The Care Quality Commission
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East Midlands Ambulance Service NHS Trust

This is an organisation that runs the health and social care services we inspect

Overall: Good read more about inspection ratings

All Inspections

12 and 13 April 2022

During an inspection of Emergency operations centre (EOC)

East Midlands Ambulance Service NHS Trust provides emergency 999 and urgent services and serves a population of 4.8 million across the East Midlands (Derbyshire, Leicestershire and Rutland, Lincolnshire, Northamptonshire and Nottinghamshire), covering 6,425 square miles.

East Midlands Ambulance Service provides the following core services:

• Emergency & Urgent Care (E&UC)

• Patient Transport Services (PTS)

• Emergency Operations Centre (EOC)

• Resilience Services including the hazardous area response team (HART).

The service exists to respond to 999 calls and responds to over 730,000 emergency and urgent incidents per year, with over 2,000 emergency calls per day being received.

The front-line E&UC staff include paramedics, technicians, emergency care support workers (ECSWs) and specialist practitioners. They are based in up to 90 ambulance stations across the region. The trust also subcontracts some of its work to voluntary and private organisations.

The trust has two emergency operations centres (EOC). One in Lincoln and a larger EOC at trust headquarters in Nottingham. This inspection will only visit the Nottingham EOC.

The two EOC’s work as one virtual EOC and all calls are routed to the next available operator across the two centres. Clinicians work at both EOCs triaging lower priority calls and providing clinical advice to patients.

The EOCs manage emergency calls from Health Care Professionals, GP urgent calls for Lincolnshire and to the community first responder (CFR) calls for the whole of the East Midlands area. Nottingham EOC responds to calls for the rest of the East Midlands including the air ambulance service.

There is also a clinical assessment team (CAT) within the EOC. The CAT supports both 999 and workflow. The resilience service works with the police, the regional fire and rescue services, and local authorities to ensure preparedness for major serious incidents in the region.

The incident command desk (the coordinated response for major incidents) is in Nottingham. The emergency operations centre receives calls from all age groups.

At the last inspection in 2019 the EOC was rated ‘Good’ in all five key questions. Practices recognised as outstanding were the management of frequent callers and that the trust was the first to start transferring calls digitally to other English ambulance services.

As this was a focused inspection, we did not look at every question in our key lines of enquiry, we did not re-rate the service at this time.

On our inspection we reviewed the Nottingham Emergency Operations Centre. We looked at elements of the safety, effectiveness, caring, responsiveness and leadership of the staff and teams at the centre responding to 999 calls.

A summary of CQC findings on urgent and emergency care services in Leicester, Leicestershire and Rutland.

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 Leicester, Leicestershire and Rutland below:

Provision of urgent and emergency care in Leicester, Leicestershire and Rutland was supported by services, stakeholders, commissioners and the local authority.

We spoke with staff in services across primary care, integrated urgent care, acute care, mental health services, ambulance services and adult social care. Staff had worked very hard under sustained pressure across health and social care services.

People reported difficulties when trying to see or speak to their GP. Some GP practices had invested in new technology to improve telephone access. Staff working in GP practices signposted patients to extended and out of hours services to prevent people attending emergency department whenever possible.

Staff working in urgent care reported an increase in demand and an increase in acuity of patients presenting to their services. Some staff reported frustrations in relation to urgent care pathways; staff working in advanced clinical practice were not always empowered to make referrals into alternative pathways.

Staff working in urgent care services reported challenges due to the volume of pilots focused on admissions avoidance running across Leicester, Leicestershire and Rutland. Many pilots ran for relatively short periods of time and were often impacted by staffing issues. This made it difficult to maintain oversight of pathways available to avoid acute services. However, some pilots had proved successful and prevented ambulance responses and hospital admissions.

Staff working across urgent and emergency care services raised concerns about their skills set. Some staff in urgent care services felt they needed additional training to meet the needs of patients presenting with higher acuity.

Patients seeking advice from NHS111 in Leicester, Leicestershire and Rutland experienced some delays getting through to the service, when compared against national targets. However, at the time of our inspection, performance was better than England averages for key indicators including the percentage of calls answered within 60 seconds, and call abandonment rates. Staffing continued to be a challenge across NHS111, however recruitment was on-going.

Out of hours care had been challenging throughout the pandemic as staff were redeployed to other key services, this had particularly impacted on home visiting services.

The emergency department serving Leicester, Leicestershire and Rutland is within a large, city centre hospital. and poor patient flow across health and social care has further increased the significant pressure on the emergency department. This pressure has resulted in long delays in care and treatment. Long delays in ambulance handovers have, in turn, resulted in a high number of hours lost to the ambulance service whilst their crews wait outside hospital. This causes further delays in responding to 999 calls to patients in the community with serious conditions.

Ambulance crews reported an increase in the volume of patients calling 999 who told them they had been unable to see their GP and crews often signposted patients back into primary care.

We found psychiatric liaison services at the city centre hospital were well run and designed to meet people’s needs. Staff demonstrated effective partnership working with a person-centred approach and good use of alternative pathways to avoid admission into acute or social care services.

We found that staff working across specialisms in acute services did not always provide sufficient in-reach into the emergency department to improve patient flow and the care received. This was particularly apparent at night. Beds were not allocated to patients until they had been accepted by specialists, this meant some patients spent additional time waiting in ED. During our inspection, between 45 and 60 beds were needed for new patients waiting in ED. Some patient transfers to other hospitals in Leicester, Leicestershire and Rutland stopped at 8pm, this restricted patient flow out of the city centre hospital.

Some staff reported frustrations with escalation processes across health and social care in Leicester, Leicestershire and Rutland. At times when the city centre hospital and the ambulance service was under significant pressure, staff felt there was a lack of diverts available to other sites or services and that system partners were slow to respond. There was a rapid ambulance handover process when services were in escalation; however, staff reported these were not effective.

There was a high number of patients in hospital who were medically fit for discharge but remained in acute services. System stakeholders worked together to consider discharge pathways; however, at the time of our inspections the number of patients awaiting discharge remained very high. Delays were still commonplace and capacity in community and social care services impacted on the ability of staff to safely discharge patients. Communication about discharge and discharge processes were impacting on the quality of transfers of care to social care services.

People living in social care setting experienced long delays, particularly when accessing 111 or 999 services. Although advice was provided, this had resulted in significant waits and poor outcome, especially for people who had fallen and remained on the floor. Staff working in social care services told us they had limited access to support and advice and relied on GPs, 111 or 999.

System wide collaboration, accountability and risk sharing needs to improve to alleviate pressure on key services in Leicester, Leicestershire and Rutland.

Summary of East Midlands Ambulance Services NHS Trust - Nottingham Emergency Operations Centre

For the emergency operations centre we found:

The service controlled infection risk well. Staff used equipment and control measures to prevent the spread of infection. The design and use of facilities were reviewed and changes made by management in response to the COVID-19 pandemic to keep people safe.

Staff new about and dealt with any specific risk issues. Staff used a recognised script which they followed when communicating with the caller.

The service had enough staff with the right qualifications, skills and training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

The service monitored and met agreed response times so that they could facilitate good outcomes for patients. 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.

Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. Staff felt respected, supported and valued. The service promoted equality and diversity in daily work and provided opportunities for career development.

How we carried out this inspection

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection

For the emergency operations centre inspection, we met with staff from across the organisation. We spoke with the chief executive officer, deputy director of operations, duty managers, team leaders, call handlers, emergency medical dispatchers and clinical assessment team.

We listened to calls coming into the service from the public and observed how they were answered by the emergency medical dispatchers and the clinical assessment team. We viewed minutes of meetings, records and documents relating to the service operation.

12 and 13 April 2022

During an inspection of Emergency and urgent care

East Midlands Ambulance Service NHS Trust (EMAS) provides emergency 999 and urgent care services for a population of approximately 4.86 million people within the East Midlands region.

This region, which covers approximately 6,425 square miles, includes the counties of:

Derbyshire

Leicestershire

Lincolnshire

Nottinghamshire

Northamptonshire

Rutland.

The service operates from over 90 facilities including ambulance stations, community ambulance stations (smaller facilities which are often shared buildings with other organisations and are used as standby points for our crews), two emergency operations centres (Nottingham and Lincoln), training and support team offices and fleet workshops. EMAS has a fleet of over 746 vehicles, including emergency ambulances, fast response cars and specialised vehicles.

EMAS responds to over 730,000 emergency and urgent incidents per year, with over 2,000 emergency calls per day being received. The front-line Emergency and Urgent Care staff include specialist practitioners, paramedics, technicians and emergency care support workers. They are based in up to 90 ambulance stations across the region. The trust also subcontracts some of its work to voluntary and private organisations.

The trust employs over 4, 077 staff, the majority being frontline accident and emergency ambulance personnel. Patient Transport Services (PTS) are currently provided for people who have routine (non-urgent and scheduled) clinic appointments across Derbyshire and Northamptonshire.

The trust has AMPDS accreditation: Advanced Medical Priority Dispatch System (AMPDS) which is a unified system used to dispatch appropriate aid to medical emergencies including systematised caller interrogation and pre-arrival instructions. Priority Dispatch Corporation is licensed to design and publish MPDS and its various products, with research supported by the International Academy of Emergency Medical Dispatch (IAEMD).

We carried out this short notice announced inspection on 12 and 13 April 2022. We had an additional focus on the urgent and emergency care pathway for patients across the integrated care system in Leicestershire. As the trust serves six counties, not all information will relate to Leicestershire, but we have included specific data and evidence where we can.

A summary of CQC findings for the overall urgent and emergency care services in Leicester, Leicestershire and Rutland.

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 Leicester, Leicestershire and Rutland below:

Provision of urgent and emergency care in Leicester, Leicestershire and Rutland was supported by services, stakeholders, commissioners and the local authority.

We spoke with staff in services across primary care, integrated urgent care, acute care, mental health services, ambulance services and adult social care. Staff had worked very hard under sustained pressure across health and social care services.

People reported difficulties when trying to see or speak to their GP. Some GP practices had invested in new technology to improve telephone access. Staff working in GP practices signposted patients to extended and out of hours services to prevent people attending emergency department whenever possible.

Staff working in urgent care reported an increase in demand and an increase in acuity of patients presenting to their services. Some staff reported frustrations in relation to urgent care pathways; staff working in advanced clinical practice were not always empowered to make referrals into alternative pathways.

Staff working in urgent care services reported challenges due to the volume of pilots focused on admissions avoidance running across Leicester, Leicestershire and Rutland. Many pilots ran for relatively short periods of time and were often impacted by staffing issues. This made it difficult to maintain oversight of pathways available to avoid acute services. However, some pilots had proved successful and prevented ambulance responses and hospital admissions.

Staff working across urgent and emergency care services raised concerns about their skills set. Some ambulance staff feared the shift from dealing with multiple emergencies to providing longer term care for one patient in a shift. Some staff in urgent care services felt they needed additional training to meet the needs of patients presenting with higher acuity.

Patients seeking advice from NHS111 in Leicester, Leicestershire and Rutland experienced some delays getting through to the service, when compared against national targets. However, at the time of our inspection, performance was better than England averages for key indicators including the percentage of calls answered within 60 seconds, and call abandonment rates. Staffing continued to be a challenge across NHS111, however recruitment was on-going.

Out of hours care had been challenging throughout the pandemic as staff were redeployed to other key services, this had particularly impacted on home visiting services.

The emergency department serving Leicester, Leicestershire and Rutland is within a large, city centre hospital. and poor patient flow across health and social care has further increased the significant pressure on the emergency department. This pressure has resulted in long delays in care and treatment. Long delays in ambulance handovers have, in turn, resulted in a high number of hours lost to the ambulance service whilst their crews wait outside hospital. This causes further delays in responding to 999 calls to patients in the community with serious conditions.

Ambulance crews reported an increase in the volume of patients calling 999 who told them they had been unable to see their GP and crews often signposted patients back into primary care.

We found psychiatric liaison services at the city centre hospital were well run and designed to meet people’s needs. Staff demonstrated effective partnership working with a person-centred approach and good use of alternative pathways to avoid admission into acute or social care services.

We found that staff working across specialisms in acute services did not always provide sufficient in-reach into the emergency department to improve patient flow and the care received. This was particularly apparent at night. Beds were not allocated to patients until they had been accepted by specialists, this meant some patients spent additional time waiting in ED. During our inspection, between 45 and 60 beds were needed for new patients waiting in ED. Some patient transfers to other hospitals in Leicester, Leicestershire and Rutland stopped at 8pm, this restricted patient flow out of the city centre hospital.

Some staff reported frustrations with escalation processes across health and social care in Leicester, Leicestershire and Rutland. At times when the city centre hospital and the ambulance service was under significant pressure, staff felt there was a lack of diverts available to other sites or services and that system partners were slow to respond. There was a rapid ambulance handover process when services were in escalation; however, staff reported these were not effective.

There was a high number of patients in hospital who were medically fit for discharge but remained in acute services. System stakeholders worked together to consider discharge pathways; however, at the time of our inspections the number of patients awaiting discharge remained very high. Delays were still commonplace and capacity in community and social care services impacted on the ability of staff to safely discharge patients. Communication about discharge and discharge processes were impacting on the quality of transfers of care to social care services.

People living in social care setting experienced long delays, particularly when accessing 111 or 999 services. Although advice was provided, this had resulted in significant waits and poor outcome, especially for people who had fallen and remained on the floor. Staff working in social care services told us they had limited access to support and advice and relied on GPs, 111 or 999.

System wide collaboration, accountability and risk sharing needs to improve to alleviate pressure on key services in Leicester, Leicestershire and Rutland.

Summary of East Midlands Ambulance Service NHS Foundation Trust

As this was a focused inspection, we did not look at every question in our key lines of enquiry, we did not re-rate the service at this time. This inspection was focused around system pathways focusing on Leicester, Leicestershire and Rutland, we did not visit any other regions during this inspection. We continue to monitor services provided by EMAS.

At our previous inspection published in 2019, we rated emergency and urgent care services at the trust as good overall with caring rated as outstanding and the other key questions as good.

On this inspection we reviewed emergency and urgent care services. For this core service we looked at elements of the safety, effectiveness, caring, responsiveness and leadership of the staff and teams responding to 999 calls, and those supporting the emergency departments on site.

For emergency and urgent care, we found:

  • The service was under immense pressure from a lack of bed-capacity in the acute hospitals and the community with patients waiting in ambulances at emergency departments (which were also full). The service was staffed and resourced safely to meet people’s needs in most areas for commissioned and planned levels of demand. Staffing levels had been increased to deal with some of the predicted increase in demand for ambulances, but not to cope with the lack of bed capacity experienced. However, additional recruitment of staff continued across the service.
  • Delays in the handover of patients at emergency departments meant the service was unable to reach all patients who needed an ambulance in a timely way, in line with national targets. There was evidence to show the trust had taken internal action to manage the increasing demand on urgent and emergency care capacity. However, incidents of patients waiting long periods of time for an ambulance were increasing and occurred on most days. This was having a significant impact on patients waiting and the morale of staff across the service
  • There were risks for patients because of ambulance handover delays in emergency departments. There were known and unknown risks of harm to patients who were held in an ambulance or waiting in the community and an ambulance was not available or excessively delayed. This led to harm for some patients.
  • The NHS contractual response times for ambulances to attend patients were not being met and some were exceptionally long and increasing, ambulances were waiting at emergency departments due to the increase demands and capacity pressures in hospitals and other parts of the health and social care system.

However:

  • Staff were discreet and responsive when caring for patients. Staff took time to interact with patients in a respectful and considerate way.
  • Patients said staff treated them well and with kindness.
  • Staff treated patients with exceptional compassion and kindness, respected their privacy and dignity, and took account of their individual needs in increasingly difficult circumstances.

How we carried out the inspection

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

For our emergency and urgent care inspection, we met with staff operating in Leicester, Leicestershire and Rutland. We spoke with the trust’s commander and the deputy commander for Leicester, Leicestershire and Rutland. We talked with paramedics, emergency care assistants and other members of staff on duty at the emergency department at Leicester Royal Infirmary Hospital NHS Trust. We spoke with 15 paramedics, emergency care assistants and other support personnel, and the tactical commander.

We spoke with patients while on site at the emergency department. Some were still in ambulances and others had arrived by ambulance and been taken into the emergency department. Although we observed care delivered by ambulance staff for a number of patients, some of these were not well enough to talk with us. Due to rules of safety in the COVID-19 pandemic, and in light of the pressures of demand on the ambulance service, we did not ride out with crews or observe them on the scene with patients.

02 Apr to 04 Apr 2019

During a routine inspection

We rated safe, effective, responsive and well-led as good, and caring as outstanding.

We rated all four of the trusts core services as good.

  • The trust provided mandatory training in key skills to all 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 provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Response times and time to answer calls in the EOC were generally better than the England average.
  • Trust performance in the seven-minute national standard for Cat 1 calls had improved significantly over recent months and was on an improving trajectory. The trust had implemented a new service and improved triage to maintain these improvements.
  • Staff interacted in a respectful and compassionate way with patients and those close to them. Staff showed support and an encouraging and sensitive attitude. We observed staff taking time to talk to patients and their relatives to gain further understanding of the patient’s needs.
  • Feedback from patients was continually positive about the way staff treated them. Comments from patients included “they were very caring and pleasant and careful with me”, very professional and courteous, sorted everything that I needed”, “and “very helpful, very reassuring”.
  • The service ensured patients were treated as individuals, with their needs and preferences being met. Staff respected people’s ethnicity, language, religious and cultural background
  • The service provided reflected the needs of the population served and they ensured flexibility, choice and continuity of care. Service capacity was planned to cope with differing levels and nature of demand in different localities
  • The service was accessible to all and took account of people’s individual needs. It identified and met the information and communication needs of people with a disability or sensory loss. Reasonable adjustments were made so that people with a disability could access and use services on an equal basis to others.
  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care. There was clear leadership of the trust to drive and improve the delivery of high-quality person-centred care.
  • Most staff described how the culture had changed significantly over the last two years, this had been reflected in the national staff survey results. The morale amongst frontline staff had improvement significantly since our last inspection.
  • Most staff told us they were supported by management which had improved since our last inspection. We saw there were co-operative, supportive and appreciative relationships among staff, despite the challenges faced on a daily basis.
  • Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website

02 Apr to 04 Apr 2019

During an inspection of Emergency and urgent care

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

  • All staff we spoke with were aware of how to refer a safeguarding issue. Staff told us they were always given time to make safeguarding referrals and were stood down to allow them to complete referrals.
  • Ambulance crews had up to date satellite navigations and communication systems in their vehicles to guide crews to patient pickups and incidents. In addition, vehicles could be ‘talked-in’ from the operations centre if this was required.
  • Consumables were stored safely; stock levels were checked and stock rotated to ensure things were used in expiry date order. Equipment was available to suit all patients, for example child restraints and baby harnesses.
  • Staff showed awareness of responding appropriately to a deteriorating patient. A NEWS2 tool score card was witnessed in the same place onboard every EMAS vehicle. All staff are trained to both adult, paediatric and neonatal intermediate life support.

  • Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

  • All staff we spoke to told us they have protected time for meal breaks and are encouraged to take regular breaks. Staff told they did not feel pressurised to undertake extra shifts and overtime.
  • Staff we spoke with had access to the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) app on their personal mobile phones and said they used it regularly to receive updates and access relevant guidelines. Guidelines were followed across the trust.
  • Staff has full understanding of their roles and the limitations of it so if a paramedic was working as an emergency medical technician, accountability was clear.
  • Throughout our inspection we saw staff interact in a respectful and compassionate way with patients and those close to them. Staff showed support and an encouraging and sensitive attitude.
  • Staff were patient focused. Staff considered patients physical mental and social needs to ensure that their journey was comfortable and safe.
  • Services provided reflected the needs of the population served and ensured flexibility, choice and continuity of care and ambulance deployment was always aimed at meeting the needs of patients in a timely manner. Facilities and premises were all appropriate for the services delivered.
  • Leaders had skills, knowledge, experience and integrity when appointed and ongoing. All the staff we spoke with held the divisional managers in high esteem and told us they were visible and very approachable.

However:

  • Some staff were administering prescription only medicines to patients without a prescription.

02 Apr to 04 Apr 2019

During an inspection of Emergency operations centre (EOC)

  • Staff had received adequate training to keep people safe from harm including children and vulnerable persons. Premises were visibly clean and tidy, well equipped and well maintained.
  • There were robust procedures in place for assessing and responding to patient risk using accredited risk assessment systems and experienced clinical staff.
  • Staffing levels had improved since our last inspection and continued to improve through a rolling programme of recruitment.
  • Patient records were comprehensive, accurate and contained up to date information.
  • Staff gave advice on medicines within the remit of their role.
  • Incident management was embedded in the service, staff were familiar with incident reporting systems. Staff understanding of incident management had improved since our last inspection.
  • Care and treatment incorporated evidence based best practice.
  • Arrangements were in place for staff to access clinical support and advice if needed and an annual plan of audit was in place which included local and national benchmarking audits.
  • Staff used pain assessments tools housed within the clinical assessments software and gain pain relief advice within the remit of their role.
  • Response times, time to answer calls, were generally better than the England average.
  • The service monitored patient outcomes, the trust was better than the England average for hear and treat incidents.
  • Staff were competent to perform the duties of their role, there was adequate role preparation training followed by a period of supervision.
  • Multidisciplinary working was evident through the EOC centre, particularly with other health care organisations, primary care and social services.
  • Robust systems were in place to manage frequent callers which was an improvement since our last inspection.
  • Most staff had an understanding of the Mental Capacity Act and obtaining patient consent, assessment systems included mental capacity tests.
  • Staff were polite and respectful at all times despite the challenging nature of some calls.
  • Staff communicated with callers in a way they could understand and involved family and carers when appropriate.
  • Service were planned to meet the needs of local people using historical data and forecasting tools.
  • Systems were in place to enable people from diverse backgrounds and with communication difficulties to access the service.
  • Call flow was continuously monitored and Resourcing Escalatory Action Plans were embedded into the day to day running of the service.
  • Complaints were managed within timescales and learning identified from complaints was shared with staff.
  • Leaders and managers were knowledgeable, visible and approachable and staff told us they felt valued and supported.
  • There were clear vision and values which were reflected in a strategy which had been developed with staff and public involvement.
  • There was a culture of openness and honesty enhanced by whistle blowing policies and freedom to speak up guardian.
  • There was good governance of the service including risk and information management. Recruitment practices followed best practice, risks were identified with mitigating actions and information was managed according to Data Protection rules.
  • The trust had engaged with staff, patients and the public in several ways to gather views and comments on the service.
  • A high priority had been given learning, improvement and innovation and the trust proactively shared best practice with other NHS services and organisations.

However:

  • Assessment systems did not incorporate up to date risk assessments for mental health or sepsis.
  • Medicines governance group terms of reference did not include reference to medicines advice given by EOC staff.
  • Outcome data was not collected for mental health patients.
  • Some staff had not attended Mental Capacity Act training or mental health awareness training.
  • Some staff were unaware of the on call clinical support arrangements.
  • Staff at the Lincoln EOC left their work stations without locking their screens.
  • EMAS Promotional material was not available in other languages.

02 Apr to 04 Apr 2019

During an inspection of Patient transport services

This is was our first inspection of the service where ratings were awarded so we cannot compare ratings with previous inspections. We rated it as good because:

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right transport and care. Staff were up to date with their mandatory and safeguarding training.
  • Staff were patient focused. They completed and updated individual risk assessments and planned journeys to mitigate risks. Staff considered patients physical mental and social needs to ensure that their journey was comfortable and safe. Control centre staff and transport crews asked patients and relatives the right questions to ensure that patients were kept comfortable and safe and took action to assure themselves of the safety of patients who were unexpectedly not at home for pick up
  • The incident reporting system was well understood. Incidents were investigated and the service learned from them. The service learned from complaints.
  • The service provided reflected the needs of the population served and they ensured flexibility, choice and continuity of care. It provided for a range of individual patient needs and disabilities.
  • Most people generally had timely access to transport and the service took action to resolve issues where this was not the case.
  • The service had a clear vision and reflected the trust’s values. They had an action plan to improve performance against key performance indicators, and clear governance arrangements to ensure that performance and quality issues were addressed. The service invited feedback from patients and staff and used this to benefit patients.

02 Apr to 04 Apr 2019

During an inspection of Resilience

This is was our first inspection of the service where ratings were awarded so we cannot compare ratings with previous inspections. We rated it as good because:

  • The service had the right number of properly trained staff who were available to be deployed when they were needed. Patients were protected from avoidable harm and abuse. There were suitable premises and equipment which was kept clean and well maintained. There were good infection prevention and control measures including for the most serious threats. Good records were kept of patient’s care and treatment. There was good practice in dealing with medicines. Safety incidents were managed properly and the service learnt from them. However, we found concerns with the temperature at which medicines were stored,lack of paper forms on some ambulances and availability of major incident pocket books and smart cards.
  • Patients had good outcomes because they received good care that adhered to national guidelines and staff were competent. Patients’ condition including pain was monitored and responded to appropriately. Response times met national standards and teamwork with other agencies was very good. Staff understood the Mental capacity Act 2005, the Mental Health Act 1983 and applied there training properly.
  • While we were not able to observe care being given we found nothing that gave rise to any concerns.
  • The trust assessed local risks well alongside other emergency services and statutory agencies and had plans in place to deal with them. The trust prioritised the availability of the HART team and so they were available when people needed them. Complaints systems were in place and promoted as best they could be although patients rarely used them.
  • Leaders were knowledgeable and skilled and there was a positive culture across all the EPRR function. The trust had a vision as to the future of the EPRR function and had good plans to get there. There was a strong governance framework that together with rich information systems allowed good audit and risk assessment. The trust worked to engage with other staff outside of the EPRR function and with the public.

21, 22, 23 February & 3 March 2017

During an inspection looking at part of the service

East Midlands Ambulance Service NHS Trust (EMAS) covers the six counties of Derbyshire, Nottinghamshire, Leicestershire, Rutland, Lincolnshire and Northamptonshire. This is an area which has a population of around 4.8 million people and covers approximately 6,425 miles. The trust employs 3,290 staff over 60 locations.

We carried out a follow up inspection of the East Midlands Ambulance Service NHS Trust from 21 to 23 February and 3 March 2017, in response to a previous inspection as part of our comprehensive inspection programme of East Midlands Ambulance Service NHS Trust in November 2015. In July 2016 we served the trust with a Warning Notice in which we required them to make significant improvements to the quality of health care provided. This was specifically in relation to ensuring there were sufficient staff with the right skill mix and sufficient vehicles as well as requiring the trust to ensure staff received appropriate training, support and appraisal to carry out their roles.

Focused inspections do not look across a whole service; they focus on the areas defined by the information that triggers the need for the focused inspection. As the trust were no longer commissioned to provide patient transport services in Lincolnshire we did not look at that core service.

During this inspection we looked at:

The safety and effectiveness of Emergency and Urgent Care Services.

The safety and effectiveness of the Emergency Operations Centres.

Safety, effectiveness and well led at provider level.

The overall rating for East Midlands Ambulance Service remains unchanged at requires improvement although safety for emergency and urgent care services is no longer inadequate but requires improvement.

Our key findings were as follows:

  • The trust had made significant improvements as required by the July 2016 warning notice. However we remained concerned about response times.
  • Response times for Red 1, Red 2 and A 19 calls were consistently below the national target and patients were not receiving care in a timely manner.
  • There were variable standards of incident investigation, limited recommendations, lack of learning at an organisational level and a lack of evidence that recommendations had been actioned.
  • There was a lack of consistency in the management of risk due to trialling a revised risk register proforma.
  • Staff did not know about the Duty of Candour requirements or their responsibilities under it and the trust had not consistently fulfilled their responsibilities under the Regulation.
  • We found pockets of concern about the potential bullying and harassment of staff who were not confident to report this. We found instances where policies and procedures relating to staff wellbeing were not followed in practice.
  • Not all staff had been trained on the use of and supplied with filtered face piece masks (FFP3). Those that had been supplied with a mask did not always have them available for immediate use.
  • The trust were not compliant with the requirements of the Fit and Proper Persons Regulation.
  • Whilst the trust had a clear vision and strategy, frontline staff were not aware of these.
  • Whilst training completion rates for statutory and mandatory training had significantly improved, mandatory training completion rates for equality and diversity and risk management modules were too low and there were challenges in two specific divisions around completion rates in general.
  • The trust had taken appropriate actions which had been successful in increasing the number of front line staff.
  • Standards of cleanliness had improved.
  • The majority of equipment and vehicle checks were appropriately completed.
  • There was an increased number of operational vehicles available to deliver emergency and urgent care services.
  • Medicines were stored securely and the management of controlled drugs was in line with the trust’s policy. However, we had some concerns about the lack of robust audit trail for access to controlled drugs on solo responder vehicles.
  • There were notable improvements in the security of patient records.
  • Potential risks to the service were anticipated and planned for in advance.
  • The trust had taken action to provide frontline staff with the knowledge and information they needed to respond to a major incident.
  • People’s care and treatment was planned and delivered in line with current evidence-based guidance, standards and best practice.
  • Patient outcomes were mainly above or equivalent to national average levels.
  • Staff had received timely appraisals which had been perceived by most to be a meaningful process.
  • Improvements in training and development opportunities were evident and staff told us about them.
  • Where patients received care form a range of different staff, teams or services this was effectively coordinated.
  • Staff were confident in their understanding of the principles for patient consent and the Mental Capacity Act 2005 and they followed them.
  • There was a governance framework able to support the delivery of safe, high quality care.
  • There was a high level of confidence in and respect for the leadership of the acting chief executive.
  • There was increased confidence in the effectiveness of the board and frontline leaders were better equipped with skills and knowledge.
  • The culture of the trust from board to frontline staff was overwhelmingly patient focussed. Our inspection team observed caring, professional staff delivering compassionate, patient focussed care in circumstances that were challenging due to the continued demand placed on the service.
  • Staff engagement and satisfaction had improved since our last inspection.

We saw several areas of outstanding practice including:

  • The trust had run a highly effective recruitment campaign and received a national award for equality and diversity in recruitment.
  • The trust were trialling a pre-hospital sepsis treatment in North and North East Lincolnshire. Where patients presented with the symptoms of sepsis, blood cultures were taken and a pre-hospital dose of intravenous antibiotic therapy administered to the patient. This saved valuable time and provided prompt lifesaving treatment. The results of the study had not been published at the time of our inspection but early indications showed positive outcomes for patients. The trust was the only ambulance trust in England providing pre-hospital care to this group of patients.
  • The trust had extended the provision of a mental health triage car in Lincolnshire and also to include patients in Derbyshire increasing the provision of appropriate care and treatment for patients with mental health conditions.
  • We observed caring, professional staff delivering compassionate, patient focussed care in circumstances that were challenging due to the continued demand placed on the service.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • The trust must ensure patients receive care and treatment in a safe way by meeting national and locally contracted response time targets for Red1, Red2 and A19 categorised calls.
  • The trust must take steps to improve EOC call taking response times therefore reducing the number of calls abandoned and the length of time callers are waiting on the phone.
  • The trust must ensure all staff know how to report incidents. The trust must ensure serious incidents are appropriately and consistently investigated with lessons learnt acted upon and shared widely.
  • The trust must ensure all staff understand the Duty of Candour Regulation and their responsibilities under it.
  • The trust must ensure all staff access and attend mandatory training with particular focus on compliance rates for equality and diversity and risk management training.
  • The trust must ensure all staff are fitted for and trained in the use of a filtered face piece mask to protect them from air borne infections.
  • The trust must increase the percentage of frequent callers who have a specific plan of care.
  • The trust must ensure there are systems in place to ensure staff have received, read and understand information when there are updates to trust policies, procedures or clinical practice.
  • The trust must ensure they comply with the Fit and Proper Persons Requirement (FPPR) (Regulation 5 of the Health and Social Care Act (Regulated Activities) Regulations 2014).

Professor Sir Mike Richards

Chief Inspector of Hospitals

21, 22, 23 February 2017 and 03 March 2017

During an inspection looking at part of the service

East Midlands Ambulance Service NHS Trust (EMAS) covers the six counties of Derbyshire, Nottinghamshire, Leicestershire, Rutland, Lincolnshire and Northamptonshire. This is an area which has a population of around 4.8 million people and covers approximately 6,425 miles. The trust employs 3,290 staff over 60 locations.

We carried out a follow up inspection of the East Midlands Ambulance Service NHS Trust from 21 to 23 February and 3 March 2017, in response to a previous inspection as part of our comprehensive inspection programme of East Midlands Ambulance Service NHS Trust in November 2015. In July 2016 we served the trust with a Warning Notice in which we required them to make significant improvements to the quality of health care provided. This was specifically in relation to ensuring there were sufficient staff with the right skill mix and sufficient vehicles as well as requiring the trust to ensure staff received appropriate training, support and appraisal to carry out their roles.

Focused inspections do not look across a whole service; they focus on the areas defined by the information that triggers the need for the focused inspection. As the trust were no longer commissioned to provide patient transport services in Lincolnshire we did not look at that core service.

During this inspection we looked at:

The safety and effectiveness of Emergency and Urgent Care Services.

The safety and effectiveness of the Emergency Operations Centres.

Safety, effectiveness and well led at provider level.

The overall rating for East Midlands Ambulance Service remains unchanged at requires improvement although safety for emergency and urgent care services is no longer inadequate but requires improvement.

Our key findings were as follows:

  • The trust had made significant improvements as required by the July 2016 warning notice. However we remained concerned about response times.
  • Response times for Red 1, Red 2 and A 19 calls were consistently below the national target and patients were not receiving care in a timely manner.
  • There were variable standards of incident investigation, limited recommendations, lack of learning at an organisational level and a lack of evidence that recommendations had been actioned.
  • There was a lack of consistency in the management of risk due to trialling a revised risk register proforma.
  • Staff did not know about the Duty of Candour requirements or their responsibilities under it and the trust had not consistently fulfilled their responsibilities under the Regulation.
  • We found pockets of concern about the potential bullying and harassment of staff who were not confident to report this. We found instances where policies and procedures relating to staff wellbeing were not followed in practice.
  • Not all staff had been trained on the use of and supplied with filtered face piece masks (FFP3). Those that had been supplied with a mask did not always have them available for immediate use.
  • The trust were not compliant with the requirements of the Fit and Proper Persons Regulation.
  • Whilst the trust had a clear vision and strategy, frontline staff were not aware of these.
  • Whilst training completion rates for statutory and mandatory training had significantly improved, mandatory training completion rates for equality and diversity and risk management modules were too low and there were challenges in two specific divisions around completion rates in general.
  • The trust had taken appropriate actions which had been successful in increasing the number of front line staff.
  • Standards of cleanliness had improved.
  • The majority of equipment and vehicle checks were appropriately completed.
  • There was an increased number of operational vehicles available to deliver emergency and urgent care services.
  • Medicines were stored securely and the management of controlled drugs was in line with the trust’s policy. However, we had some concerns about the lack of robust audit trail for access to controlled drugs on solo responder vehicles.
  • There were notable improvements in the security of patient records.
  • Potential risks to the service were anticipated and planned for in advance.
  • The trust had taken action to provide frontline staff with the knowledge and information they needed to respond to a major incident.
  • People’s care and treatment was planned and delivered in line with current evidence-based guidance, standards and best practice.
  • Patient outcomes were mainly above or equivalent to national average levels.
  • Staff had received timely appraisals which had been perceived by most to be a meaningful process.
  • Improvements in training and development opportunities were evident and staff told us about them.
  • Where patients received care form a range of different staff, teams or services this was effectively coordinated.
  • Staff were confident in their understanding of the principles for patient consent and the Mental Capacity Act 2005 and they followed them.
  • There was a governance framework able to support the delivery of safe, high quality care.
  • There was a high level of confidence in and respect for the leadership of the acting chief executive.
  • There was increased confidence in the effectiveness of the board and frontline leaders were better equipped with skills and knowledge.
  • The culture of the trust from board to frontline staff was overwhelmingly patient focussed. Our inspection team observed caring, professional staff delivering compassionate, patient focussed care in circumstances that were challenging due to the continued demand placed on the service.
  • Staff engagement and satisfaction had improved since our last inspection.

We saw several areas of outstanding practice including:

  • The trust had run a highly effective recruitment campaign and received a national award for equality and diversity in recruitment.
  • The trust were trialling a pre-hospital sepsis treatment in North and North East Lincolnshire. Where patients presented with the symptoms of sepsis, blood cultures were taken and a pre-hospital dose of intravenous antibiotic therapy administered to the patient. This saved valuable time and provided prompt lifesaving treatment. The results of the study had not been published at the time of our inspection but early indications showed positive outcomes for patients. The trust was the only ambulance trust in England providing pre-hospital care to this group of patients.
  • The trust had extended the provision of a mental health triage car in Lincolnshire and also to include patients in Derbyshire increasing the provision of appropriate care and treatment for patients with mental health conditions.
  • We observed caring, professional staff delivering compassionate, patient focussed care in circumstances that were challenging due to the continued demand placed on the service.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • The trust must ensure patients receive care and treatment in a safe way by meeting national and locally contracted response time targets for Red1, Red2 and A19 categorised calls.
  • The trust must take steps to improve EOC call taking response times therefore reducing the number of calls abandoned and the length of time callers are waiting on the phone.
  • The trust must ensure all staff know how to report incidents. The trust must ensure serious incidents are appropriately and consistently investigated with lessons learnt acted upon and shared widely.
  • The trust must ensure all staff understand the Duty of Candour Regulation and their responsibilities under it.
  • The trust must ensure all staff access and attend mandatory training with particular focus on compliance rates for equality and diversity and risk management training.
  • The trust must ensure all staff are fitted for and trained in the use of a filtered face piece mask to protect them from air borne infections.
  • The trust must increase the percentage of frequent callers who have a specific plan of care.
  • The trust must ensure there are systems in place to ensure staff have received, read and understand information when there are updates to trust policies, procedures or clinical practice.
  • The trust must ensure they comply with the Fit and Proper Persons Requirement (FPPR) (Regulation 5 of the Health and Social Care Act (Regulated Activities) Regulations 2014).

Professor Sir Mike Richards

Chief Inspector of Hospitals

16-20 November 2015 and 3 December 2015

During an inspection looking at part of the service

The East Midlands Ambulance Service NHS Trust (EMAS) is one of 10 ambulance trusts in England providing emergency medical services to Derbyshire, Nottinghamshire, Lincolnshire, Leicestershire, Rutland and Northamptonshire, an area which has a population of around 4.8 million people. The trust employs around 2,900 staff who are based at more than 70 locations including ambulance stations, an air ambulance station, emergency operations centres (EOCS) and support offices across the East Midlands.

The main role of EMAS is to respond to emergency 999 calls, 24 hours a day, 365 days a year. 999 calls are received by the emergency operation centres (EOC), where clinical advice is provided and emergency vehicles are dispatched if required. Other services provided by EMAS include patient transport services (PTS) for non-emergency patients between community provider locations or their home address and resilience services which includes the Hazardous Area Response Team (HART).

Every day EMAS receives around 2,000 calls from members of the public dialling 999. In 2014-15 they provided a face to face response to 649, 625 emergency calls. The service provided by EMAS is commissioned by 22 separate Clinical Commissioning Groups with one of these taking the role as co-ordinating commissioner.

Our announced inspection of EMAS took place between 16 to 20 November 2015 with unannounced inspections on 3 December 2015. We carried out this inspection as part of the CQC’s comprehensive inspection programme.

We inspected three core services:

• Emergency Operations Centres

• Urgent and Emergency Care including the Hazardous Area Response Team (HART) and the air ambulance.

• Patient Transport Services

Overall, the trust was rated as requires improvement. Caring and Responsive were rated as good. Effective and Well Led were rated as requires improvement and Safety as inadequate. We have taken enforcement action against the provider in this respect.

Our key findings were as follows:

  • The trust was working hard to improve response times for emergency calls but these were consistently below the national target.

  • There were insufficient staff and a lack of appropriate skill mix to meet the needs of patients in a timely manner.

  • Standards of cleanliness and infection control, although inconsistent in some trust buildings were generally good on ambulances.

  • All staff, especially those at the frontline were passionate about and committed to providing high quality, safe care for patients. At the same time they were open and honest about the challenges they were facing.

  • Whilst the trust were working hard to recruit staff, they were finding it a challenge to retain staff and overall numbers were only increasing minimally.

  • Staff morale was low and they often did not feel valued. There was an unrelenting demand for emergency services combined with a lack of staff and resources to meet the need.

  • Frontline leaders did not have the capacity or in some cases the skills to support teams and individuals and fulfil the requirements of their roles.

  • Many staff were not receiving performance development reviews (appraisals), clinical supervision (where appropriate) or mandatory training.

  • There was a clear statement of vision and values driven by quality and safety. The trust board functioned effectively.

  • Without exception the Chief Executive was held in high regard by staff for her visible, open approach.

We saw several areas of outstanding practice including:

  • We observed many examples of non-clinical staff supporting patients and saving lives in what were extremely difficult and stressful situations. Staff remained calm and gave callers confidence to deliver life-saving treatment.

  • The trust had introduced ‘change Wednesdays’ in the emergency operations centre (EOC) to avoid daily contact with staff about minor changes to policies and systems. Staff were confident any changes to policies or procedures would take place on the same day every week.

  • The trust were the best performing ambulance trust in England for the number of calls abandoned before answered.

  • A mental health triage car was available in Lincolnshire between 4pm and midnight, staffed by a paramedic and a registered mental health nurse from a mental health trust. They could assess the needs of the patient and provide appropriate care which in some cases avoided hospital admission or the use of a Section 136 detention under the Mental Health Act 1983.

  • The trust had a joint ambulance conveyance project working with six fire and rescue services in their region. This was the first service of its kind for an ambulance service nationally.

  • The trust, in partnership with six fire and rescue services across the region, had introduced a regional emergency first responder (EFR) scheme. This was the first regional service of its kind of an ambulance service nationally.

  • A project was in place to improve treatment for patients in acute heart failure. Crews had been issued with continuous positive airway pressure (CPAP) machines. The CPAP machine improves oxygen saturation levels in these patients.

  • Staff in patient transport services (PTS) had direct access to electronic information held by community services including GPs. This meant they could access up to date information about patients including their current medication.

  • The patient advice and liaison service had recruited existing patients to report to them about their planned journeys and experiences of patient transport services (PTS). They called this a ‘secret shopper’ programme.

  • Staff name badges included their name in braille to assist patients with visual impairment. Guide dogs were allowed to accompany visually impaired patients.

  • The Chief Executive was praised by all staff for her visible, open approach and her commitment to engaging staff face to face.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure staff report all appropriate incidents which are then appropriately and consistently investigated.

  • Ensure learning from incidents, investigations and complaints is shared with all staff.

  • Ensure all staff receive statutory and mandatory training.

  • Ensure all domestic, clinical and hazardous materials are managed in line with current legislation and guidance.

  • Ensure vehicle and equipment checks are carried out to the determined frequency.

  • Ensure there are sufficient emergency vehicles to safely meet demand.

  • Ensure medicines, including controlled drugs are stored and managed safely.

  • Ensure paper patient report forms are stored appropriately and securely in trust premises and in such a way on trust vehicles as to maintain patient confidentiality

  • Ensure there are sufficient numbers of staff with an appropriate skill mix to meet safety standards and national response targets.

  • Ensure arrangements to respond to emergencies and major incidents are practised and reviewed in line with current guidance and legislation.

  • Ensure response times meet the needs of patients by reaching national target times.

  • Ensure all staff receive appropriate non-mandatory training to enable them to carry out the duties they are employed for.

  • Ensure all staff receive an annual appraisal.

  • Ensure service level agreements are in place to monitor the quality of taxi service provision for patient transport services.

Professor Sir Mike Richards

Chief Inspector of Hospitals

16 – 20 November and 3 December 2015

During a routine inspection

The East Midlands Ambulance Service NHS Trust (EMAS) is one of 10 ambulance trusts in England providing emergency medical services to Derbyshire, Nottinghamshire, Lincolnshire, Leicestershire, Rutlandand Northamptonshire, an area which has a population of around 4.8 million people. The trust employs around 2,900 staff who are based at more than 70 locations including ambulance stations, an air ambulance station, emergency operations centres (EOCS) and support offices across the East Midlands.

The main role of EMAS is to respond to emergency 999 and urgent calls, 24 hours a day, 365 days a year. 999 calls are received by the emergency operation centres (EOC), where clinical advice is provided and emergency vehicles are dispatched if required. Other services provided by EMAS include patient transport services (PTS) for non-emergency patients between community provider locations or their home address and resilience services which includes the Hazardous Area Response Team (HART).

Every day EMAS receives around 2,000 calls from members of the public dialling 999. In 2014-15 they provided a face to face response to 643, 115 emergency calls. The service provided by EMAS is commissioned by 22 separate Clinical Commissioning Groups with one of these taking the role asco-ordinating commissioner.

Our announced inspection of EMAS took place between 16 to 20 November 2015 with unannounced inspections on 3 December 2015. We carried out this inspection as part of the CQC’s comprehensive inspection programme.

We inspected three core services:

• Emergency Operations Centres

• Urgent and Emergency Care including the Hazardous Area Response Team (HART) and the air ambulance.

• Patient Transport Services

Overall, the trust was rated as requires improvement. Caring and Responsive were rated as good. Effective and Well Led were rated as requires improvement and Safe as inadequate. We have taken enforcement action against the provider in this respect.

Our key findings were as follows:

  • The trust was working hard to improve response times for emergency calls but these were consistently below the national target.
  • There were insufficient staff and a lack of appropriate skill mix to meet the needs of patients in a timely manner.
  • Standards of cleanliness and infection control, although inconsistent in some trust buildings were generally good on ambulances.
  • All staff, especially those at the frontline were passionate about and committed to providing high quality, safe care for patients. At the same time they were open and honest about the challenges they were facing.
  • Whilst the trust were working hard to recruit staff, they were finding it a challenge to retain staff and overall numbers were only increasing minimally.
  • Staff morale was low and they often did not feel valued. There was an unrelenting demand for emergency services combined with a lack of staff and resources to meet the need.
  • Frontline leaders did not have the capacity or in some cases the skills to support teams and individuals and fulfil the requirements of their roles.
  • Many staff were not receiving performance development reviews (appraisals), clinical supervision (where appropriate) or mandatory training.
  • There was a clear statement of vision and values driven by quality and safety. The trust board functioned effectively.
  • Without exception the Chief Executive was held in high regard by staff for her visible, open approach.

We saw several areas of outstanding practice including:

  • We observed many examples of non-clinical staff supporting patients and saving lives in what were extremely difficult and stressful situations. Staff remained calm and gave callers confidence to deliver life-saving treatment.
  • The trust had introduced ‘change Wednesdays’ in the emergency operations centre (EOC) to avoid daily contact with staff about minor changes to policies and systems. Staff were confident any changes to policies or procedures would take place on the same day every week.
  • The trust were the best performing ambulance trust in England for the number of calls abandoned before answered.
  • A mental health triage car was available in Lincolnshire between 4pm and midnight, staffed by a paramedic and a registered mental health nurse from a mental health trust. They could assess the needs of the patient and provide appropriate care which in some cases avoided hospital admission or the use of a Section 136 detention under the Mental Health Act 1983.
  • The trust had a joint ambulance conveyance project working with six fire and rescue services in their region. This was the first service of its kind for an ambulance service nationally.
  • The trust, in partnership with six fire and rescue services across the region, had introduced a regional emergency first responder (EFR) scheme. This was the first regional service of its kind of an ambulance service nationally.
  • A project was in place to improve treatment for patients in acute heart failure. Crews had been issued with continuous positive airway pressure (CPAP) machines. The CPAP machine improves oxygen saturation levels in these patients.
  • Staff in patient transport services (PTS) had direct access to electronic information held by community services including GPs. This meant they could access up to date information about patients including their current medication.
  • The patient advice and liaison service had recruited existing patients to report to them about their planned journeys and experiences of patient transport services (PTS). They called this a ‘secret shopper’ programme.
  • Staff name badges included their name in braille to assist patients with visual impairment. Guide dogs were allowed to accompany visually impaired patients.
  • The Chief Executive was praised by all staff for her visible, open approach and her commitment to engaging staff face to face.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • Ensure staff report all appropriate incidents which are then appropriately and consistently investigated.
  • Ensure learning from incidents, investigations and complaints is shared with all staff.
  • Ensure all staff receive statutory and mandatory training.
  • Ensure all domestic, clinical and hazardous materials are managed in line with current legislation and guidance.
  • Ensure vehicle and equipment checks are carried out to the determined frequency.
  • Ensure there are sufficient emergency vehicles to safely meet demand.
  • Ensure medicines, including controlled drugs are stored and managed safely.
  • Ensure paper patient report forms are stored appropriately and securely in trust premises and in such a way on trust vehicles as to maintain patient confidentiality
  • Ensure there are sufficient numbers of staff with an appropriate skill mix to meet safety standards and national response targets.
  • Ensure arrangements to respond to emergencies and major incidents are practised and reviewed in line with current guidance and legislation.
  • Ensure response times meet the needs of patients by reaching national target times.
  • Ensure all staff receive appropriate non-mandatory training to enable them to carry out the duties they are employed for.
  • Ensure all staff receive an annual appraisal.
  • Ensure service level agreements are in place to monitor the quality of taxi service provision for patient transport services.

Professor Sir Mike Richards

Chief Inspector of Hospitals