Archived: Alliance-Pioneer Limited

Updated 25 August 2021

Alliance-Pioneer Limited were registered with the Care Quality Commission (CQC) in 2018. They are an independent ambulance service providing events medical cover nationally, with the office based in Plymouth, Devon. There is a registered manager in post, and they have held the position since the provider was registered with the CQC.

They provided medical cover for events, which included when required, the conveyancing of people to hospital. The provision of medical cover for events is not a CQC regulated activity but the conveyancing to hospital was regulated by CQC. Due to the COVID-19 pandemic, the provider’s main source of business (events) was not taking place and so the provider had diverted the main body of their work to emergency and urgent care, with a smaller amount of patient transportation.

At the time of the inspection, the provider worked as a subcontractor to an NHS trust to provide emergency transfers to hospitals, including responding to 999 calls. The provider also transported people with high dependency needs for the local clinical commissioning group.

The provider was registered to provide the following regulated activities:

• Transport services, triage and medical advice provided remotely

• Treatment of disease, disorder or injury

This was the first inspection for Alliance-Pioneer Limited since they registered with the CQC in 2018. At the time of the inspection, the provider had 14 ambulances and two four-wheel drive vehicles.

Updated 25 August 2021

We rated it as requires improvement because:

The provider had failed to maintain good governance systems. Audits of systems and processes to ensure they were effective were not consistently completed. Management oversight of how well the service was working was unstructured and so did not enable the providers to effectively review the quality of the service.

The provider’s management and analysis of data and records was not being consistently used to ensure the service was being well managed, for example by use of key performance indicators to identify any shortfalls in service.

Routine equipment checks completed by the provider failed to identify out of date surplus fire safety equipment on a small proportion of their ambulances. Additionally, staff equipment checks failed to identify one ambulance had out of date medical equipment or that packaging to keep equipment clean had been damaged. This ambulance was undergoing maintenance, so the risk to people using the service was minimised. However, these issues further indicated gaps in the providers’ governance processes.

Ongoing review of staff practical competency and performance through structured supervision and appraisal was not consistently taking place. This meant a review of staff practical skills and how they interaction with the public was not being consistently carried out to ensure the gave a good standard of care in line with Alliance-Pioneer Limited policies and procedures.

However:

Feedback from the public and partner agencies received by the provider was very positive about the care and compassion shown by staff.

The provider worked well with other agencies to meet the needs of people and the local health care systems.

Some governance systems were in place, especially for the work carried out for an NHS trust, to ensure standards were being met.

Staff understood their roles and responsibilities with regards to protecting people from abuse. Hazards to people’s health and safety were identified and action was taken to minimise the risk of harm.

All staff received an induction prior to beginning work for Alliance-Pioneer Limited, and mandatory training was given to ensure staff kept up-to-date with key skills. The management team monitored the training staff had undertaken and ensured this was kept up-to-date.

The maintenance of professional registrations, such as to be a paramedic, were also monitored by the provider to ensure ambulance crews’ professional competencies were up to date.

Staff felt supported by the management team and enjoyed their work.

The registered manager and the management team welcomed feedback and used it to make improvements to the service. We found the leadership team were responsive to our concerns and were honest with us when information did not exist or was found to be out of date. They showed a willingness to make improvement.

Updated 25 August 2021

Patient transport services was currently a small proportion of Alliance-Pioneer Limited activity, due to the closure of events as a result of the COVID-19 pandemic. The last routine patient transport had been carried out in April 2021. The main service was currently emergency and urgent care. Where arrangements were the same, we have reported findings in the emergency and urgent care section.

We rated this provider as requires improvement because it needed to improve in the domains of effective and well led, although the safe and responsive domains were good. We did not have enough evidence to rate caring.

Updated 25 August 2021

We rated this provider as requires improvement because it needed to improve in the domains of effective and well led, although the safe and responsive domains were good. We did not have enough evidence to rate caring.

• The provider had failed to maintain good governance systems. Audits of systems and processes to ensure they were effective were not consistently completed. Management oversight of how well the provider was providing a safe and effective level of care was unstructured.
• The provider’s management and analysis of data and records was not used effectively to ensure the service was being well managed, for example by use of key performance indicators.
• Routine equipment checks completed by the provider had failed to identify out of date equipment on ambulances, or that packaging to keep equipment clean had been damaged. An ambulance was found to be unlocked, with the keys in the ignition, in a place accessible to the public.
• Ongoing review of staff competency and performance through structured supervision and appraisal was not consistently taking place.

However:

• Staff understood their roles and responsibilities with regards to protecting people from abuse.
• Managers made sure that staffs mandatory training was up to date and the professional registration, such as being a paramedic, were current.
• Hazards to people’s health and safety were identified and action was taken to minimise the risk of harm.
• The provider worked well with other agencies to meet the needs of people and local health care systems.
• Staff felt supported by the management team and enjoyed their work.
• Feedback was welcomed by the registered manager and the management team. Where complaints had been made, an apology was given, and each issue had been investigated and responded to.
• Leadership where open and honest with us when we found areas for improvement. They demonstrated a willingness to make improvements as a result of feedback.