Harley Street Ambulance Service

Updated 6 September 2023

The service is managed by Harley Street Ambulance Service Limited. The service provides patient transport services (PTS) and emergency and urgent care (EUC) services. EUC patient transfers are between hospitals.

Harley Street Ambulance Service (HSAS) operates as a subcontractor to main contractors (identified as commissioners in this report). The main contractors who commission services from HSAS liaise directly with NHS providers. A small part of its work is private and for this work, HSAS liaises directly with the private hospitals or private organisations. HSAS transports patients (adults and children) across the whole of the United Kingdom and works across different boroughs and populations. The service has six ambulances. The main service provided by HSAS was the patient transport service (PTS).

The service registered with the Care Quality Commission (CQC) on 13 May 2011.

The provider is registered for the regulated activities: transport services, triage and medical advice provided remotely and treatment of disease, disorder and injury. They provide services to adults and children.

The service had a registered manager in the post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. They have legal responsibilities for meeting the requirements set out in the Health and Social Care Act 2008.

The service had been previously inspected in January 2019 and was rated as Good overall.

Updated 6 September 2023

We inspected Harley Street Ambulance Service on 23 May 2023 and followed up with a meeting with the provider on 8 June 2023. It was a focused inspection in response to the information we received about the provider. During the inspection, we raised concerns related to the safety and management of the service:

• The provider had failed to establish and effectively operate systems to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity.
• The provider did not have all information required to be kept by providers about all persons employed in the provision of services. The provider did not demonstrate that agency staff working for the service had met requirements related to persons employed in the carrying on of the regulated activity.
• The provider did not operate an effective system to ensure staff were suitably trained and their competencies were regularly reviewed. Agency staff did not undergo formal induction to the service. There was no evidence to confirm agency staff completed appropriate minimal training.
• The provider had not established a system for regular staff appraisals to support employees in their professional development.
• The provider did not proactively seek and act on feedback from staff on the services provided to continually evaluate and improve such services.
• Although incidents were reported, there was no system to ensure a structured way for learning from incidents to improve the quality and safety of the services provided. In addition, there was no evidence of sharing knowledge with staff and actions taken to prevent further occurrence.

Updated 6 September 2023

Our rating of this service went down. We rated it as requires improvement because:

• The service had not improved in areas that we asked them to address during the previous inspection of 2019.
• The service did not manage patient safety incidents well. There was no system to ensure staff learnt from incidents and further occurrences were prevented.
• The service did not have systems to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity.
• The provider did not have all information required to be kept by providers about all persons employed in the provision of services. They did not demonstrate agency staff working for the service met requirements related to persons employed in the carrying on of the regulated activity.
• Not all staff had training in key skills. Agency staff did not undergo formal induction to the service. There was no evidence to confirm agency staff completed appropriate minimal training.
• Managers did not have a system to monitor if staff were competent.
• The provider did not establish a system for regular staff appraisals to support employees in their professional development.
• The provider did not proactively seek and act on feedback from staff on the services provided to continually evaluate and improve such services.

We rated this service as requires improvement because it was rated as such in the safe and effective domains. Whilst we did not inspect against all the key lines of enquiry for the effective domain, we decided to rate this domain as we have identified a regulatory breach which means rating limiters applied. Where we have identified a breach of a regulation and we issue a Requirement Notice, the rating linked to the area of the breach will normally be limited to ‘requires improvement’ at best.

We rated the well led domain as inadequate. Where we have identified a breach of a regulation and we take action under our enforcement powers, such as issuing a Warning Notice or imposing a condition of registration, the rating linked to the area of the breach will normally be ‘inadequate’.

As this was a focused inspection we did not inspect or rate the caring and responsive domains.

Updated 17 May 2019

Emergency and Urgent Care (EUC) services were a small proportion of activity by the provider making up 20% of the work they carried out. EUC services included high dependency transfers between hospitals.

Arrangements for patient transport services (PTS)  and EUC were mostly the same. Therefore, we have reported most of our findings in relation to this core service in the relevant sections of the PTS report.

We rated the EUC service good overall for the same reasons set out in the PTS summary of findings below.