When we visited the service we spoke with the manager who told us how the service operated. We were not able to speak with patients due to the nature of the service.

Patients were able to comment on their experience of the service through various measures. For example, telephone, email and the hospital Patient Advice and Liaison Services (PALS). Thank you cards were displayed at the base from people who had used the service.

We saw that infection control and prevention procedures were in place. Helicopters, equipment and staff facilities were cleaned in accordance with a detailed infection control policy and cleaning schedule.

We found that staff felt well supported by the team and received training appropriate for their role.

We reviewed patient care records and staff records and saw they were completed appropriately. We saw that there were systems in place for the regular audit of records.

We were not able to speak with patients using the service because of the nature of the service, providing emergency treatment and transport for critically injured or ill patients. We saw that patients had been invited to comment on their experience of using the service through the completion of comment cards, which were available for us to review. We found that patients' experiences were positive, including statements such as, "Without Warwickshire and Northamptonshire Air Ambulance I would not be here today" and "I really am so very grateful."

We reviewed records relating to recruitment and selection, infection prevention and control and patient care and treatment. We found that there were systems in place for the regular audit of records maintained within the service.

Warwickshire & Northamptonshire Air Ambulance Service is operated by The Air Ambulance Service. The service provides emergency and urgent care and a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 15 and 16 January 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.

The main service provided by this service was emergency and urgent care. Patient transport services were a small proportion of activity. Where arrangements were the same, we have reported findings in the emergency and urgent care section.

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 areas of good practice:

• There was an effective system and policy in place to report and respond appropriately to incidents. Learning was shared.
• There were effective systems and processes in place to protect people from the spread of infection, to ensure safe storage and administration of medicines and to safeguard patients from the risk of abuse.
• The maintenance and use of equipment kept patients safe from avoidable harm during treatment and transfer in the aircraft or vehicle.
• Patients’ individual care records were written and managed appropriately. Appropriate protocols were in place to assess and respond to patient risk. Staff had access to relevant information when needed.
• Staffing levels and skill mix were planned and reviewed to ensure that people received safe care and treatment at all times.
• The service planned for any anticipated risk and these were outlined in the business continuity policy. Staff understood their roles in a major incident.
• The care and treatment of patients was based on nationally recognised guidance. The service monitored compliance against its own key performance indicators (KPIs) to continue to drive improvements in patient outcomes.
• Staff had the skills, knowledge, and experience to deliver effective care and treatment.
• Care was delivered in a coordinated way with all other services involved. Effective and positive multi-disciplinary working was clearly evident.
• Staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005 (MCA).
• Care was provided in a sensitive and dignified way, wherever possible. Feedback received was very positive. Staff kept patients and families well informed regarding the treatment taking place on the scene and the plan ahead, including which hospital they would be transferred to.
• The service effectively planned and delivered services based on patient needs and were planned to take into account the different needs of the type of incidents and patients they responded to.
• Patients had access to timely care and critical care treatment.
• Effective procedures were in place to respond and learn from complaints.
• Leaders had the skills, knowledge, experience, and integrity they needed to ensure the service met patient needs.
• The service had a clear vision and strategy, underpinned by holistic values that were embraced by all staff at every level.
• Governance and risk management systems were effective in maintaining a clear oversight of the safety and high quality of services delivered.
• The service had an open and learning culture, fully focused on safe and high quality patient care.
• Staff and public engagement was positive and designed to seek feedback to continue to improve the service.

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

• The safeguarding adults’ policy referenced out of date guidance. This was raised with the registered manager during the inspection who took immediate action to update the policy.
• Aircraft pilots had not had safeguarding training.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Please refer to the end of the report.

Heidi Smoult

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