Emergency Medical Services (UK) Limited is operated by Emergency Medical Services (UK) Limited. The service provides emergency and urgent care and a patient transport service.
We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 28th to 30th March 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.
The main service provided by this ambulance service was urgent and emergency care. This was sub-contracted from two local NHS ambulance trusts. A patient transport service was in place; however, there were no contracts to provide this service. At the time of the inspection this service was provided on an ad-hoc basis to the local hospitals. The same staff were used for both services therefore, both services are reflected in the main service section of urgent and emergency care.
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.
There was a genuinely open culture in which all safety concerns raised by staff, people who use services and from the NHS Trusts from which the service sub-contracts, are highly valued as integral to learning and improvement.
Robust investigations were carried out. Feedback and lessons learnt because of incidents were shared amongst staff.
There were reliable systems in place to prevent and protect people from health-care associated infections. Infection prevention and control procedures were embedded.
Equipment and vehicles were well maintained.
Medicines were stored and handled appropriately and regular audits took place. Patient group directions were in place and all were signed and in date.
Safeguarding vulnerable adults, children and young people was given sufficient priority.
Record keeping was in line with best practice. Records were stored confidentially and an audit of all the patient report forms allowed the management team to benchmark and ensure that staff were following the correct care and treatment for patients. The management team would feedback any underperformance to the crews and take appropriate action.
Staff were aware how to detect and respond to deteriorating patients and followed national guidelines. A national early warning score was used to detect early deterioration. Crews could access advice and support from a clinical hub at the NHS Trust from whom the service sub-contacts.
Staffing was managed by a resource manager. All shifts were able to be covered. Shift patterns were in line with the working time directives.
The service had a proven track record in the management of first on scene at a major incident and exercising their business continuity plan.
A range of pathways were used that complied with the National Institute for Health and Care Excellence (NICE) guidelines and the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines. These pathways were from the NHS Trust from whom the service sub-contracts.
An audit of patient report forms captured if the pathways were followed correctly and we saw evidence of learning when this was not the case.
Key performance indicators were audited and results were excellent.
Patients had their needs assessed and their care provided in line with evidence based practice
Response times were in line with the NHS Trusts from which the service sub-contracted. If the service did not meet the response times then the NHS provider would contact the management team who would investigate.
Training and education was high priority and a strong focus for the service. The service worked in close collaboration with their sister training and education organisation. They provided training programmes for the emergency care assistant and ambulance technician roles and supported their staff through these programmes.
The continued development of staff skills, competence and knowledge was recognised as being integral to ensuring high quality care. Staff were proactively supported to acquire new skills.
The service was committed to working collaboratively and had taken part in joint training sessions with the fire and rescue services and the mountain rescue teams.
The NHS ambulance services and hospital staff we spoke with reported good working relationships with the service.
Various means of communication was used to enable staff to access information, these included newsletters, and email.
Consent to care and treatment was obtained in line with legislation and guidance, including the Mental Capacity Act 2005 and the Children’s Acts 1989 and 2004. People were supported to make decisions and their mental capacity assessed and recorded on the patient report form.
Feedback from people who used the services was consistently positive about the way staff treated people.
There was a strong person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity.
Staff were respectful and showed a caring attitude to relatives and carers travelling with the patients.
Staff explained to the patients what each observation, treatment was for, and why they were performing the checks.
The service was planned and delivered in a way that met the needs of the NHS Trusts from which the service sub-contracted.
The service worked with the NHS ambulance services to support them to meet patient demand for the service
Patients’ individual needs were managed and staff had received training to care for patients with dementia and learning disabilities.
Translation services were available.
Complaints were managed and investigated thoroughly and feedback and training was given to staff.
The leadership strived for continuous improvement. There was a clear proactive approach to seeking out and embedding new and more sustained models of care and governance processes.
Leadership was strong, open, honest and supportive.
The leadership was knowledgeable about quality issues and priorities, understood what the challenges were and took action to address them. Performance information was used to hold staff to account.
There was a clear vision and strategy, driven by quality and safety.
Staff understood the vision, values and strategic goals.
All staff prioritised safe, high quality, compassionate care and there was a culture of collective responsibility between all staff.
The information used in reporting, performance management, and delivering quality care was accurate, valid, timely and relevant.
There was effective and comprehensive processes in place to identify, understand, monitor and address current and future risks. Audit processes functioned well and had a positive impact in relation to quality governance, with clear evidence of action to resolve concerns.
Information and analysis was used proactively to identify opportunities to drive improvements in care. Service developments and efficiency changes were developed and assessed to understand their impact on the quality of care. The impact on quality and financial sustainability was monitored effectively.
Financial pressures were managed so that they did not compromise the quality of care. However, we also found the following areas that the service provider needed to improve:
Sharps bins were not signed and dated
The audit of medicines did take place and the variance was discussed at the management risk meeting however, any variance needed further investigation
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. Details are at the end of the report.
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