Special Ambulance Transfer Service (SATS) provided patient transport services, repatriation services, event services and bariatric transport services for adults, children and babies. Staff had various qualifications ranging from First Person on Scene Intermediate to Registered Nurses with Intensive Care Experience. This ensured that the provider was able to deal with all forms of patient transport.

We were not able to speak to patients using the service on the days we visited. We were told by the provider that they consulted regularly with the hospital trust's transport department to obtain feedback on the service provided. Patients mobility needs were appropriately assessed and the transport provided promoted their safety, comfort and dignity.

Suitable arrangements were in place should a patient become unwell whilst they were being transported.

Patients were transported in a clean, hygienic environment. Appropriate protective equipment had been supplied to staff.

We looked at one ambulance used by the provider and found that these were appropriately equipped to promote the independence and comfort of patients. We were shown records that evidenced the equipment used in ambulances was regularly serviced and maintained.

We looked at a range of records maintained by the provider. We found that these records were relevant to the management of the service and were accurate and fit for purpose.

We found that there were enough qualified and experienced staff to meet patients needs.

We were not able to speak to people using the service because they were not present during the inspection. We gathered evidence of people’s experiences of the service by reviewing their feedback and talking to two of the hospitals and primary care trusts the service is contracted with.

We read a few comments by people, who gave satisfactory comments to questions about staff’s competency, integrity and general conduct. Their comments included, “very friendly and pleasant crew”, “very reassuring”, “excellent service and would recommend” and “absolutely great”.

This was affirmed by relevant hospitals, who commended the service for punctuality, professionalism, competency and excellence. Their comments included, “staff are fully trained to the level we require”, “patient care is excellent”, “response time is good and “constantly in touch with the operations manager, who is a phone call away”.

We were satisfied that patients’ privacy and dignity were respected. From reviewing patients’ comments and talking to staff, it was clear patients experienced effective, safe and appropriate care, treatment and support that met their needs and protected their rights. The familiarity of staff with safeguarding policy and relevant procedures along with appropriate management support structures, meant patients were protected from abuse.

The provider had systems to monitor the quality of the service, some of which we saw and were up to date.

We did not speak to people using the service on this occasion. We noted that the service gives people feedback forms which they can complete and return. The feedback we saw was positive about the service.

Special Ambulance Transfer Service (SATS) was founded in 2006 and is an independent ambulance service providing a range of different patient transport services based in north west London. This includes the transfer of high dependency and critical care patients, non-emergency transfers, repatriations and event medical cover such as sporting events.

The service has contracted work with both NHS and independent hospitals. Journeys are made to various locations within London and longer journeys occurred on a regular basis. The service also occasionally transfers patients from international European locations back to the UK. The service has vehicles operated by emergency care assistants, emergency medical technicians and nurses.

We carried out this inspection as part of our comprehensive independent health inspection programme. The announced inspection took place between the 13-14 July 2016.

We saw areas of good and outstanding practice including:

• Staff adhered to good infection prevention and control practice.
• Vehicles were maintained to a high level of cleanliness.
• There were good systems in place for checking drugs on ambulances.
• Patient record forms were stored appropriately and audited to ensure good completion by staff.
• There was good coordination with other providers.
• We saw staff treating and caring for patients with compassion, dignity and respect.
• Staff felt valued and proud to work for the service.
• Staff feedback was collected and used in service development.

However, there were also areas of poor practice where the service needs to make improvements:

• There was no formal documented log of all incidents and staff were unable to show us how to access the incident reporting form. Therefore, we was not assured all incidents were being reported.
• Staff were not trained to the recommended level of safeguarding training, as per national guidance.
• The safeguarding policy was out of date and did not include updated relevant national guidance.
• There were no hand hygiene audits.
• Oxygen canisters were not being stored appropriately, which put people at risk.
• Medications were not stored appropriately.
• Some equipment was not safety checked and maintained.
• Staff had no training in information governance.
• We saw no evidence of early warning scores being used during the transportation of patients.

• We found limited evidence that complaints and low level concerns were being documented.

Importantly, the service must ensure:

• Staff are appropriately trained in safeguarding adults and children. All staff should be trained to level two in safeguarding and the safeguarding lead should be trained to level four. The service needs to establish systems and processes to effectively respond to any safeguarding concerns raised and prevent abuse and improper treatment of service users.

• The safeguarding policy is up to date and incorporates relevant national guidance.

• Oxygen and medications are stored safely and securely and do not pose a risk to others.

• All staff receive information governance training.

• All staff receive training on duty of candour and understand their role with regards to the regulation. Duty of candour must be incorporated into the serious incident investigation process.

• Equipment is serviced and safety checked on a regular basis and staff know how to check equipment appropriately.

• That any serious incidents are appropriately investigated and the duty of candour is applied. The manager will need to ensure a written record is kept, investigation reports are documented and patients receive a written apology.

In addition, the provider should ensure:

• The incident reporting policy is adhered to and a log is kept of incidents reported in order to identify themes and appropriate learning identified.

• Early warning scores are used to assess for deteriorating patients during journeys.

• All staff have a Disclosure and Barring Service (DBS) check completed by the service to ensure staff are suitable to work with vulnerable people.

• They establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints by service users. Any complaints received must be investigated and necessary and proportionate action taken. The service should ensure responses to complaints are recorded.

The above list is not exhaustive and the service should examine the report in detail to identify all opportunities for improvement when determining its improvement action plan.

Professor Sir Mike Richards

Chief Inspector of Hospitals