Medical Response Services

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

We assessed 4 quality statements learning culture, safe environments, safe and effective staffing and infection prevention and control. The service had enough staff to support the hospitals with additional support available when required. Managers carried out recruitment checks and made sure staff were competent in their roles. Staff had training in key skills, understood how to protect people and managed infection risks well. Premises, facilities and equipment were clean and well-maintained. The service managed concerns and learned lessons from them. .

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

All services users had a positive experience with the service, most people had been given information on how to raise a complaint if required. People felt supported to raise any concerns they may have. Some services users had received feedback verbally from management following their involvement with the service.

Staff were confident to report incidents, had knowledge of the incident policy and understood what should be reported and when. Staff understood the Duty of Candour. Staff said incidents were reviewed and feedback was given where relevant. They received emails, discussed and shared learning in meetings and on the company staff portal. Leaders investigated incidents in a timely manner and supported staff as required.

Staff followed systems to raise any concerns they may have, both formally and informally. Leaders reviewed reports of any concerns and took action to manage or remove risks, where identified. The service had relevant policies and procedures to manage incidents and complaints. Leaders used systems to identify and respond to any risks where these were identified. Managers kept staff aware of safety incidents and complaints and shared these through the company’s communication application.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

People said they felt safe while being transported. They had no concerns about the general condition of the ambulance or the equipment.

All staff were aware and able to explain the requirement to check the vehicle prior to use. All staff could explain the pre and post shift checks and the documentation to be completed. Staff completed a pre and post shift check for each vehicle and associated equipment, recording the actions taken where any defect was identified. All staff were comfortable to raise a defect where this had been identified and had vehicles reassigned to prevent those vehicles going on the road. The service employed two mechanics to monitor, maintain and carry out repairs for the ambulance fleet where required.

The ambulances where well maintained, clean and tidy. All equipment was specific to each ambulance and remained on the vehicle. During any equipment repairs, the ambulance would be removed from service. Keys for vehicles were stored securely. Crews only had access to the keys for the ambulance which was assigned to them. The service ensured staff could only access areas that were immediately relevant to their own area of work and there were secure controls in place to limit this access. The service had an onsite garage where the mechanics were based. The ambulances were fitted with trackers and crews used mobile phones to receive information from the office. When not on the road, the ambulances are on a forecourt of the service. CCTV across the site supported security. Medical gases were stored safely. COSSH substances were also held in a locked cabinet and clinical waste was in secure area. Locked cupboards held overflow equipment, paperwork, uniforms and training items. The ambulance station had a training area, this included out of date consumables used for training purposes only. Out of use equipment, such as stretchers being used for parts, was stored at the ambulance base. All staff were aware not to use any equipment unless it was kept on the vehicle. All fire escapes within the ambulance station were clear of clutter, accessible and sign posted. Fire extinguishers were in date, fire exists were unobstructed and sign posted.

The service had an inclusion/exclusion criteria, this was used to inform staff about who can use the service, and how to access this. Ambulance crews completed a pre shift check form and pre shift equipment check form before every shift, followed by a post shift vehicle check and cleaning report form. These were submitted to the office staff for review and auditing purposes. The service had an electronic system which showed when vehicles require routine interventions such as MOT’s. The provider had an embedded process which staff followed when completing defect reports from the pre and post vehicle checklists, or when vehicles were being taken off the road for review. The company kept a record of all vehicle defects and reviewed these to monitor any trends. Ambulance staff would also share their knowledge of any themes in vehicle defects they were aware of. Adverse weather conditions were identified as a potential risk on the company risk register. Staff completed fire risk assessments action plans and evacuation plans, with yearly checks of ramps, piped oxygen and fire extinguishers. We saw the latest ramp check had been completed and the piped oxygen check was due to be completed.

People had no concerns about the staffing numbers, or the skills held by staff. All people we spoke with said staff were professional and explained all interventions and gained consent to them prior to completing these. Some individuals needed to have support from multiple crews for transport; there were no issues when accessing the number of staff required.

All staff stated they had adequate training and supervision to fulfil their role. Staff confirmed they had received training to perform their role, and that the manager prompted them to update their training regularly. Staff said they were up to date with their mandatory training. All staff stated yearly appraisals were completed and they have supervision quarterly. New staff completed a full induction to the service. They also completed a probation period which included more frequent supervision and shifts shadowing colleagues. Staff and leaders told us that they could request further training when needed. Leaders arranged for staff to complete additional external training sessions for some subjects, including for example, use of oxygen therapy. Staff told us they worked as teams of two, with one driver and an assistant allocated for each of the trusts. Staff confirmed they had enough time to take adequate breaks during the working day. Leaders told us the service had a backup crew on daily standby which could be deployed as required. The service arranged for any cover needed due to staffing shortfalls, offering extra shifts for colleagues already working in the service.

The service recruited staff safely with relevant pre-employment checks completed including Disclosure and Barring System checks, two references, right to work documentation and identity checks. There were appropriate staffing levels and skill mix to provide the service. Mandatory training was up to date and had been completed for 91% of all staff. Staff had access to additional service, specific training, such as The Level 3 Certificate in First Response Emergency Care is a regulated and nationally recognised qualification. (FREC 3). New staff had a full induction with documented records of supervision. Appraisals were up to date and completed appropriately.

People found all staff well-presented and professional. There were no concerns regarding the cleanliness of the staff, vehicles or equipment.

Staff told us they were provided with a uniform which they laundered themselves at home. Each uniform is replaced every 6 months. Should a staff member have an incident and require a spare uniform, this was provided from the base. Staff told us the ambulances were expected to be cleaned on return to the base, as part of the post shift completion. Staff cleaned vehicles using an outside sink and power washer for the external cleaning of the ambulance. Staff informed us they do not transport infected patients with other patients and would complete a deep clean of the ambulance following the transfer of any patients who had with an infection. Staff told us there were sufficient available supplies of personal protective equipment (PPE) for them to use. Staff informed us if they had an infectious illness, they needed to refrain from work until better or 48 hours clear. Staff and leaders told us linen, and waste is returned to the trust in line with trust policy. Staff had completed mandatory training for infection control. Leaders told us they have a routine deep cleaning schedule for all ambulances, this was seen on site.

Staff appeared clean and well-presented all uniforms were clean and in good repair. Staff were bare below the elbow and had access to suitable PPE. The vehicles were all clean and visibly tidy with no clutter and all items stored correctly. Alcohol gel was seen on the vehicles and carried by all staff members as part of their uniform. Sharps boxes were assembled correctly, labelled and secured in the vehicle. At the time of inspection these were empty. The service had suitable hand wash facilities in the base.

The service had hygiene and infection prevention control policies for staff to follow. These included guidance for different processes and practices, including such as hand hygiene, personal protective equipment, cleaning and isolation of people with known or suspected infections. Staff completed level 2 infection prevention control training. There was clear guidance available to staff to guide them in deciding when people required to be transported in isolation or with other passengers. The service used an electronic system to maintain oversight of the ambulance deep clean schedule. This was up to date and all ambulances compliant at the time of inspection. Infection, prevention and control spot checks were completed on the vehicles.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.