British Red Cross Mitcham is operated by British Red Cross Society. The main service provided by British Red Cross Mitcham is events medical cover, which is outside the scope of regulation. However, they transport patients from event sites to local hospitals, which is in scope of our regulation.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 2 November 2017, along with an unannounced visit to an event where the service were providing healthcare on 4 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 issues areas of concern:

• Although safeguarding training was undertaken by staff and volunteers it did not meet the level of safeguarding training required by national guidance and there was no regular planned retraining. Therefore the provider could not show us staff or volunteers were kept up to date with how to recognise different types of abuse and ways they can report concerns.
• The system for managing and controlling confidential patient information was unsafe as staff and volunteers posted completed patient report forms through the royal mail postal system with no formalised or routine tracking.
• There was a risk that incidents were either not reported or not had their severity assessed, actions taken or learning documented.
• Medicines management did not always follow the provider policy which meant there was a risk of errors occurring. There was no Home Office licence at the time of the inspection for storage of the controlled drug diazepam; however an application was in progress.

• The were no robust DBS renewal process in place. The organisation did not comply with its own standards for DBS renewal and the majority of records we checked were past their DBS renewal date  and two people had not have an enhanced check completed.
• Ambulance crew volunteers received no formal clinical supervision or performance appraisal with the service and competency was only reassessed every three years.
• There was limited training and support in the assessment of mental capacity and actions to be undertaken if a patient presented with limited capacity. Volunteers were not confident in being able to explain what actions they would take if they did not have support from a healthcare professional at an event.

However, we also found the following areas of good practice:

• The provider had undertaken a large scale national restructure in response to identified risk of consistency of service quality across the country. Managers at the Mitcham location supported the changes to improve quality despite the challenges of implementing large scale change. There were many methods used to engage volunteers and receive their feedback.
• Despite the challenges for a service where a large proportion of the volunteer workforce worked remotely, the provider had a robust method of communicating clinical updates and learning through case studies. Volunteers were able to tell us about recent clinical updates and the multiple methods of communication used to pass on this information to them.
• Staff and volunteers followed evidence-based care and treatment and nationally recognised best practice guidance that was clearly colour coded to show what treatment could be carried out by different skill levels. In addition there was a robust system for ensuring that only volunteers with the required skill level were planned and assigned appropriately to an event.
• Patient feedback was collected using a survey. Although response rates were limited, it showed an overwhelmingly positive response about the care that patients received.
• Volunteers received training for psychosocial skills to support them in their communication with patients.

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 three requirement notices that affected emergency and urgent care. Details are at the end of the report.

Professor Ted Baker

Chief Inspector of Hospitals