Network Medical is operated by Network Medical Services Ltd. This service is registered with 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 types of service and these are set out in Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

CQC regulates the patient transport service and treatment of disease, disorder and injury service provided by Network Medical, which makes up approximately one per cent of the business. The other services provided are not regulated by CQC as they do not fall into the CQC scope of regulation. The areas of Network Medical that we do not regulate are occupational health services and event services. The service had not transported any children since it was opened in 2016.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 17 July 2018.

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 planned and carried this inspection out under our previous comprehensive methodology, before we had the legal duty to rate services.

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:

• Although the service had reported no incidents, no serious incidents and no never events, staff were aware of their roles and responsibilities to report, investigate and learn from incidents, offering apologies and explanations to patients in an open and transparent manner.
• Staff were up-to-date on mandatory training and there were systems in place to monitor staff compliance with mandatory training.
• Patients, planned journeys and events were risk assessed prior to completion. Templates were used to collect key information such as past medical history, any clinical risks, mobility issues, and equipment needs.
• Patient records were written and managed in line with good practice. We saw patient transport forms were accurate, complete, legible, and up-to-date. Staff had access to relevant information when needed.
• Policies and guidance were largely based on national guidance and recommendations.
• Patient transfers were delivered in a coordinated way with all other services involved.
• Staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005 (MCA).
• Patients were treated with compassion, in a respectful and dignified way. Patients and their relatives/carers were kept informed if there was likely to be any delay.
• The service effectively planned and delivered services based on patient needs.
• The service could facilitate the transfer of patients with additional needs, such as patients living with dementia.
• Effective procedures were in place to respond and learn from complaints.
• The service had a clear vision underpinned by strong patient-centred values.
• The service had an open and learning culture, fully focused on patient care. Stakeholders told us that the service was flexible, reliable, with professional and dedicated staff.
• The service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The service had a clear vision underpinned by strong patient-centred values.

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

• Infection prevention and control and environmental audits were not undertaken. This meant procedures and practice were not reviewed which meant opportunities to learn and improve were lost.
• There was not an effective governance process in place to provide oversight of medicines and disposable equipment checks.
• There was not an effective system in place to manage medicines as we found a variety of out of date medicines. We raised this with the registered manager who immediately removed the out of date medicines from use. Staff administered medicines, but had not received recognised training and we did not see clear evidence of their competency to enable them to administer these medicines. Temperatures where medicines were stored were not monitored or recorded. Therefore, we could not be assured medicines were stored at their recommended temperatures. We could not be assured of the efficacy of some medicines stored by the service.
• Staff administered life-saving medicines under patient group directions. We saw no evidence that staff had necessary the competencies to enable them safety administer these medicines to patients in their care.
• The provider did not ensure staff had the required authorisation to administer prescription-only medicines. Paramedics, nurses and technicians had access to several medicines they were lacked authorised to administer.
• The registered manager/safeguarding lead was not trained to level four safeguarding adults and children which was not in line with national guidance.
• A registered manager led the service who had most of the skills, knowledge, experience, and integrity they needed to ensure the service met patient needs.
• The service did not have an effective system in place to demonstrate risks had been identified and actions taken to mitigate risks. Risks found on inspection had not been recognised by the service. Audits were not planned so learning could not be used to drive improvements.
• Due to the small size of the service, it did not have any key performance indicators and did not routinely monitor performance beyond bookings taken. Governance systems were not established or effective. There were not effective systems in place to ensure policies were reviewed to reflect current guidance.

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 patient transport services. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region),

On behalf of the Chief Inspector of Hospitals