The Care Quality Commission
  • Ambulance service

Archived: E-zec Medical Transport - Bristol

Overall: Requires improvement read more about inspection ratings

Avonside Industrial Park, 12 Feeder Road, Bristol, Avon, BS2 0UQ (01737) 822782

Provided and run by:
E-Zec Medical Transport Services - Trading As EMED Group Limited

All Inspections

5 July 2023

During an inspection looking at part of the service

We carried out this focused follow-up inspection on 5 July 2023.

We did not inspect all key questions as defined within our methodology but focused on those areas highlighted in the warning notice as requiring significant improvement following our comprehensive inspection on 24 January 2023.

We have not changed the rating of the service as we focused on the areas we told the service required significant improvement previously identified in the Section 29 warning notice.

The inspection was announced with one working days’ notice to ensure the registered manager would be available.

During our focused inspection we reviewed all information to ensure the required actions against the Section 29 warning notice served against the provider in February 2023 had been completed.

We found that all areas of the warning notice had been met as follows:

  • Patients had experienced a significant reduction in transport delays, particularly for dialysis.
  • The management team demonstrated improved awareness of patient delays by improving journey scheduling methods.
  • Patients were able to access transport when they needed it.

Although this was not part of the warning notice, we found the following improvements:

  • Clinical waste bins were locked and secured correctly.
  • Storage of chemicals were safely secured in a locked cupboard.
  • Staff facilities has been resolved following concerns identified.

24 January 2023

During a routine inspection

We carried out a comprehensive inspection of E-Zec Medical Transport Services - Bristol, as part of our inspection programme. We inspected all our key questions: safe, effective, caring, responsive and well led.

They were last inspected in March 2018 but were not rated as the Care Quality Commission did not have the legal powers at that time to rate independent ambulance services. They were issued with 2 requirement notices, 1 for Regulation 17 (Good governance) and the other for Regulation 19 (Fit and proper persons employed). We found at this inspection the service had made improvements to meet those requirement notices.

Before the inspection, we reviewed information we had about the provider, including information we had received and intelligence available.

Following the inspection, the provider was served a warning notice under Section 29 of the Health and Social Care Act 2008, requiring them to make significant improvements to the responsiveness of the service and to reduce long waiting times for some patients to be collected and returned following outpatients/dialysis appointments.

We rated this location as ​requires improvement​ because:

  • Not all maintenance issues had been identified and storage of some chemicals was not safe.
  • Some patients were subject to long waits for transport which was not acceptable and placed them at potential risk of harm. Some patients had missed vital hospital appointments and one patient had their treatment time reduced.
  • Not all patients could access their transport when they needed it which impacted on their access to care and treatment at other health care providers.
  • Not all staff knew how to manage complaints in line with the providers policy.
  • There had been improvements with the recruitment practices of new staff, but systems and processes to check staff had a full employment history with gaps explored was not effective.
  • There were no staff meetings at this location for managers to impart information to the whole team.

However:

  • The service had enough staff with the skills and experience to care for patients and keep them safe. Staff had training in key skills and understood how to protect patients from abuse. They were above the providers target for completion of the yearly mandatory training day. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
  • Managers monitored the service provision and staff worked well together for the benefit of patients.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs. They provided emotional support to patients, families and carers.
  • The service took account of patients’ individual needs and made it easy for people to give feedback.
  • Leaders ran services well using reliable information systems. Staff understood the service’s vision and values, and how to apply them in their work. Most staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and staff were committed to improving services. They had plans to reduce their carbon footprint to protect the environment.
  • The provider automatically renewed all Disclosure and Barring Service checks every 3 years for staff to reduce the risks to patients.

19 to 21 March 2018

During a routine inspection

E-zec Medical Transport Bristol is operated by E-zec Medical Transport Services Ltd. The service is contracted to provide non-emergency patient transport services. They are commissioned by the clinical commissioning group to serve the communities of Bristol, North Somerset and South Gloucestershire. E-zec Medical Transport Bristol had been awarded the patient transport contract in April 2017, therefore at the time of inspection had been operating in Bristol for under one year.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 20 and 21 March 2018, and held a drop in session with staff on the 19 March 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.

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

  • There was a basic governance structure. This was not effectively used to monitor service performance and identify areas for improvement.

  • There was a lack of evidence of the responsibility, overview and scrutiny by the board.

  • There was no local management meeting.

  • There was no assurance third party providers, who were providers completing patient transport work on behalf of E-zec, had appropriate recruitment checks or training. There had been a reliance on these third party providers, to include other independent ambulance providers and taxi firms, to help deliver the patient transport contract.

  • There was no evidence staff references had been received and reviewed when recruiting new staff.

  • There was not a strong or positive culture. There was a disconnect between management and staff, and between staff groups. The mechanisms to engage staff were ineffective.

  • Staff were not suitably trained and assessed to carry out driving duties safely. Staff told us driving assessments were completed at the point of interview, which involved a short drive, they did not feel this prepared them for the role.

  • There was not a culture of learning from incidents. Staff told us they did not receive feedback or the lessons learnt from the incidents they reported. This was discouraging staff from reporting incidents, and therefore there was a risk staff would not report incidents.

  • The provider was unable to tell us their compliance against mandatory training, and did not hold a local record to report on performance. However, the managers were informed by the human resources department when staff training was due to expire.

  • Staffing recruitment and retention had been a challenge since the start of the patient transport contract. Although the provider was nearly at full staffing, the staff were mostly new and inexperienced.

  • The provider did not consistently provide a good service. They measured their effectiveness of delivering a timely patient transport service using measures set by the commissioner called key performance indicators. These key performance indicators were not always being achieved.

  • Staff were not aware of the available translation and interpretation services which could be used to meet peoples individual needs. Staff told us escorts were used to translate for the patient, this is not best practice.

However, we found the following areas of good practice:

  • Staff were observed to provide good care to patients, which was kind and respectful.

  • Safeguarding was well understood by staff and they were confident about how they would respond if there was a safeguarding concern.

  • The provider maintained good working relationships with stakeholders to ensure coordinated working.

  • Patient transfer liaison officers were a valuable role to link between E-zec and hospitals to support the flow of patients.

  • Information was clearly recorded so staff could access special notes and patient needs.

  • Standards of cleanliness and hygiene were well maintained and there were systems to prevent and protect people from infection.

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 two requirement notices that affected the patient transport service. Details are at the end of the report.

Amanda Stanford

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