England's Chief Inspector of Hospitals has told South Western Ambulance Service NHS Foundation Trust that it must make improvements to some of its services following an inspection in June by the Care Quality Commission.
Overall the trust has been rated as Requires Improvement – although its services were rated Outstanding for caring, and Good for being responsive. The trust was rated Requires Improvement for whether its services were safe, effective and well-led.
South Western Ambulance Service NHS Foundation Trust, one of ten ambulance trusts in England, provides emergency medical services to a population of around 5.3 million people, in an area served by 18 acute hospital trusts.
A team of inspectors looked at six core services: Emergency Operations Centres, Emergency and Urgent Care including the Hazardous Area Response Team (HART) and Patient Transport Services. Full reports for each service have been published on this website.
Professor Sir Mike Richards, Chief Inspector of Hospitals, said:
“As demand for emergency care grows year by year, our ambulance services have never been busier. I know that South Western Ambulance Service is at the forefront of national improvements in the ambulance service, exploring better ways to deal with emergency calls so that people get the attention they need, in the right place and at the right time.
“The trust has a strong and stable leadership team, which has put quality and safety as key priorities and has organised the staff and resources well across a wide geographic area, responding well, on the most part, to the most urgent calls, and working closely with other NHS providers to maximise the effectiveness of the service.
“We found staff in the emergency operations centres and emergency and urgent services to be outstanding in the way they supported people who were distressed or overwhelmed in often highly stressful situations.
“However we also found some variation in quality across the services we inspected. There were significant gaps in mandatory training and we found the levels of staffing were not always sufficient to provide relief when staff were training, or on leave.
“I am concerned that not all staff were reporting incidents, particularly when they were verbally abused by callers. Some felt that they did not have time to report all incidents, so losing the chance to learn from them and take appropriate action in future.
“During the inspection we identified a number of areas for improvement which we have passed on to the trust and to local commissioners. Our inspectors will return at a later date to check on their progress.”
Inspectors found there was good organisation and distribution of staff and services to manage specific areas of the region. In the 19 months until January 2016, the trust was better than the national average for responding within eight minutes to Red I calls (calls to the service which were immediately life threatening such as cardiac arrest).
Emergency operations centre clinical teams provided an effective hear and treat service for patients which was recognised as one of the highest performing in England. The service enabled clinicians to assess and triage patients over the telephone and close the call without sending an ambulance. The introduction of Right Care had resulted in 56.8% of patients who called for an ambulance being treated at the scene or referred to other services, rather than being conveyed to hospital emergency department.
While the trust had made significant efforts to support staff wellbeing, their efforts were overshadowed at times by the intensity of work. Staff morale and motivation was mixed. Most staff felt valued and were committed to the organisation, but in the 2015 staff survey a significant proportion of frontline ambulance staff reported they felt unwell due to work related stress, or had experienced musculoskeletal problems as a result of work activities. The survey also highlighted that a significant proportion of staff suffered physical violence or harassment, from patients, their relatives or other members of the public
The reports highlight a number of areas of outstanding practice including:
- There was, at times, outstanding professionalism under pressure among the emergency medical advisors in the Bristol and Exeter emergency operation centre (clinical hub) teams. Although staff may be criticised, shouted at, or threatened, they remained calm, and handled the callers with courtesy and patience.
- Staff in the emergency operations centres showed outstanding compassion and understanding to people in difficult and stressful situations. Staff made a genuine connection with patients and others who were scared or anxious and developed an, albeit temporary bond, with the person trying to help them.
- There was an outstanding and commended programme to manage frequent callers to the service. This was helping to release the organisation’s limited resources to more appropriate situations. There was strong multidisciplinary working to support frequent callers with the service promoting the issue among the wider community and partner organisations.
At the time of the inspection the trust had just embarked on 12-week pilot programme aimed to improve response times to critically ill patients, making sure the best response was sent to each incident first time and with the appropriate degree of urgency. The trust was one of two ambulance services nationally participating in this trial.
Across the trust, the inspection team found a number of areas where improvements must be made, including:
- The trust must ensure work intensity and fatigue is monitored and actions put in place to mitigate risks to staff
- Governance meetings at local levels must contain a strong focus on quality and safety. This will include performance reports on training, appraisals, patient outcomes, complaints and incidents relevant to the local level.
- The trust must ensure a system is put into place which informs patient transport service crews of any important clinical information relating to the patients they convey, such as when a patient has diabetes.
- Heathcare assistants who undertake initial clinical assessment of patients must be assessed as competent before working independently
- The trust must ensure partly administered controlled medicines which are no longer required are disposed of in accordance with the service standard operating procedures and that medicines are stored securely in the back of ambulances and cars when the crew is not present.
On 30 September 2016, CQC presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit was to develop a plan of action and recommendations based on the inspection team’s findings.
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