England's Chief Inspector of Hospitals has told Yorkshire Ambulance Service that it must improve the quality of some of its services following an inspection by the Care Quality Commission.
Overall, Yorkshire Ambulance Service NHS Trust has been rated as Requires Improvement. A team of inspectors found that the trust delivered services that were caring, but that work was needed to improve safety, effectiveness and responsiveness.
Yorkshire Ambulance Service provides 24-hour emergency and healthcare services to a population of more than five million people.
During the inspection in January and February, a team of inspectors and specialists looked in detail at the trust’s emergency operations centres, the emergency and urgent care service, patient transport services and the resilience service including the hazardous area response team.
A full report of the inspection, with detailed ratings for each service is available here.
Inspectors found that patients were treated with compassion, dignity and respect by ambulance staff. Staff explained treatment and care options in a way that patients could understand and involved patients in decisions. Patients, their relatives and others received emotional support when experiencing distressing events.
The ambulance service was not meeting national target emergency response times for responding to life threatening conditions. During the first two quarters of 2014-2015 information showed that the trust had performed worse than the 75% national target rate, with less than 71% of calls being responded to within eight minutes. However, the trust performed consistently above the England average for category A calls requiring the arrival of an ambulance at the scene of the incident within 19 minutes.
The trust had major difficulties in recruiting staff. National shortages of paramedics contributed to the trusts difficulty in recruiting, and this had impacted on the trust’s ability to be responsive or enable staff the time to attend training.
Infection control practices were not always followed by staff. A large number of ambulances were dirty on the outside and the general cleanliness of the inside of ambulances and procedures for disposal of clinical waste gave cause for concern.
Inspectors were particularly concerned at the lack of checks on equipment by the hazardous area response team (HART) who provide ambulance service response to particularly hazardous or challenging incidents. A large amount of lifesaving equipment had passed its expiry date, but checks undertaken by the trust had not detected this. Inspectors also found out of date stock of medical supplies in some ambulances and at ambulance stations.
Patients using the patient transport service told inspectors they had difficulty in getting through to the control centre to book or cancel appointments.
The report identifies three main areas for improvement:
- The trust must ensure all ambulances and equipment are appropriately cleaned and infection control procedures are followed.
- The trust must ensure that equipment and medical supplies are checked and are fit for use.
- The trust must ensure that all staff are up to date with their mandatory training.
Ellen Armistead, Deputy Chief Inspector of Hospitals, said:
“Overall, we found services provided by Yorkshire Ambulance Service NHS Trust required improvement.
“It is clear that within the trust there is an ambition to develop a culture of clinical and professional excellence. There has been a history of change at executive level and the trust would benefit from a period of stable management to see this vision through.
“Staff we met told us that they were proud to do their job but were under intense pressure. Although the inspectors found many examples of good practice, we have also identified areas of concern, including the failure to adopt good hygiene and infection control standards. The issue had been known to the trust for some time and as such is disappointing the trust has not effectively addressed the problem.
“Any person using the service is entitled to receive treatment and care that is consistently safe, effective, caring and responsive to their needs.
“The trust has told us they have listened to our inspectors’ findings and we are aware that they have begun to take action where it is required. We will return in due course to check that the improvements have been made.”
The inspection team highlighted several areas of outstanding practice including:
- The trust’s ‘Restart a Heart’ campaign trained 12,000 pupils in 50 schools across Yorkshire.
- The trust supported 1,055 volunteers within the Community First Responder and Volunteer Care service Scheme.
- The emergency operations call centre was an accredited Advanced Medical Priority Dispatch System (AMPDS) centre of excellence.
- Mental health nurses working in the emergency operations centre to give effective support to patients requiring crisis and mental health support
The two reports which CQC publish today are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations including Healthwatch.
On 18 August the Care Quality Commission presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.
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