Hospital Car Services is operated by Streamline (Kent) Limited. It provides a patient transport service.

The service uses wheelchair-adapted vehicles and saloon cars purchased and used solely for the purposes of providing patient transport services. All vehicles have livery branding. The service carries out pre-planned, non-urgent patient transport journeys only, such as transport to outpatient appointments. Non-clinical patient transport drivers with relevant training and competencies to carry out patient transport undertake all journeys. An NHS ambulance service commissions all the provider’s patient transport journeys.

We inspected this service using our comprehensive inspection methodology. We carried out this announced inspection on 6 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:

• Staff prided themselves on giving compassionate care to patients. Patient feedback we reviewed demonstrated a high level of patient satisfaction.

• The culture encouraged learning from incidents and complaints to drive continuous improvements. We saw examples of learning the service shared with staff, such as following incidents of inappropriate parking. Staff felt well supported by the management team and felt confident to raise concerns.

• The management team demonstrated an understanding of risks related to the service. Managers held and kept records of monthly governance meetings. This demonstrated ongoing oversight of quality and governance issues such as policies, risk management and human resources.

• All staff had undertaken mandatory training in key areas to provide them with the knowledge and skills they needed to do their jobs safely.

• We saw evidence the service had appropriate processes to keep vehicles roadworthy and meet legal requirements relating to vehicles. This included evidence of road tax, motor insurance and regular servicing and maintenance.

• The service had appropriate processes to ensure business continuity in a variety of business continuity incidents, such as loss of power or vehicle incidents.

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

• At the time of our visit, the provider transported small numbers of children under the age of 18. At this time, staff had completed level one safeguarding children training. This was not in line with the national intercollegiate guidance, which recommends all staff that have contact with children as part of their role undergo level two training. We raised this issue with the provider, who took action to arrange level two safeguarding children training for all drivers. The provider subsequently sent evidence they had booked face-to-face safeguarding children level two training sessions on 20 and 21 January 2018 for all drivers to ensure they met the national intercollegiate guidance.

• The service checked the presence of fire extinguishers on all vehicles daily and as part of their six-weekly “quality and compliance spot checks”. Although the fire extinguisher on the vehicle we inspected was in date, the provider did not have a system to obtain ongoing assurances all fire extinguishers were in date. Following our feedback, the provider planned to introduce this to their “quality and compliance spot check” audit tool.

• Although staff received an induction and drivers and managers were able to describe the process, there were no written induction records.This meant the provider might not have had assurances new staff received a consistent induction in all relevant areas.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve.

Amanda Stanford

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