Archived: Premier Rescue Ambulance Services Limited

Premier Rescue Ambulance Service Ltd provides a patient transport service to people living in Somerset and the surrounding areas. If required, the service reaches further out into the south west to provide patient transport services. The service provides non-emergency ambulance transport for people with mental health conditions, most of who are detained under the Mental Health Act 1983. The service also provides transport for non-detained patients, for example patients who are voluntarily going into hospital for referral or treatment. We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 17 April 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 only service provided by this service was patient transport services.

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 a good track record of safety. Staff we spoke with understood their responsibilities to raise concerns, to record safety incidents and to report them.
• Lessons were learned when things went wrong, and action was taken as a result.
• All staff were up to date with their mandatory training. The service maintained accurate and complete staff training records.
• Staff we spoke with understood their responsibility to report safeguarding concerns.
• Vehicles and equipment were visibly clean and tidy and staff were presentable in their uniforms.
• Records showed completed and up-to-date vehicle maintenance and servicing schedules. All vehicles in use had an up-to-date MOT, vehicle tax and insurance.
• Staff we spoke with about patients under the Mental Health Act 1983 were aware of evidence-based practice in relation to control and restraint. For example, staff told us they should be aware of preventing or minimising periods during which a patient would be in a face-down (prone) position.
• Staff and other services worked well together to deliver effective care and treatment through the provision of timely and appropriate transport.
• Patients’ consent to care and treatment was sought in line with legislation and guidance.
• We did not observe any direct patient care. However, during our discussions with staff, they spoke about patients in a respectful and caring manner. They told us that when transporting patients, they took the necessary time to engage with patients. Patients and those close to them received the support they needed to cope emotionally with their care and support.
• The provider risk-assessed and took relevant background information into account to plan and deliver services.
• Services were delivered and co-ordinated to be accessible and responsive to patients’ needs.
• Concerns and complaints were used as an opportunity to learn and drive improvement.
• The provider had a clear vision and a set of values with quality and sustainability as top priorities.

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

• There was a limited understanding of the formal definition and the legal implications of the duty of candour.
• The service did not undertake any driving assessments to ensure staff drove appropriately when transporting patients.
• There were no systems or procedures in place to manage the storage and removal of clinical waste.
• The service was unable to assure itself staff followed restraint policy and procedures. This was due to the lack of comprehensive reporting paperwork.
• The service had no business continuity plan that would ensure continued service provision in, for example, the event of a vehicle loss or fire.
• The service had no formal system to record, plan against or mitigate risks to the service.
• None of the eight policies we looked at had a review date. The provider was unable to tell us when they were due to review their policies and procedures.
• Some policies reviewed, such as the infection prevention and control policy, were not clearly defined as belonging to Premier Rescue Ambulance Services Ltd.
• There was no documented record of monitoring the cleaning of vehicles.
• The provider had no system in place to allow them to determine whether they were delivering an effective patient transport service.
• None of the staff employed had received an appraisal or supervision.
• Staff did not complete any competencies following induction.
• Patients were not told routinely that they could comment or complain about the service.
• There were some structures, processes and systems of accountability to support the delivery of the strategy and good quality, sustainable services, but they were not regularly reviewed and improved. The provider did not have a system or process in place to regularly manage the governance of the service in a formal manner.
• There were no processes to manage current or future service performance.  During the inspection the provider was not able to confirm the number of patient transport journeys over the past 12 months. After the inspection the provider confirmed that they had undertaken 43 patient journeys in the previous three months.
• Mechanisms for providing all staff at every level with the development they needed were yet to be established.
• The registered manager was not able to demonstrate the arrangements to ensure the availability, integrity and confidentiality of identifiable data.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices that affected Premier Rescue Ambulance Service Limited. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (South), on behalf of the Chief Inspector of Hospitals