Falck Medical Services Ltd (Bow) is operated by Falck Medical Services Ltd. The organisation provides emergency and urgent care, including the transportation of high dependency patients, and non-emergency patient transport services, together with a call centre and control room. It provides transport services for adults and children. The service has been registered to provide transport services, triage and medical advice provided remotely since 2011.

Emergency and urgent care covers the assessment, treatment and care of patients at the scene by ambulance crews with transport to hospital. It includes high dependency and intensive care transport between hospitals or other care settings. Patient transport services (PTS) are the non-urgent and non-specialist services that transport patients between hospitals, home and other places such as care homes.

The main service provided by this independent ambulance provider was emergency and urgent care, but non-emergency patient transport represented a similar proportion of work. We have prepared reports for each service. However, where our findings on emergency and urgent care also apply to patient transport services, for example, management arrangements, we do not repeat the information but cross refer to the emergency and urgent care section of the report.

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 across urgent and emergency care (First Response) and patient transport services (PTS):

• There was a good overall safety performance and good compliance with cleanliness, infection control and hygiene standards and vehicle and equipment maintenance.
• There were effective safeguarding processes and 100% of staff were up to date in safeguarding training. There was a dedicated safeguarding ‘hotline’ for staff to seek advice and guidance.
• There was good completion of mandatory training amongst all staff groups.
• The organisation had a detailed business continuity plan and clear processes to respond to emergency incidents.
• Ambulance crews kept up to date with national guidelines and good practice and staff demonstrated this in the application of evidence-based practice.
• First Response performance was generally good and targets were being met.
• Staff told us the organisation supported them in their development and progression.
• Staff demonstrated a caring and compassionate approach. They communicated in a polite and professional manner and maintained patient dignity.
• Ambulance staff received training in the care and transportation of patients with specific individual needs, including those living with dementia or learning disabilities.
• There were examples of very good involvement of patients to develop services that met their needs.
• There was a dedicated patient experience team which responded to complaints and concerns.

• Senior leaders understood their challenges and vulnerabilities but also recognised their organisational strengths. Managers and the senior leadership team were visible and accessible. Staff told us there was a good team spirit.

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

• No staff had received a formal documented appraisal since August 2016.
• Some staff did not understand the term Duty of Candour.
• There were challenges with the recruitment and retention of staff and this resulted in high levels of vacancies in First Response and PTS services.
• Feedback from partner NHS trusts was that the PTS service generally delivered an effective service, but there were concerns about frequent delays with arrivals and pickups.
• Some staff were unclear when to request a patient chaperone or escort.
• The organisation did not have robust systems to collect and use patient feedback.
• Governance processes did not always facilitate the timely mitigation of some long-standing concerns, risks and issues.
• There were some concerns around staff engagement and ensuring that all staff felt respected and recognised for their work.

Following this inspection, we told the provider that it must take action 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 issued the provider with one requirement notice that affected both core services. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (London and South East), on behalf of the Chief Inspector of Hospitals

People who used the service were given appropriate information regarding their care or treatment. Information taken from and given to people by the transport booking staff was comprehensive and included the person’s health care conditions, mobility needs and any possible complications or known risks. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Information given to the transport staff was sufficiently detailed and included appropriate risk assessments. Staff said they reported to their line manager any concerns regarding a patient’s safety or care.

Arrangements were in place to protect people from the use of unsuitable or unsafe equipment. Each vehicle had a checklist which detailed all equipment carried and the checks staff were required to make each day. Equipment such as oxygen and health monitors were stored safely and in a clean environment.

Equipment was disposed of appropriately when no longer in use.

Not all staff received appropriate professional development. Although we were told that all staff had an annual appraisal, the four we requested to see were not available for inspection. Some staff told us they received formal supervision and some met with their line manager informally. However, most said they did not have any supervision.

There was evidence that a comprehensive quality monitoring system was in place. The registered manager undertook audits or received information relating to the monitoring of all aspects of the service on a monthly basis.

The staff spoken to on the day of the inspection visit appeared confident and knowledgeable.

The provider was able to demonstrate that consent to care was usually sought before support or care was offered/given. People that used the service told us that they did not recall being asked for their consent however they did not have any concerns or complaints about the care they received.

Staff said they felt supported and were confident they had been given the right training to do their job.