Background to this inspection
Updated
2 July 2018
ShowMed is operated by The Risk Practice Ltd. The service opened in 1999. It is an independent ambulance service located in Bury, Greater Manchester with further bases in the Midlands and the South of England. The service provides doctors, nurses, paramedics, emergency care technicians, emergency care assistants and first aiders to organised sporting and public events nationwide.
The service had 10 permanent staff, with defined roles and responsibilities and 212 staff working for them on a casual basis. Staff referred to throughout the report included those employed on a permanent and on a casual basis. Staff were deployed to events based on an electronic booking system overseen by a dedicated workforce planning co-ordinator. Permanent members of staff included the registered manager who was the director of clinical care and training, a workforce director and a managing director.
The service supported a range of venues and events varying in size and location, for example, sporting arenas, race courses, cycling centres, concerts, filming locations, and historic buildings amongst others. The service had a member of staff responsible for major events planning, where large crowds were expected to attend. The service provided medical management, safety, event first aid and a patient transport service to its clients. We regulate the part of this independent ambulance service related to the urgent transfer of patients and their care and treatment during their transfer.
Between February 2017 and February 2018 the service transferred six patients from an event site via ambulance to local urgent and emergency centres.
At the time of our inspection, we inspected one high dependency level ambulance. The service had another ambulance of the same specification based in Coventry, to enable them to provide cover to the Central and Southern regions. Ambulances were relocated between the sites depending on the location and scope of the events being covered.
The service is registered to provide the following regulated activities:
The Bury location for this service was registered by CQC on 12 June 2017, the service had previously operated from a number of different locations. New services are assessed to check they are likely to be safe, effective, caring, responsive and well-led. This is the first inspection under this registration.
The service has had the current registered manager in post since 2017.
Updated
2 July 2018
ShowMed is operated by The Risk Practice Ltd. ShowMed supplies doctors, nurses, paramedics, emergency medical technicians, emergency care assistants and first aiders to organised sporting and public events.
The main service provided by this service which falls under the scope of CQC regulation was patient transport.
We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 27 and 28 of February 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 areas of good practice:
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There was a robust electronic staff booking system, overseen by a workforce planning co-ordinator. This enabled the service to utilise the right levels of skilled staff and resources to meet the needs of the service safely.
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The service had comprehensive policies and processes to identify, assess and monitor risks and to improve quality and safety. Staff were knowledgeable about how to record incidents and had ready access to incident reporting forms. We saw evidence and examples of incident reporting, reviews and learning from incidents to drive improvements.
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The service had developed an effective recruitment system. This ensured the service had sufficient numbers of suitably skilled staff and accurately monitored whether all staff had the qualifications and skills needed to provide safe and high quality care. The service carried out skills assessments, qualifications checks and ensured the suitability of staff by conducting Disclosure and Barring Service (DBS) background checks.
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The service was excellent at finding ways to engage with their staff and in providing information to a workforce that was casual by nature. They had sought numerous ways to do this to ensure that information was readily accessible at all times, including the use of a duty emergency point of contact.
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We saw evidence that showed the service were actively seeking to improve their services, such as considering the introduction of BS 76000, a management standard that provides a framework for organisations to value people.
However, we also found the following issues that the service provider needs to improve:
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Staff completed training in safeguarding children and adults; however this was not always to a sufficiently high and skilled level for their roles.
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The service performed and documented regular monthly deep cleaning of their ambulances. However, they did not have a robust system to identify that vehicles had been cleaned prior to transportation, in between conveyances, or as and when required. Since routine cleaning was not recorded there was no means to identify if vehicles had been cleaned and were ready for use.
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There was no formalised process for checking the contents of paramedic bags and for the service ensuring that the correct items, such as blood glucose meters were present, correct and in date. The paramedic bags were also not identifiable as being ready for use or requiring restocking.
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The systems for managing equipment and medical gases were not robust. We found that oxygen cylinders were not stored appropriately and there was no means to identify and segregate full, part used and empty cylinders. The service used a vehicle equipment checklist, which did not include checks for expiry date or function. This meant that the service could not ensure itself that medical gases and other equipment on the ambulance were in date and functioning before the point of use.
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The completion of the patient report forms were not always to a sufficiently high standard particularly with the lack of documenting and witnessing consent.
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The service was registered to provide urgent transport services to the whole population; however we did not see specific policies, equipment, skills assessments or competencies relating to the needs of children and young people.
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The service did not currently check that relevant staff had been vaccinated for infectious diseases such as Hepatitis B and that they had achieved immune status, which may be appropriate for their role.
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 one requirement notice that affected patient transport services. Details are at the end of the report.
Ellen Armistead
Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals.
Patient transport services
Updated
2 July 2018
The main service provided was urgent patient transport. Therefore we have reported findings in the patient transport section.
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.
The leaders of the service had a clear vision and strategy. Management appeared open and inclusive. This was evident in the morale of the staff and in their comments, which were overwhelmingly positive. They spoke with enthusiasm and passion about the service and its culture. Staff also spoke of a commitment to providing the best possible care and treatment to patients.
A collaborative multi agency approach was evident in the pre-planning for urgent patient transport services during events. Pre-planning incorporated risk assessments and addressed relevant patient safety issues.
The service had developed numerous ways to engage with their staff and provide information to a workforce that was casual by nature. They had also invested in new team management software.
We found the online staff booking system to be effective. This enabled the service to utilise the right levels of skilled staff and resources to meet the needs of the urgent patient transfer service safely.
The service had established policies and processes to identify, assess and monitor risks and to improve quality and safety. Staff knew how to record incidents and had ready access to incident reporting forms. We saw evidence and examples of incident reporting, reviews.
We found that the service had an effective recruitment system. Skills assessments, qualification and Disclosure and Barring Service (DBS) checks were performed. This ensured that they had sufficient numbers of suitably skilled staff and accurately monitored whether all staff had the qualifications and skills needed to provide safe and high quality care.
The service worked hard to establish a good relationship with its existing and potential clients. We spoke to one client who was very satisfied with the service and described how they always met their expectations and requirements.
We found evidence of service innovation, improvement and sustainability. The service was developing a clinical competency framework for staff to ensure that they were working within the boundaries of their role. A new alternative to controlled drugs for pain relief was introduced into the medicines formulary. The service had in place a business continuity policy.
However, we found the following issues that the service provider needs to improve:
The service did not have effective systems in place to ensure that medical gases were available in the necessary quantities and at all times. We found that oxygen cylinders had not been stored appropriately and there was no system in place to identify and segregate full, part used and empty cylinders.
The service could not ensure itself that medical gases and other equipment on the ambulance were in date and functioning before the point of use.
There was no formal process for checking that the contents of paramedic bags were correct and in date. The paramedic bags were also not identifiable as being ready for use or requiring restocking.
The service did not have a robust system to identify that ambulance vehicles had been cleaned prior to transportation, in between conveyances, or as and when required. Since routine cleaning was not recorded there was no means to identify if vehicles had been cleaned and were ready for use.
The service had performed audits which highlighted issues with completion of the patient report forms. Information was not always recorded to a sufficiently high standard, particularly surrounding the lack of documenting and witnessing consent.
Staff had completed mandatory training in safeguarding children and adults; however this was not always to a sufficiently high and skilled level for their roles.
The service was registered to provide urgent patient transport services from events to the whole population; however we did not see specific policies, skills assessments, competencies or equipment relating to the needs of children and young people. We were not assured that staff had the right competencies and training to provide urgent transport services to this population group.
The service did not currently check that relevant staff had been vaccinated for infectious diseases such as Hepatitis B and that they had achieved immune status.