Archived: Patient Transport, Colindale

Updated 17 March 2017

Patient Transport Colindale is an independent ambulance service providing patient transport services as a subcontractor to main contractors (identified as commissioners in this report). The main contractors who commission services from Patient Transport Colindale liaise directly with NHS providers. Patient Transport Colindale provides services as a subcontractor to two main commissioners working with the NHS. The service also carries out private work. However, private work is limited as the priority is to fulfil their contracts. The service also transports patients detained under the Mental Health Act 1983 using cell vehicles. Cell vehicles are a secure vehicle with the option of accommodating escorts to travel with the service user. Patient Transport Colindale does not undertake emergency and urgent transfers such as high dependency transfers.

Journeys are made to numerous locations within London and longer journeys across the United Kingdom occur on a regular basis.

Updated 17 March 2017

Patient Transport Colindale is an independent ambulance service providing patient transport services as a subcontractor to main contractors (identified as commissioners in this report). The main contractors who commission services from Patient Transport Colindale liaise directly with NHS providers. Patient Transport Colindale provides services as a subcontractor to two main commissioners working with the NHS. The service also carries out private work. However, private work is limited as the priority is to fulfil their contracts. The service also transports patients detained under the Mental Health Act 1983. Patient Transport Colindale does not undertake emergency and urgent transfers such as high dependency transfers.

We visited the ambulance service for a two day announced inspection on 21 and 22 September 2016 as part of our comprehensive programme of inspections.

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and issues that service providers need to improve.

We found the following issues that the service provider needs to improve:

• There was a lack of incident reporting and complaints monitoring within the service.

• The service did not carry out local audits as a way of monitoring performance and making improvements.

• We found expired oxygen cylinders in storage and on one of the vehicles we inspected. This vehicle was not in use.

• Staff did not always follow the service’s infection control policies.

• Most staff had a limited understanding of the principles of duty of candour.

• There was minimal reference to best practice and national guidelines by staff.

• There was no monitoring of key performance indicators (KPIs) against the commissioners’ contracts as a way of measuring performance in order to make necessary improvements. The operations manager told us the service was not given access to KPI information by their commissioners and could not measure their service’s performance against this data.

• It was not always possible for staff to communicate with patients who did not speak English. While the service employed multilingual staff who control staff could allocate to patient journeys accordingly in order to aid communication, this was not always possible. The managing director told us staff used language translation applications on their mobile phones in order to aid communication but this was not reflected in our interviews with staff. There was no provision for patients who had other communication difficulties.

• There was a clear vision for the service but there was no formal strategy for achieving that vision.

• There was little staff engagement to obtain their views and experiences in order to improve the service.

However, we found the following areas of good practice:

• Disclosure and Barring Service (DBS) checks had been applied for in relation to all staff before staff commenced employment. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups.

• Staff had a good understanding of safeguarding processes and there was evidence of safeguarding referrals being made.

• The completion rate for mandatory training was 100% and all staff we spoke with except one had been appraised.

• All vehicles inspected were visibly clean.

• There was good coordination between the service and its commissioners in planning the delivery of the service.

• During our inspection, all observations of care provided by the ambulance service showed patient dignity being maintained. Patients were treated kindly and compassionately. We observed positive and courteous interactions between staff and patients.

• The same crews transported the same patients wherever possible in order to maintain a degree of continuity in patient care.

• Staff had received training around dementia, mental health, and learning disability.

• All staff we spoke with were happy to work for Patient Transport Colindale and spoke positively about the leadership of the service.

Information on our key findings and action we have asked the provider to take are listed at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 17 March 2017

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and issues that service providers need to improve.

We found:

• There was a lack of incident reporting within the service. The service had an incident reporting policy and incident reporting forms but no incidents were reported between September 2015 and September 2016. Due to a lack of incident reporting we were not assured incident reporting was embedded in the culture of the organisation. There was no evidence of staff learning from incidents.

• We found expired oxygen cylinders in storage and on a vehicle which was not in use. Also, four of the twelve oxygen containers in storage had expired. However we saw evidence of processes for checking vehicles which offered assurance that the expired oxygen cylinder would have been changed prior to the vehicle being used operationally.

• Staff including the safeguarding lead were trained up to level two adult safeguarding. A safeguarding lead would normally have a level of knowledge relating to safeguarding which exceeds the level required for operational staff, enabling the provision of advice and access to support across a safeguarding network in the event of difficult cases.

• Staff did not always follow the service’s infection control policies in relation to single mop use and wearing protective gear when deep cleaning vehicles.

• There was minimal reference to best practice and national guidelines. Policies made reference to an old version of The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines even though there had been two further versions of the guidelines.

• The service did not carry out local audits as a way of monitoring performance and making improvements.

• Most staff had a limited understanding of the duty of candour.

• The service did not monitor key performance indicators against the commissioners’ contracts as a way to measure performance in order to make necessary improvements. The operations manager told us they were not given access to KPI information by their commissioners and could not measure their service's performance against this data.

• It was not always possible for staff to communicate with patients who did not speak English. The service employed multilingual staff and control staff took this into account when allocating journeys where a second language would aid communication. The managing director told us staff used language translation applications on their mobile phones to aid communication but this was not reflected in our interviews with staff. There was no provision for patients who had other communication difficulties.

• There was a clear vision for the service. However there was no formal strategy for achieving that vision.

• There was a lack of complaints monitoring and carrying out of audits within the service.

• Staff were not formally engaged in order to obtain their views and experiences in order to improve the service.

However:

• Staff had a good understanding of safeguarding and there was evidence of safeguarding referrals being made.

• The completion rate for mandatory training was 100%. Staff were appraised annually and all staff we spoke with except one had been appraised.

• All vehicles inspected were visibly clean and free from dust.

• Disclosure and Barring Service (DBS) checks had been applied for in relation to all staff. Staff whose DBS checks had expired had new checks applied for. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups.

• There was good coordination between the service and its commissioners in planning the delivery of the service.

• During our inspection, all observations of care provided by the ambulance service showed patient dignity being maintained.

• Patients were treated kindly and compassionately. We observed positive and courteous interactions between staff and patients.

• The same crews transported the same patients wherever possible in order to maintain a degree of continuity in patient care.

• Staff had received training around dementia, mental health, and learning disability.

• All staff we spoke with were happy to work for Patient Transport Colindale and spoke positively about the leadership of the service.