The Care Quality Commission
  • Ambulance service

Harley Street Ambulance Service

Overall: Requires improvement read more about inspection ratings

Unit 8, London Group Business Park, 715 North Circular Road, London, NW2 7AQ (020) 8208 4440

Provided and run by:
Harley Street Ambulance Service Limited

All Inspections

23 May and 8 June 2023

During an inspection looking at part of the service

We inspected Harley Street Ambulance Service on 23 May 2023 and followed up with a meeting with the provider on 8 June 2023. It was a focused inspection in response to the information we received about the provider. During the inspection, we raised concerns related to the safety and management of the service:

  • The provider had failed to establish and effectively operate systems to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity.
  • The provider did not have all information required to be kept by providers about all persons employed in the provision of services. The provider did not demonstrate that agency staff working for the service had met requirements related to persons employed in the carrying on of the regulated activity.
  • The provider did not operate an effective system to ensure staff were suitably trained and their competencies were regularly reviewed. Agency staff did not undergo formal induction to the service. There was no evidence to confirm agency staff completed appropriate minimal training.
  • The provider had not established a system for regular staff appraisals to support employees in their professional development.
  • The provider did not proactively seek and act on feedback from staff on the services provided to continually evaluate and improve such services.
  • Although incidents were reported, there was no system to ensure a structured way for learning from incidents to improve the quality and safety of the services provided. In addition, there was no evidence of sharing knowledge with staff and actions taken to prevent further occurrence.

29 to 30 January 2019

During a routine inspection

Harley Street Ambulance Service is operated by Harley Street Ambulance Service Limited. The service was registered with the Care Quality Commission (CQC) on 13 May 2011. The service provides patient transport services (PTS) and emergency and urgent care (EUC) services. EUC patient transfers are between hospitals. The provider is registered for the regulated activities: transport services, triage and medical advice provided remotely and treatment of disease, disorder and injury.

Harley Street Ambulance Service (HSAS) operates as a subcontractor to main contractors (identified as commissioners in this report). The main contractors who commission services from HSAS liaise directly with NHS providers. A small part of its work is private and for this work HSAS liaises directly with the private hospitals or private organisations.

HSAS transports patients (adults and children) across the whole of the United Kingdom and works across different boroughs and populations.

The service has six ambulances equipped for and used for both PTS and EUC.

We carried out an unannounced inspection of both the PTS and EUC core services using our comprehensive inspection methodology on 29 and 30 January 2019.

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.

The main service provided by HSAS was PTS. Where our findings on EUC – for example, management arrangements – also apply to PTS, we do not repeat the information but cross-refer to the PTS core service.

We last inspected this service in July and November 2016 but at the time we did not have the legal duty to rate independent ambulance services. However, following this inspection we rated the service good for both core services.

We rated this service good overall because:

  • Staff treated patients and relatives with compassion, kindness, dignity and respect.

  • The provider had systems, processes, and practices to keep people safe and safeguard them from abuse. Staff were aware of and knowledgeable about these processes.

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.

  • Staff reported a positive working culture within the service.

  • The service kept patient data safe and secure and this was an improvement from the previous inspection in 2016.

  • The service had enough staff, with the right qualifications and skills, training and experience to deliver effective care, support and treatment.

  • We observed effective multidisciplinary working between HSAS staff and staff at the various hospitals they worked with.

  • Staff understood the relevant consent and decision-making requirements of guidance and legislation including the Mental Capacity Act 2005.

  • There were effective recruitment and training processes to ensure staff were appropriately qualified and trained to deliver good quality care.

  • Policies and procedures were in date and reviewed in line with set review dates.

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

  • Only 50% of staff had received an appraisal at the time of our inspection.

  • The provider did not have access to translation services which meant they relied on staff or relatives who spoke the same language to communicate with patients.

  • There were no regular staff meetings as part of the service’s governance arrangements.

  • The provider did not have systems and processes to ensure that ambulance staff declared working arrangements outside of the service and monitor this to make sure staff were not working excessive hours that may adversely impact on the care being provided.

  • There was limited formal engagement with staff and not all staff were aware of the service’s vision, strategy or values.

  • Commissioners did not always make the service aware of patients’ pre-existing conditions or risks and the provider did not have a policy or system to manage this.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Nigel Acheson

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

Announced visit on 7 July 2016 and unannounced visit on 30 November 2016

During a routine inspection

Harley Street Ambulance Service provides patient transport services and urgent and emergency care to their National Health Service (NHS) contracted partners and the private sector. Urgent and emergency care services include high dependency transfers between hospitals. The service, which was established in 1982 and has one location in North West London, operates as a subcontractor to main contractors (identified as commissioners in this report).The main contractors who commission services from Harley Street Ambulance Service liaise directly with NHS providers.

Harley Street Ambulance Service transports patients across the whole of the United Kingdom and works across different boroughs and populations.

We inspected this service on 7 July 2016 as part of our comprehensive programme of inspections. We inspected the service again on 30 November 2016 following our quality assurance process. We obtained further information and followed up on some concerns arising from the July inspection. There were improvements within the service when we inspected in November 2016 compared to when we initially inspected in July 2016. The findings of both inspections are set out in this report. We do not currently have a legal duty to rate independent ambulance services but we do highlight good practice and issues that service providers need to improve and as a result we have not rated this service.

On our initial inspection on 7 July 2016, and following a consideration of evidence submitted to us prior to the inspection, we found the following areas of poor practice:

  • Staff were not trained in children safeguarding and the service had low rates of completion of the adults safeguarding training.
  • Staff left patient identifiable information on vehicles overnight posing data protection concerns.
  • Mandatory training completion rates were low overall.
  • We were not assured that the service was dealing with the level of risk within the service or had effective governance structures in place to identify risks within the service.
  • No incidents were reported between 30 April 2015 and 30 April 2016. No incidents had been reported between April 2016 and the time of our inspection in July 2016.
  • There was a high rate of staff turnover with the provider reporting 73% staff turnover between 30 April 2015 and 30 April 2016.
  • We found poor infection control practices on the vehicles and on the premises.
  • Some staff reported insufficient stock in their cars.

However, there were some areas of good practice:

  • Those staff we spoke with on the inspection were happy to work for the service and felt supported and valued.
  • Staff treated patients with respect, compassion and dignity.
  • Staffing levels and skill mix were planned and reviewed so that people received safe care and treatment.
  • The service was well coordinated with its commissioners to meet patients’ needs.
  • The service responded to and investigated complaints in a timely manner.

Findings of the follow up inspection on 30 November 2016 were:

  • The service had introduced children safeguarding training and the completion rate was 75% as of 30 November 2016. However, this training was set at level one and this was not in line with national guidance.
  • Some incidents had been reported between July 2016 and November 2016.
  • We found improvements in infection control practices in the vehicles and on the premises.
  • We found that ambulances were appropriately stocked.
  • There were improvements in training completion rates overall.

However:

  • We found patient identifiable information in one of the vehicles we inspected.
  • The administration of the medicine salbutamol, a medicine used for the lungs, by paramedics and emergency ambulance crews was in breach of regulations.
  • A disclosure and barring service (DBS) certificate had not been applied for a member of staff we spoke to on the day of the follow up inspection.
  • One risk had been recorded by the service. However, not all within the service had been identified and recorded.

Information on action we have asked the provider to take are listed at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

29 October 2013

During a routine inspection

We did not talk with people who had received support and treatment from the service during our inspection, but we did see quality assurance questionnaires from people using the service and their representatives. All were complimentary about the service and said staff were "well-trained" and "competent and highly professional."

We found the service maintained patient's privacy and dignity whilst being transported. The records showed us patients were involved in their care and offered appropriate choices in relation to their treatment.

The care provided was tailored to meet the specific needs of each individual and ensured their safety and welfare. Staff followed appropriate infection control procedures to ensure the health and safety of patients, staff and the general public.

The ambulances were clean and well maintained.

We found the staff were supported by management and undertook appropriate training to enable them to meet the needs of their patients.

The service had effective systems in place to monitor levels of customer satisfaction.

We found that records were stored safely and people's confidentiality was ensured and protected.

29 November 2012

During a routine inspection

There were no patients using HSAS available to talk to us during the day of our inspection. Equipment used and provided was maintained and up to date. Vehicles were cleaned and maintained regularly.

Appropriate cleaning procedures ensured that the risk of infection was minimised. We were told that patients were given a choice of where to sit during transport that was safe and appropriate to their condition.

Information given to the ambulance crew was appropriate and sufficient, to transport patients safely.

Staff were checked appropriately for their suitability to work with vulnerable people.

Robust complaints procedures ensured that all complaints were dealt with and investigated thoroughly, this ensured that patients were satisfied with the service provided by HSAS.