The East of England Ambulance Service NHS Trust (EEAST) is one of 10 ambulance trusts in England providing emergency medical services to Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk; an area which has a population of around 6 million people over 7500 square miles. The trust employs around 4000 staff and 1500 volunteers who are based at more than 130 sites including ambulance stations, emergency operations centres (EOCS) and support offices across the East of England.

The main role of EEAST is to respond to emergency 999 calls, 24 hours a day, 365 days a year. 999 calls are received by the emergency operation centres (EOC), where clinical advice is provided and emergency vehicles are dispatched if required. Other services provided by EEAST include patient transport services (PTS) for non-emergency patients between community provider locations or their home address and resilience services which includes the Hazardous Area Response Team (HART).

Every day EEAST receives around 2600 calls from members of the public dialling 999. The service provided by EEAST is commissioned by 19 separate Clinical Commissioning Groups with one of these taking the role as co-ordinating commissioner.

Our announced inspection of EEAST took place between 4th and 8th April 2016 with unannounced inspections on 19th April 2016. We carried out this inspection as part of the CQC’s comprehensive inspection programme.

We inspected three core services:

• Emergency Operations Centres

• Urgent and Emergency Care including the Hazardous Area Response Team (HART).

• Patient Transport Services

Our key findings were as follows:

• The trust was under significant pressure and was failing to meet performance standards and targets for response to emergency calls.
• The chief executive had been in post for approximately 7 months and was developing new models of care and new strategies to address performance and recruitment concerns. These were yet to reach fruition.
• Resources were frequently unavailable as they were unable to hand over patients to acute providers in a timely way. This occurred throughout or inspection.
• There was ongoing significant issues in recruitment of paramedics across the trust with particular ‘hotspots’ in certain areas including Norfolk and Cambridgeshire.
• The trust had identified new models of workforce development and new roles to support the service. This was in the process of consultation and implementation during our inspection.
• There was variation across the trust in many areas including governance, medicines management and infection control.
• The emergency operations centres were recruiting clinical staff into ‘clinical hubs’ to dramatically improve the number of patients treated over the telephone or signposted to more appropriate services.
• All staff were passionate about providing the best possible service to patients. We consistently observed staff to be caring and compassionate and concerned for the welfare of patients.
• There were low levels of mandatory training and many staff were not equipped with the skills to care for people living with dementia and mental health problems and a poor knowledge of the Mental Capacity Act 2005.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

• Improve performance and response times for emergency calls.
• Ensure that there are adequate numbers of suitable skilled and qualified staff to provide safe care and treatment
• Ensure staff are appropriately mentored and supported to carry out their role including appraisals.
• Ensure staff complete mandatory training (professional updates).
• Ensure that incidents are reported consistently and learning fed back to staff.
• Ensure that all staff are aware of safeguarding procedures and there is a consistent approach to reporting safeguarding.
• Ensure that medicines management is consistent across the trust and that controlled medicines are stored and managed according to regulation and legislation.
• Ensure that all vehicles and equipment are appropriately cleaned and maintained.
• Ensure all staff are aware of their responsibilities under legislation including the Mental Capacity Act 2005.
• Ensure all staff are aware of their responsibility under Duty of Candour requirements.
• Ensure records are stored securely on vehicles.

In addition the trust should:

• The trust should consider how all risks associated with PTS can be captured and reviewed on the risk register.
• The trust should improve the numbers of patients offered hear and treat services.

Professor Sir Mike Richards

Chief Inspector of Hospitals