This report describes our judgement of the quality of care at this location. We based it on a combination of what we found when we inspected and from all information available to us, including information given to us from people who use the service, the public and other organisations.

Medical Response Services is an independent ambulance service provider based in Wigan, Lancashire. Medical Response Services is registered to provide patient transport services. Medical Response Services offers ambulance transport on an ‘as required’ basis and provides pre-planned transport. The service provides services on request from local NHS ambulance trust and Clinical Commissioning Groups.

The patient transfers included patients detained under sections of the Mental Health Act 1983 going to or from mental health units.

We inspected this service using our comprehensive inspection methodology. We carried out a scheduled comprehensive inspection on 14 November 2017. The service had one base which we inspected.

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.

The main service provided by this service was patient transport.

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 issues that the service provider need to improve:

• Although there were processes in place for reporting incidents, staff did not receive feedback and shared learning to prevent them from occurring again and to ensure the safety of people using the service.
• Staff did not receive the appropriate training, to enable them to carry out the duties they were employed to perform.
• The provider did not have robust safeguarding procedures and processes that made sure patients were protected. Staff did not receive safeguarding training that was relevant and at a suitable level for their role. We found no evidence that it was updated at appropriate intervals and enabled them to recognise different types of abuse and the ways they could report concerns.
• The provider did not ensure that staff had completed pre-employment checks completed prior to undertaking employment including fit and proper persons assessments for directors.
• Although, the provider had a duty of candour policy in place and were open and transparent, staff did not receive training in the duty of candour.
• We did not find robust systems to assess monitor and improve the quality and safety of the services provided.
• We found concerns regarding the governance and strategic risk management processes of the service. There were no effective governance arrangements in place to evaluate the quality of the service or to improve delivery.

• There was no formal risk register in place at the time of the inspection and therefore we had no assurance that risks were being tracked, managed or mitigated.

• A vision and strategy for the service had not been developed.

However, we found the following areas of good practice:

• Staff were knowledgeable about how to report an incident and had access to incident reporting forms including whilst on ambulances. We saw evidence and examples of incident reporting.
• The service ensured a minimum of two staff were allocated to each patient transfer depending on risk and need. The staffing levels and skill mix of the staff met the patients’ needs.
• All vehicles and the ambulance station were visibly clean and systems were in place to ensure vehicles were well maintained.
• All equipment necessary to meet the various needs of patients was available.
• Services were planned and delivered in a way that met the needs of the local population. The service took into account the needs of different people, such as bariatric patients or people whose first language was not English, and journeys were planned based upon their requirements.
• We observed good hand hygiene, and infection control processes.
• The service had a system for handling, managing and monitoring complaints and concerns.

Ellen Armistead

Deputy Chief Inspector of Hospitals 

(North), on behalf of the Chief Inspector of Hospitals

Our visit was carried out in response to information we had received. We visited to check that the service was continuing to meet the essential standards of quality and safety.

On this occasion we did not speak to people about the service. The service does not provide support to a regular core of individuals who we could refer to.

During our visit we saw that systems were in place to identify people’s needs and wishes to help ensure that individuals were transported safely.

Systems were in place to help ensure that equipment in use was clean and suitably maintained.

On this occasion we did not speak to people about the service. This service does not provide support to a regular core of individuals who we could refer to.

We found that systems were in place to identify people’s needs and wishes to ensure that they were transported in a manner that protected their health and welfare.

Equipment in use was clean and maintained.

We saw that improvements had been made to the services recruitment procedures and the support staff received to carry out their role.

On this occasion we did not speak to people about the service. This service does not provide support to a regular core of individuals who we could refer to.

We found that the service had procedure in place for ascertaining people’s consent to treatment.

Systems were in place to identify people’s needs to ensure that they were transported in a manner that protected their health and welfare.

We found that people’s personal records were managed in a manner that protected their personal information.

We found that improvements were needed on what checks were carried out on newly recruited staff prior to them starting their role. In addition, staff employed by the service need to have the opportunity to discuss their role on a regular basis with their manager.