Archived: Ambuline Leicestershire

Ambuline Leicestershire is operated by Ambuline Ltd, which is a subsidiary of Arriva Transport Solutions Ltd. The service provides patient transport services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection between 13 and 15 March 2017, along with an unannounced visit on 27 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.

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 issues the service provider needs to improve:

• The incident reporting procedure was not effective. Some staff did not know the procedure and the organisation did not share feedback and learning from incidents.

• Staff did not know about or understand the principles of duty of candour.

• Staff did not always follow infection control procedures. Audits identified some infection control issues. Vehicles and equipment were not always clean.

• Bases did not store highly flammable liquids in in accordance with the Dangerous Substances and Explosive Atmospheres Regulations 2002 (DSEAR).

• Staff did not receive training which supported them in their roles. The inspection team had concerns regarding the effectiveness of the organisation’s moving and handling, safeguarding and mental health training.

• Staff knowledge of the safeguarding pathway was inconsistent. Staff did not have access to the organisation’s safeguarding policy.

• The organisation’s safeguarding trainer was not qualified to train staff in safeguarding. The trainer did not know what level of training they delivered to staff.

• We reviewed nine staff training files and saw there was no assurance staff had successfully completed safeguarding training and understood what constituted abuse.

• The safeguarding lead could not articulate knowledge or oversight of the safeguarding incidents within the service.

• Staff had challenges with vehicles off the road. Between November 2016 and February 2017, the number of vehicles off the road for Leicestershire was constantly over 30 per month (almost 50%).

• At our previous inspection we identified patients were waiting long periods for transport. Data from the organisation showed they were not meeting contractual response time targets. We saw a number of patients waiting long periods for transport during this inspection.

• In addition, data from the organisation showed the organisation was not meeting its targets regarding the transport of renal dialysis patients.

• We saw the control room was consistently not meeting contractual targets for call answering times. We also saw call abandonment (a call ended before any conversation occurs) rates were high meaning callers were waiting longer to speak to staff on the phone.

• Staff did not assure the inspection team they knew their roles and responsibilities regarding mental capacity consent and the restraint of patients.

• The organisation did not have aids for patients with visual impairments. Vehicles did not have any signage in languages other than English or for patients living with dementia.

• The organisation did not share feedback or learning from complaints with staff.

• The majority of staff were not aware of the strategy and vision of the organisation and could not describe how they would apply them to their role.

• We saw there was a lack of discussion and oversight of risk, safeguarding and incidents at leadership meetings.

• We saw managers had not appropriately identified some risks. The management of risks was not timely or effective. Where risks had been identified there were either no actions or actions had been slow to be completed.

• We found staff morale to be low because of pay and conditions, organisation culture and unrealistic targets. Staff perceived a blame culture within the organisation.

• Staff felt senior managers did not communicate or engage them effectively. Managers had processes to communicate with staff using briefings however, it relied on staff finding the time to read them.

However, we found the following areas of good practice:

• Staff were without exception kind, caring and compassionate. We saw staff continuously support and reassure patients and callers. Staff demonstrated and told us about their commitment to patient care.

• Staff used electronic devices to conduct daily vehicle checks. We observed staff conducting daily checks prior to shifts.

• All equipment had been tested and checked with stickers stating test and retest dates.

• Oxygen was securely stored on vehicles and at bases.

• Patient records were stored securely both on ambulances and in the control room. The control room had procedures to dispose of confidential waste.

• Staff used an electronic patient record system, which identified possible risks to patients and staff. The system helped staff to assess and plan care.

• The organisation had a vision and strategy underpinned by values and objectives linked to staff personal development reviews.

• All staff we spoke with had received an appraisal. All three bases had positive staff appraisal rates.

• We observed positive relationships and coordination between staff and with other health and social care providers.

• Staff had access to important information or special notes. The electronic patient record system alerted staff to any special notes or requirements for patients.

• Staff ensured where patients had them, do not attempt cardio pulmonary resuscitation (DNACPR) orders were up to date.

• The service had a system to access interpreters for patients whose first language was not English. Crews and control staff could access a telephone translation service.

• The organisation had different ways transport could be booked including online and by phone. Any carer, patient or health professional could book appointments.

• Local managers were visible and staff said they were supportive. We found local leaders had a greater understanding of staff concerns, risk and performance than some senior managers did. Staff said there was a positive team working culture amongst colleagues.

• Staff demonstrated a culture and commitment to good patient care.

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 four requirement notices and a warning notice in relation to their patient transport service. Details are at the end of this report.

Importantly, the provider must take action to ensure compliance with regulations 15 13, 17, 18 and 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Heidi Smoult

Deputy Chief Inspector of Hospitals