2019 inspection we received adequate assurance and the provider was able to provide regulated activities again.

We inspected the patient transport service as this was the main service provided by this company at the May and June 2019 inspections. We did not inspect the urgent and emergency care service. We asked two of our five key questions, during these inspections, examining whether services were safe and well led.

We inspected this service using our focused inspection methodology. Our inspections were announced (staff knew that we were coming) to enable us to observe routine activity.

Following the March 2019 inspection, the service had closed one base station in Durham and was operating from its only base in Ossett, West Yorkshire.

Throughout the inspections, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005. However, at the time of the inspections the service did not transport patients detained under the Mental Health Act.

Due to the inspections being focussed we did not rate these inspections. Following the May and June 2019 inspections we found:

• Improved standards of cleanliness and hygiene; the registered manager had developed reliable systems to prevent and protect people from a healthcare-associated infection.

• The service had improved training requirements to ensure staff had the relevant qualifications, competence, skills and experience to care for patients safely.

• The service had improved record keeping in relation to mandatory training undertaken and appraisal records for staff members.

• The service had improved record keeping in relation to safeguarding training. Although, due to the lack of regulated activity we were unable to speak to staff during these inspections to gain assurance on their understanding of safeguarding and how Heart Medical would report, act on or monitor any safeguarding issues.

• Improved systems to ensure that equipment was routinely checked for safety.

• Improvements had been made in relation to record keeping.

However, the following issues still needed further improvement:

• Although the registered manager had plans to improve governance structures to monitor and improve the quality and safety of the services they provided; these had not been implemented

• There were limited systems to identify risks and plan to eliminate or reduce risks.

• The service did not seek and act on feedback to evaluate and improve the services provided.

• We were not assured that medical gases were consistently stored in line with guidance.

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

Ann Ford, Deputy Chief Inspector of Hospitals (North Region), on behalf of the Chief Inspector of Hospitals