Medic 1 Direct Ltd is a private ambulance service operated by Medic 1 Direct Ltd. The service provides first aid services for the public and staff at events across England including transporting patients to emergency departments.

This service is registered with the CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC, which relate to particular types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Medic 1 Direct Ltd provides services to patients taking part in or attending a sport or cultural event. These types of arrangements are exempt by law from CQC regulation. Therefore, at Medic 1 Direct Ltd, we did not inspect the services provided to patients taking part in or attending a sport or cultural event. However, providers are required to register with CQC if they transport patients off the event site to the local hospital. Medic 1 Direct Ltd had transported 10 patients to hospital from an event site within 12 months prior to inspection.

We inspected this service using our comprehensive inspection methodology. The Care Quality Commission does not have any regulatory powers in Wales; therefore, this was a partial inspection of the service. The provider’s headquarters is in Wales but the regulated activity is carried out within England.

We inspected the provider’s only location in Canterbury, Kent, which is a non-operational administrative base. We carried out the announced part of the inspection on 9 January 2018. There were two members of staff present at the inspection, the registered manager and the senior administrator.

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 followed infection prevention and control procedures to reduce the spread of infection to patients.
• Staff completed extensive training in a range of clinical skills and theory to enable them to undertake their roles.
• The service carried out comprehensive risk assessments prior to each event and liaised with local services.
• Staff within the service had completed training to assist with meeting the needs of individuals including patients living with dementia and learning disabilities.
• The service encouraged feedback from patients.
• Staff felt supported by the managers of the service and said the managers were always available to discuss concerns.
• The recruitment procedure ensured patients were safeguarded against unsuitable staff.

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

• There was a lack of incident reporting which suggested staff were not able to identify incidents.
• Senior management lacked understanding of the duty of candour and there was no policy for the duty of candour.
• The service did not record informal training, observations or spot checks.
• The wording in the adult safeguarding policy required amending to make it easier to read.
• The service had a patient feedback form, but there was a lack of information available to patients and their families regarding raising a formal complaint.
• Patient record forms were not always fully completed.
• Staff did not have access to translation services.
• Audits were not undertaken and therefore learning did not take place from review of procedures and practice.
• The organisational risk register was incomplete as it did not rate the risks or contain any actions taken to mitigate the identified risks.

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 three requirement notices that affected urgent and emergency services. Details are at the end of the report.

Amanda Stanford

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