England's Chief Inspector of Hospitals has told South East Coast Ambulance Service NHS Foundation Trust that it must continue to make significant improvements to its services, following its latest inspection by the Care Quality Commission.
Professor Ted Baker has recommended that the South East Coast Ambulance Service NHS Foundation Trust remains in special measures. Following CQC’s recommendation, NHS Improvement placed the trust into special measures in September last year.
This latest inspection was to review progress against the requirements of a Warning Notice issued last year. Inspectors looked at two core services: emergency operations centres which has been rated Requires Improvement and emergency and urgent, including resilience and the hazardous area response team care which has been rated Inadequate.
The trust’s overall rating of inadequate remains unchanged. The full reports are available on our website.
CQC have also inspected the NHS 111 service provided by the trust which has been rated as Good.
At the CQC inspection in May 2016 had rated Emergency and Urgent Care (EUC) as inadequate and both the Emergency Operations Centre and Patient Transport Services were rated as requires improvement and a warning notice detailing the areas where the trust needed to make improvements was also issued.
Inspectors found the trust had made some improvements in many of the concerns previously mentioned in the May 2016 inspection, particularly around reporting of incidents, and staffing levels during busy periods. A new board was tackling the issues but further progress is still needed.
However, staff were found to be consistently compassionate, treating patients and callers with kindness and respect including those in mental health crisis.
Although some staff did indicate improvements in the trust culture and there was a reduction in bullying and harassment, there still remained concerns about the overall culture within the trust.
CQC has told the trust that it needs to make urgent improvements in a number of other areas including ensuring that:
- The trust must take action to ensure it keeps a complete and accurate recording of all 999 calls.
- The trust must protect patients from the risks associated with the unsafe use and management of medicines. This should include the appropriate administration, supply, security and storage of all medicines.
- The trust must take action to ensure there are a enough number of clinicians in each emergency operation centre at all times.
- The trust must investigate incidents in a timely way and share learning with all relevant staff.
- The trust must ensure all staff working with children, young people and their parents receive the appropriate level of safeguarding training.
- The trust must ensure patient records are completed, accurate and fit for purpose, kept confidential and stored securely.
- The trust must ensure the computer aided despatch system is effectively maintained.
- The trust must ensure all medical equipment is adequately serviced and maintained.
Inspectors also found some areas of good practice, including:
- The trust’s mental health street triage service was found to be an area of outstanding practice
- The trust’s Hazardous Area Response Team was an approved training centre of excellence and offered training to external agencies.
Inspectors also visited the NHS 111 service provided by South East Coast Ambulance NHS Foundation Trust. Inspectors found the NHS111 service had embedded a number of improvements to the service they provided since the first inspection in May 2016.
While working at arms-length from the main part of the trust, there was a shared management structure in place with Care UK Surrey, with whom they sub-contracted services. Both SECAmb and Care UK Surrey recognised the challenges to effective collaborative working and in response to meet these challenges developed a senior management team staffed by people from both organisations.
CQC’s Chief Inspector of Hospitals, Professor Ted Baker, said:
“Although we have seen some areas of improvement, South East Coast Ambulance NHS Foundation Trust has not yet made enough progress for me to recommend that it should leave special measures."
“I am concerned that the previous leadership had not fully addressed longstanding cultural issues and in particular the historical problems of bullying and harassment. While the problem is now being addressed there is still work to be done here and in the management of medicines."
“It is clear there have been deep rooted problems and the trust would now benefit from a period of stable management to address these issues. I am aware that there has been a recent appointment of a new Chief Executive who has considerable experience within the ambulance service and should bring that renewed stability. The board have assured us that they are focussed in supporting the Chief Executive to carry the improvements that are needed."
“In the circumstances however, I have advised NHS Improvement that the trust should continue to receive the additional oversight and support provided by special measures until such time we can report on significant and sustained improvement.”
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