Quad Medical Limited

Quad Medical Limited is an independent ambulance service that provides emergency and urgent care as well as first aid and medical welfare to people attending music venues and public events in and around London. The company is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides.

In England, the law makes licensed venue owners and event organisers responsible for ensuring safety. This means event medical cover comes under the supervision of the local authority and Health & Safety Executive (HSE) and not the Care Quality Commission (CQC).

In addition to event medical cover, Quad Medical Limited offers first aid and ambulance training to staff and other people working in the industry. Training activities such as these are not regulated by the CQC either and not included in this report.

The service is registered with the CQC to provide ‘transport services, triage and medical advice provided remotely’ along with ‘treatment of disease, disorder or injury’. These regulated activities relate to patients who are conveyed from a venue or event to hospital. Last year around 30 people were taken to hospital.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced visit on 28 November 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.

Services we rate

This was our first inspection of this organisation using our new methodology and since we began rating independent ambulance services.

We rated it as Good overall, although we were not able to rate caring as the service was not treating or transporting any patients when we inspected.

We found the following areas of good practice:

• As events were booked in advance, the service was able to ensure it had enough staff with the right qualifications, skills, training and experience to provide safe care and treatment. Staff had undertaken ‘in house’ induction and mandatory training in key areas to provide them with the knowledge and skills they needed to do their jobs safely.
• The provider had up-to-date incident and safeguarding reporting systems and we saw examples of learning from incidents. Staff were familiar with them and knew how to report an incident or concern.
• The service acted to meet patients’ individual needs. This included the innovative use of mobile welfare facilities, which supported the medical facilities in a way that helped reduce the number of patients needing transport to hospital.
• The service controlled the risk of infection well. All the ambulances we inspected were visibly clean and we saw evidence of deep-cleaning every twelve weeks or sooner if needed. Staff demonstrated an understanding of their daily duties in relation to cleanliness and infection prevention and control, in line with the provider’s infection prevention and control policy. Regular audits provided assurance around standards of cleanliness.
• Staff expressed pride in delivering compassionate care and treating patients with respect and dignity. Although we did not directly observe care interactions, we spoke with three patients by telephone and the feedback we reviewed demonstrated a high level of satisfaction.
• Staff completed clear and thorough records of patients’ care and treatment. The service stored records securely to protect confidentiality. Regular audits provided ongoing assurance around clinical practice and standards of record keeping.
• The service had clear processes and systems to keep vehicles and equipment safe. This included annual MOTs, regular servicing and maintenance.
• All staff spoke highly of the leadership and caring culture. The service took concerns seriously and acted to address them.
• Comprehensive plans and risk assessments were circulated to all staff in advance of an event.
• Management meetings included a review of all incidents on the incident reporting system.
• There was a named duty manager available at all times to provide support and guidance to staff.
• There was a secure staff social media group and a staff internet portal accessible to all staff, which provided easy access to company files, policies and other resources.

During the inspection we told the provider to improve the security of clinical waste and investigate the presence of out-of-date medicines in a clinical bin. We were shown evidence that our concerns were immediately addressed and later, we were provided with the results of the investigation into the source of the medicine and remedial action undertaken to eliminate further risk. We were satisfied with the provider’s response and on this basis, we have not issued a requirement notice.

Following this inspection, we told the provider that it should make other changes, even though a regulation had not been breached, to help the service improve. We told the provider it should review its risk register in regard to succession planning and business continuity and develop plans for risk mitigation. We acknowledge the service had already trained new duty managers and was making other changes to enhance supervision.

The service is currently seeking premises for vehicle storage and related facilities and we agree this is also a priority to be addressed.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South)