Advance Medical Transport Services Limited is operated by Advance Medical Transport Services Limited. They are an independent medical transport provider based in Chatham, Kent. The service provides patient transport and high dependency transfers.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection 3rd December 2018.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this service is patient transport service.

We found the following areas of good practice:

• There was a system to ensure all incidents were recorded and monitored, with learning and outcomes shared with staff.
• Staff followed infection prevention and control procedures to reduce the spread of infection to patients. We found all vehicles were in good condition, well maintained and visibly clean and tidy.
• Journeys were planned and considered patient safety by using information provided at the time of booking.
• Records were clear, accurate and up to date.
• Patients were cared for and staff were respectful to patients.
• The service had a system for handling and managing complaints and concerns.
• There was a positive culture within the organisation and leaders were approachable.

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

• Staff understood their safeguarding responsibilities and what constituted abuse but staff records did not tell us if they were trained to the correct level for safeguarding children and adults. However, action was taken by the provider to improve training records after the inspection.
• There was no risk register for the organisation or system to ensure the effective oversight of the potential risks to the service and there was no governance framework for quality assurance.
• There were no audit processes which meant there was no way of checking protocols were being followed.
• There was no policy for managing the use of medical gases or how to manage deteriorating patients. However, the provider issued a policy that detailed how to manage deteriorating patients after the inspection.
• Policies and procedures were not always tailored to the company or dated, given a version number or date for renewal.

• The service did not assess staff competence and relied on the fact staff worked elsewhere within the NHS or for other providers. There were no staff appraisals or monitoring to assess how well they were performing within their roles.
• Paper copies were kept of incidents and risk assessments but there was no log or reporting tool to show trend analysis to prevent recurrence.
• Consent or Mental Capacity Act training was not included in the e-learning package nor was it on the checklist of skills that staff must have.
• There was no provision on ambulances to support people who were unable to communicate verbally or if English was not their first language.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected this patient transport service. Details are at the end of the report.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals (South East), on behalf of the Chief Inspector of Hospitals