Criticare UK Ambulance Service

Updated 7 November 2019

Criticare UK Ambulance Service is operated by Criticare UK Ambulance Service Limited. The service was registered on 6 April 2011. It is an independent ambulance service in Southampton, Hampshire. The service primarily served the communities of Hampshire, Dorset and Oxfordshire.

The service has had a registered manager in post since 27 January 2014.

The service provided pre-planned patient transport services, for all age groups from birth. Journeys included discharges from hospitals, transfers for specialist treatment, transport to and between care homes and repatriation of patients from within the UK and Europe.

The service had four vehicles, one response car and three ambulances. Three vehicles were equipped to carry out outpatient transfers, hospital discharges, repatriation work, admissions and urgent transfers. At the time of our inspection, one ambulance was being serviced before an MoT and another was off the road and not in service.

The service also provided high dependency transfers to private organisations and some NHS trusts. The ambulance crew were accompanied by a medical crew, who were provided by an air ambulance provider for all high dependency transfers.

The service also provided medical cover for some events including a small amount of transport for other locations. The CQC does not have the power to regulate this service

We inspected this location in August 2018 and issued three requirement notices and one warning notice. We told the provider they must take action to address concerns in eight areas. We told the provider they must ensure all staff were competent to carry out their role, the needs of patients were assessed and recorded at the time of booking, staff received regular and documented appraisals. The provider must ensure all medical devices were serviced according to manufacturer’s guidance, monitor the safety and quality of the service and keep adequate records of this. The provider must check vehicles for roadworthiness and ensure equipment checks were carried out and recorded by staff daily. The provider must formally record incidents and ensure lessons learned from were shared with staff. The provider must ensure all patient records were stored securely. On this inspection we found the provider had made significant improvements in all areas of concern.

We inspected this service using our comprehensive inspection methodology. We gave the service 48 hours’ notice of our inspection to ensure everyone we needed to speak with was available. We carried out the inspection on 29 August 2019.

Updated 7 November 2019

Criticare UK Ambulance Service is operated by Criticare UK Ambulance Service Limited. The service provides emergency and urgent care and a patient transport service.

We inspected this service using our comprehensive inspection methodology. We gave the service 48 hours’ notice of our inspection to ensure everyone we needed to speak with was available. We carried out the inspection on 29 August 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 this service was patient transport services with some emergency and urgent care transport from events. On this inspection we inspected both core services.

Where our findings on patient transport services – for example, management arrangements – also apply to other services, we do not repeat the information but refer the reader to the patient transport core service.

We rated it as Good overall.

We found the following areas of good practice:

• The service managed patient safety incidents well. There was improved incident reporting and sharing of learning through a staff electronic communication application (app) group and staff bulletins.

• Staff had mandatory training in key skills, including advanced life support.

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it. Safeguarding concerns were raised correctly and clearly reported to the local authorities.

• The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment, vehicles and premises visibly clean.

• The design, maintenance and use of facilities, premises, vehicles and equipment kept people safe. Staff were trained to use them. An external company had been employed to service all medical equipment.

• Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified patients at risk of deterioration and acted quickly if their condition worsened.

• Staff kept detailed records of patients’ care and treatment. Records were clear, up to date, stored securely and easily available to all staff providing care. There had been significant improvements in the forms used to record patient details and transfer information including the development of electronic patient booking and record keeping.

• Staff assessed and monitored patients’ pain regularly and gave pain relief when required in a timely way.

• The service provided care and treatment based on national guidance and evidence-based practice.

• The service monitored, and met, agreed response times so that they could facilitate good outcomes for patients. They used the findings to make improvements.

• The service made sure staff were competent for their roles. Managers appraised staff work performance.

• Staff supported each other to provide good care and worked with other organisations to benefit patients.

• Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

• Staff treated patients with compassion and kindness, respected their privacy and dignity and took account of their individual needs. They provided emotional support to patients, families and carers.

• People could access the service when they needed it, in line with national standards, and received the right care in a timely way.

• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff, including those in partner organisations.

• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work. The registered manager was visible and approachable for all staff and staff could raise concerns without fear.

• It was clear throughout the inspection that governance systems had much improved since the last inspection in 2018. This included a detailed performance dashboard and a clearer governance overview.

• The registered manager and staff were very responsive to requests for information and in completing actions required to maintain compliance with regulations.

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

• Staff did not always clearly document mandatory training in staff records.

• Documentation of staff appraisals was not clearly recorded.

• Records that showed the cleaning vehicles were not completed. There were discrepancies in the recording of time and date the daily vehicle checklist and the vehicles leaving the site to start work and the deep cleaning for one vehicle was not fully documented.

• Servicing dates were due to expire for medical equipment on two vehicles and staff had not booked a date for this to be completed.

• The child safety harness for use on the ambulance was on another vehicle currently off site for servicing.

• Staff used an electronic booking system alongside paper-based patient record systems and these did not always correlate.

• The service had systems and processes to administer, store and record medicines but staff did not always document these.

• There was no documented assurance of adequate breaks between or during shifts for drivers and technicians.

• There was no evidence of annual driving licence checks for staff.

• We noted policy documents had a version control but no evidence of review date. This meant staff were not be able to tell if they had read the most recent version.

  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 (Acute Hospitals South), on behalf of the Chief Inspector of Hospitals

Updated 7 November 2019

The service provided urgent and emergency care at events which is not currently in our scope of regulation. However, the service transferred a small number of patients to hospital services when required. This meant the service met the criteria for the emergency and urgent care core service. The service did not carry out any emergency ambulance work, for example, responding to 999 calls.

Urgent and emergency services were a small proportion of activity. The main service was patient transport services. Where arrangements were the same, we have reported findings in the patient transport service section.

Updated 7 November 2019

Patient transport services were the main regulated activity provided by the service. The same staff group provided all services including patient transport, urgent and emergency services and events activity.

We have rated safe, effective, responsive and well-led as good. As we were unable to speak to patients on this inspection we were unable to rate caring. However, we were able to see from patient feedback cards and compliments evidence that staff were caring and compassionate.

Overall, we rated the service as good because the service was responsive in addressing the concerns raised at the last inspection. They complied with all previous warning and requirement notices. The service kept people safe and provided effective care that met people’s needs. The registered manager had developed systems to monitor governance of the service and had implemented new electronic performance management and booking processes to ensure the service was organised and delivered safely. Staff reported they were well supported by a leadership team that was open and had a vision for the future.