St John Ambulance West Midlands Region is part of St John Ambulance, a national first aid charity. St John Ambulance provides a number of services including first aid at events, emergency and non-emergency patient transport services and first aid training. The objective of the organisation nationally is the relief of sickness and the protection and preservation of public health. Both volunteers and employed staff are involved with the services provided by St John Ambulance.

We inspected St John Ambulance West Midlands Region on 22 and 30 November 2016. This was an announced comprehensive inspection of the region’s patient transport services. We visited the regional operations centre and the regional headquarters during the inspection. We have reported on patient transport service, although the organisation does undertake urgent and emergency care, we were not able to see this during the inspection.

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and issues that service providers need to improve.

We found the following areas of good practice:

• We saw a positive incident reporting culture. The national incident management framework had been implemented across the region. Staff knew how to report an incident and felt able to do escalate any concerns to management as required.

• The planning of patient transport services (PTS) was made in advance in order that sufficient resource could be allocated to each job, taking account of individual patient’s needs.

• Following our previous inspection in which we raised concerns surrounding the infection prevention and control techniques the service has since upgraded theirsluice facilities.Additionalcleaning and decontamination of its vehicles was provided through a third party provider.Vehicles inspected were visibly clean and we saw vehicle fully completed decontamination audit results.

• Patients that we spoke to said that staff provided a compassionate, kind and considerate service.

• There was a national vision and strategy that had been embedded across the region. Staff that we spoke to were aware of the strategy and understood the values of the organisation.

• An external fleet management company maintained vehicles used by the service. Maintenance and servicing of vehicles was seen to be effective, timely and accurately documented.

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

• Safeguarding training was not in line with national safeguarding children standards. Staff were not trained to the required safeguarding level as set out in the Safeguarding Children and Young Peoples: Roles and Competencies for Health Care Staff Intercollegiate Document: March 2014. Following the inspection the provider has undertaken work to provide the correct levels of training to appropriate staff.

Information on our key findings and action we have asked the provider to take are listed at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

During our visit we were not able to speak with people who used the service. However, we contacted and spoke with representatives from four services that contract with St John Ambulance West Midlands. This included an NHS ambulance service, an NHS Hospital Trust and two organisers of public events. We also visited two offices and an ambulance station in Birmingham where we spoke with a group of eight ambulance crew staff and four senior staff.

The representatives we spoke with were satisfied with the service provided by St John Ambulance. They told us that they were happy to continue to use the service or use the service again for further events. Comments received from the representatives included:

“The level of service received is excellent. We have a very mature relationship with St John Ambulance.”

“Brilliant, really good. They came up with the goods and provided more staff than needed. Would definitely consider using them again.”

We found that staff received appropriate training to ensure they had the skills suitable to meet the needs of people using the service.

Processes were in place to monitor the quality of service provision. This included routine checks to ensure ambulances were roadworthy and protect people from the risk of infection. People received care and treatment in a hygienic environment.

We visited the regional head office located in Birmingham City Centre, Smethwick offices (Summit Crescent) and ambulance station and the Coventry offices and ambulance station. During our inspection we spoke with six emergency transport attendants (ETA), a team leader, the regional director, the registered manager, the regional assurance manager and an additional five staff members in lead roles within the organisation. We also spoke with three people who had used the service and four representatives from four services that had contracted with the St John Ambulance. The registered manager retired at the end of February 2014.

Overall the representatives we contacted were satisfied with the service provided. One of the representatives told us, “I have been a commissioner for many years and I cannot praise St John Ambulance highly enough”. Another representative told us,“The patients tell me that they feel safe and unrushed during transfer to and from the ambulance, completely comfortable and secure during transit”.

We found that systems were in place to ensure that vehicles and equipment used were well maintained. Systems were in place to regularly clean vehicles. However, the provider needed to ensure that these were adequate to prevent risks to people that used the service.

Arrangements in place to recruit staff ensured that only staff that were suitable were employed.

Systems were in place to monitor the quality of the service and make any improvements needed.