Criticare UK Ambulance Service

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed a total of 4 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 dropped to requires improvement.

Although we found leaders had the skills and abilities to run the service, they did not always manage the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. Staff were not always given opportunities to meet, share knowledge and develop their skills. Leaders did not operate effective governance processes throughout the service. Staff were clear about their roles and accountabilities. Leaders had systems to manage performance but did not use them effectively. They identified risks and issues however they did not always implement actions to reduce their impact.

We found a breach of regulation related to good governance.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff spoken with stated that they felt supported by the manager. The manager was described by staff as being visible.

There was no clear process for staff to be supported in raising concerns. There were no records of regular staff meetings or individual meetings with staff.

A review of the governance structure found that the provider was not monitoring the quality of their service effectively. There was limited evidence that director and governance meetings were held regularly to discuss the performance of the service.

A review of the available meeting records did not show evidence of action planning and the escalation of risk. The meetings did not appear to have a formal agenda and no attendance was recorded.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The Registered Manager told us no audits, such as infection control, handwashing, health and safety had been carried out. This was not in line with their own policy and therefore posed risks to patients and staff.

Governance meetings were not being held regularly or used effectively to identify and share learning.

The service has a current risk register. The information provided on the risk register has entries from Dec 2013 to August 2024. Identified risks relating to business continuity, staffing, clinical aspects, equipment do not appear to be easily distinguished or separated. 3 risks added in 2024 (which included the CQC inspection), 1 risk 2023 (January), 1 risk 2020 (February) and the next previous risk was added in 2018. This suggests the risk register is not actively used or monitored to provide leaders of the service with assurance.

There were no systems or processes to assess, monitor and drive improvement for the quality of the service. There was a limited programme/schedule of audits to monitor service provision and to help identify any risks.

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

The RM described the nature of work the service undertook and how they worked to support the community. Primarily this involved patient transfers: hospital to hospital, hospital to care/nursing home, hospital to home.

The RM said they also worked closely with local NHS trusts to help facilitate timely discharge or transfer of patients.

Another aspect of their work involved transfer of patients from the Channel Islands to hospitals in England. The service usually provided an ambulance and crew and the patient would be escorted by an appropriate medical or nursing team.

We saw feedback from partners and organisation who had commissioned services. All the feedback was positive and complimentary both about the timeliness of the service provided but also about the capability and conduct of staff.

The service did not have any additional communication tools or aids on board their vehicles. The Registered Manager and crews said they would use online translation tools or family members for support.

Staff described the level of training they had received for their role and described how they only worked within their competencies.

Staff confirmed they had not been invited to or attended any staff meetings.

Staff told us there were not able to access company policies.

The RM said that all policies and procedures were available to staff via an online portal. Changes to policies and any information or updates were communicated using secure messaging services.