The Care Quality Commission (CQC) has found that the London Ambulance Service has made significant progress. The trust, which was rated Inadequate in November 2015, is now rated Requires Improvement overall, but Outstanding for being Caring and Good for effectiveness.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“The events of the last few months have underlined what a crucial service London Ambulance provide to the capital, and how hard its staff work to deliver this service - sometimes in unimaginably difficult conditions."
“During our inspection in February we observed - and people told us - that staff were providing excellent care."
“There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Relationships between staff and people who used the service, were strong, caring and supportive. Staff recognised and respected people’s needs. They always took people’s personal, cultural, social and religious needs into account. For these reasons, we rated the trust as Outstanding for the caring domain."
“Overall, the trust has made sustained progress since our last inspection, including significant improvements in emergency preparedness resilience and response. Response times to incidents classified as a HART (Hazardous Area Response Team) response are being met."
“However, there is more work still to do - for example to ensure that they meet national performance targets for the highest priority calls - which is why the trust is rated Requires Improvement overall. I am hopeful that the trust will be able to deliver these improvements and we will be back again in the near future to check progress. In particular, the leadership team is very new. As long as this has become properly established I am confident that we will be able to recommend that they should exit Special Measures within a few months."
CQC inspectors looked at three core services: the Emergency Operations Centres (EOC), emergency and urgent care (EUC), and the Emergency Preparedness, Resilience and Response (EPRR).
Inspectors found that:
- Significant improvements had been made in Emergency Preparedness Resilience and Response. Response times to incidents classified as a HART response had been met.
- Staff across all services were caring, compassionate and treated patients with dignity and respect. Patients who spoke with us were very positive about the service they received and the way they were treated by staff.
- The emotional needs of patients and their relatives were addressed by staff providing information, treatment and care. Staff used a range of skills to provide empathy, support and reassurance when dealing with patients who were anxious or distressed.
- Call handlers took their time to provide information and advice in a manner which was understood. They were patient, respectful and kind.
- Staff had good induction procedures and access to training, and the introduction of the in-house academy provided an opportunity for staff to progress to the paramedic role.
However, inspectors also found areas where the trust needs to make improvements, including:
- Doing more to ensure they meet the national performance targets for highest priority calls.
- Improving the oversight and management of infection prevention and control practices. This includes ensuring consistent standards of cleanliness in the ambulance stations, vehicles and staff adherence to hand hygiene practices.
- Ensuring continued monitoring and improvements are made in medicine management, so that safety procedures are embedded in everyday practice.
- Allocating ambulance personnel appropriately, taking into account individual qualifications, experience and capabilities.
- Ensuring sufficient time is factored into the shift pattern for ambulance crews to undertake their daily vehicle checks within their allocated shift pattern.
- Reviewing the leadership and management styles of key staff with responsibility for managing emergency and urgent care ambulance crews.
- Improving staff uptake of mandatory training subjects, including safeguarding vulnerable people and infection prevention control.
London Ambulance will remain in special measures but CQC will undertake a well-led review in about six months’ time, therefore allowing the new leadership team a period of time to settle in.
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