Criticare UK Ambulance Service

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 a total of 8 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question has remained as good.

We found the service provided and maintained safe systems of care, however they were not always managed and monitored effectively. Concerns about patient’s experience were listened to and were investigated. Risks were not always understood, managed or regularly reviewed. Care was delivered in safe environments however the environment where vehicles were stored was not well managed. The service had qualified, skilled and experienced staff, who worked together effectively to provide safe care that met patient's individual needs.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had processes in place to identify compliments and concerns. However, there was no information readily available on ambulances for patients. They would need to ask how to make a complaint, which could limit whether someone would do so.

People using the service had raised concerns about their experience of the service. The service reviewed each response and provided feedback to people. This demonstrated the service took concerns seriously.

The service had policies and procedures in place to ensure incidents and complaints were appropriately investigated and reported.

Staff said they had not reported any incidents but they were aware of their responsibility to report incidents. Managers said policies and procedures were available via a staff portal. However, staff told us they were unsure how to access this.

Staff understood their responsibility to be open and honest with patients and their relatives when something had gone wrong.

The service had policies and procedures in place to ensure incidents and complaints were appropriately investigated and reported. However, staff reported having limited access to relevant documentation.

Staff told us there had not been any team meetings whereby service information could be shared. However, the service provided evidence of clinical bulletins shared with staff which included some operational updates and National Safety alerts.

Feedback to the service from patients was generally positive and complimentary about their experience.

Staff followed policies and procedures and worked together to provide safe and effective care throughout the patient’s journey.

There was staff awareness of the risks to people during their journey. The service had processes in place to keep patients safe. However, there was limited monitoring of effectiveness of these processes.

Leaders and staff told us they had good working relationships with their local NHS trusts and other organisations they work with.

Feedback from partners highlighted positive working relationships and demonstrated how the service fulfilled, and sometimes exceeded, the journey request.

The service only accepted journeys it had the expertise and equipment to cater for. Leaders could describe the process for receiving and accepting patient transfer journeys. They were clear on what types of journey and patient they could accept. Staff could describe the criteria of patients they would and would not be able to transport, based on the training and role.

The service booking system could capture relevant information, such as mental health status or requirement for the use of blue lights. However, there was no documented policy or procedure that explained the specific inclusion or exclusion criteria for the service.

Staff told us they knew how to report incidents or concerns regarding safeguarding but had never done so. They knew who the safeguarding lead for the service was.

The service had policies and procedures to ensure patients and staff understood and managed risks regarding safeguarding. The service had a named safeguarding lead.

Feedback from patients, their family members or carers regarding their experience of using the service was positive .

Staff explained the patient transport pathway to us and how risk was assessed and reviewed regularly throughout the patient’s journey.

Staff told us they carried out dynamic risk assessments for each patient and journey. Information for each patient journey was recorded and captured on the service electronic patient transport system.

The service only undertook journeys for patients the service had the facilities and expertise for.

There was no formal feedback from patients regarding their experience of the environment. There was only one adverse comment in the form of a complaint regarding the cleanliness of an ambulance. The service had reviewed and responded appropriately to the comments made.

Staff told us they had enough suitable equipment to support them to safely transport patients.

People were transported in vehicles that were designed to meet their needs. Equipment used to deliver care was suitable for the intended purpose.

The ambulance base inspected did not have its own security systems. The service used a portacabin to store equipment, this was locked but the site was accessible to unauthorised access and not monitored. Keys to vehicles were were not stored securely.

There was no signage on the portacabin to indicate medical gases were located/stored inside. This posed a safety risk to staff and emergency services should there be a fire.

The ground around the parking area and portacabin was uneven and there was no external lighting. This posed a risk to staff during wet or cold weather and when it was dark. There was damaged and disused equipment abandoned in the brambles around the outside of the portacabin.

The electricity in the portacabin was controlled by the site owner and, on the day of the inspection, was disconnected. The registered manager was unsure how long the electricity had been off for or how to get it reconnected. This meant there was no lighting inside the portacabin. We saw equipment and bags being stored on the floor, this was unsafe to staff and not in line with infection prevention policy. The portacabin was visibly dirty.

Safety checks were not always performed on emergency equipment in line with the services own policy or manufacturer guidelines.

The service showed evidence of policies and procedures to ensure facilities, equipment and technology were maintained.

However, the service did not always follow these to ensure vehicle cleanliness checks or equipment safety checks had been carried out. There was limited audit that staff carried out their responsibility to perform daily vehicle and equipment checks. We also observed unclean areas and equipment within all vehicles we inspected including those deemed ready to be deployed.



After the inspection the provider made changes and improvements based on feedback. They provided evidence that demonstrated improved security for the base and vehicles. Additional evidence was provided regarding the provision of electricity and running water. We saw evidence that the portacabin had been tidied, with equipment and medical gases stored in a safe and an ordered way.

Feedback from patients, their relatives or carers described how staff had positively managed and supported their journey.

Staff told us they received training appropriate and relevant to their role. We saw evidence that confirmed staff had received training appropriate to their role. Learning was self-directed using external and recognised trainers and eLearning platforms.



Records demonstrated staff had received training to enable them to drive ambulances in emergency situations. Staff told us they would only work within their professional competencies.

However, staff were unable to provide details of any supervision, appraisal and support they had received. Staff told us there was an induction policy but were unable to confidently describe the process.

Leaders and staff told us there were appropriate staffing levels and skill mix to make sure people received consistently safe, good quality care that met their needs.

The service could evidence that they had systems and process regarding recruitment. Applicants completed online application forms. The service had retrospectively completed forms for staff who had joined prior to the online form being used.

The service carried out relevant personal checks including right to work in the UK, driving license and disclosure and barring service checks (DBS). The service could evidence they had carried out annual checks on key aspects, such as DBS.

There was a process and checklist for induction of new starters to the service. This consisted of a checklist completed and signed off by a senior leader, usually one of the operational directors.

We had no specific evidence from patients regarding the cleanliness of vehicles or staff. However, we saw one complaint which suggested a patient believed a vehicle was dirty. This was investigated by the service itself and was unfounded.

Staff described the process for cleaning vehicles after each patient or at the end of the shift. They told us they sprayed the inside of the vehicle and wiped surfaces. They did not use mops to clean the floors. This was not in line with the service own policy for cleaning of vehicles. We also observed a vehicle after it had cleaning performed and saw multiple areas of ingrained dirt and unclean surfaces. There was also discarded food items in staff areas of the vehicle.

Staff told us they were not aware of a specific process for clinical waste or linen, they would dispose of clinical waste at a hospital and replace linen from a hospital.

The ambulance base was on a farm site and had parking area for ambulances and staff parking. The storage facility was a portacabin. There was no running or hot water and no dedicated handwashing facilities for staff. The ground around the portacabin was uneven and dusty. Brambles around the outside of portacabin contained disused and abandoned pieces of kit, such as a stretcher.

There were limited amounts of cleaning products for staff to use to clean the vehicles and equipment. However, the products themselves were high street branded products that did not align with the services own infection, prevention and control policy.

There was one bucket with one mop head fixed. The mop head itself was visibly dirty. With no running water at the base it was unclear how staff would be able to clean the vehicles in line with the service policy.

We inspected 3 vehicles; 2 were designated as not operational and the other had just completed a patient journey and was deemed ready for its next job.

Both the non-operational vehicles (1 ambulance, 1 rapid response vehicle) were visibly dirty inside both the front and rear cabins. The rapid response vehicle would be used to support event work which the CQC does not currently regulate.

The vehicle itself was visibly dirty, both internally and externally and we saw no evidence of a cleaning log for this vehicle.

The ambulance that had returned to base and declared ready was inspected. The crew had sprayed the inside of the cabin but they had not wiped the surfaces or mopped the floor and it remained visibly dirty. There was no paper in the AED that was on the ambulance and pads to used with the machine had expired (June 2024). The AED was found to be faulty and would not be able to be used in an emergency. There were various items of paperwork in the drivers cab, including completed incident forms with other company’s branding.

The RM described the process for the management and disposal of clinical waste from vehicles. Staff were required to dispose of clinical waste at hospitals during their shift and could also use a clinical waste bin located at the registered address for the service. However, on one vehicle we inspected there was clinical waste in situ and managers were unclear how long it has been there as the vehicle was not in recent service.

There was a contract in place with a 3rd party provided for clinical waste collection. This confirmed what the RM had described. There was evidence of regular collection from the registered address for the service.

The service had an in date Infection, Prevention and Control policy which described the process both staff and leaders should follow regarding cleaning and audit. The policy itself was appropriate however our observations and discussions demonstrated both the leaders and staff were not following their own policy.

The IPC policy stated an annual IPC report was produced, however the provider was unable to provide the latest report.

There was no apparent system for stock control in the portacabin meaning items of in date and out of date stock were stored together. The portacabin was untidy, with dirty equipment on the floor and was visibly dirty inside with no cleaning schedule on display.

Concerns regarding IPC were highlighted during the inspection.

After the onsite inspection the service provided evidence highlighting changes and improvements made to improve the position. For example, an invoice detailing new healthcare cleaning equipment and products had been purchased. We were shown posters that had been placed in the portacabin and vehicles regarding the correct cleaning process. Evidence was provided for a deep clean that had taken been carried out on one of the ambulances.

These were positive changes, albeit they took place after the onsite inspection.

Feedback from patients, their relatives or carers described how staff had positively managed and supported their journey.

Training certificates provided by the provider showed staff had received training relevant to their role in a patient transport service. This included basic first aid and use of medical gases.

Staff told us they did not work outside of their competencies.

The RM told us that if they utilised a paramedic, as specifically requested or appropriate for a journey, then they would bring their own medicines under their own registration.

The service provided patient transport and therefore did not routinely use or administer medications. The ambulances carried medical gases, oxygen and nitrus oxide , where staff were appropriately trained to administer.

There were no separate storage facilities at the ambulance base for medicines. The RM told us oxygen and nitrus oxide were stored on the vehicles and there were no additional storage facilities. When the portacabin was opened on our arrival there were 5 mini oxygen cylinders in the portacabin. They were all full and in date, they had not been secured and were freestanding. There was no signage on the portacabin to indicate medical gases stored inside and there was no ventilation.

The RM was informed and it was confirmed immediately after the inspection that the cylinders had been removed from the portacabin and stored securely.

The service had a rapid response vehicle which was currently not in service. The vehicle would be used to support event work which the CQC does not currently regulate. The vehicle contained appropriate but limited equipment for the nature of its role. However, some items in the kit were beyond their expiry date, including a cannulation kit (expired June 2023) and an IV giving set (expired May 2024). We informed the RM during the inspection.

The service had an in date Medicines Management policy. The policy was detailed and cover all aspects of medicines appropriate to a service providing patient transport. This also included the safe storage and use of medical gases.