Grimsby Office

Updated 27 August 2019

Thames Ambulance Service Grimsby Office and Hull satellite location is operated by Thames Ambulance Service Limited. The service opened in 2016. It is an independent non-emergency patient transport service (PTS) in Grimsby, Lincolnshire with satellite location in Hull and Louth. The service primarily serves the communities of North Lincolnshire and Humberside.

The service undertook PTS contracts awarded by local clinical commissioning groups

At the time of the inspection, a new manager had recently been appointed and was registered with the CQC in January 2019.

We previously inspected this service as part of Thames Ambulance Service Limited. Following our inspection of that service in October 2018, we issued the provider with a warning notice over their non-compliance of Regulations 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also imposed four further conditions on their registration, which also apply to Grimsby Office and Hull satellite location.

Updated 27 August 2019

Thames Ambulance Service Grimsby Office and Hull Office satellite location is operated by Thames Ambulance Service Limited. The service provides a non-emergency patient transport service from several sites throughout England. Thames ambulance Service Ltd had 17 ambulance stations throughout the UK from which patients transport services were delivered. This inspection report details our findings at the Grimsby Office.

We inspected the service using our comprehensive inspection methodology. We carried out the short-announced part of the inspection on 1 May 2019.

We previously carried out an announced comprehensive inspection as part of Thames Ambulance Service Limited on 23 October 2018. During our inspection, there were several safety concerns identified, primarily regarding the safe transport of patients with mental health needs, transport of patients with bariatric needs and transport of children aged under 12 years. Because of this, we issued the provider with a warning notice over their non-compliance of Regulations 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also imposed four further conditions on their registration.

Prior to this, we carried out focussed inspection on the 15 May 2018 to follow up a warning notice we had issued to the provider in October 2017 over a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 (MCA).

Our rating of this service improved. We rated it as Requires improvement overall.

• The provider had systems and process in place for staff to report incidents. However, incident investigation records were not always fully detailed, and evidence of wider learning was not fully embedded.

• We were not assured that the service had enough staff with to provide the right care.

• The service did not always ensure that policies reflected national guidance.

• The provider monitored response time, however, commissioner’s key performance indicators were not met.

• Staff had not participated in the appraisal processes to discuss their performance and learning needs.

• Frontline staff worked well together to support the needs of patients, however there was sometimes conflict between control room staff and frontline staff.

• The service did not always plan and provide services in a way that met the needs of local people.

• The service did not always take into account patients’ individual needs.

• Waiting times were not always in line with good practice.

• The service did not always systematically improve service quality and safeguarded high standards of care.

• The service had made improvements to working practices with further improvements planned. However, performance remained below commissioner targets.

However, we also found:

• There were systems and processes in place to monitor and oversee staff compliance with mandatory training completion.

• Staff had received training on how to recognise and report abuse.

• The service controlled infection risk well

• The service had suitable premises and equipment for the range of services it provided.

• Staff completed risk assessments for each patient.

• Staff kept records of patients’ care and treatment.

• The service followed best practice when storing oxygen.

• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• Staff provided emotional support to patients to minimise their distress.

• Staff involved patients and those close to them in decisions about their care and treatment.

• Leadership and management of the service had been through a number of changes. The senior management team had been restructured and station managers had been introduced, which had increased staff confidence in the leadership of the service.

• The service had a vision of what it wanted to achieve and plans to turn this in to action.

• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

• The service had systems in place to identify local risks and plans to eliminate or reduce them.

• The service collected and managed information, using secure electronic systems with security safeguards.

• The service had improved patient and staff engagement process.

We rated the service as Requires improvement overall.

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, 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.

Nigel Acheson

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

Updated 27 August 2019

We rated the service as Requires improvement overall, we rated effective inadequate; safe, responsive and well-led as requires improvement and caring good. This is an improvement from our last inspection when we rated the service Inadequate.

The service had made improvements since the last inspection in October 2018. The cleanliness of the Grimsby Office had improved with measures in place to maintain these standards.

Incident investigation records were not always fully detailed, and evidence of wider learning was not fully embedded.

The service did not always systematically improve service quality and safeguarded high standards of care. The provider monitored response time, however, commissioner’s key performance indicators were not met. The service did not always plan and provide services in a way that met the needs of local people and did not always take into account patients’ individual needs. Waiting times were not always in line with good practice. There was sometimes conflict between control room staff and frontline staff. We were not assured that the service had enough staff with to provide the right care.

The service had conveyed bariatric and child patients while registration conditions were in place for these patient groups.

The service did not always ensure that policies reflected national guidance.

Staff had not participated in the appraisal processes to discuss their performance and learning needs. Staff had not always completed mandatory training in line with the target set by the provider.

However, we also found:

The service had suitable premises and equipment for the range of services it provided and controlled infection risk well. The service followed best practice when storing oxygen.

Staff kept records of patients’ care and treatment and completed risk assessments for each patient.

Staff had received training on how to recognise and report abuse. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

Staff cared for patients with compassion and provided emotional support to patients to minimise their distress. Feedback from patients confirmed that staff treated them well and with kindness. Staff involved patients care.

Leadership and management of the service had been through a number of changes. The senior management team had been restructured and station managers had been introduced, which had increased staff confidence in the leadership of the service. The service had a vision of what it wanted to achieve and plans to turn this in to action.

Managers across the service promoted a positive culture. Frontline staff worked well together to support the needs of patients. The service had improved patient and staff engagement process.

The provider collected and managed information, using secure electronic systems with security safeguards. The service had systems in place to identify local risks and plans to eliminate or reduce them.