Special Ambulance Transfer Services Ltd (SATS)

Updated 18 February 2022

Special Ambulance Transfer Services is operated by Special Ambulance Transfer Services Limited. Special Ambulance Transfer Services (SATS) was founded in 2006 and is an independent ambulance service providing a range of patient transport services based in north west London.

The main service is patient transport services (PTS) and some emergency and urgent care (EUC) transfers. The EUC transfers the service undertakes are non-time critical and are between hospitals with hospitals’ own medical teams on board SATS’ dedicated high dependency unit (HDU) vehicles.

The service provides transport for both adults and children and young people. This includes the transfer of high dependency patients, paediatric and neonatal intensive care transfers, patients receiving Extracorporeal Membrane Oxygenation (ECMO), non-emergency patient transfers, repatriations and event medical cover such as for sporting events. ECMO is a form of life support that provides both cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange to sustain life.

Journeys are made to various locations within London and longer journeys across the UK. In the last year, the service undertook 3273 journeys of which 3% were HDU journeys.

The service has vehicles operated by emergency care assistants, emergency medical technicians and nurses.

The provider is registered for the regulated activities:

• Transport services, triage and medical advice provided remotely

• Treatment of disease, disorder and injury

The service performs contracted work with London NHS Trusts and independent hospitals. SATS also operates as a subcontractor to main contractors (identified as commissioners in this report).

At our last inspection, the main service provided was Emergency and Urgent Care (EUC) which made up 84% of the provider’s work. Since our last inspection, the provider’s activity had changed and the main service now provided by this ambulance service is Patient Transport Services (PTS). PTS makes up 97% of the work the service undertakes. Emergency and Urgent Care (EUC) takes up 3% of the work the service undertakes. Where our findings on Patient Transport Services (PTS) – for example, management arrangements – also apply to EUC, we do not repeat the information but cross-refer to the PTS section.

The service was last inspected in April 2019 and rated requires improvement overall. We carried out an unannounced inspection on 18 January 2022. We inspected this service using our comprehensive inspection methodology and we checked to see if the provider had complied with the Requirement Notice issued in July 2019. The provider had made improvements in relation to oversight of medical gases and they no longer stored, prescribed, or administered medicines.

Systems and processes had been established to ensure the service assessed monitored and improved the quality and safety of the service. This included formal governance meetings, improved risk management processes, equipment safety checks in place. The provider also now conducted their own Disclosure and Barring Service (DBS) checks for staff, had put in processes for staff to declare working arrangements outside of the service, and were carrying out re-checks of staff members driving license to make sure they were safe to drive the vehicles.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Updated 18 February 2022

Our rating of this service improved. We rated the service Good overall because:

• The service had made improvements in relation to the management of medical gases. There was an up to date medical gases policy and a process for the signing in and out and of oxygen cylinders so no cylinders could be left on vehicles when they went out for servicing. There was also more secure storage of oxygen cylinders in place at the base.
• Patient record forms were now being returned to the office after every shift and not left on vehicles for extended periods of time.
• The service had improved their processes around the safety testing and servicing of equipment. Equipment we checked was all in date and safety tested.
• The service used an electronic application for vehicle daily inspection checks where videos of equipment checks as well as pictures were uploaded and sent through to management allowing for full oversight of the vehicle checks.
• The provider had improved their processes for Disclosure and Barring Services (DBS) checks. All staff had up to date DBS checks and the service audited this to make sure processes were working effectively.
• The provider had improved their process around the re-checking of staff members’ driving licenses. All staff had up to date driving license checks in place and these were now being regularly checked by management.
• The provider had now implemented a process to ensure that ambulance staff declared their working arrangements outside of the service. This ensured staff did not work excessive hours.
• Staff knowledge around the Gillick competency had improved. Children under the age of 16 can consent to their own treatment if they're believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment. This is known as being Gillick competent. Otherwise, someone with parental responsibility can consent for them.
• There were now regular clinical governance meetings where service risks, issues and performance were discussed. The meetings were minuted and included actions to take forward.
• The service had improved their risk register which reflected risks within the service and was updated and discussed regularly by the management team.
• The leadership team had significantly improved their governance processes since the last inspection and there were clear processes and systems in place which showed the service assessed, monitored and improved the quality and safety of the service.
• Staff reported a positive working culture and commented on a supportive leadership team who were friendly and approachable.
• Staff knowledge around infection, prevention and control was comprehensive and ambulances we inspected were visibly clean.
• The service’s vehicles were bespoke to the services offered by the provider.

However:

• While staff we spoke with reported that the provider’s main service was patient transport, the service’s Scope of Practice Policy did not reflect the service’s main service delivery offer of patient transport. It did not specify the new service provision for high dependency unit (HDU) transfers whereby transfers were non-time critical, and patients were always accompanied by their own medical teams from hospitals who would bring their own emergency equipment and medicines. The policy still went into detail about medicines administration by certain staff groups however the service no longer stored, prescribed or administered medicine. Information within the policy around medicines administration by certain staff groups was therefore no longer relevant and there was a risk that new staff could be confused about the service’s scope of practice when they read the policy.

Nigel Acheson

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

Updated 18 February 2022

The main service was patient transport services (PTS) which made up 97% of the provider’s work. The provider had 13 ambulances used for both PTS and emergency and urgent care (EUC).

The arrangements for PTS and EUC were the same. Therefore, we have reported most of our findings for EUC in the relevant PTS sections of the report.

Updated 18 February 2022

Emergency and urgent care services (EUC) made up 3% of the work carried out by the provider. Arrangements for EUC and patient transport services (PTS) were mostly the same. Therefore, we have reported most of our findings in relation to this core service in the relevant sections of the PTS section of the report. We rated the EUC service good overall for the same reasons and using the same relevant evidence set out in the PTS summary.