- Ambulance service
Ambulance Headquarters, Bernicia House
All Inspections
13th -14th September 2022
During an inspection looking at part of the service
This service is rated as Requires improvement overall. (Previous inspections carried out in September 2018 and March 2016 both rated the service as Good overall)
The key questions are rated as:
Are services safe? – Requires improvement
Are services effective? – Requires improvement
Are services caring? – Good
Are services responsive? – Requires improvement
Are services well-led? – Requires improvement
We carried out an announced comprehensive inspection at North East Ambulance Service NHS Foundation Trust NHS 111 Service on 13 and 14 September 2022 as part of our inspection programme. The inspection was undertaken as part of a joint inspection in partnership with the CQC hospitals inspection team.
We have rated this service as requires improvement overall
We rated the service as requires improvement for providing safe, effective, responsive and well led services because:
- There were inconsistent approaches to the process for raising a safeguarding referral which put patients at risk.
- The service did not have enough staff in post to facilitate the provision of care and treatment at the right times.
- Gaps in systems and processes had been identified by the provider, but not addressed, and had been on the service risk register for some time.
- There was not a clear system for the co-ordination of significant events and incidents.
- The service was not meeting national targets, these related to call handling and the number referred to a clinical advisor. However, plans were in place and some progress had been made to address this.
- We were concerned about how the competency of senior health advisors was assessed.
- People could not always access care and treatment at a time when they needed it. Some of the systems and policies in place did not support good governance and management.
- The processes for managing risks, issues and performance could be improved.
We rated the service as good for providing a caring service because:
- The NHS friends and family test survey results were mostly positive.
- Staff involved treated patients with compassion, kindness, dignity and respect.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure patients are protected from abuse and improper treatment.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA
Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services
18 and 19 September 2018
During a routine inspection
This service is rated as Good overall. (Previous inspection March 2016 – Good)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Good
We carried out an unannounced comprehensive inspection at North East Ambulance Service NHS Foundation Trust NHS 111 Service on 18 and 19 September 2018 as part of our inspection programme. The inspection was undertaken as part of a joint inspection with the CQC hospitals inspection team.
At this inspection we found:
- The service had well established systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
- The service routinely reviewed the effectiveness and appropriateness of the care provided. Staff were supported in the effective use of the NHS Pathways tool to triage telephone calls (NHS Pathways is a licensed computer based operating system that provides a range of clinical assessments for triaging telephone calls from patients, based on the symptoms the patients share when they call).
- Staff involved and treated people with compassion, kindness, dignity and respect.
- There was a focus on continuous learning and improvement at all levels of the organisation. Regular call audits were carried out for all staff.
- The service had a clear system for managing and learning from complaints.
- The service had an overarching governance framework in place, including policies and protocols which had been developed at a provider level and had been adapted to meet the needs of the service locally.
- The service had not met all of the Minimum Data Set (MDS) targets, for example, calls answered within 60 seconds.
The areas where the provider must make improvements are:
- Improve systems to ensure that the service can deliver local and national performance targets.
- Ensure that sufficient clinical advisors are available to meet patient demand.
Regulation requirement notices in relation to the above two areas of concern have been included in the North East Ambulance Service NHS Foundation Trust Quality Report.
The areas where the provider should make improvements are:
- Identify measures to improve noise levels at Russell House.
- Take steps to give all staff the opportunity to attend regular team meetings; to provide support and opportunities to share learning.
- Develop a system to monitor that staff have been made aware of and understand interim Pathways updates.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
18,19,20 April 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We inspected the NHS 111 service which is provided by North East Ambulance Service NHS Trust (NEAS) on 18, 19 and 20 April 2016. This inspection was undertaken as part of a joint inspection of the whole Trust with the CQC hospital team
The NHS 111 service is delivered from two sites - Bernicia House, Newburn, Newcastle Upon Tyne and Russell House, Hebburn , South Tyneside. We carried out this announced inspection as part of our comprehensive approach to inspecting NHS 111 services. Overall the provider is rated as good.
Our key findings were as follows:
NEAS 111 provided a safe, effective, caring, responsive and well led service to a diverse population spread across a wide area in the North East of England.
- There was an open and transparent approach to safety and an effective system in place to report and record significant events. Staff knew how to raise concerns and understood the need to report incidents and near misses. Front line staff did not directly report incidents. These were escalated through team leaders.
- The service was monitored against National Minimum Data Set (MDS) and Key Performance Indicators (KPI). The data provided information to the provider and commissioners about the level of service being provided. Where variations in performance were identified, the reasons for this were reviewed and action plans implemented to improve the service.
- NEAS worked closely with the four lead Clinical Commissioning Groups (CCGs), (Northumberland CCG, Sunderland CCG, Durham Dales, Easington and Sedgefield CCG, Hartlepool and Stockton on Tees CCG) who commissioned the service on behalf of all 11 CCGs in the North East. Monitoring of the service was managed on behalf of the lead CCGs by NHS North of England Commissioning Unit
- Staff were trained and monitored to ensure they used the NHS Pathway safely and effectively. (NHS Pathways is a licensed computer based operating system that provides a range of clinical assessments for triaging telephone calls from patients, based on the symptoms they report when they call)
- Patients using the service were supported effectively during the telephone triage process. Consent to triage was sought and their decisions were respected. We saw that staff treated patients with compassion, and responded appropriately to their feedback.
- The service responded to complaints and patient and staff feedback.
- The leadership within the NHS 111 service was accessible and visible. There was a culture of continuous improvement and development of the service.
- Safeguarding systems and processes were in place to safeguard both children and adults at risk of harm or abuse, including frequent callers to the service.
- The provider was aware of, and complied with the Duty of Candour. They encouraged a culture of openness and honesty.
We saw an area of outstanding practice:
- The service had implemented an effective communication and learning system via the Learning Access Meeting Point (LAMP), an electronic based programme by which staff received updates on policies and procedures, service and Trust announcements, training dates and updates and a wide range of additional information. This interactive learning tool and resource helped to improve staff engagement. Team Leaders and Section Managers could monitor how often and for how long each staff member accessed this communication tool. This was reviewed at staff one to one meetings. Staff were very positive about The LAMP and confirmed its frequent use.
There were areas where the provider should make improvements:
- Review the working environment and take action to mitigate the sound levels at Russell House call centre, to improve callers and staff experiences.
- Continue to monitor the availability and access to clinicians for NHS 111 call handlers.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
4, 5, 6, 7, 13 February 2014
During a routine inspection
We spoke with 13 patients who had used the emergency ambulance service and 15 relatives. Patients were happy with the service they had received. One patient commented, 'The crew were always polite and respectful.' Another patient told us, 'They couldn't do enough for you the staff. They talked to me all the way to the hospital; explaining things.'
We saw that patients experienced positive interactions with ambulance staff and the care they received was appropriate. One patient told us, 'The ambulance crews were great, very good in fact. They asked questions, they were very thorough and polite with me. They asked about my medication and they took my sugar levels and blood pressure.' One relative said, 'They were lovely with my mam. I couldn't fault the ambulance service at all.
Medicines required for resuscitation and other medical emergencies were available to be administered quickly. However, we found that medicines, other than controlled drugs, were not always kept safely in ambulance stations.
We were already aware of serious shortfalls in recruitment checks on front line staff and the extent of this was confirmed at this inspection. An intensive recovery plan was underway but Disclosure Barring Checks (previously known as CRB checks) had not yet been completed on all staff.
The majority of emergency ambulance crews and dispatch staff spoken with told us they had difficulty in accessing meaningful supervision and appraisal due to work pressures and the need to prioritise operational work. Staff at the emergency call centre told us they had good access to training and supervision.
There were systems in place to assess, monitor and improve performance which included learning from incidents, complaints and investigations. However, there were shortfalls in human resource governance, complaint management and medication audits.
10, 11, 12, 13 December 2012
During a routine inspection
We also spoke with five people, and two relatives of people, who had used patient transport services (PTS) from the provider. Comments included, 'It's an excellent service, I use them pretty often now, you cannot praise them enough' and a relative told us, 'They're very good. They talk to him all the time and keep me updated as to who is coming back to get us.' We concluded that people received care, treatment and support which met their needs.
Most of the care was necessarily carried out with people's verbal or implied consent. We found the provider had clear procedures, followed in practice, where people did not appear to have capacity to consent to care or where they chose to withhold their consent.
We found there were systems in place to prevent, detect and control the spread of healthcare associated infections.
We checked staff records and found the provider operated effective recruitment procedures.
There was a complaints system in place and we found that complaints were recorded, investigated and, where appropriate, the complainant was responded to.