ERS Medical East is an independent ambulance service in East Anglia operated by ERS Transition Ltd. The service primarily serves the communities in East Anglia. ERS Transition Ltd took over the services and became the registered provider with CQC in October 2017. The service is registered for patient transport service (PTS).

ERS Medical East primary service transports non-emergency patients within Norfolk, Suffolk and Essex. The service can transport patients detained under the Mental Health Act 2007 in a formal and informal context.

The service has had a registered manager in post since October 2017. At the time of the inspection, a temporary registered manager was registered with the CQC. A permanent registered manager had been appointed and their application was being processed.

We inspected this service using our next phase inspection methodology. We carried out a short notice announced inspection on 2 and 3 October 2018, followed by an unannounced inspection on 16 October 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? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

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 rate

We rated the service as good overall because:

• There were effective systems to monitor vehicles and equipment maintenance.

• There were systems in place to safeguard vulnerable adults and children. Staff could identify safeguarding concerns and knew how to report them.

• Policies and procedures were in line with national guidelines and were version controlled and within date. There was an audit programme in place to monitor compliance with policies and procedures.

• Staff received annual competency update training.

• Staff treated patients with dignity and respect. They were kind and caring. Staff told us that caring for their patients was the best part of their role.

• The service had good oversight of the booking process and monitored drop off and pick up times and kept patients informed about delays.

• There were systems of governance at management level to monitor performance and risk.

• The service had effective, integrated business management systems which gave them up to date information and oversight of the service.

However, we also found the following:

• Processes for incident reporting were not fully embedded. Staff described different processes for reporting incidents. Staff could not tell us how learning from incidents was shared. Some members of staff were unclear as to what constituted an incident.

• Staff had not received an annual appraisal.

• Staff did not always document on the patient record forms that verbal consent had been obtained.

• Staff did not have access to translation sheets for patients whose first language was not English. Staff did not have access to communication prompts for patients who were hearing or visually impaired.

• The process for shared learning from complaints was not embedded. Staff could not tell us how learning from complaints was shared.

• Staff felt that there was not effective communication between managers and staff, team meetings were not embedded. There was low morale amongst the staff and staff told us that they did not feel valued by managers.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals