Inter-County Paramedic Ltd

Updated 13 October 2022

Inter-County Paramedic Riverside Park is operated by Inter-County Paramedic Ltd.

It is an independent ambulance service which is registered for two core services:

• Urgent and emergency care
• Patient transport services

At the time of our inspection the service had not undertaken any patient transport services for over 12 months therefore we did not inspect this core service.

We inspected the urgent and emergency care core service.

The service provides medical cover for events including sporting events. This includes medical care and treatment on the event site (this activity is not regulated and therefore is not included in this report) and conveyance to hospital for patients that require ongoing care and treatment. The care and treatment provided during conveyance to hospital is regulated and is the focus of this inspection. From August 2021 to August 2022, the service conveyed 105 patients to hospital.

We inspected this service using our comprehensive inspection methodology. We carried an unannounced inspection on 18 August 2022. We also conducted staff interviews remotely after the site inspection.

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?

The service was last inspected under a different address in 2017. The service was not rated at this previous inspection. No breaches of regulation were identified at the previous inspection however some areas for improvement were identified. These were:

• The service did not have a Home Office licence in place for the management of controlled drugs.
• The service did not have a system in place to regularly receive medicine and medical device alerts.
• There was no risk register in place to give an overview of all known risks.
• Staff were unaware whether there was a vision and strategy for the service.
• There were limited systems in place to measure quality and service improvement.
• There was an appraisal process in place, however at the time of our inspection, only 39% of staff had received one.
• Not all staff had completed mandatory training. At the time of our inspection, compliance with mandatory training was between 54% and 88%.

Updated 13 October 2022

We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service learned lessons from issues. Staff collected safety information and used it to improve the service.
• The service promoted using best practice clinical interventions to support better patient outcomes over and above what was required for the service. Staff provided good care and treatment and gave patients pain relief when they needed it. Managers made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged with staff and stakeholders to plan and manage services. The service demonstrated innovative practice supported by skilled clinicians.
• The service demonstrated aspects of outstanding practice when adopting advanced ways of managing trauma patients.

However:

• Not all patient records were fully secured at the time of our visit.
• Patient record forms reviewed were not always completed fully for the patient consent section or handover to NHS staff section.
• The service used third party providers and used CQC registration and ratings to select these. However, the service did not routinely document all due diligence checks.
• The service did not document certain governance processes such as clinical governance meetings; or ongoing checks of Health and Care Professionals Council (HCPC) registrations for paramedics.
• Two provider policies had not been reviewed for some time.

Updated 12 April 2017

Are services safe?

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

We found the following areas of good practice:

• We found staff were knowledgeable about the incident reporting system and received feedback when they submitted an incident.
• All vehicles were visibly clean and tidy and we saw evidence of regular deep cleans of the vehicles.
• All vehicles were serviced, an up to date MOT and the service maintained a database which highlighted when these were next due.
• There were comprehensive records to demonstrate medicine management which provided an auditable trail for where all medicines were located. Medicines were regularly checked and we saw evidence of these checks.
• All patient record forms (PRFs) were stored in accordance with policies and procedures, and were not kept on the vehicles.

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

• The service did not have a Home Office licence for the management of controlled drugs, although they had previously tried to seek advice on whether this was required or not.
• There was no process in place for the service to receive alerts from the central alerting system (CAS), to alert them to any medicine or medical device safety alerts.
• Information provided by the service at the time of the inspection showed mandatory training compliance was between 54% and 88%.

Are services effective?

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

We found the following areas of good practice:

• Staff followed evidence-based care and treatment and nationally recognised best practice guidance. All staff had access to the Joint Royal College Ambulance Liaison Committee (JRCALC) guidelines from 2016.
• All staff worked well with members of the multi-disciplinary team as well as working well with each other.
• All 14 staff files we reviewed contained the relevant documentation including Disclosure and Barring Service (DBS) checks, photo identification, references and health checks.
• Staff were aware of the requirements for consent to treatment and recorded consent on patient record forms. The service had forms available for patients who refused treatment.
• The service conducted regular six monthly reviews of all staff with a driving licence.

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

• Appraisal rates were low at the time of inspection with only 39% of staff having an up-to-date appraisal. However, all staff permanently employed by the service were included in those who had received an appraisal.
• The service did not benchmark their performance internally or against other providers of a similar service.
• Only one staff file contained evidence of immunisations and immunity against infections.

Are services caring?

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

• During our announced and unannounced inspections, we did not observe any patients being treated during regulated activity.

However:

• We spoke with staff and conducted a telephone interview with a patient about the care and treatment they received whilst they were conveyed to a local acute hospital.

Are services responsive?

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

We found the following areas of good practice:

• The service had access to translation and interpretation services through a recognised translation service.
• The service were able to meet the individual needs of patients with hearing deficiencies.
• The booking system was straightforward and co-ordinated by the manager. The main events for which they were contracted to were prioritised and any additional work would only be accepted if the service could meet the requirements.
• The service had not received any complaints from January 2016 to January 2017.

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

• There were no additional aids for communication for patients with sight deficiencies.
• The service had not provided training for meeting the needs of patients with learning disabilities or people living with dementia.

Are services well-led?

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

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

• The service did not have a clear vision or strategy which was shared with staff members.
• There was no risk register available which provided an over-sight of the risks to the service.
• There were no formalised meetings between staff for governance purposes where risk management and quality measurement was discussed.
• There was no formalised audit programme for the service, although there was evidence of clinical auditing happening.

However, we also found the following areas of good practice:

• All staff spoke highly of the manager of the service and the professional and well organised service they ran.
• All staff told us the manager was supportive and had an open door policy. All staff told us they would feel comfortable approaching the manager if they needed to.
• The service had implemented an inventory system to improve their stock rotation and minimise unnecessary waste.

Updated 13 October 2022