Chief Inspector of Hospitals rates East Midlands Ambulance Service NHS Trust as Requires Improvement

England's Chief Inspector of Hospitals has told East Midlands Ambulance Service NHS Trust that it must make improvements following an inspection by the Care Quality Commission.

East Midlands Ambulance Service NHS Trust was rated as Requires Improvement overall following an inspection which took place between 16 and 20 November and on 3 December last year.

The trust was rated as Good for whether its services were caring and responsive, as Requires Improvement for whether its services were well-led and Inadequate for whether services were safe.

East Midlands Ambulance Service NHS Trust’s headquarters are in Nottingham and it provides emergency medical services to around 4.8 million people living in Derbyshire, Nottinghamshire, Lincolnshire, Leicestershire, Rutland and Northamptonshire.

CQC’s inspection looked at three core services: Emergency Operations Centres, Urgent and Emergency Care including the Hazardous Area Response Team (HART) and the air ambulance, and Patient Transport Services.

Inspectors found that the trust suffered from a lack of staff and resources against high demand for the service. 

However, it was noted that staff were exceptionally caring despite the added pressures on their workloads.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“Our inspectors found that a number of improvements were needed at East Midlands Ambulance Service NHS Trust.

“Our main concerns surrounded whether services were protecting people from the risk of avoidable harm at the trust. There was an unrelenting demand for emergency services combined with a lack of staff and resources to meet the need. We found that, while people were cared for and treated well, there were insufficient staff and a lack of appropriate skill mix to meet the needs of patients in a timely manner.

“We found that staff were passionate about their jobs and committed to providing high quality, safe care for patients, but they also openly recognised they faced challenges and morale was low. “Since our inspection we have been monitoring the trust and working closely with NHS Improvement and other stakeholders, such as NHS England.

“The trust leadership knows what it needs to do to bring about improvement and our inspectors will return at a later date to check on what progress has been made.”

Full reports for the trust will be published on CQC’s website today at the following link: www.cqc.org.uk/location/RX901

Across the trust, the inspection team found several areas where improvements must be made, including:

• Staff needed to report any incidents so they could be appropriately and consistently investigated.
• Any learning from incidents, investigations and complaints must be shared with staff.
• Staff must receive statutory and mandatory training.
• All domestic, clinical and hazardous materials need to be managed in line with legislation and guidance.
• Vehicle and equipment checks must be carried out with the right frequency.
• The trust must ensure there are sufficient emergency vehicles to safely meet demand.
• Medicines, including controlled drugs, must be stored and managed safely.
• Paper patient report forms must be stored appropriately and securely in trust premises and in such a way on trust vehicles as to maintain patient confidentiality.
• The trust must ensure sufficient numbers of staff with an appropriate skill mix to meet safety standards and national response targets.
• Arrangements to respond to emergencies and major incidents must be practised and reviewed in line with current guidance and legislation.
• Response times must meet the needs of patients by reaching national target times.
• All staff must receive appropriate non-mandatory training to enable them to carry out their duties and receive an annual appraisal.

Inspectors also witnessed some outstanding practice across the trust, including:

• There were many examples of non-clinical staff supporting patients and saving lives in what were extremely difficult and stressful situations. Staff remained calm and gave callers confidence to deliver life-saving treatment.
• The trust introduced ‘change Wednesdays’ in the emergency operations centre (EOC) to avoid disruption from contacting staff too frequently about minor changes to policies and systems, meaning they were notified of these changes on the same day of the week.
• The trust was the best performing ambulance trust in England for the number of calls abandoned before answered.
• A mental health triage car was available in Lincolnshire between 4pm and midnight, staffed by a paramedic and a registered mental health nurse from a mental health trust. They could assess the needs of the patient and provide appropriate care which, in some cases, avoided hospital admission or the use of a Section 136 detention under the Mental Health Act 1983.
• The trust was the first service of its kind to have a joint ambulance conveyance project working with six fire and rescue services in their region.
• A project was in place to improve treatment for patients in acute heart failure. Crews had been issued with continuous positive airway pressure (CPAP) machines to help these patients.
• Staff in patient transport services (PTS) had direct access to electronic information held by community services including GPs, meaning they could access up to date information about patients.
• The patient advice and liaison service recruited existing patients to report to them about their planned journeys and experiences of patient transport services (PTS). They called this a ‘secret shopper’ programme.
• Staff name badges included their name in braille to assist patients with visual impairment and guide dogs were allowed to accompany visually impaired patients.
• The Chief Executive was praised by all staff for her visible, open approach and commitment to engaging staff face to face.

CQC’s inspection team informed the trust of its findings immediately after the inspection so that it could take steps to make any improvements.

Ends

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