Alexandra Private Ambulance Service is an independent ambulance service provider based in Cheadle, Cheshire. Alexandra Private Ambulance Service is registered to provide patient transport services. Alexandra Private Ambulance Service offers ambulance transport on an ‘as required’ basis and provides pre-planned transport. The service provides patient transport services to and from a private hospital as well as a repatriation service for people from the Isle of Man who require further inland medical treatment. Alexandra Private Ambulance Service collects these patients from a local airport.

We inspected this service using our comprehensive inspection methodology. We carried out a scheduled comprehensive inspection on 16 January 2018. The service had one registered base which we inspected.

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 was patient transport.

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:

• Staff were knowledgeable about how to report an incident and had access to incident reporting forms including while on the ambulances.
• The service ensured a minimum of two staff were allocated to each patient transfer depending on risk and need. The staffing levels and skill mix of the staff met the patients’ needs.
• The ambulance at the station and the ambulance station itself were visibly clean and systems were in place to ensure ambulances were well maintained.
• All equipment necessary to meet the various needs of patients was available.
• Services were planned and delivered in a way that met the needs of the local population. The service considered the needs of different people, such as bariatric patients or people whose first language was not English, and journeys were planned based upon their requirements.
• We observed good hand hygiene, and infection control processes.
• The service had a system for handling, managing and monitoring complaints and concerns.

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

• Although staff were aware of how and when to report incidents, a policy on incident reporting was not in place. Staff followed the incident policy for the local hospital where the service was based, but this process was not formalised.

• Records did not show that staff were up to date with training, to ensure they were able to carry out the duties they were employed to perform. The registered manager told us that staff attended some of the training provided by the local hospital where the service was based, however this was not formally recorded.

• The provider did not have robust safeguarding procedures and processes that made sure patients were protected. Not all staff were up to date with safeguarding training.

• The provider did not have systems and processes in place to implement the statutory obligations of Duty of Candour and ensure all staff are trained and understand it.

• The provider did not have records management or consent policies.
• Not all staff received an annual appraisal.

Ellen Armisted

Deputy Chief Inspector of Hospitals (North), on behalf of the Chief Inspector of Hospitals

We were told that the service provided patient transport to and from the Hospital as well as repatriation services for people who have been injured whilst out of the United Kingdom. A small amount of other work includes transporting people on admission to or discharge from care homes. The provider does not offer any “blue light” or emergency services. We saw that because the needs of the people using the service were stable and predictable, that the provider had matched many arrangements to this.

We were unable to speak with people who used the service due to the nature of the service provided. However we did speak to one of the organisations which commissions services from the provider. They told us that they were "absolutely satisfied" with the service provided and that the Alexandra Private Ambulance Service "works well with us". It was described as "operationally efficient".

When we inspected the Alexandra Private Ambulance Service it was clear from the description given by the person responsible that the service focussed on only one of the regulated activities - transport services, triage and medical advice provided remotely. The provider has told us that they are in the process of applying to the CQC for the removal of the other two regulated activities from their registration. We therefore inspected the service only in relation to transport services, triage and medical advice provided remotely.