North East Ambulance Service NHS Foundation Trust

Updated 7 July 2023

The North East Ambulance Service NHS Foundation Trust (NEAS) provides an emergency ambulance service 24 hours a day, 365 days a year across the North East of England.

The trust provides an emergency and urgent care (999) service and the NHS 111 service across the region. The trust also has a Hazardous Area Response Team (HART) and provides a patient transport service (PTS).

The trust covers just over 3,200 square miles, which includes across rural, urban and coastal areas, and serves a population of 2.7 million people.

The trust has just under 3,500 staff and volunteers, 55 ambulance stations and has a fleet of over 600 vehicles. Every year trust staff answer over half a million 999 calls and almost 1 million 111 calls, and transport around 300,00 patients to hospital and completes more than 500,000 PTS journeys.

We carried out this unannounced inspection of North East Ambulance NHS Foundation Trust as part of our continual checks on the safety and quality of healthcare services.

We inspected Emergency and Urgent Care, the Emergency Operations Centre and the NHS 111 service. We also inspected the well-led key question for the trust overall. We did not inspect PTS or Resilience (HART) services at this inspection.

At our last inspection in 2018 we rated the trust overall as good.

Our rating of services went down. We rated them as requires improvement because:

• Overall, we rated safe and effective as requires improvement and caring and responsive as good. We rated well-led as inadequate.
• We rated Emergency and Urgent Care as inadequate. We rated safe and well-led as inadequate. We rated effective and responsive as requires improvement and caring as good.
• We rated the Emergency Operations Centre as requires improvement. We rated safe, effective and well-led as requires improvement and rated caring and responsive as good.
• We rated NHS 111 as requires improvement. We rated safe, effective, responsive and well-led as requires improvement and rated caring as good. This report is published separately. The ratings are displayed in the ratings table in this report as ‘Ambulance Headquarters, Bernicia House’.
• In rating the trust, we took into account the current ratings of the other core services that were not inspected this time.

What we found

• Leaders did not always understand or manage all of the priorities and issues the service faced and governance processes did not operate effectively across the organisation to ensure risk and performance issues were identified, escalated appropriately, managed and addressed promptly. We were not assured the board had sufficient oversight and focus on the operational risks or had effective systems to ensure incidents were consistently reported in line national patient safety reporting guidelines.
• Although staff were focused on the needs of patients receiving care, they did not always feel respected, supported and valued. Some staff told us they did not feel they could raise concerns without fear of blame or reprisal and the trust did not have effective systems to seek and act upon feedback from staff and other relevant persons.
• Although leaders actively and openly engaged with patients, equality groups, the public and local organisations to plan and manage services, engagement with staff was less robust.
• The portfolios for executive leaders were large and corporate services teams lacked capacity to be able to provide appropriate support. There were also limited succession plans to support staff to develop their skills and take on more senior roles.
• Services did not always have enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Although the trust had a workforce plan and had secured additional funding to increase the number of staff in patient facing roles, the Emergency Operations Centre did not have enough health advisors or clinical staff, and we were not assured advanced call-handler experts had received appropriate training or competency assessments.
• The trust monitored agreed response times to facilitate good outcomes for patients however, although the trust was one of the top performing ambulance services in the country for its response time to category one calls, performance did not meet the national target against this and other call category standards
• The trust aimed to provide the right care in a timely way and prioritised life-threatening responses, however people could not always access the service when they needed it, in line with national standards.
• Systems and processes for continually learning and improving services were not robust. Learning from complaints and incidents was not embedded across the trust and the pace of delivering improvement was slow.
• Following this inspection, we served the trust with a notice under Section 29A of the Health and Social Care Act 2008. We told the trust it needed to make the following significant improvements: (1) to ensure governance systems operated effectively; (2) in listening, responding, and acting upon feedback from staff and other relevant persons; (3) in incident reporting, investigating and monitoring of actions to prevent re-occurrence ensuring improvements are made as a result; (4) in medicines management to reduce risks to patients.

However:

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual cultural and religious needs. Staff provided emotional support to patients, families and carers to minimise their distress and supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
• The service provided mandatory training in key skills to all staff and made sure everyone completed it.
• 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.
• All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.
• Staff promoted equality and diversity in daily work.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously and investigated them.

How we carried out the inspection

The team that carried out the well led inspection included two inspection managers, 13 inspectors, one assistant inspector and an inspection planner. In addition, there was an executive reviewer plus three specialist advisors experienced in executive leadership of NHS trusts, including the CQC national professional advisor for ambulance services. The inspection team was overseen by Sarah Dronsfield, Head of Hospital Inspection.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 2 February 2023

Updated 1 November 2016

Overall, we rated the resilience service as good because:

• Staff understood their responsibilities to report incidents and raise concerns. There were a low number of reportable incidents with none resulting in patient harm. There were clearly defined processes to keep people safe and these were underpinned by robust national guidance. Staff shared and learnt lessons from debriefings.

• Safety risks were assessed, planned and responded to accordingly. Resilience functions and business continuity plans were embedded and ensured service continuity.

• Staff within the service were trained and proficient in their role. This was supported by a sound evidence base, in line with national standards and competencies, informing practice and clinical skills. The service fully utilised the NARU Proclus database.

• There was evidence of outstanding co-operation and effective working relationships with allied agencies and multi-disciplinary services.

• The service cared about the work it carried out and patients were central to this. We observed kind and compassionate interactions with patients. Physical and emotional needs were promptly assessed and appropriate treatment options were discussed to secure an agreed care pathway.

• Resilience services were planned and delivered for the benefit of the local population. The service developed robust plans with other services and providers to maintain its core functions to meet patient needs. The service was open to learn from patient concerns.

• The trust had a clear strategic vision which resilience staff felt reflected what the organisation represented. Senior and local managers were engaged. The resilience service worked well as a team and was well led by an approachable, supportive and committed management team.

• The resilience team felt collectively responsible for the efficiency and quality of the service. Staff welcomed challenge and dialogue to improve practices. The service had made some impactful improvements to safety in sports grounds and a number of staff were involved in national and international programmes.

• Feedback from incident investigations needed to be more consistent. There was a need to refresh training around base cleanliness in the sluice area and in using the Omnicell system for the management and storage of controlled drugs.

• Data collection for HART response times was incomplete and patient outcomes were not routinely collected.

• There was some confusion within the HART service regarding their deployment in support of general operations. This led to an inconsistent approach in responding to non-urgent calls outside the agreed deployment protocol.

• There was a lack of a formal documented local resilience strategy due to various staffing changes, service restructuring and transient appointments. Staff acknowledged the resilience structure was lean and was “running hot” most of the time leading to concerns being raised about long-term sustainability within the current configuration.

Updated 1 November 2016

Overall, we rated Patient Transport Services as good because:

• The service had a clear vision and strategy that was linked to the overarching corporate objectives. Managers monitored the risk register regularly and could explain what mitigating actions they were taking.

• Staff told us they felt proud to work for the trust. PTS crews felt their immediate operational managers supported them in their role.

• All operational staff knew how to keep patients safe through incident reporting, assessing risks and taking appropriate action, and the maintenance and cleanliness of vehicles.

• Staff were caring towards patients and we observed ambulance care assistants and call handlers from the control centre treat people with kindness, dignity and respect.

• The service took into account the needs of different people, such as bariatric patients or people living with dementia, and journeys were planned based upon their requirements. Patients could also book their own transport and some hospitals could book transport for their own patients attending the clinic.

• Managers monitored the performance of PTS on an ongoing basis and held meetings every month to discuss the outcomes. The latest performance figures showed the service had exceeded its target in relation to the time patients spent on a vehicle and local commissioners had extended the contract for the transportation of patients receiving renal dialysis.

However:

• Patients did not always arrive at hospital on time for their appointment. To address this, the service was looking at different ways to improve its performances. This included providing specific information to PTS crews about the patient’s actual appointment time and an option to text patients when the vehicle was on its way to collect them.

• Managers only reviewed the performance of ambulance care assistants once a year. There were no arrangements for 1-1 or team meetings, or supervision.

Updated 7 July 2023