We carried out an inspection of Transcare Secure Services - Birmingham using our comprehensive methodology under the core service framework of Patient Transport Services (PTS). The service has not been previously inspected.
Our inspection was announced. We gave the provider short notice of the inspection date to ensure their availability on the day. We undertook a site visit on 23 August 2022.
This was the first time we inspected the service. We rated it as inadequate because:
- The service did not provide mandatory training in key skills to staff or ensure staff had completed training through other employers. Safeguarding systems, processes and standard operating procedures were not effectively implemented to keep people safe. The service did not always control infection risk well. Processes were not in place to ensure the maintenance and use of facilities, premises, vehicles and equipment kept people safe. Risk assessments were not always completed. Assessments of the risks identified lacked detail and did not demonstrate how risks would be mitigated. Patient booking and transfer documentation was not fully completed by staff. The service did not always follow best practice when storing and transporting medicines. The service did not have an effective process for reporting, investigating and learning from incidents.
- The service could not evidence that it provided care and treatment based on the most up to date national guidance and evidence-based practice. Managers did not routinely check to make sure staff followed guidance. The service did not monitor response times. Systems to make sure staff were competent for their roles were ineffective. The service did not ensure all staff had received training in the Mental Health Act (MHA), Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).
- The service did not have formal arrangements in place for working with other organisations to plan care. The service was not always inclusive of patients’ individual needs. We could not determine if people could access the service when they needed it. The service collected information about times from journey referral to the time of patient collection, but this was not monitored. It was not easy for people to give feedback and raise concerns about care received.
- Leaders did not demonstrate they had the skills and abilities to run the service. Leaders did not always understand or manage the priorities and issues the service faced. The service did not have a clear vision for what it wanted to achieve or a robust strategy to turn it into action. There was no evidence the service promoted equality and diversity in daily work or provided opportunities for career development. Leaders did not operate effective governance processes, throughout the service or with partner organisations. Staff did not have regular opportunities to meet, discuss and learn from the performance of the service. Systems were not in place to manage performance effectively. The manager did not collect and use data to understand performance or make decisions and improvements. Leaders did not actively engage with patients, staff or the public to plan and manage services. The service was not committed to continually learning and improving services.
However:
- Staff understood how to protect patients from abuse. Staff understood how to respond to a patient at risk of deterioration. The service employed enough staff with the right skills and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Records were generally stored securely.
- Staff considered patients’ food and drink requirements to meet their needs during a journey. Staff in the service worked together as a team to benefit patients. They supported each other to provide good care. Staff supported patients to make informed decisions about their care and treatment. They generally followed national guidance to gain patients’ consent.
- The service provided care in a way to support local services in meeting the needs of local people and the communities served.
- Leaders were visible and approachable in the service for patients and staff. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.
We did not rate caring as we had insufficient information to rate. We did not observe any patient care.
We have taken enforcement action as a result of this inspection to promote patient safety. We served a notice of suspension to the provider on 25 August 2022 with immediate effect until 30 September, under Section 31 of the Health and Social Care Act 2008. We have told the provider that it must take some actions to comply with the regulations and a review of these actions will be completed at the end of the suspension.
We are placing the service into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.