Hatzola Ambulance Service Ltd

We inspected Hatzola Ambulance Service Ltd using our focused inspection methodology after obtaining information which gave us some concerns about the safe use of medicines, standard of policies and governance processes within the service.

We carried out an unannounced inspection (the provider did not know that we were coming) on 31 March 2021, with further interviews and evidence requests continuing until 21 April 2021. To get to the heart of patients’ experiences of care and treatment, we normally ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? During this focused inspection we focused on the domains of safe, effective and well led.

As this was a focused inspection we did not rate the service.

We found:

• The pathways within the provider’s ‘Call and Dispatch Policy’ did not clearly prioritise the identification of people at highest risk to life, or the referral to NHS emergency services to ensure the appropriate level of trained response was sought, other than to ask the caller to make the NHS emergency services call. This may put service users at risk of harm where the caller does not follow the advice to call 999, thus causing a delay in the attendance of an NHS suitably qualified emergency care practitioner. Hatzola Ambulance Service have since advised, however, that in the case of category one patients their call handlers will also contact local emergency services to request their attendance. Recommendations have been made that their policy is amended to reflect these actions.
• The Call and Dispatch Policy did not provide enough detail to define a category one call priority to ensure that safe care and treatment is offered to the service user. However, call response times by the service were found to be consistently rapid, which reduced the risk to patients.
• The Call and Dispatch Policy did not clearly identify the calls that would be categorised as Cat One (purple) calls, which are referenced in the procedure, ie. those where a service user’s condition may be life threatening. Although, it did list those calls that would be considered as priority calls (red).
• Whilst the service had enough first response staff with the right qualifications, skills, training and experience, there could be a lack of certainty around the availability of suitable staff for calls; the on-call system relied purely on the members’ availability to respond at any given time.
• The service did not have sufficient numbers of senior medical officers (SMO) to provide a rota system which ensured access to clinical advice at all times. Following the inspection we were advised that the provider had since employed further clinical staff as SMOs, which allowed the introduction of a rota system.
• There was no risk assessment for temperature variations for medicines stored in vehicles to ensure they were stored within the safe storage temperature range required.
• Some Hatzola Ambulance Service response staff were included in treating patients with prescription only medicines (POMs) that would normally need either a patient specific direction or a patient group direction (PGD). Although this practice is not supported by current legislation, we were assured that an appropriate governance process was in place to assess and manage ongoing risk.
• The provider’s ‘Critical Care Pathway’, ‘Urgent Care and Discharge Pathway’ and ‘Paediatric Care Policy and Procedure’ did not always accurately reflect the protocols or pathways followed by its first response staff. These policies did not always give clear, definitive guidance to staff and instead provided them with a choice of options. Although the provider advised that staff would always request attendance of NHS emergency services in the first instance, the lack of clarity in the policy could potentially put patients at risk should staff follow the policy and delay a request being made for NHS emergency services ie. where staff call a SMO for advice initially. Hatzola Ambulance Service has agreed to make these changes to their policies.

However:

• The service provided mandatory training in key skills to all response staff and made sure everyone completed it.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
• The service used electronic systems and standardised processes to record and audit the use of medicines and to securely store medicines.
• The service used electronic systems to monitor and audit business and staff performance and used this to make improvements.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up to date, stored securely and easily available to all staff providing care.
• The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team, the wider service and partner organisations.
• The service provided care and treatment based on national guidance and evidence-based practice.
• The service monitored response times so that they could facilitate good outcomes for patients. They used the findings to make improvements.
• Managers appraised work performance and held supervision meetings with staff to provide support and development.
• All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.
• Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
• Staff always had access to up-to-date and accurate information relating to the patient’s care and treatment. All staff had access to an electronic records system that they could all update.
• People could access the service when they needed it and received care in a timely way.
• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for staff. They supported staff to develop their skills and take on more senior roles.
• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.
• Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
• Leaders and teams used systems to manage performance effectively. They identified and escalated most risks and issues and identified actions to reduce their impact.
• The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure.