Archived: Private Ambulance Service Ltd

Updated 10 October 2016

Private Ambulance Service Ltd was established in 2012 and provides patient transport services. They also supply first aid services to public events.

The service holds contracts with three NHS trusts, as well as a range of private contracts across Essex and London. All management functions for this service are managed from the Essex head office location.

Whilst Private Ambulance Service Ltd employs emergency response trained staff and has 10 rapid response vehicles and 28 intermediate tier vehicles, the service does not directly provide emergency response services. Private Ambulance Service Ltd provides staff and vehicles to support the fleet of NHS ambulance trusts as part of ongoing contracts and service level agreements (SLAs). The terms of the agreements mean that the staff work on the NHS rota alongside the NHS crews where needed.

The service is registered for transport services, triage and medical advice provided remotely.

At the time of our inspection there was no registered manager in post. The service had appointed a new manager by the time of our unannounced inspection and this individual would go through the registered manager process following commencement of employment with the service.

Updated 10 October 2016

We carried out an announced inspection visit on 2 August 2016 and an unannounced inspection on 12 August 2016.

Our key findings were as follows:

• On our announced inspection we found many safety concerns regarding infection control and hygiene; equipment and medicines management. There were also poor governance and leadership arrangements owing to a lack of registered manager; fit and proper persons checks not being carried out, contrary to regulation 19; and a poor culture among some operations managers. These findings are detailed in the report. However, when we returned for the unannounced it was clear that these issues had been resolved and systems and processes had been introduced to prevent these issues reoccurring. We were impressed with how quickly and effectively the service had addressed the problems.

• Staffing levels were sufficient to meet patient needs.

• Staff were confident in assessing and managing specific patient risks and processes were in place for the management of deteriorating patients.

• The concerns regarding infection control, equipment and medicines had all been resolved when we conducted a subsequent unannounced inspection.

• The service coordinated well with the local NHS ambulance provider to meet patients’ needs

• We spoke with six patients and one relative. All patients told us that staff were kind and caring.

• The service was planned to meet the needs of its contractual arrangements with health service providers. The service utilised its vehicles and resources effectively to meet patients’ needs.

• There was unanimously positive feedback from staff regarding the support and availability of the managing director

We saw several areas of good practice including:

• Safeguarding adult and children training to level two was completed to a high rate of over 99%.

• The culture amongst the staff we spoke with was good, and they liked working for the service.

• Mandatory training rates were good and staff were automatically booked onto refresher training courses when they were due for renewal.

• Staff were competent in carrying out their responsibilities and felt they received appropriate training and support for this.

However, there were also areas of poor practice where the location needs to make improvements.

The location must:

• Ensure that incident reporting procedures to ensure staff report all incidents and ‘near misses’; and implement systems for sharing learning and feedback with all staff following incidents and investigations to reduce the risk of incidents reoccurring.

• Ensure that governance processes and quality assurance measures and processes improve to provide effective oversight of all aspects of the service, in accordance with regulation 17.

The location should:

• Improve the governance systems within the service.

• Ensure that staff always receive adequate rest time between shifts, to reduce the potential risk of becoming fatigued.

• Have a registered manager in post. The service had not had a CQC registered manager in post for more than six months; although one had been appointed at the time of their inspection, they had not yet commenced work and were therefore not registered with CQC.

• Implement robust processes for risk assessing the vehicles for the transport of mental health patients, as this forms a significant part of the work of the service.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 10 October 2016

Overall we have not rated patient transport services at Private Ambulance Service Ltd because we are not committed to rating independent providers of ambulance services at the time of this inspection.

We found that there was clear evidence of effective learning from the feedback we had given the service relating to the issues around medicines management, equipment and infection control. When we returned for our unannounced inspection we found actions had been taken to ensure these issues did not reoccur. Staff used information provided by the cleric booking system to help them plan patient journeys effectively. The service coordinated well with the local NHS ambulance provider to meet patients’ needs. The service was active across the independent ambulance sector and had close links with other local providers to help them understand growth and demand. The patients we spoke with gave consistently positive feedback on the care from and interactions with staff. Staff were responsive to specific patient needs. Staff were positive about the support from and visibility of the managing director and enjoyed working for the service. There was limited learning from incidents and staff reported they did not receive feedback from incidents. However, during our unannounced inspection we observed a new process for sharing learning from incidents with staff, which staff were aware of. There were cleanliness concerns for the vehicles during our announced inspection. However, during our unannounced inspection we found that all vehicles inspected were cleaned thoroughly and all cleaning procedures had been changed and updated.

However, we found that there were areas where the provider could make improvements. Specifically that the staff did not always receive adequate rest time between shifts, which meant they were at greater potential risk of becoming fatigued. Also that the service had not had a CQC registered manager in post for more than six months.