Air Alliance is operated by Air Alliance Medflight UK Limited. The service provides a planned and emergency patient transport service for adults and children abroad.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 3 July 2018.

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.

Services we do not rate

We regulate independent ambulance services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• There was a good incident reporting culture which resulted in improvements in practice.

• Staff were up to date with mandatory training, all of which had evidence of reviews and updates. Staff had completed safeguarding children and adults training to the required level. The registered manager was trained to a level 4 qualification in safeguarding adults and children.

• There was a strong focus on infection prevention and control measures to ensure ongoing compliance, including regular audit.

• The equipment and environment used by the provider were appropriate and well maintained. There were effective systems to ensure ongoing safety.

• Staffing levels were appropriate to meet the needs of the patients. There were sufficient numbers of qualified staff on the sub-contractors register.

• Patients records were complete and up to date and accessible to those that needed them.

• There were safe medicines management policies/processes/practices which included a service level agreement with a local NHS trust for supply and audit.

• Patients had their nutrition and hydration needs met and staff used evidence based risk screening tools to assess and manage risks.

• The service operated a 24-hour, seven-day week service with operational staff who were multi-lingual carrying out assessments.

• Staff were employed based on their competency to ensure they were skilled to meet the needs of the individual patients. Staff were multi-disciplinary and worked well together to provide good quality care.

• People provided feedback about the care they received. The feedback about staff was overwhelming positive, for example staff were described as caring and experiences were good.

• The service met people’s individual needs. For example, they sourced aeroplanes that were the right size to accommodate patients with families. They had accessible translation services to communicate with patients using their own language. Staff were from diverse backgrounds and when assessing a job, staff could be employed based on their cultural or religious background, for example, employing a Muslim team member if that was a patient’s preference.

• The leadership and staff team were highly qualified. There were effective governance systems to ensure oversight and standards were being met.

• Staff worked alongside accredited bodies, were involved with other regulatory bodies and were involved in research.

However, we found the following issues that the service provider needs to improve:

• Sub-contracted patient transport services on the ground did not always have all the relevant checks in place to assure the provider that vehicles had up to date insurance certificates.

• Patient outcomes were not routinely monitored.

• The provider was in the process of writing a business strategy, however it was not available at the time of inspection.

• Documentation to confirm staff competency was not checked and verified by an experienced member of staff.

• Managers did not have a system in place to document and review annual appraisals and supervision.

Heidi Smoult

Deputy Chief Inspector of Hospitals), on behalf of the Chief Inspector of Hospitals