Archived: Arriva Transport Solutions - Canning Town

Updated 8 May 2018

Arriva Transport Solutions Ltd Canning Town is operated by Arriva Transport Solutions Ltd. The service opened in 2013. It is an independent ambulance service in London. The service primarily serves the communities of Hackney and East London.

The current registered manager had been absent from their post due to long term sick leave, and the service had notified CQC of this. At the time of the inspection, a new manager had recently applied to take over the registered manager’s post.

Updated 8 May 2018

Arriva Transport Solutions Ltd Canning Town is operated by Arriva Transport Solutions Ltd. The service provides a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 23 and 24 January2018.

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:

• The provider introduced a new system of incident reporting in July 2017 and we were told that the quality of recording had improved since in terms of timeliness and accuracy.

• There was an effective system in place for staff to report safeguarding incidents and staff were confident about how to raise a safeguarding alert.

• Each vehicle we inspected had a complete service history and 12 week safety check and was visibly clean and free from contamination.

• NHS commissioners told us the provider demonstrated a continued desire to improve the quality of the service provided.

• Staff had regular appraisals.

• Crews were made aware of special notes to alert them to patients with pre-existing conditions.

• There was a robust process of induction and newly inducted staff were assigned a more experienced member of staff as their mentor.

• We observed how staff were respectful and kind in their interactions with patients when waiting in the hospital transport waiting area.

• Patients told us “the driver could not be better if he tried”, and “all the staff are absolutely fantastic; they always apologise when there are delays.”

• Managers used a ‘demand tool’ to identify when demand for transport was heaviest and made adjustments to the staff rota accordingly to meet this fluctuating demand.

• There were systems in place to audit the quality of responses to complaints and monitor all actions and trends.

• Staff told us how a recent operational restructure significantly improved operational systems and lines of communication.

• There was a staff incentive scheme which rewarded staff for performance in different areas.

• There were arrangements in place for identifying, recording and managing risks, issues and mitigating actions.

• An NHS commissioner told us that the provider demonstrated commitment to address performance related issues.

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

• Risk assessments were not in place to support the decision that a director post was not eligible for a DBS check.

• The current fleet whilst well maintained showed signs of wear.

• One vehicle had the appearance of a high dependency vehicle rather than a patient transport vehicle only.

• The provider was not meeting their key performance indicators for inward journeys completed between 50 minutes before and 20 minutes after the appointment time and outward journeys collected within 60 minutes of planned or booked time.

• Many complaints related to late pick-up either from home or the hospital.

• Aborted journeys accounted for almost 10% of all journeys. These are journeys which were abandoned en route either by the patient or the commissioner.

• There was a low response rate to the provider’s survey of patient experiences.

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 the patient transport service. Details are at the end of the report.

Amanda Stanford

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

Updated 8 May 2018

Safe:

We do not currently have a legal duty to rate independent ambulance services.

We found the following areas of good practice:

• The provider introduced a new system of incident reporting in July 2017 and we were told that the quality of recording had improved since in terms of timeliness and accuracy.

• Commissioners of the service told us the provider was open and transparent in relation to incident reporting and we were assured from discussions we had that staff understood what constituted an incident and how to report it.

• We saw there was almost 100% compliance with mandatory training for all staff.

• We were assured that safeguarding adults and children training delivered was aligned with national training standards.

• There was an effective system in place for staff to report safeguarding incidents. Staff were confident about how to raise a safeguarding alert and told us they were actively encouraged by managers to report all safeguarding concerns.

• Standards of cleanliness and hygiene amongst staff were maintained through a series of daily, weekly and monthly checks. We saw an audit for June to December 2017 which showed there was 100% compliance with infection prevention and control knowledge and hand hygiene.

• Each vehicle we inspected was visibly clean and free from contamination. We saw there was a complete service history and 12 week safety check for each vehicle.

• Medical gases were stored securely in compliance with guidance from the British Compressed Gases Association.

• Crew could describe how to identify and respond to patients whose health deteriorated in their care and the process they followed.

• Managers told us staffing levels and skill mix were planned and reviewed so that people received safe care and treatment at all times; and staffing rotas were reviewed against demand every three months. Crew told us there were enough staff to cover the work.

• The staff sickness rate was 1.2%, which was lower than the company target of 3%.

However;

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

• We saw one vehicle which had the appearance of a high dependency vehicle and was fitted with blue lights and emergency sirens. This could be mistaken for an emergency and urgent care vehicle and the service provider was not registered to provide urgent and emergency care.

• Managers told us the current fleet, whilst well maintained, was in need of replacement.

Effective:

We do not currently have a legal duty to rate independent ambulance services.

We found the following areas of good practice:

• There were up to date policies accessible to crew at the base, in the vehicles and in a pocket sized guide issued to all staff.

• NHS commissioners told us the provider demonstrated a continued desire to improve the quality of the service provided.

• There was an appraisal system and we saw that staff were regularly appraised.

• There was a robust process of induction and newly inducted staff were partnered with a more experienced member of staff who acted as their mentor.

• Driver competence was continuously reviewed through a real time tracking system.

• The provider maintained regular contact with their commissioner in order to review the effectiveness of their service provision.

• Crews were made aware of special notes to alert them to patients with pre-existing conditions or safety risks and flags were placed on the patient record which automatically was added to the electronic job sheet.

• Staff told us the training they received in Mental Capacity Act 2005 (MCA) was good and gave them confidence when faced with a patient who refused to get into the vehicle.

However;

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

• Data for inward journeys completed between 50 minutes before and 20 minutes after the appointment time demonstrated an average compliance of 83%, which was slightly below the provider’s compliance target of 85%; compliance with outward journeys collected within 60 minutes of planned or booked time during the same time period averaged 67% where the compliance target was 85%.

Caring:

We do not currently have a legal duty to rate independent ambulance services.

We found the following areas of good practice:

• We observed how staff were respectful and kind in their interactions with patients when waiting in the hospital transport waiting area.

• Crew told us they ensured they did all they could to maintain peoples dignity and had blankets on board to cover patients up.

• Patients told us “the driver could not be better if he tried”, and “all the staff are absolutely fantastic; they always apologise when there are delays.”

• Crew told us whilst they were not always aware of the patient’s condition, they ensured they did their best to be sensitive to the patient’s needs.

Responsive:

We do not currently have a legal duty to rate independent ambulance services.

We found the following areas of good practice:

• The provider held one contract with a sole commissioner with whom they had frequent engagement and good communication.

• The provider conveyed patients with a range of needs, including those with learning disabilities and those living with dementia and ambulance crew told us their training gave them the knowledge and confidence to be able to support these patients.

• Managers used a ‘demand tool’ to identify when demand for transport was heaviest and made adjustments to the staff rota accordingly to meet this fluctuating demand.

• There were systems in place to audit the quality of responses to complaints and monitor all actions and trends. We saw that all complaints were dealt with in a timely manner and in accordance with the provider’s complaints policy.

However;

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

• Aborted journeys currently made up for 9.7% of all journeys in the previous six months. These are journeys which were abandoned en route either by the patient or the commissioner.

• The main theme of complaints related to late or non-arrival of the transport.

Well-led:

We do not currently have a legal duty to rate independent ambulance services.

We found the following areas of good practice:

• The operations structure was reviewed in June 2017. Staff told us this gave better consistency to working practices and line management and improved communication.

• Staff told us their local management team was very visible and approachable.

• The national and local leadership teams held an annual engagement event with staff in order to discuss annual performance and share ideas for the year ahead.

• The provider ran a staff incentive scheme which rewarded staff for performance in different areas.

• There was a monthly staff meeting at the base and a companywide newsletter issued each month to keep staff up to date on developments within the company.

• The values of the provider were widely displayed and included in the staff pocket guide.

• The provider initiated an improvement programme with the commissioner in March 2017 in order to understand reasons behind poor performance and identify areas for improvement.

• There were arrangements in place for identifying, recording and managing risks, issues and mitigating actions. These included governance meetings and processes, risk registers and reporting structures.

• Quality performance was reviewed on a regular basis and recommendations for improvement were made in those areas which were performing poorly.

• We were told by an NHS commissioner that the provider demonstrated commitment to address performance related issues.

However;

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

• A risk assessment was not undertaken for a director position to support the decision that the post was not eligible for a DBS check.

• There was a low response rate to the provider’s survey of patient experiences