PSS Birmingham

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question good. At this assessment, the rating remained good. This meant people were safe and mostly protected from avoidable harm.

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.

We did not observe any patient journeys during this assessment and were unable to speak to patients.

There was formal learning from incidents, but this was not always effectively communicated to the staff. Most staff told us they did not receive feedback or learning from incidents. Some staff told us they felt there was a “blame culture”, rather than lessons being learned. We raised this with managers, they showed us, and we reviewed, multiple forms of communication sent to staff feeding back lessons learned from incidents. We saw that a high proportion of staff had read these communications. For example, November 2024 newsletter was viewed by 71% of staff; this contained lessons learned. Staff told us about changes that had been made. For example, an incident occurred where handcuffs were used, and they did not need to be. They changed the practice so that the RMNs needed to gain authorisation from a manager if they wanted to use handcuffs for restraint. However, some of the staff were not able to tell us about changes made following incidents. We saw learning from incidents was sent to them via an application, it was shared in meetings, and was discussed in clinical supervision meetings. Some staff told us debriefing happened after incidents, others told us they did not get support from their managers and incidents were not always acknowledged. Managers told us incidents were acknowledged and support given where they were categorised as moderate or above or if it was a difficult incident and the staff needed support. Staff raised concerns and were encouraged to report incidents by their managers. They had reported 353 incidents in the last 12 months. Managers had recently introduced incident reporting online which staff could do via a QR code in the vehicles. We reviewed 3 serious incident investigations for incidents reported since April 2024. Each of them had a full investigation and clear actions. Although 2 out of 3 of the investigation reports had not provided an update to the action plans. Actions showed learning from incidents.

The service had a policy for managing incidents. Where learning was required, there were processes to follow for staff to ensure this was shared and embedded. They also had lessons learned posters which were displayed in the staff room; it was also embedded in the clinical supervision forms to ensure it was discussed when they had their supervision meetings. The newly introduced newsletter for November 2024 included lessons learned. It gave detail about incidents which had occurred, and the improvements needed.

We did not observe any patient journeys during this assessment and were unable to speak to patients.

The service mostly worked well to understand and manage risks when transitioning patients between services. However, staff told us that at times, the risks were not always identified by the hub. This meant the staff were not always allocated correctly. We were told the professional booking the service may see risks as higher or lower. The RMN completed a second risk assessment on arrival to the job to ensure all risks had been captured. This meant at times, staff turned up to collect a patient from a home extraction and there were unanticipated risks and they could not complete the job. However, we found there was mostly a collaborative approach to safety between services to ensure patients transitioned well. There was an awareness of the risks to people across their care journeys. The approach to identifying and managing these risks was mostly effective. Patients were referred to the service for patient transport where key details were taken about them including their mobility status, current mental health section they were under, and any current risks the patient had. There was a RMN in the hub for staff to ask clinical advice from. Team members were then allocated to the journey based on the information that was given and the risk level of the patient. Staff told us the teams allocated were mostly appropriate and safe.

Partners told us they worked well with the service in a collaborative way. We were told the patients were conveyed safely.

Safety policies and processes were in place to ensure the patients remained safe as they were conveyed through different services. There was a standard operating procedure for the service which detailed how patients would be transferred safely. There was a physical interventions policy and de-escalation and management policy which all staff were aware of and followed to ensure patients remained safe whilst transferring them between care providers.

There was a good understanding of safeguarding across the service and staff knew how to take appropriate action. Staff received training specific for their role on how to recognise and report abuse. Safeguarding incidents were reported on an online portal. If there was an incident that staff had found difficult, it was discussed as part of learning within their safeguarding supervision meetings; these occurred every 3 months. Staff understood the Mental Health Act 1983 (MHA), Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and had completed training on this. All patients who were transported were sectioned under the MHA. Staff were knowledgeable and knew how to ensure a patient was sectioned appropriately. For example, we joined a team on a transfer and the RMN reviewed the patient’s paperwork whilst they were on the ward. They identified the patient had not been sectioned appropriately and would not be able to be transferred to a secure mental health unit without the correct paperwork.

We spoke to partners and no concerns were raised about safeguarding. One told us they had not had any specific safeguarding incidents but where learning was shared operationally this was discussed, evaluated and followed accordingly.

There were effective safeguarding systems, processes and practices to make sure people were protected from abuse. There were clear roles and responsibilities around safeguarding, however, not all staff were aware of who the safeguarding lead was. Each safeguarding incident that was reported was allocated to an investigator and discussed at a weekly managers meeting. We reviewed 3 safeguarding referrals and found them to be appropriate. Some safeguarding referrals required a strategy meeting with the local authority to ensure all teams involved reached the right outcome for the patient. We saw evidence of a strategy meeting in May 2024 following a safeguarding incident.

We did not observe any patient journeys during this assessment and were unable to speak to patients.

The service worked with stakeholders to understand patients’ risks prior to transporting them to ensure this was done safely. Control room staff took the patient details and completed risk assessments for all planned activities. This information gathered allowed the staff to allocate the appropriate team to transport the patient. For example, if there were steps or stairs for entry, this would require 5 members of staff to be allocated. Staff told us they were mostly assigned appropriately for the risk identified. But at times, the risks were not reported appropriately by the professional booking the service and the team allocated was not appropriate. The RMN in charge always completed a second risk assessment on arrival to ensure all risks had been captured. Within the team, there was always a RMN who oversaw transferring the patient safely alongside the team of healthcare assistants. We looked at 10 sets of notes and found the paperwork to be fully complete. Staff knew what to do if a patient became unwell during their journey and a policy was in place. All vehicles had life-saving equipment on board for if patients deteriorated. All registered RMNs and most bank RMNs had completed immediate life support training. Healthcare assistants were required to complete basic life support training; most had completed this.

There was an exclusion policy which detailed which patients were appropriate to use the service. Patients were required to be sectioned under the MHA to use the service. There were policies in place to ensure patient and staff safety whilst being transported. All staff underwent bespoke 5-day annual de-escalation management interventions training, most staff had completed this. There was a registered RMN who worked within the control hub at the service. This meant they could offer advice from a clinical perspective for call handlers to understand the patient risks.

We did not observe any patient journeys during this assessment and were unable to speak to patients.

People were cared for in environments, and with equipment, that was safe and designed to meet their needs. Vehicles, equipment and technology were appropriately maintained and supported staff to consistently deliver safe and effective care. Staff told us they had access to suitable equipment to enable them to complete their role. Staff were required to complete a vehicle checklist prior to and post transporting a patient. If they found any issues, they were to be reported to the fleet and logistics manager and then vehicles would be taken off the road for repair. There were plans in the future to introduce electric vehicles.

We inspected 2 secure ambulances and found them to be in good condition. The vehicles were fitted with side steps on both sides to support patients and staff entering and exiting the vehicles. There was a secure bulkhead between the rear of the vehicle and the driver. In addition, there was a break glass hammer in the rear in the event of an accident; this had been recently added following feedback from staff. We observed an ambulance crew completing the vehicle checks prior to leaving the base.

The fleet supervisor managed the ambulances in accordance with routine and additional servicing and maintenance plans. We looked at 5 vehicle maintenance records and found they were all up to date. There was a monthly vehicle audit. We saw results ranged from 86% to 100%. Where results were low, the fleet supervisor acted upon the issues found. The service had a contract with a waste disposal company for clinical waste. There was a bi-annual health and safety site audit. The site was audited against controls and the risk was graded from tolerable to major. July 2024 results showed most controls were tolerable with no action needed, 3 were moderate and 1 was major. The major risk had no associated action plan and no update provided since this was completed in July 2024. We were not assured this risk has been reduced.

We did not observe any patient journeys during this assessment and were unable to speak to patients.

The service did not always have enough nursing staff to complete a requested service. The service had had a reduction of 28% of permanent staff in the last 12 months following a recent transformation project. This meant that they could not always fulfil each job which was requested due to lower staffing numbers. The managers told us they were actively recruiting. There was an 8% vacancy for RMNs and 9% for healthcare assistants. Staff were allocated to jobs based on the patient risk. Most staff told us their jobs were well staffed and they felt safe with the staffing levels they had. However, a few staff told us they did not feel the risks were looked at and they were allocated based on availability rather than risk, which left them feeling unsafe and open to injury. The service had a team of bank staff who gave their availability on a weekly basis who could be called upon if extra jobs came in. Between October 2023 and September 2024, 31% of work was completed by bank staff. Staff absences were mostly covered by existing staff and bank staff.

There were gaps in management and support arrangements for staff, such as appraisal, supervision and professional development. Staff appraisals had been suspended during the transformation project and had just restarted. The service had recently introduced new appraisal paperwork and policy and were re-doing all staff appraisals. The service had recently employed a head of nursing to support with revalidation, clinical practice and create development opportunities but this was in its infancy. All staff had clinical supervision every 3 months and operations staff had a group supervision monthly; both had a fixed agenda. Figures showed for between July and September 2024, 49% of staff had completed their supervision. Some staff we spoke to said they felt it was not useful; they felt pushed to attend and did not always feel comfortable to speak up in the group setting. They said they would value either 1-1 supervision or an appraisal. Managers told us the supervision was mandatory for learning and development and we saw this had been communicated to staff with the supervision policy. The senior leadership team were developing progression pathways and inductions for new starters. Managers had a weekly meeting which included staffing, sickness, appraisal and training discussions. Actions were created from this meeting to improve compliance. The managers discussed training at their weekly meeting and clinical quality governance board (CQGB) monthly. We saw the training compliance had hugely improved throughout 2024. The service monitored staffing utilisation hours which looked at ‘unused’ hours versus hours on shift. They found in week commencing 4 November 2024, RMN utilisation was 96.5% and healthcare assistant was 84%. They adjusted the staff on shift based on utilisation data over time.

We did not observe any patient journeys during this assessment and were unable to speak to patients.

There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance and standards. Staff received appropriate training and there were clear roles and responsibilities around infection prevention and control. People were protected as much as possible from the risk of infection because ambulances and equipment were kept clean. All vehicles were cleaned after each transfer to ensure all rubbish was removed, consumables replaced, and all surfaces were wiped down.

We observed the ambulance crew use appropriate personal protective equipment, alcohol gel when entering clinical area, and cleaning the vehicle on return to base with all appropriate paperwork completed. We looked at 2 vehicles whilst on assessment and they were both visibly clean internally and externally.

Guidance was available for staff in the form of an infection prevention and control (IPC) policy. Audits were completed to assess staffs’ compliance with IPC standards and guidance. We reviewed the audit results from August, September and October 2024; all were near 100% compliance.

Patients were not given medication whilst being transported by the service.

Staff told us they did not keep any medicines on site or within any vehicles. They did not handle any medications whilst transporting a patient. If they were on time critical medications, they arranged the transport around this to ensure they did not need to give any medication.

We did not observe any patient journeys during this assessment.

The service did not keep any medication on site or on the vehicles.