E-Zec Medical Transport Services - Cornwall is operated by E-Zec Medical Transport Services Ltd. The service is registered with the Care Quality Commission to provide the regulated activity: transport services, triage and medical advice provided remotely. Commissioning of the service was through the local acute NHS trust and NHS Kernow. NHS Kernow is the clinical commissioning group for Cornwall and the Isles of Scilly.
The CQC registered location is at the Redruth Depot. Throughout this report we will refer to the services provided in Cornwall as ‘E-Zec’.
E-Zec had three depots in Cornwall at Redruth, Bodmin and Saltash. At Redruth station there were 13 ambulances capable of transporting patients on stretchers and wheelchairs, two ambulances for use with wheelchairs only, two bariatric ambulances and two cars. At Bodmin station there were a total of nine ambulances all capable of transporting patients on stretchers and wheelchairs and two cars. The Saltash station had four ambulances available all capable of transporting patients on stretchers or wheelchairs and a further two for use for independently mobile patients or those using a wheelchairs. A further ambulance was kept in Penzance to reduce the mileage when covering West Cornwall.
Between October 2016 and May 2017 E-Zec had completed 24,505 patient journeys in Cornwall. The total number of journeys each month in this time period ranged from 2757 to 3537.
The service employed 110 members of staff which included ambulance care assistants, management and administration staff. There were no paramedics employed in this registered location. Any community first responders working at E-Zec were not trained or utilised by the organisation.
A patient transport service was provided to adults and children, although children were required to be accompanied by an escort.
We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 18 and 19 May 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.
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 issues that the service provider needs to improve:
Staff did not always complete incident reporting tools to ensure the provider was aware of all incidents and near misses that occurred. Staff were concerned that when they did report incidents they did not always receive feedback about the issues they had raised.
Not all areas of the ambulance stations and vehicles were clean and hygienic. This did not promote the control of infection and increased the risks from cross infection. The provider needs to get better at monitoring and auditing the effectiveness of the cleaning procedures carried out by the staff.
The system of exchanging or disposal of soiled linen was not safe. Staff did not always know if there was an infection control risk when returning linen to the hospitals for laundering. There was not a formalised service line agreement in place for staff to return linen to the hospitals to exchange for clean supplies.
Storage of equipment and consumables was poor at Redruth station with clean consumables stored on the floor in the ambulance station and together with substances that are hazardous to health such as chemicals and engine oil. This could pose a risk of cross contamination.
Improvement is needed in the timeliness of repairing faults to vehicles. Staff reported that repairs such as to side door steps and seat handles were not mended promptly causing a danger to themselves and patients. We observed a number of issues with vehicles that needed addressing.
Staff reported a lack of training provision since they had transferred to E-Zec from the previous provider. We were unable to evidence that all staff were trained and competent in their roles. For example, we could not evidence that all staff were trained to use all of the equipment on the ambulances or that they had completed infection control training.
Staff were not trained to meet the needs of patients with specialised care needs such as mental health issues, patients living with dementia or a learning disability. We were concerned that at times patients were left unattended or with fellow passengers on ambulances, particularly when they had specialised needs that put themselves or others at risk.
Five members of staff we spoke with, were unable to demonstrate they were familiar with or had a good understanding of the organisation’s policies and procedures, which were stored on the organisation’s intranet, to support them in their role. The provider could not demonstrate that all staff had read and understand the policies and procedures. The policies and procedures provided information on organisational procedures and operational and clinical guidelines.
It was not clear from the documentation available and provided for us that all staff had received regular supervision and appraisal to highlight any issues or training needs.
Security was not always given high priority with ambulances left unlocked and keys unsecured in one of the stations.
Oxygen cylinders were not stored within a locked storage area, which meant they were accessible to anyone who entered the premises. They were also stored at Redruth in a way that posed a fire risk.
There was not a system in place for staff to record any care intervention provided to patients when being transported. This meant relevant information risked not being communicated to the receiving department or care home.
We received concerns prior to the inspection of delayed journeys which had had a negative outcome on the patients care, treatment and welfare. We evidenced during the inspection that there had been a number of journeys that had been delayed.
Staff were not familiar with, or could not discuss, the strategy and vision of the organisation. Staff did not feel supported by the management of the organisation and did not feel they worked as a cohesive team. There were not regular staff meetings for them to voice their opinions or feel listened to.
Senior staff were not familiar with the risk register, where to access it or how risks were processed to be identified on the risk register.
However, we also found the following areas of good practice:
The provider produced a monthly quality report that was presented to the board meeting to identify all incidents, complaints and reported safeguarding concerns.
Records showed that vehicles were serviced regularly and up to date with legal checks such as the MOT.
Staff followed the appropriate local procedures to report any safeguarding concerns they identified when collecting and transporting patients to appointments and home from hospital.
The provider had undertaken a planned recruitment drive to increase the numbers of staff following taking over the service in Cornwall.
The provider met regularly with colleagues from the local commissioning group and the acute NHS trust to enable face to face discussions to take place regarding developing or improving the service delivered.
The service employed a liaison officer to work at the local acute NHS hospital to improve communication between wards, departments and E-Zec.
Complaints received by the organisation were responded to in a timely way.
A new system of staff meetings was being implemented following our inspection and a staff representative had been elected from each station to attend a meeting with the managers of the service. The purpose of this was to enable the staff to give their views on the service and the working arrangements at E-Zec.
The views of patients were sought through telephone calls requesting a response to satisfaction survey questions. Most patients surveyed were satisfied with the service they had been provided with. Staff were kind, respectful and empathetic when talking about their patients.
Professor Sir Mike Richards
Chief Inspector of Hospitals