Aero Medical Ambulance Service is operated by Mind and Behaviour Limited. The service provides patient transport and is an independent provider of emergency and non-emergency private ambulances. The services covered include the repatriation of people from overseas, short and long distance ambulance journeys within the greater London and surrounding area.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 28 February 2017.

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.

Services we do not rate

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• The service had processes and systems in place to keep patients and staff safe from avoidable harm. This included a process for reporting incidents, effective cleaning regimes, and appropriate maintenance of equipment.
• There was a safety culture surrounding the management of medicines, with a medical director taking ownership of the process. Medicines were stored, administered, and disposed of appropriately.
• Patient records had detailed risk assessments and were found to be legible. Identifiable information was stored securely. The service was registered with the Information Commissioner’s Office.
• Staff completed training appropriate to their roles and responsibilities.
• The service worked collaboratively with local healthcare providers and individual patients to provide a safe transfer between locations. Transfers were bespoke to the individual’s needs and the service was able to facilitate the transfer of patients with additional needs, such as patients living with a dementia, registered blind and bariatric.
• Local policies and guidance were largely based on national guidance and recommendations.
• The service used a template to record all relevant patient information for transfer and event bookings. This ensured that all staff were aware of the details of the service being provided. Copies of the information was shared with the patients.
• The service had systems in place to ensure staff competence prior to completing any roles. Bank and agency staff completed a service induction programme and worked alongside the manager who would identify any learning needs.
• Staff had completed Mental Capacity Act training and were aware of their roles and responsibilities in ensuring consent and escalating concerns.
• Facilities were appropriate to the needs of the service. Ambulances were secure.
• The registered manager had the appropriate skills and experience to manage the business, and was supported by clinical experts to provide a safe service.
• The service had a clear vision for development. This included the introduction of a quality assurance framework and quality dashboard.
• The service had a risk register, which was descriptive and detailed actual and potential risks.

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

• To consider keeping a formal vehicle maintenance log:  however, we found that there was evidence to support that all necessary maintenance was completed when it was required.
• The service did not have a major incident policy or plan.
• A small number of policies were not dated with the year of writing nor had a date for next review.

• Due to the small size of the service, there was no formal audit process or audit calendar in place but we saw evidence of equipment and checks carried out when required.

• Due to the small size of the service, it did not formally record any details of one to one discussions, coaching or mentoring sessions. The service was in the process of transferring to an electronic management system, which would facilitate this process.
• Due to the small size of the service, there was a limited governance system but there was evidence of an audit trail of email discussions about quality improvement.
• Due to the specific nature and small size of the service, it did not have any key performance indicators and did not routinely monitor performance, although it did capture patient feedback through questionnaires.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Edward Baker

Deputy Chief Inspector of Hospitals (Central Region)

Professor Sir Mike Richards

Chief Inspector of Hospitals

Due to the nature of the service, we were unable to speak with people using the service or the staff. However, the provider had sent out survey questionnaires to the clients after each journey. Although not all the clients had responded, the ones who did had given positive feedback about the care and service provided.

The manager stated that ambulance crew were deployed as required through a recruitment agency. We were told that regular agency staff had been used. The manager said that when an agency staff such as a nurse, doctor or driver was required, their identity, training certificates and vetting documents had been checked each time before they carried out their role. This had ensured that people received safe care from experienced and competent staff.

Due to the nature of the service, we were not able to speak to people who used the service.

Due to the nature of the service, we were unable to speak with people who used the service or the staff when we inspected. However, the provider had sent out survey questionnaires to the people that had used the service after each journey. Although not all people had responded, three users had given recent positive feedback about the care and service provided. One of the comments we saw said ‘Exceptional care and confidence. I would definitely recommend them’.

The manager told us that ambulance crew were deployed as required through a recruitment agency and that regular agency staff were used. We saw that the service had carried out checks on the identity, professional accreditation and training for the doctors, nurses and drivers that had been used. There were systems in place so that people received safe and appropriate care from experienced and competent staff. The service had two vehicles in operation at the time of our visit.

The service had appropriate procedures and systems in place to ensure that people who used the service for longer journeys were not at risk of malnutrition as vehicles carried appropriate food and drink as required based on people’s individual needs. The service had appropriate and safe systems in place for the handling of medicines.

There were effective systems in place to monitor the quality of the service and sought feedback from the people who used the service.