G4S Patient Transport Services - Kent & Medway

Updated 2 July 2019

G4S Patient Transport Services - Kent & Medway was operated by G4S Health Services (UK) Limited. The service opened in 2018 and was an independent ambulance service based in Chatham, Kent.

This service was contracted by the clinical commissioning groups of Kent, Medway, Bexley and Bromley to help people access healthcare in their respective areas. The provider employed 453 staff and had 200 vehicles operating from seven depots in; Tonbridge, Margate, Maidstone, Gillingham, Dartford, Canterbury, and Ashford. They offered transport services for people attending outpatient appointments and renal dialysis clinics as well as admissions or discharges from hospitals and inter-hospital transfers. The service transported adults and children of any age as long as they did not need an incubator to travel.

The service has had a registered manager in post since 2018.

We had not inspected this service before.

Updated 2 July 2019

NHS non-emergency patient transport services help people access healthcare in England. They are free at the point of use for patients who meet certain medical criteria and are unable to use public or other means of transport.

In Kent the patient transport service is managed by a lead clinical commissioning group. To help meet demand for transport requests, the group subcontracts to independent providers such as G4S.

G4S Patient Transport Services - Kent & Medway was operated by G4S Health Services (UK) Limited.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on 24 April 2019, along with staff telephone interviews on 25 April 2019.

This was the service’s first inspection since registration.

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.

We rated it as Requires improvement overall because:

• Some staff did not understand when they could raise a safeguarding concern without the consent of the individual.

• At Gillingham depot the premises needed cleaning. The vehicle park, vehicle “make-ready” area and bulk storage facilities were insufficient for an operation of this size and complexity. Some aspects were not fit for purpose.

• We observed the unsafe use of an electrical cable by a contractor in the vehicle park. However, this was corrected by managers as soon as we raised our concern.

• Appraisal rates for some staff groups did not meet their target of 85%. However, managers and ambulance care assistants were meeting this target.

• We found that staff followed the service’s procedure for staff to report incidents relating to abuse of risk of abuse but that five incidents that should have been reported to CQC were not. Also, the services procedure did not help staff identify when incidents should be reported to CQC.

• Some staff did not feel supported by their managers and felt they could not speak about their complaints.

However,

• The service had high compliance rates for staff mandatory training and had met most of their targets.

• The service had clear processes and systems to help keep vehicles and equipment ready for use. This included yearly MOTs, regular servicing and maintenance.

• Vehicle interiors were visibly clean, and we saw they were deep-cleaned every eight weeks or sooner if needed.

• Staff demonstrated clear understanding of their daily duties about cleanliness and infection prevention and control in line with the provider’s infection prevention and control policy. The service was piloting a portable computer system which significantly improved the way in which vehicle preparation checks and post-use cleaning was monitored. This system provided an excellent level of assurance and was due to be cascaded to all depots.

• Staff demonstrated a willingness to report incidents and raise concerns. Staff received feedback and any relevant extra training to ensure the service learned from incidents to improve patient safety.

• All staff had undertaken in-house induction and mandatory training in key areas to provide them with the knowledge and skills they needed to do their jobs safely.

• The service had up to date policies and guidance to support staff.

• Staff treated patients with compassion. One patient told us crews went above and beyond to ensure their safety and wellbeing.

• The service acted to meet patients’ individual needs. This included patients for whom English was not a first language.

• The service met the needs of children that travelled with them. Staff ensured that children had their favourite toy for comfort before they started on their journey.

• The service had company wide and local risk registers that assessed, reviewed, and mitigated risks.

• The leadership looked for innovation and improvements.

• Most managers supported their staff.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals (South East), on behalf of the Chief Inspector of Hospitals

Updated 2 July 2019

We rated this core service as Requires improvement overall because:

• Some staff did not understand when they could raise a safeguarding concern without the consent of the individual.

• At Gillingham depot the premises needed cleaning. The vehicle park, vehicle “make-ready” area and bulk storage facilities were insufficient for an operation of this size and complexity. Some aspects were not fit for purpose.

• We observed the unsafe use of an electrical cable by a contractor in the vehicle park. However, this was corrected by managers as soon as we raised our concern.

• Appraisal rates for some staff groups did not meet their target of 85%. However, managers and ambulance care assistants were meeting this target.

• We found that staff followed the service’s procedure for staff to report incidents relating to abuse of risk of abuse but that five incidents that should have been reported to CQC were not. Also, the services procedure did not help staff identify when incidents should be reported to CQC.

• Some staff did not feel supported by their managers and felt they could not speak about their complaints.

However, we also found the following areas of good practice:

• The service had high compliance rates for staff mandatory training and had met most of their targets.

• The service had clear processes and systems to help keep vehicles and equipment ready for use. This included yearly MOTs, regular servicing and maintenance.

• Vehicle interiors were visibly clean, and we saw they were deep-cleaned every eight weeks or sooner if needed.

• Staff demonstrated clear understanding of their daily duties about cleanliness and infection prevention and control in line with the provider’s infection prevention and control policy. The service was piloting a portable computer system which significantly improved the way in which vehicle preparation checks and post-use cleaning was monitored. This system provided an excellent level of assurance and was due to be cascaded to all depots.

• Staff demonstrated a willingness to report incidents and raise concerns. Staff received feedback and any relevant extra training to ensure the service learned from incidents to improve patient safety.

• All staff had undertaken in-house induction and mandatory training in key areas to provide them with the knowledge and skills they needed to do their jobs safely.

• The service had up to date policies and guidance to support staff.

• Staff treated patients with compassion. One patient told us crews went above and beyond to ensure their safety and wellbeing.

• The service acted to meet patients’ individual needs. This included patients for whom English was not a first language.

• The service met the needs of children that travelled with them. Staff ensured that children had their favourite toy for comfort before they started on their journey.

• The service had company wide and local risk registers that assessed, reviewed, and mitigated risks.

• The leadership looked for innovation and improvements.

• Most managers supported their staff.