Ambulance Transfers (Essex) is operated by Ambulance Transfers Limited. The service provides a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 7 November 2017at the service’s station in West Thurrock along with an unannounced visit to the same station on 13 November 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:

• We saw evidence of good infection prevention and control, including vehicle deep cleaning processes.

• Vehicles were all up to date with servicing, tax and MOT requirements.

• There was sufficient equipment both in the station and on vehicles. All equipment we saw was stored appropriately and within its service date. There was an equipment audit to monitor this.

• Vehicles were checked daily and these checks were documented prior to staff starting their shifts. This ensured that vehicles were safe for staff to use.

• Each ambulance vehicle had a patient report form (PRF) which was a record of pick up and drop off times. We saw evidence of this clearly documented.

• Staff showed a good understanding of safeguarding and how to report concerns. The safeguarding investigation we reviewed was comprehensive and appropriate.

• Staff gave examples when they had dealt with patients who were known to have disturbed or aggressive behaviour, or present specific risks, in a safe way.

• Staffing levels and skill mix was appropriate to meet the needs of patients.

• The service had an up to date business continuity plan in place.

• Staff all received a comprehensive local induction and felt they had the necessary support and competencies to carry out their roles.

• All staff consistently displayed a caring and patient-focused approach to their work and this was reflected in patient feedback.

• Services were planned and delivered to meet the needs of the local population.

• There was evidence of staff meeting patients’ individual needs; for example, describing clearly to a patient living with dementia how they were going to move them and checking that he agreed to this before moving the patient.

• The service had a clear vision and strategy, which was highly patient-focused and which staff shared.

• Managers had an understanding and oversight of risks in their service.

• There was a positive and team-based culture and staff wellbeing was a key focus. Service leads told us how they had focused on integrating new recruits into the team and making them feel welcome during a recent period of growth and transition for the service.

• Staff consistently told us that managers were approachable and visible.

• There were development opportunities available for staff who wished to progress.

• There was evidence of innovation, including a new adapted vehicle design for more effective patient transport experience; and close working with local job centres as part of a recruitment drive.

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

• Incident reports were not being collated to identify themes and trends in order to effectively monitor and reduce incidents, although we were assured the service was going to address this. Service managers still showed effective oversight of incidents.

• All staff we spoke with were aware of their responsibilities to raise concerns to record incidents and could give examples of this. However, there were no systems to ensure feedback and learning from incidents was shared with all staff.

• The service did not have a clinical dashboard (or equivalent) to provide an overall picture of safety and quality in the service.

• There were no formal systems to ensure updates to policy and best practice were consistently shared with staff.

• The service did not have a comprehensive local audit schedule, although there were individual audits around infection prevention and control (IPC) and vehicles; and key performance indicators (KPIs) and patient feedback were being closely monitored.

• Staff were not all receiving annual appraisals, although the service was in the process of addressing this.

• The complaints monitoring system did not provide sufficient detail for clarity and to ensure there was learning where appropriate.

• The risk register did not specify a specific risk in relation to the mobilisation of the new contracts, which had significantly increased the service’s workload, although it was otherwise comprehensive and well monitored.

• Meetings were not being minuted at the time of inspection, although managers subsequently formalised their monthly meeting schedule to include individual monthly meetings for the board; operations; risk management; and clinical governance and policy review.

Following our 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 two requirement notices that affected patient transport services. Details are at the end of the report.

Professor Edward Baker

Chief Inspector of Hospitals