Archived: St John Ambulance North East Region

Updated 31 January 2018

St John Ambulance North East Region is operated by St. John Ambulance, a national first aid charity. St John Ambulance became a separate legal entity and subsidiary of The Priory of England and the Islands of the Order of St John in 1999. St John Ambulance nationally provides a number of services including first aid at events, emergency and non-emergency patient transport services and first aid training. The objective of the organisation is the relief of sickness and the protection and preservation of public health. The organisation works with both volunteers and employed staff to provide services.

St John Ambulance North East Region was formed in 2012 following a restructure in the organisation. The service primarily serves the communities of Yorkshire and Tyne and Wear. They have contracts with two NHS Ambulance Trusts and deliver bespoke services for community events. They undertake the movement of emergency and urgent care patients between hospitals, homes and care facilities. The service has specific contracts for transporting patients who are receiving end-of-life care and for managing alcohol-related health concerns.

At the time of our inspection, there was one registered manager, covering all regulated activities related to events. An existing Sector Manager, previously responsible for the North West and West Midlands, had also recently been moved to cover the North West and North-East Regions.

Updated 31 January 2018

St John Ambulance North East Region is operated by St. John Ambulance. The service mainly provides emergency and urgent care.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 31 October 2017.

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.

Services we do not rate

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• Staff were committed to providing the best quality care to patients. Staff displayed a caring and compassionate attitude and took pride in the service they were providing.

• Staff checked patients’ requirements prior to transporting them to ensure that they were able to meet their needs.

• Staff operated comprehensive systems to make sure that all vehicles, equipment and medicines were safely managed and fit for purpose.

• Vehicles and stations were visibly clean and tidy, with evidence of regular deep cleaning of vehicles.

• Staff followed evidence-based care and treatment and nationally recognised best practice guidance. All staff had access to the Joint Royal College Ambulance Liaison Committee (JRCALC) guidelines 2016.

• The provider had developed systems to accurately monitor whether all staff had the qualification and skills needed to provide high-quality care; a national, skills assessment system ensured that feedback from staff was acted on to improve the range and quality of training offered by the provider.

• The provider had made a commitment to continuously improving the quality of the service. There had been a range of organisational restructuring activities and the implementation of standardised processes. Staff understood the rationale for these activities and cited examples of how this had led to improvements in their day-to-day practice.

However, we also found the following issues that the service provider needs to improve:

• The service had a system to monitor the accuracy of patient records through the use of an audit system. However, patient report forms had only been audited for one of the two NHS ambulance trusts that the service worked with.

• The service did not yet have a system for monitoring the clinical outcomes of patients who had been treated while under the care of the provider. There was evidence that some consideration had been given to initiating this type of monitoring, but this was not in place at the time of our inspection.

• The service did not routinely monitor the promptness of their service, for example, in terms of handover times, for all patients, although this was in place for some patients. Staff performance was monitored in terms of handover times for one NHS trust that the service worked with. However, the same level of monitoring was not used for work with a second NHS trust.

• Vehicles were equipped to monitor patient’s health status during patient transfers. However, some paediatric-specific equipment, such as harnesses and pulse oximeters were not available on all vehicles. This meant that risks to children using the service could either not be assessed or had not been sufficiently identified and mitigated.

• There were systems to manage confidential patient sensitive information, but these were not always effective. Staff posted completed patient report forms through the postal system with no formalised or routine system of tracking that the information had been either sent or received.

• Staff feedback was usually well managed. However, staff meetings with frontline staff at one of the locations had not taken place for eight months. This had led to some concerns remaining unaddressed.

• There was a comprehensive staff training programme. However, we found that only 14% of clinical staff were compliant with equality and diversity training at the time of the inspection.

• All operational ambulance staff had received some safeguarding training, however the named, regional safeguarding lead had not completed training to an appropriate level for their role.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements. We also issued the provider with two requirement notices that affected emergency and urgent care services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region), on behalf of the Chief Inspector of Hospitals.

Updated 31 January 2018

We have not rated this service because we do not

currently have a legal duty to rate this type of service or the regulated activities which it provides.

The main service was urgent and emergency services. Other services such as patient transport services were a small proportion of activity; therefore we have reported our findings in relation to patient transport services in the urgent and emergency services section.