Lincs and Notts Air Ambulance Charity

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This is the first assessment for this service. This key question has been rated outstanding.

We rated safe as outstanding. There was a proactive, systematic approach to managing safety. Leaders embedded and maintained a culture to continuously improve and encouraged openness and collaboration, and safety was everyone’s top priority. Staff demonstrated a commitment to improve safety and there were clear roles, responsibilities and structures to meet safety goals.

There was proactive identification of hazards and risks, which were assessed and managed to avoid adverse outcomes. Solutions to risks were developed collaboratively with the right people and the effectiveness of the controls were monitored and measured. Staff were actively encouraged and appreciated for raising concerns about safety and ideas to improve.

Leaders ensured there were enough skilled staff to deliver safe care and could demonstrate adaptive strategies for responding to demand and capacity issues. Training included safety expertise, human factors and communication to support a positive safety culture within all levels of the workforce.

Information and intelligence was actively sought to ensure people were always safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination.

This service scored 91 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were confident in raising any concerns about their care. These were taken seriously, and staff gave prompt responses and would make any appropriate changes from information gained through this feedback. When a patient and their family raised concerns about the actions of staff at the scene of an incident, the service met with them and provided a written reply to the queries raised. The relevant staff members acknowledged opportunities for reflection in the case of similar future incidents. However, in response to some questions they explained these were carried out following the relevant current guidance around procedures.

The service had a systematic and embedded approach to its culture of learning. All staff we spoke with during the inspection gave examples of how opportunities for learning had helped to shape the practices within the service. For example, a weekly case review meeting included all staff and reviewed all details of the emergency attended including staff wellbeing and patient aftercare. Learning and best practice taken from these case reviews was fed back to all staff.

Staff were encouraged to discuss safety and any learning. They were able highlight cases they had attended which they felt would be good for discussion so they could easily contribute to the input of information the service reviewed. Patient safety and an open transparent culture were consistently spoken about by all staff. Duty of candour and its importance was clearly understood throughout the service.

Staff told us safety for patients and crew was a top priority. A red, amber, green system was used daily to assess whether crew felt safe to undertake their duties. Not only could the member of staff declare ‘red’ (they were not ready to carry out their duties for any reason), but also other members of staff were able to declare ‘red’ if they were concerned one of the team members were not operating at their best. We heard examples this being put into practice when staff had been unwell and tired. This was never questioned or challenged by any of the leadership within the service, only supported.

Incidents were reported and investigated for any learning. Staff told us any safety incidents were noted on an electronic reporting system. Teams held post incident de-brief meetings to share learning. Weekly governance meetings also reviewed incidents, and pertinent learning was shared with all staff. On occasion, where different actions might have been taken, staff members wrote 'self-reflection' reports to support their individual learning.

The service had effective policies for staff to raise safety concerns and record specific issues. Safety issues were discussed with relevant staff at shift handovers and briefing sessions, with any urgent actions taken to manage risks. The service issued a monthly safety newsletter to all staff. The service had a safety committee which reviewed any issues and shared learning through the minutes. This committee reported back to the board of trustees and relevant external agencies. Any learning and improvement actions were monitored by the quality and performance committee.

Patients and their families praised the responsiveness of the service and staffs’ ability to work with other agencies to ensure a smooth transfer to hospital. For example, patients told us that in situations where other loved ones or family members were present at an incident, staff worked with other services to ensure they were able to travel on to the hospital to be with the patient.

The service had appointed a senior clinical lead for patient safety. This was a senior highly qualified and experienced paramedic. They also worked in a role in the NHS and were enabled to bring any learning and experience for patient safety. A compliance manager was focused on all aspects of patient safety using various tools and audits to look for themes and trends for further investigation, change and improvement if needed. They also scanned all clinical guidance for new or amended information to be distributed throughout the service.

Staff could outline the processes and policies which formed the basis of safe systems in the service. They used industry recognised reporting systems to highlight specific concerns or track themes. Staff told us they worked closely with other emergency services along with other trauma centres to ensure an effective patient transfer from the scene of the incident to the right place of care.

The local NHS ambulance service that commissioned the air ambulance service acknowledged the prompt response and effectiveness of the service at the scene of incidents. They also praised service teams for their efficiency and good communications. The trauma network representative told us they respected that staff did not do anything that went beyond patient need but focused on stabilising patients and transferring them to the right place of care as quickly as possible.

The service had policies and processes to ensure patient safety was maintained at the scene of the incident and beyond. Monthly clinical safety meetings were held with senior managers to consider risks. Health and safety committee meetings were held quarterly to consider all aspects of safety across the service. The service received national notifications and other guideline updates through a 'safety inbox', which was reviewed by managers and shared with the relevant staff. A ‘situation awareness memo’ (known as ‘SAM’) would be sent to relevant staff for urgent actions while general safety updates and learning were included in the all-staff newsletter.

Staff told us they had received the relevant mandatory training and could explain the safeguarding referral process and how these were recorded. If patients and families or carers had concerns, staff members could signpost to appropriate external agencies to provide support. Staff also told us if they suspected any safeguarding issues, such as domestic violence, they would raise this with the safeguarding lead who would make the appropriate referral to the local authority.

Service partners we spoke said there were no safeguarding or referral concerns.

The service had a comprehensive safeguarding policy which covered escalating concerns, the training of staff, and freedom to speak up guidance. The service conducted annual safeguarding audits to ensure correct processes were followed and actions completed. The safeguarding committee held quarterly meetings to consider risks and how to manage them.

Staff had completed the appropriate level of safeguarding training. At the time of the assessment, some doctors were in the process of updating their training, but arrangements were made to ensure this would be completed within a reasonable timeframe. The service had safeguarding leads who took overall responsibility for ensuring all safeguarding systems were safe and effective.

Patients and their families told us how staff discussed with patients the risks and benefits of the treatment and transfer options at the scene. They checked other people involved were also looked after. The service asked patients for their feedback about the decisions taken in after-care meetings. If patients made any suggestions for improvements, the service shared these with colleagues through staff newsletters.

Staff said there was a balanced and proportionate approach to risk so people could make the right choices. They managed risks to themselves and to patients well. This included understanding behaviour that could challenge and being able to de-escalate it when needed. They listened to people when they were distressed to provide support and help to reduce anxiety.

The service had system and processes to make sure that care was safe, and risks were carefully managed. Staff were encouraged to listen to patients and their families but ensure they were given the best advice to manage the risks they were facing. Individual risks to people were assessed, and people were involved in this process as much as possible. There was therefore a balanced and proportionate approach to risk in individual care and treatment that supports people and respects the choices they make about their care.

People had no concerns about safety. Patients and their families confirmed they felt the helicopter was safe and well maintained and staff took all safety precautions on landing and taking off. People who travelled the aircraft said they were asked to wear seatbelts and wore ear protection for safety. Those patients and families we spoke with who had visited the service HQ in their follow-up meetings also commented on the excellent facilities at the service’s headquarters.

Staff told us the aircraft, vehicles and equipment were monitored daily, with appropriate testing and calibration carried out. At the time of the assessment, the main helicopter was undergoing its annual maintenance service, and a replacement helicopter was in use. Although this was smaller, it was fully equipped and able to handle all patients.

Staff told us if there were any safety concerns with equipment or a vehicle, it would be taken out of service and a request promptly made for repair/replacement. Otherwise, the helicopter was licenced and regulated by the Civil Aviation Authority. This included the regulation and requirements for the pilots, landing areas, and flight operations.

Any equipment used in the service went through rigorous governance from procurement to training for staff. It was regularly reviewed when in service to ensure it fully met all requirements and safety standards. There was a full medical device inventory for maintenance and service requirement to be followed and met.

The helicopter and response vehicles were all in working order. All equipment functioned correctly, with testing and calibration up to date. The base area was clean and tidy. We observed a practical layout of the base, which included a physical pathway to enable staff returning from an incident to go through suitable environmental control procedures before entering the main office area.

The service had various policies and charters in place to maintain a safe environment. Regular checks and audits for safety were conducted. The head of facilities was accountable for compliance with policy guidelines, but all staff were responsible for ensuring that the environment was safe for patients and staff. If any issues relating to the safety of the environment arose, a ‘situation awareness memo’ (known as SAM) would be circulated to staff to improve practice.

Patients and their families told us that they felt reassured that staff were competent and skilled, and they provided prompt, appropriate care. Those we spoke with confirmed there was a doctor and paramedic from the helicopter or response car on the scene.

There were safe levels of staff who were trained, qualified and experienced. The service was fully staffed to its establishment numbers and carried no vacancies. Staff told us there was a well-managed system of training to ensure they were appropriately skilled for their role. Mandatory training was closely monitored by managers, with oversight by the board. Staff undertook refresher training and cases were regularly reviewed with staff for learning purposes.

There was a standard operating model for both paramedics and doctors. However, managers told us on rare occasions only a paramedic may attend an incident. This was entirely appropriate, and at these times, paramedic staff would work within specific legal guidelines to ensure they provided treatment and medications within their practise. Managers told us if staff members had any concerns about treatment or care at the scene of an incident, they could contact the on-duty consultant doctor for guidance.

There were senior clinical medical on call around the clock, and out of hours they were on an on-call rota and could be contacted by any staff for guidance and advice. To that end, the senior clinician took full responsibility for the patient’s care and treatment, even if this was managed remotely.

The service had strategic plans, audits and policies to ensure there were the right number of fully trained staff to care for patients. Mandatory training completion rates met the service’s compliance with paramedics at 100% and doctors at 98%. The service acknowledged the usual risks to staffing issues such as undergoing recruitment when needed and bring new staff up to speed. This was therefore mentioned on the corporate risk register, which described how the service would fully manage the situation.

The service worked with clinical fellows who had a six-month placement with the air ambulance service and six months with the major trauma centre. They received supervision with the service and were all given projects to work on and deliver.

Patients and families told us they recalled the helicopter was clean. They also confirmed appropriate actions were taken to minimise and control infection risk at the scene.

There was an effective approach to managing the risk of infection and people were protected as a result. Staff we spoke with confirmed that infection prevention and control was taken very seriously. Cleaning and management of clinical and general waste was monitored using a QR code system. The premises were cleaned on a daily basis. Staff advised how one day a week was dedicated to cleaning the vehicles and helicopter, with monthly deep cleans carried out. Clinical waste bins were in the right places and an external waste company picked up waste and sharps bins under a contract. Staff were encouraged to raise any concerns about the cleanliness of the area with the infection prevention and control lead.

The premises, helicopter and vehicles were visibly clean. For example, the shared toilet facilities were clean and well-maintained with everything required provided and in full working order. All the premises we saw were clean and well maintained to ensure they could be cleaned effectively. For example, equipment was in racks and off the floor to enable to floors to be easily accessed. Cleaning checklists were updated using the provider's QR system, which could be spot checked by staff using service devices. Checklists carried out at the time of the assessment confirmed that waste bins, hand hygiene, uniforms, premises and vehicles were all clean and correctly maintained.

The service had an infection prevention and control policy which applied to all staff. A dedicated IPC lead staff member provided guidance in accordance with the policy. The head of facilities was responsible for compliance with the cleanliness charters which covered specific areas in the building. The service conducted regular audits around infection prevention and control to ensure that any actions raised from the regular checks were being carried out. Infection prevention and control was included in the risk register and business continuity plan and was a standing agenda item in health and safety meetings.

Patients told us that pain relief was given at the scene of the incident, and staff would explain what medicines were being given and how they would help. They were also asked about medical conditions and any allergies. One patient’s family told us a specific medication was given to "settle the patient for the flight", which was explained to the patient at the time.

Staff told us medicines were checked and stored correctly. The service had a dedicated doctor responsible for all medications. Daily stock checks were undertaken by two staff members.

There was clear guidance around who could dispense certain medications. Patients were informed about which medication was being given. Staff told us all medication information was recorded on the patient record form and the service-to-service handover sheet. The use of any controlled drugs was also noted on the controlled drug register.

At the time of our second visit, the service explained there had been an administration error in renewing its licence for controlled drugs. This was being carefully managed in order to be resolved at the earliest opportunity. Arrangements had been made for the service to undertake a different level of service in consultation with the NHS ambulance service so it could continue with most emergency care.

Medicines stocks were securely stored on aircraft, vehicles and on the premises and were up to date. We checked the controlled drugs cabinet books which had been designed by the service. However, we noticed the labelling of the books which contained details of a certain pain relief medicine might cause confusion. This was raised with the registered manager, who flagged this as an incident. We were told following the first visit how the labelling of the cabinet books was promptly changed with learning to be shared across the service.

The service had a medicines policy with guidance on the procurement, storage and dispensing of medication. Regular audits of medication held on the premises were carried out. The policy also provided instructions relating to informing patients of any proposed medication and made it clear how patients had the right to refuse medication.

Any errors or incidents around dispensing would be logged as an incident. On one occasion, a staff member made a medicine error which was identified. Evidence showed the incident was reviewed and the staff member reflected on the error in process. To prevent recurrence of this incident, the service ensured the medicine ordering was amended. This learning was shared in the staff newsletter and guidance updated to prevent this reoccurring.