Festimed Limited provides emergency and urgent care at events such as music festivals and marathons. It operates a mobile hospital department, providing day care only and transports patients to local NHS emergency departments when needed. We inspected the transportation of patients only as the other services provided by Festimed did not fall within the scope of registration under the Health and Social Care Act 2008. The service covered six events and undertook 45 emergency and urgent care patient journeys in the 12 months prior to the inspection.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 08 September 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 areas of good practice:

• There was an incident reporting process in place and staff knew how to report incidents.

• Ambulances were visibly clean and we saw cleaning schedules in place. We saw staff washing their hands and using hand-cleansing gel. There was sufficient personal protective equipment available in both of the ambulances we inspected on-site.

• There were systems in place to ensure that emergency vehicles were regularly serviced and that they had an MOT.

• Festimed employed a pharmacist who remained on site throughout any events. The pharmacist supported staff in all areas of medicines management.

• Staff kept an electronic log of patients who had accessed the service. Staff could add details to warn of any risks such as if a patient had a medical condition that staff needed to be aware of.

• The registered manager planned staffing levels and skill mix to ensure that patients received safe care and treatment at all times. Staff adhered to the most up to date guidelines and evidence based treatment when treating patients on site.

• The registered manager carried out local audits, when improvements were identified; the service provided specific training for staff.

• The registered manager provided staff with a comprehensive induction; staff completed the induction prior to attending an event.

• We received positive feedback from patients via CQC feedback cards. The cards enabled members of the public that had used the service to share their experience with us.

• We did not observe any direct care during the inspection but staff demonstrated an understanding of maintaining patient privacy, dignity and well-being.

• We saw examples of feedback letters and complaints investigation documentation and felt managers at Festimed dealt with complaints efficiently and in a timely manner.

• We saw and staff told us that the company’s registered manager was visible. The staff felt supported and that managers would go out of their way to resolve any issues.

• Regular clinical governance meetings took place. At the meetings the management team discussed matters of importance including risk.

• Managers actively sought feedback from patients and staff and used this information to identify how the service could improve. Staff told us they received feedback from managers when things went wrong.

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

• Some paramedics employed by the service were not trained to the required level 3 in safeguarding children and young people as stated in the safeguarding children and young people: roles competencies for health care staff intercollegiate document (2014).

• There was no clear policy in place for transporting children to hospital when a child’s own car seat was unavailable.

• There was no Mental Capacity Act, 2005 and deprivation of liberty safeguarding policies in place.

• We saw there were no complaint information leaflets or posters available on vehicles for patients who wished to raise concerns.

• There was no specific training provided for staff around learning disabilities.

Following this inspection, we told the provider that it should make other improvements to help the service improve. We also issued the provider with one requirement notice. Details are at the end of the report.

Heidi Smoult

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