Archived: Jigsaw House Cheshire

Jigsaw Medical Services provides emergency and urgent care and a patient transport service.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 9 and 10 January 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 main service provided was emergency and urgent care with a smaller level of patient transport activity therefore we have reported findings in the emergency and urgent 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.

We found the following areas of good practice:

• The provider had strong leadership with a clear focus on high quality provision and care.
• We found all vehicles were in good condition and a comprehensive system was in place to ensure they were fit for purpose.
• An effective compliance process was in place to ensure operational staff had completed induction and mandatory training before commencing employment and also that staff remained compliant during the time they continued to work for the provider.
• Risk assessments were completed for any ad hoc patient transfers to ensure the correct vehicle, equipment and appropriately trained crew were assigned to meet the needs of the patient.
• Arrangements were in place for escalating issues with contracting trusts. A contract manager was identified within each trust and monthly contract meetings took place to monitor performance and provide feedback regarding incidents and referrals.
• Mental Capacity Act (2005) training compliance was 100% for operational staff at the time of our inspection.
• Staff were committed to providing the best quality care to patients and we observed staff demonstrating patience, kindness and respect.
• Staff had access to practitioners trained in Trauma Risk Management (TRiM) to support personnel following traumatic events. TRiM is a peer delivered psychological support system designed to allow organisations to proactively support personnel following traumatic events.

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

• The provider did not have a record of all incidents or safeguarding referrals reported through trust processes and relied on the contracting trust to feed the information back either by telephone or during monthly contract meetings. This meant the provider did not have oversight of all incidents and safeguarding situations operational staff had been involved in and relied on the NHS trust to identify any immediate learning.
• The provider did not have robust processes to ensure the safe disposal of out of date medicines.
• Not all staff had received an appraisal and documentation we reviewed did not indicate any standards or provide a clear scoring system.
• Patient feedback forms were not available on all vehicles we inspected. Staff were not always involved in complaints from the NHS trust and did not always receive feedback.

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 issued the provider with one requirement notice that affected both emergency and urgent care and patient transport services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North), on behalf of the Chief Inspector of Hospitals.