Archived: Invictus Medical Services Limited

Invictus Medical Services Limited is operated by Invictus Medical Services Limited. The service provides an emergency and urgent care ambulance service by conveying patients from event sites to the local acute NHS trust. Invictus Medical Services Limited is not commissioned by other organisations to deliver services. The service had one emergency ambulance used to carry out the regulatory activities.

We previously inspected the service on 27 November 2018, following which the service was placed in special measures and rated inadequate. We took action and served a decision notice to urgently suspend the registration of the provider until 11.59pm on 28 February 2019, because we believed that people were or may be exposed to the risk of harm if we did not take this action.

We carried out a focused follow up inspection of Invictus Medical Services Limited on 18 February 2019 to assess whether the provider had made sufficient changes to the service to lessen the risk to people using the service. We gave the service two weeks’ notice of our inspection to ensure everyone we needed to speak with was available.

We found the following areas of improved practice:

• Since the last inspection processes had been introduced to make sure all staff working for the service were of good character, had the qualifications, competence, skills and experience necessary for the work to be performed.

• Processes had also been introduced to ensure all staff working for the service had completed mandatory training.

• The registered persons had made the decision that staff without completed checks and training records could not work for the service.

• There were new processes to make sure all equipment required to deliver safe care and treatment was available, in working order and in date.

• Systems to supervise staff who worked for the service had been developed.

• Auditing processes to monitor the completeness of patient records had recently been introduced.

• Medicines held on the ambulance were in date.

• The ambulance vehicle and equipment were clean.

However, we found the following issues that the service needs to improve:

• Policies and procedures did not always provide clear guidance for staff

• Although action had been taken to address risks identified at the last inspection, there was no clear evidence of how the provider continually monitored and identified any risks to the service.

This was not a full inspection and the rating and actions of the last report remain active until a comprehensive inspection is completed.

Following this inspection, we told the provider of additional areas 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 one requirement notice that affected Invictus Medical Services Limited. Details are at the end of the report.

Nigel Acheson

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

Invictus Medical Services Limited is operated by Invictus Medical Services Limited. The service provides an emergency and urgent care ambulance service by conveying patients from event sites to the local acute NHS trust. Invictus Medical Services Limited was not commissioned by other organisations to deliver services. Work was acquired through tendering processes with event organisers. Although the provider told us they would provide patient transport services, if the opportunity arose, at the time of the inspection they were only delivering was emergency and urgent care services.

We inspected this service using our comprehensive inspection methodology. We gave the service two weeks’ notice of our inspection to ensure everyone we needed to speak with was available. We carried out the inspection on 27 November 2018. We had not carried out any inspections of the service previously.

The service had one emergency ambulance used to carry out the regulatory activities.

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 service understood and complied with the Mental Capacity Act 2005.

The service provided by this service was emergency and urgent care.

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

• The registered persons did not make sure all staff working for the service were of good character, had the qualifications, competence, skills and experience necessary for the work to be performed. They did not keep records about staff who worked for them.

• The registered persons did not make sure all equipment required to deliver safe care and treatment was available, in working order, in date and undamaged.

• There was no process to ensure all staff working for the service had completed appropriate mandatory training.

• The registered persons could not be assured about the quality of care and treatment staff gave to patients; there were no systems to supervise staff who worked for the service.

• The registered persons did not make sure that patients were not at risk from the risk of cross infection.

• The registered persons did not make sure patient records were fully completed.

• The registered persons did not make sure there was safe management of medicines that complied with national guidelines and legislation.

• There was no governance process to support systematic improvement of service quality and safeguarded high standards of care.

• There were no systems in place to identify risks, and to plan or to eliminate risks.

• The service did not have policies and procedures that were relevant to the service being delivered, or accurately detailed current legislation and national guidance.

• The registered persons did not consider national guidance to determine what level of children’s and young people’s safeguarding training that staff working for the service needed complete.

• The registered persons did not have processes in place to support staff to identify and respond to patient risks.

• The registered persons did not make sure that staff who worked for the service, where required, considered patients’ capacity to consent to care and treatment.

• The registered persons had not carried out the fit and proper persons process for all company directors.

• The directors and leaders of the service did not demonstrate a good understanding of their legal responsibilities towards the Health and Social Care Act.

• The registered persons did not ensure all staff who worked for the service had a good understanding about their responsibilities and obligation towards the Duty of Candour legislation.

However, we found the following areas of good practice:

• The service took account of national guidance and local legislation to ensure there were sufficient numbers of staff deployed for event work. This included ensuring there were sufficient staff to convey patients from the event to the local acute hospital.

• Staff had access to an online translation service.

• The service deployed on occasions staff, such as a learning disability nurses, to meet the needs of the patient groups.

Following this inspection, we told the service that it must take some actions to comply with the regulations.

The service was rated as inadequate overall. I am placing the service into special measures.

The service has also been subject to urgent enforcement action. Following this inspection we have used our enforcement powers to suspend the registration of  Invictus Medical Services Limited  to protect the safety and welfare of patients. The suspension will continue until 28 February 2019. Further details are shown in the table at the end of this report.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

Professor Sir Mike Richards

Chief Inspector of Hospitals