The Care Quality Commission (CQC) gave short notice of 48 hours to the provider of this inspection to ensure that the necessary senior staff were available to assist during the inspection.

A CQC inspector and a CQC specialist critical care advisor completed the inspection over one day. Due to the nature of the service provided we were only able to speak with one patient and relative about their experience of the service. They told us they were happy with the service and that they had been given all the relevant information about the planned transfer. We saw that during the transfer the patient and their relative were treated with dignity and respect by Capital Air staff. We saw that feedback from patients who used the service was consistently good, with the majority of patients rating the service they received as “excellent”.

We met with a variety of staff during the inspection, including the chief pilot and company representative, nursing staff and several operations staff. All staff were professional in their approach and demonstrated that they were skilled and competent in their respective roles.

Capital Air provided a variety of services for a diverse acuity of patient groups, predominately focusing upon intensive care or critically ill patient groups. We found patients experienced care, treatment and support that met their needs and protected their rights. There were effective systems in place to reduce the risk and spread of possible infection.

Patients were cared for by, suitably qualified, skilled and experienced staff. Patients were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service people received. Documentation evidence and observations demonstrated patient care and quality service was at the forefront of Capital Air Ambulance culture.

Capital Air Ambulance is an aeromedical transport service providing emergency and urgent care, run by Capital Air Ambulance Limited.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 12 December 2017, along with a further visit on 18 December 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:

• Incidents were investigated and actions were taken where appropriate.
• Medical equipment and aircrafts were regularly serviced, maintained and safe for use.
• Thorough risk assessments were carried out prior to missions taking place.
• Infection risks associated with patients were actively assessed to prevent and control the spread of infection.
• Patients’ individual care records were written and managed in a way which kept them safe. They were up to date, identified individual patients’ needs, detailed the individuals’ care needs and the treatment provided during the mission.
• Staffing levels and skill mix were planned according to the needs of the individual. This ensured patients received safe care and treatment.
• Care and treatment was based on nationally recognised guidance which had been tailored to meet the requirements of the aeromedical environment.
• Patients’ individual needs were assessed and planned to ensure they received the correct care and treatment to maintain their safety and wellbeing during the mission.
• The service monitored the quality of its response times for commissioned contracted work, against specified key performance indicators.
• Staff had the skills, knowledge and experience to deliver effective care and treatment and underwent bespoke professional development in aeromedical care and treatment.
• The service coordinated care and treatment with other providers to ensure the effectiveness of the mission.
• Information needed to deliver effective care was accessible to relevant staff in a timely way.
• Staff gained consent before providing care and treatment. They also knew how to make decisions in patients’ best interests when required.
• Feedback from people who used the service was consistently positive. Comments written by service users praised the medical and aviation staff for the way they treated people with dignity and respect.
• The service understood the importance of communicating with a patient’s next of kin and keeping them informed.
• Staff provided emotional support for patients during a time of high anxiety and uncertainty.
• The service worked closely with the commissioners for the contracted work to ensure services were planned and delivered to meet the needs of the patients.
• The office was staffed and operational 24 hours a day, seven days a week to fulfil the terms and conditions of the commissioned work.
• Some of the clinical staff were able to support the care and treatment of patients whose first language was not English.
• The governance framework supported the delivery of good quality care, although some processes needed to be formalised and carried out more regularly to identify areas where quality could be improved.
• The service maintained risk registers which were reviewed regularly to effectively monitor and manage risks to the service.
• Leaders were supportive and approachable, and staff felt valued.
• The service engaged with patients and stakeholders to receive feedback and identify areas for improvement.

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

• A small number of policies we reviewed not always based on the most current legislation and guidance.
• There was no formal system or process to track which members of staff had received an appraisal and not all staff who had carried out a specified number of missions had received a recent appraisal.
• There was no formal process to ensure the quality of the service provided by the preferred ground ambulance providers used to support missions.
• There was no formal programme of clinical or internal audit used to provide a clear oversight of the service to monitor quality to identify areas for improvement.

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 two requirement notices. Details are at the end of the report.

Amanda Stanford

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