North West Private Ambulance Liaison Services is operated by North West Private Ambulance Liaison Services Ltd providing mainly patient transport services.

We inspected this service using our comprehensive inspection methodology. We carried out an announced inspection on 10 and 11 July 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 issues that the service provider needs to improve;

• We found that although staff had an understanding of the need to report incidents, incidents were not always reported in a timely manner and all possible eventualities were not always considered when an investigation had taken place. This meant that potential opportunities for learning had been missed.

• The service did not have an effective system in place to identify, mitigate and control clinical and non-clinical risks. The management team were able to identify a limited number of risks, however, there was insufficient evidence to show that all potential risks had been identified.

• There were a number of policies and procedures in place that were available to staff. However, we found examples of policies that were not available including medicines management, records as well as mental capacity, consent and best interest. This meant that staff did not have guidance to support them in these areas.

• The service had not provided safeguarding level 3 to staff providing direct care and treatment to children. In addition, the identified safeguarding lead had not completed level 4 training for children. This was not in line with the Intercollegiate Document, 2014.

• The service did not complete up to date competency checks for registered nurses and paramedics who were employed by the service.

• There was a recruitment policy in place. However, the service had not undertaken risk assessments for staff that had convictions listed on their enhanced disclosure and barring service check to assess their suitability for completing their role.

• The service had not undertaken all checks that were required for directors in line with the fit and proper persons requirement.

However, we also found the following areas of good practice;

• Staff were committed to providing the best quality care to patients. Staff showed a caring and compassionate nature as well as being proud of their role.

• The management team operated a comprehensive system to make sure that all vehicles and equipment were fit for purpose.

• We found that all vehicles were in good condition and that they were visibly clean and tidy. The service had contracted an external provider to complete deep cleans. They used swabbing to make sure that vehicles had been cleaned thoroughly.

• We found that a sufficient number of staff had been deployed in order to care for patients safely.

• The service had a comprehensive induction training package for new staff. This included making sure that they had a minimum of 150 hours working alongside a more experienced member of staff.

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 six requirement notices that affected patient transport services. Details of these are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region), on behalf of the Chief Inspector of Hospitals.