Archived: Surrey Ambulance Service

Updated 14 August 2017

Originally established as a security and training company, Sites Limited added an ambulance service in 2011 and formed Surrey Ambulance Services (SAS) in 2015. SAS now has over 100 staff and 25 vehicles operating from three bases and provides a range of services to business and the NHS in Surrey and Berkshire. In addition to urgent and emergency care services for the NHS, SAS offers first aid training, private ambulance transport and repatriation, blood or organ transportation and medical cover for sports events and festivals.

The company holds frontline support contracts (urgent and emergency care) with two NHS ambulance trusts. NHS ambulance services have limited influence over the number of ‘999’ emergency calls they receive, but have a statutory duty to resolve 999 calls once made. In addition, NHS ambulance services are required to take patients to hospital where a doctor, midwife or other healthcare professional identifies the need as urgent.

To help meet response targets and an increasing demand, NHS ambulance trusts contract with independent ambulance companies like SAS to take emergency calls. Calls are prioritised through the trust’s control centre and directed to the appropriate crew (NHS or private) depending on factors such as the skill mix of the crew, incident location and type of injury or illness reported. As part of the contract agreement, the private ambulance company adopts the operational policies, standards and procedures of the trust and accepts a level of supervision and monitoring by the trust’s management. This also includes fitting their ambulances with the same electronic GPS navigation and communication devices used by the trust.

In practice, this means SAS must provide skilled crews and rapid response capability 24 hours a day, all year round, to accidents and incidents throughout the region. They have to be able to integrate seamlessly with the ‘assess and treat’ and ‘assess and convey’ roles of the NHS service. In addition to frontline support, one ambulance trust has purchased non-emergency patient transport services. To fulfil these contracts, SAS established two ambulance bases in Surrey and one base in Berkshire for this work.

The service has had a registered manager in post since 2011. Mr Roger S Fuller is the registered manager for this provider and is the nominated individual. Surrey Ambulance Services are registered with the CQC to provide the following regulated activities:

• Transport services, triage and medical advice provided remotely, and
• Treatment of disease, disorder or injury

In England, the law makes event organisers responsible for ensuring safety at their venue, which means event medical cover comes under the remit of the Health & Safety Executive (HSE) and not the CQC.

Updated 14 August 2017

Surrey Ambulance Services is operated by Sites Ambulance Service Limited. The company is contracted to provide emergency and urgent care support to two NHS ambulance trusts along with a patient transport service. We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 16 March 2017, along with an unannounced visit to the service on 29 March 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.

The main service provided by this provider was urgent and emergency care (frontline support). Where our findings on the patient transport service also applies, we do not repeat the information but cross-refer to the urgent and emergency care core service.

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. In this case, we found no major issues of concern. After our inspection, we concluded the company provided a safe and effective service to the commissioning trusts and we observed several areas of good practice:

• Effective fleet management and vehicle clean and make ready processes.
• Medicine management, particularly controlled drugs, was safe and effective.
• Development and competency of staff was well managed.
• Multidisciplinary working with NHS trusts worked well.
• Patient assessment and interaction showed individualised patient care that took into account physical, emotional and capacity needs of the patient and relatives.
• Lessons learnt and action taken in response to any feedback and complaints worked well.
• All crews carried multilingual phrase books to assist communicating with those patients that did not speak English as their first language.
• The SAS had a duty officer system that operated 24 hours day and rotated between senior managers, fleet supervisors, the registered manager and clinical lead.
• Senior staff were visible with frequent interactions with colleagues and were readily available.The managing director would go on the road either as an observer, trainer or as a crew member.
• There was strong performance management demonstrating that leaders were proactive.
• There were robust performance management processes for both self-employed workers as well as those that had permanent contracts.

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

• The provider should take action to ensure the risk register details risks to the organisation rather than reacting to problems that have arisen.
• The provider should improve the clarity in appraisal reporting lines.
• SAS should ensure all clinical waste bins are secured and not accessible to the general public.
• SAS should take steps to remove any ‘blacked out’ windows in ambulances and replace with tinted windows.
• SAS should ensure that all vehicle have functioning rear-cabin CCTV.

Professor Edward Baker

Deputy Chief Inspector of Hospitals (South East)