Updated 26 October 2022
South East Coast Ambulance Service NHS Foundation Trust (SECAmb) provides services to Brighton & Hove, East Sussex, West Sussex, Kent, Surrey, and North East Hampshire. This diverse geographical area includes densely populated urban areas, sparsely populated rural areas and some of the busiest stretches of motorway in the country.
The trust employs over 4,500 staff working across 110 sites in Kent, Surrey and Sussex. Almost 90% of the workforce is made up of operational staff who care for patients either face to face, or over the phone at the emergency dispatch centre where 999 calls are received.
Patients range from the critically ill and injured who need specialist treatment, to those with minor healthcare needs who can be treated at home or in the community.
As well as a 999 service, the trust also provides the NHS 111 service across Sussex, Kent and Medway.
Since June 2011, the responsibility for the delivery of the emergency preparedness policy of NHS ambulance services in England has been delegated to the National Ambulance Resilience Unit (NARU).
From April 2013, all NHS organizations have been required to contribute to coordinated planning for both emergency preparedness and service resilience through their local health resilience partnerships (LHRPs).
The SECAmb has a crucial role in the national arrangements for emergency preparedness, resilience and response (EPRR). The service is part of the civil contingency planning for both the NHS and the wider emergency preparedness network and must be able to demonstrate it can effectively manage the impact and aftermath of a major incident.
How we carried out the inspection
At our last inspection in February 2022, the overall rating of trust well-led went down. We rated it as inadequate and the chief inspector of hospitals recommended to NHS England and NHS Improvement (NHSEI) that SECAmb be placed in the Recovery Support Programme. During the previous inspection we identified further checks we needed to be carried out. Therefore, we suspended the trust's overall rating. During this current inspection we reviewed the trust's overall rating following inspection of the two remaining core services.
We inspected emergency and urgent care services. We visited the make ready centres at Paddock Wood and Ashford. We also visited three NHS hospital emergency departments to observe care and talk to staff. We spoke to over 50 members of staff which included; paramedics, emergency care support workers, student paramedics, operational managers, operational team leaders, a driving training manager, pharmacy support staff, associate ambulance practitioners, trainee associate ambulance practitioners and a practice development lead. We spoke to three patients and one relative and reviewed a variety of data.
We carried out a comprehensive inspection of the Resilience core service. Resilience services were located at Gatwick and Ashford Made Ready Centres. We inspected both locations on two occasions between the 22 July and the 2 August 2022. During the inspection process, we spoke with the director of the service, two operations managers, three operational team leaders and 10 Hazardous Area Response Team (HART) operatives across both sites.
You can find information about how we carry out our inspections and previous ratings for this service on our website:
https://www.cqc.org.uk/what-we-do/ how-we-do-our-job/what-we-do-inspection.
We conducted this comprehensive short notice unannounced inspection of the emergency and urgent care and resilience core services. We inspected emergency and urgent care on 26 July 2022 and resilience on 26 July 2022 and 02 August 2022. We rated both emergency and urgent care and resilience as requires improvement overall.
What we found
Emergency and urgent care
Our rating of this service went down. We rated the service as requires improvement because:
- The service provided mandatory training in key skills to all staff but not everyone had completed it. The service did not share learning from incidents with staff and staff often did not get feedback from incidents they had reported.
- There was a lack of training for medicines management, specifically for patient group directions.
- The service did not always support staff to develop their skills. Managers and staff told us that any additional training courses had to be self-funded and completed in their own time.
- Managers did not routinely appraise staff’s work performance or hold supervision meetings with them to provide
support and development. Managers did not always make sure staff were competent. - Staff did not receive training in patient restraint techniques. The trust did not have oversight regarding how often restraint was used and whether it was done safely. The trust did not have a restraint policy.
- The service did not always make it easy for people to give feedback. People could not always access the service when they needed it and patients often experienced delays in receiving treatment.
- There were additional risks for patients from handover delays for ambulance crews at emergency departments which were unable to take patients due to their lack of capacity.
- The NHS contractual response times for ambulances to attend patients were not being met and some were exceptionally long, ambulances were waiting at emergency departments due to the increased demands and capacity pressures in hospitals and other parts of the health and social care system.
- Leaders did not have the capacity or support to run the service well. Not all staff felt respected, supported and valued.
- Staff felt there was an overall lack of a strategy and vision for the service. Staff felt there was a lack of urgency and ownership of responsibilities within the service.
- There was not an effective communications system to ensure staff had read and understood key information.
- Staff were not clear on the roles and responsibilities of managers. For concerns requiring action from senior leaders in the organisation there were often delays in getting a response impacting on the ability of local leaders to deal with issues and concerns at a local level in a timely way.
- Managers did not have enough time to dedicate to the welfare, professional development and training of the staff they managed. There was conflicting and changing demands placed on all levels of managers from the senior leadership team and there was a lack of cohesive working.
- There was evidence of staff under such pressure that it was having a detrimental effect on both their mental and physical wellbeing. Most of the staff described feeling exhausted and burnt-out by the job with the current pressures.
Not all staff felt that staff welfare was given sufficient priority.
However:
- The service controlled infection risk well. Staff assessed risks to patients and acted on them. Staff generally managed medicines well.
- Staff kept detailed records of patients’ care and treatment. Records were clear, stored securely and easily available to all staff providing care.
- Staff provided care and treatment based on national guidance and evidence-based practice. The service monitored the effectiveness of care and treatment.
- Staff treated patients with compassion and kindness, they provided emotional support to patients, families and carers to minimise their distress. Staff supported and involved patients, families and carers to understand their
condition and make decisions about their care and treatment. - Staff worked well together for the benefit of patients, for example with staff in emergency departments. Despite the immense pressure faced every day, staff were kind, compassionate and supportive to patients.
Resilience
Our rating of this service went down. We rated it as requires improvement because:
- Not all staff had completed safeguarding training at a level appropriate to their role.
- The service were not always able to demonstrate how they measured IPC effectiveness and infection control risk.
- The service did not always keep equipment and vehicles in line with their documented policies and processes.
- The service had limited learning from safety incidents and incident reporting was low for the service.
- Staff were not always clear about information communicated through the meeting structure of the service.
- Some staff did not always feel respected, supported and valued.
- Managers showed limited strategies and systems to improve the service using quality improvement techniques.
However:
- Staff had training in key skills and understood how to protect patients from abuse. Staff assessed risks to patients, acted on them and kept good care records. The service managed medicines well.
- Staff provided good care and treatment to patients and gave them pain relief when they needed it. Managers checked the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients and had access to good information. Staff showed knowledge of consent and the considerations of patients who lacked capacity to make decisions. Staff worked with other services to ensure best outcomes; key services were available seven days a week.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers. Staff engaged well with patients and were focused on the needs of patients receiving care.
- The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
- Leaders supported staff to develop their skills. This included highly specialised training which was monitored effectively.
Our inspection team
Emergency and urgent care
The team that carried out the inspection comprised an inspection manager, lead inspector, two other CQC inspectors and two specialist advisors. The inspection team was overseen by Carolyn Jenkinson, Head of Hospital Inspection.
Resilience
The team that carried out the inspection comprised a lead inspector, one other CQC inspector and one specialist advisors. The additional visit had a team of two CQC inspection managers and two CQC inspectors. The inspection team
was overseen by Carolyn Jenkinson, Head of Hospital Inspection.