Yorkshire Ambulance Service NHS Trust

Updated 17 August 2022

Our rating of the trust stayed the same. We rated it as good because:

The emergency operations centre was rated as good; this rating was the same as the previous inspections.

Patient transport services were rated as good. This was an improvement from the previous inspection.

Well led at trust level was rated as good. This was the first time the trust had received a well led inspection.

Updated 14 October 2019

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to meet patient demand and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety. The service controlled infection risks. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care and had access to good information. The service was available seven days a week.
• 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 and took account of patients’ individual needs. People could access the service when they needed it and did not have to wait too long for emergency triage.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. 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 received positive feedback from patients and members of the public which showed they were compassionate and caring to patients.

However:

• The service did not always have enough mental health nurses and lessons learned from incidents were not routinely shared outside the department.
• Training in mental health crisis was limited and appraisal rates did not meet the trust target.
• Learning from complaints and concerns was not always shared effectively in the EOC.
• There was limited risk awareness at middle manager level. The service was taking action to mitigate this.

Updated 14 October 2019

Our rating of this service improved. We rated it as good because:

• People’s needs were central to the delivery of the service and there was a proactive approach to meeting patient’s needs. Technology was used innovatively to ensure patients received a timely response from the service.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Patients we spoke with were consistently positive in their comments about the service.
• People could access the service when they needed it, in line with national standards, and received the right care in a timely way. Staff supported patients to make informed decisions about their care and treatment. Patient flow coordinators based in hospitals supported bed management and discharge arrangements so that response times were met.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Escalation processes for deteriorating or seriously ill patients were in place and patient safety incidents were managed well.
• The service engaged with patients, staff, and equality groups, the public and local organisations to plan and manage services. It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned.
• The design, maintenance and use of facilities, premises, vehicles and equipment kept people safe. Ambulance vehicles fitted with specialised equipment were available to support the needs of bariatric and other patients with complex needs.
• The service had sufficient staff and made sure they were competent for their roles. Managers appraised staff work performance and held supervision meetings with staff to support their development.
• Infection risk was controlled well and premises and equipment were visibly clean. The service used systems and processes to safely prescribe, administer record and store medicines.
• A positive culture was evident in patient transport services. The service had an open culture where patients, their families and staff could raise concerns and promoted equality and diversity.
• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders.
• Clear governance procedures were in place in patient transport services. Managers and staff 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.
• Records were clear, up-to-date, stored securely and easily available to all staff providing care. 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.
• Patient transport services encouraged innovation and participation in research. Staff were committed to continually learning and improving services. Managers and senior staff understood and applied the concept of quality improvement.

However:

• Some staff did not have the confidence to report and escalate safeguarding concerns despite having been trained to do so.
• Some risk to premises and vehicle security was encountered at more than one ambulance station; we discussed this with the service at the time and immediate action was taken to meet our concerns.
• Some staff required the support of their manager in completing mandatory training, including e-learning. Managers were taking action regarding training support.
• The service’s achievement for patients picked up at short notice remained below the trusts own planned achievement level. We acknowledged the trust was working to manage the challenges for short notice requests.

Updated 17 August 2022

A summary of CQC findings on urgent and emergency care services in West Yorkshire.

Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, CQC is undertaking a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care. We have summarised our findings for West Yorkshire below:

West Yorkshire.

Provision of urgent and emergency care in West Yorkshire was supported by multiple provider services, stakeholders, commissioners and local authorities.

We spoke with staff in services across primary care, integrated urgent care, community, acute, mental health, ambulance services and adult social care. Staff continued to work under sustained pressure across health and social care and system leaders were working together to support their workforce and to identify opportunities to improve. System partners worked together to find new ways of working, linking with community services to meet the needs of their communities; however, people continued to experience delays in accessing care and treatment.

During our inspections, some staff and patients reported difficulties with providing and accessing telephone appointments in GP practices. Some of these issues were caused by telephony systems which were being resolved locally. We found inconsistencies with triage processes in primary care which could result in people being inappropriately signposted to urgent and emergency care services. However, a number of staff working in social care services reported good engagement with local GPs.

We visited some community services in West Yorkshire and found these were generally well run. Service leaders were working collaboratively to identify opportunities to improve patient pathways across urgent and emergency care. These improvements focused on meeting the needs of local communities and alleviating pressure on other services. There were strong partnerships with social care and community teams, so patients had the right support in place on discharge.

However, we inspected one intermediate care service and found it could only take referrals from an acute trust, which meant there were no step-up facilities for patients in the community. The service struggled for ward space to deliver therapeutic activities and there were no communal spaces for patients to meet together or engage in group therapy. Plans were in place to provide additional facilities and to reconfigure the existing layout to provide communal spaces.

The NHS111 service was experiencing significant staffing challenges and were in the process of recruiting a high number of new staff. Staff working in this service had experienced an increase in demand, particularly from people trying to access dental treatment although a system was in place to manage the need for dental advice and assessment. Due to demand and capacity issues, performance was poor in some key areas, such as providing a call back to patients from a clinician.

The ambulance service had an improvement programme in place focused on performance and staffing. Whilst we saw some improvement in ambulance response times and handover delays, performance remained below target. We identified impact on other services due to the availability of 999 responses; for example, a maternity service had to close temporarily to keep women safe, due to system escalation and because ambulance responses couldn’t be guaranteed in an emergency. Staff working in social care services also experienced lengthy delays in ambulance response times which further impacted on their ability to provide care to their residents.

We inspected some mental health services in Wakefield which were delivering person-centred care and responded to urgent needs in a timely way. Staff worked in multi-disciplinary teams and collaborated with system partners.

People’s experiences of Emergency Departments were varied depending on which service they accessed. Some Emergency Departments had long delays whilst others performed relatively well. In services struggling to meet demand, patient flow was a key factor. Poor patient flow was primarily caused by delays in discharge with a high number of people fit for discharge unable to access community or social care services.

Staff working in some social care services reported significant challenges in relation to unsafe discharge processes, this included a lack of information to support their transfer of care and we were told of examples when this resulted in people having to return to hospital. Local stakeholders had a good understanding of this problem and were looking to improve pathways and discharge planning.

Staffing and capacity issues in both care homes and domiciliary social care services have at times impacted on timely and safe discharge from hospital.

We found services were under continued pressure and people experienced difficulties accessing urgent and emergency care services in West Yorkshire. System and service leaders across West Yorkshire were working together to seek opportunities for improvement by providing services and pathways to meet people’s needs in the community; however, progress was needed to demonstrate significant improvement in people’s experience of accessing urgent and emergency care.

Due to the nature of the inspection we did not rate this service.

• The service did not consistently have enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

• The service monitored, but did not always meet, agreed response times so that they could facilitate good outcomes for patients.

• People could not always access the service when they needed it which was not always in line with national standards.

• The service generally controlled infection risk well. Staff used equipment and control measures to protect themselves and others from infection. They kept equipment and the premises visibly clean. The design, maintenance and use of facilities, premises and equipment kept people safe.

• Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.

• 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 treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

• 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 patients and staff. They supported staff to develop their skills and take on more senior roles. Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.