Leicester Office

Updated 27 August 2019

Leicester Office, also known as TASL Leicester, is operated by Thames Ambulance Service Limited. It is an independent ambulance service, which provides non-emergency patient transport services (PTS), primarily to the communities of Leicestershire, Lincolnshire, Rutland and Northamptonshire. Most of these services were awarded by local clinical commissioning groups.

Leicester Office (TASL Leicester) was first established in October 2017 and became registered with the Care Quality Commission (CQC) in March 2019 for providing transport services, triage and medical advice provided remotely. The service has had a registered manager in post since 29 March 2019.

Prior to the registration of Leicester Office (TASL Leicester), we previously inspected this service as part of Thames Ambulance Service Limited. Following our inspection of that service in October 2018, we issued the provider with a warning notice over their non-compliance of Regulations 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also imposed four further conditions on their registration, which also apply to Leicester Office.

Updated 27 August 2019

Thames Ambulance Service is operated by Thames Ambulance Service Limited. The service provides a non-emergency patient transport service from several sites throughout England. Thames ambulance Service Ltd had 17 ambulance stations throughout the UK from which patients transport services were delivered. This inspection report details our findings at the Leicester Office location.

Leicester Office (TASL Leicester) is operated by Thames Ambulance Service Limited. The service provides a non-emergency patient transport service across various locations throughout the United Kingdom.

We inspected this service using our comprehensive inspection methodology. We carried out a short-notice announced inspection on 1 May 2019.

Before Leicester Office was listed as a separate registered location, we previously carried out an announced comprehensive inspection as part of Thames Ambulance Service Limited on 23 October 2018. During our inspection, there were several safety concerns identified, primarily regarding the safe transport of patients with mental health needs, transport of patients with bariatric needs and transport of children aged under 12 years. Because of this, we issued the provider with a warning notice over their non-compliance of Regulations 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also imposed four further conditions on their registration.

Prior to this, we carried out focussed inspection on the 15 May 2018 to follow up a warning notice we had issued to the provider in October 2017 over a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 by this service was non-emergency patient transport services (PTS).

We rated it as Requires improvement overall.

• Ambulance staff we spoke with told us they had not had any specialist training on completing risk assessments when conveying children, patients with mental health needs or patients with bariatric needs, however were still asked to complete risk assessments.

• Incidents were not always investigated thoroughly by managers and any lessons learnt or outcomes identified were not always shared with staff. Staff also told us they did not usually receive any feedback or learnings following a patient complaint.

• Managers we spoke with during our inspection did not understand risk and were not aware of the provider’s current risks as listed on their risk register. We also found several risks, such as out of date fire extinguishers and breaches of confidential patient information, that the provider was not aware of.

• Data we reviewed during and after our inspection showed that the provider failed to meet the majority of their key performance indicators (KPIs) across both the Leicester and Kettering sites. Managers and ambulance staff we spoke with during our inspection also had a limited knowledge and understanding of their KPIs and were not using this data to improve the quality or performance of the service.

• Ambulance staff we spoke with during our inspection told us there was a poor working relationship between the ambulance staff and the provider’s control centre staff, and that it was sometimes difficult to contact them.

• Staff told us that workload was not evenly distributed amongst staff, with some members of staff receiving significantly higher workloads than their colleagues.

• Staff were not receiving yearly appraisals and we were not assured that the remaining appraisals could be completed in the timeframe specified by the provider.

• Concerns that we raised following our last inspection, which included the provider not checking that staff had safely returned at the end of their shift or during periods of severe weather, remained unresolved.

• Staff at the Kettering site told us that they did not feel supported by the area leadership team and raised concerns over the lack of visibility of senior leaders, such as area managers and executives. They also reported to us that they felt isolated and disconnected from the rest of the organisation, and there was a mixed report of staff feeling valued.

• Staff told us that they did not feel engaged, and whilst the provider was now holding team meetings, these remained poorly attended by staff due to high workloads and poor meeting planning.

However, we also found that:

• Since our last inspection, the provider had established a new training centre at its Lincoln head office, and most staff we spoke with had now completed their yearly mandatory training.

• The provider had improved since our last inspection and agreed a contract with a third party to undertake deep cleans of all its vehicles. At the time of our inspection, all vehicles we inspected had been deep cleaned within the last 12 weeks and appeared visibly clean and contamination-free.

• The provider had agreed a contract with a third party to undertake the servicing and maintenance of its fleet. At the time of our inspection all vehicles we inspected had been serviced and had a valid MOT certificate and correct vehicle tax status.

• The provider now had enough personal digital assistants (PDAs) for each vehicle to have its own dedicated device.

• Staff we spoke with across both locations were aware of safeguarding procedures and knew how to complete a safeguarding referral for a patient.

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, to help the service improve. We also issued the provider with one requirement notice that affected patient transport services. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

Updated 27 August 2019

The main service provided was non-emergency patient transport.

We rated the service as inadequate for effective; requires improvement for safe, responsive and well led; and good for caring. Managers were not investigating incidents thoroughly when an investigation was required. Ambulance staff told us that they did not always receive feedback following a complaint or investigation. Ambulance staff told us they had not received any training in completing risk assessments when transporting patients with mental health needs or patients with bariatric needs, although were still asked to complete them. There was a lack of awareness and ownership of risks. During our inspection, we also found further risks, such as, out of date fire extinguishers and breaches of confidential patient information that the provider was not aware of. Data we saw on inspection showed the provider was failing to meet several of their key performance indicators (KPIs). Ambulance staff we spoke with told us there was a poor working relationship between them and the provider’s control centre, and they regularly had difficulties in contacting them. Although staff appraisals had been booked in, only a small number had been completed and we were not assured that this plan would be achievable.

However, we also found that the provider had improved since our last inspection in the following areas. There was a new training centre at its Lincoln head office and that staff we spoke with had mainly completed their mandatory training in the last couple of months. Staff we spoke with were also confident and knowledgeable in making safeguarding referrals for patients. We also found that the provider had now agreed contracts with third parties for the deep-cleaning, servicing and maintenance of its vehicles. The provider had also obtained further personal digital assistants (PDAs) and ensured each vehicle had its own dedicated device.