Delta Medical Service Limited is an independent ambulance service with one location in Maidstone, Kent and primarily serves the communities of Kent and Essex. The service provides general, cardiac and secure patient transport services including transfers between hospitals, outpatient services, GPs, other medical providers, services users’ residences, and with regard to secure transport only, secure units and courts. We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 6 February 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.

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 some systems, processes and practices to ensure standards of cleanliness and hygiene were maintained. The ambulances we reviewed were visibly clean, had been deep cleaned on a regular basis and had vehicle control books.

• Staffing levels and skills mixes were planned so patients received the right level of care. The service used operational employees and bank staff to fulfil staffing demands.

• Staff gave examples of providing compassionate care to patents. This was supported by patient feedback.

• All staff we spoke to reflect a passion for the service and commitment to quality.

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

• Governance: The service lacked clear governance or reporting structure. Executive team job roles, individual responsibilities and organisational structure were not clearly defined.

• Policies: There were inadequate policies and procedures available to support evidence-based care and treatment. There was no system to ensure the policies which were available contained the most up to date and relevant information. Not all polices were dated or version controlled. Protocols were introduced into the service from other providers which were not applicable to the service’s structure.

• Incidents: While the service had an incident policy and incident forms available, we were not assured there was a culture of incident reporting within the service. The service had recorded no incidents in the year prior to inspection.

• Training: There was no system to ensure and monitor staff had up to date training. Staff files did not reflect that staff had completed mandatory training. Files did not reflect staff had had Mental Capacity Act and Mental Health Act training in line with policies.

• Safeguarding: The provider did not have processes to ensure staff (including the management and bank staff and the safeguarding lead) was trained to the appropriate level in line with guidance.

• Recruitment: The provider did not demonstrate a robust recruitment process. Staff files showed references were not routinely checked and Disclosure and Barring Service (DBS) checks were not in all staffing folders.

• Children and young people: The provider could not demonstrate that staff had the skills, experience and knowledge or competencies to care for children and young people, although they transported a small number of children and young people during the year prior to our inspection.

• Records: Booking forms and patient records were not always complete and did not always identify risks or include an assessment of risks when the information was present.

• Secure transport operations: The service had started providing secure transport in October 2017 but had not adopted or implemented an operational policy for secure transport.

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 patient transport services. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals London & South, on behalf of the Chief Inspector of Hospitals