St John Ambulance - Midlands Region

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

During the site visit we did not have any concerns from our checks about vehicles or equipment being safely secured. Risk assessments were in place with controls in relation to areas such as emergency response driving and unreliability of ambulance fleet. Ageing fleet only relating to 1 service in the Midlands was discussed in meetings and arrangements were in place to have new ambulances in August/September 2024. Following the assessment leaders told us they had an entire new fleet with some already arriving in the midlands. Leaders completed buildings and vehicle assurance checks on a regular basis. Staff reported incidents in relation to vehicle issues or equipment issues. There were induction processes in place and arrangements for staff to have personal development reviews. Staff had disclosure and barring checks in place. There were separate processes in place for the recruitment of volunteers whilst choosing a role and deciding if they wanted to stay at the service; however they were not permitted to provide direct patient care without the right level of screening in place. There was a volunteer checklist in place as well as a volunteer induction. However Not all staff were up to date with their mandatory training; however, most staff had a compliance rate of above 80%.

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 look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

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.

We were unable to speak to any patients on the day of the assessment due to the nature of the service. We reviewed patient compliment and complaints data and found were no complaints by patients raised in relation to the environment between October 2023 and March 2024. Leaders told us that due to recent changes in the organisation and the roll out of the patient record from May 2023, some data had been stored in secure folders of people who had since left the organisation. As result, leaders had identified actions to support the development of a new patient survey including reviewing the patient satisfaction survey to ensure it was fit for purpose, ensuring the survey could be completed on paper or electronically, production and publishing of quarterly reports and identifying trends and learning outcomes.

As part of the onsite assessment, we spoke with 3 ambulance staff, a fleet manager, the head of quality and feedback, a logistics co Ordinator and an ambulance operations manager. We also spoke with the registered manager and the Freedom to Speak Up Guardian. Staff told us that as part of their 8-week induction training they had been shown around the ambulances and were shown how to secure equipment onto vehicles. They told us how it was the responsibility of the driver to ensure any equipment was safely secured onto vehicles and were not aware of any incidents when equipment was not transported safely. Outside of the assessment visit we received anonymous communications from staff. Concerns raised included equipment shortages, people falling out of stretchers due to them being broken or insufficient training, and concerns regarding vehicles having numerous problems. Leaders told us there had been complaints around the Lionel Street building (administrative building) which had been closed due to safety issues and how this had caused a level of upset to some staff and volunteers. They also told us there had been one incident in relation to transportation of a piece of equipment and that leaders were still investigating this.

We looked at 4 vehicles as part of our on-site assessment. We found staff safely secured equipment, including gas cylinders and critical care equipment; for example, staff safely secured infusion pumps in vehicles with staff ensuring O2 cylinders were kept in closed cabinets. We noted that staff tagged faulty equipment to show it was out of use in a specific area. We found vehicles to be in good condition. We observed that essential emergency equipment was available, and staff had recorded any checks. We found that staff stored vehicle keys securely. Vehicles were visibly clean, tidy and appeared well maintained.

We reviewed the vehicle records of 6 vehicles and found them to have a valid MOT certificate, tax and that they all had vehicle inspection reports. Leaders completed ambulance operations buildings assurance checks. Staff identified and reported and recorded issues or concerns when they were identified this was recorded such as when a fire alarm fault was identified. Leaders audited vehicles and buildings on a regular basis as well as spot checks on vehicles. We reviewed the incident data from October 2023 to March 2024 and saw staff reported and recorded issues with vehicles and equipment. In addition to their Ordering, Storage and Transportation of Medical Gases Procedure they had standard loading lists for each type of ambulance, these outlined the services equipment and storage location. Risk assessments were in place with controls in areas such as emergency response driving, crew fatigue, reversing and vehicle faults. The control in relation to vehicle faults included 6 weekly safety inspections, a national contact for vehicle repair and recovery, national tyre replacement contracts in addition to a contract with a service for minor repairs. We reviewed the Urgent and Emergency Care Directorate meeting notes dated January 2024 and found they discussed an ageing fleet in a specific contract in the region and how they were due delivery of new ambulances in August/September 2024. Vehicle/fleet was an agenda item on ambulance operations team meetings.

We were unable to speak to any patients on the day of the inspection due to the nature of the service. We reviewed patient compliment and complaints data. Between October 2023 and March 2024, we saw patients commented on crew going above and beyond to help transport a complex patient home, exemplary actions when responding to a cardiac arrest and praise for a crew who attained a time critical transfer. There was 1 complaint in relation to a patient feeling dismissed and like they were wasting paramedics’ time.

Leaders told us there was 2 tiers of induction which included time with a local manager to talk about local processes. They spoke of how there was contract specific inductions with competency books in place and of a single national standard training course. They also told us about the annual revalidation process and portfolio of evidence presented by staff which included reflections, courses, training and compliments and complaints. They told us that in addition to personal development reviews, ambulance locality managers were carrying out regular 121’s with crew members. Staff we interviewed told us they had received an induction, had shadow shifts and how as part of their induction they had been physically shown around an ambulance. They also told us how they had received training top ups to become emergency ambulance crew. Anonymous concerns raised with us following the assessment raised concerns around not having training on stretchers, not receiving continuing professional development sessions (PDR’s) and not completing training for a long time. St John Ambulance - Midland’s Region provided and resourced its critical care transfer service ambulances with a single crew member who worked alongside NHS clinicians. The crew member being dispatched was trained in core requirements. Leaders told us how all new volunteers received an induction to the charity, delivered in the early stage of the volunteer process. In addition to the induction, they told us how volunteers received a new volunteering checklist.

Personal development reviews (PDR’s) took place, at the time of the assessment in April 2024, PDR compliance rates were 75% for the region. Plans were in place to ensure all PDRs were up to date by August 2024. We reviewed 4 examples of PDR’s. The reviews included sections on workload, wellbeing, priorities and objectives, support, values, future aspirations and development. Leaders told us in addition to the internal checklist some of their contracts have induction documents for specific contracts. We saw that there was a specific competency booklet for the intensive care and decision support neonatal transfer service. Leaders told us how as part of the staff training programme, the driving training team trained crews on how to secure loads into vehicles, this included the loading of equipment and passengers. Not all staff were up to date with all their mandatory training. However, we reviewed the training data and found that total compliance by individual members of staff across all courses was mostly above 80%. Mandatory training included topics such as conflict resolution, equity, diversity and inclusion, moving and handling, learning disability and autism and safeguarding. Leaders told us there were processes in place to highlight compliance of staff members and identify those due to become non-compliant in the next 30 days. This was then shared with the leadership team to ensure any training was completed. There was a new volunteer checklist and induction in place. All staff had a DBS in place or in process. There were separate processes in place for volunteers.

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

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