Arriva Transport Solutions- South West is operated by Arriva Transport Solutions Limited. The service provides non-emergency patient transport services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 11, 12 and 13 December 2017, along with an unannounced visit to the provider on 21 December 2017.

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.

The main service provided by Arriva Transport solutions South West was patient transport services. Where our findings on patient transport services – for example, management arrangements – also apply to other services, we do not repeat the information but cross-refer to the patient transport services core service.

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 issues that the service provider needs to improve

• Not all incidents were being captured and some safeguarding concerns had been missed and lessons from complaints and incidents were not shared effectively with frontline staff.
• Children (with escorts) and adults were being transported in mixed vehicles with no evidence of a risk assessment for this.
• Operational staff did not have access to all policies and procedures necessary, there was no accessible deteriorating patients policy for staff out on the road or a policy to advise staff on the safe transportation of wheelchairs or the use of wheelchair seatbelts.
• Arrangements to protect staff who were lone working were not sufficient, staff did not always receive call backs from control when requested in an emergency and staff who worked alone did not always receive welfare calls from the control room during and at the end of their shifts.
• Control room staff did not always inform operational bases of staff sickness.
• Only 23% of staff had received updated level 2 safeguarding training against a target of 85% and control room mandatory training was 62% against a target of 85%.
• Only 51% of control room staff had received an appraisal in the 12 months to October 2017 against an 85% company target.
• Staff vacancy reports showed 26 full-time equivalent (FTE) vacancies at the time of our inspection.
• There was no embedded process to assess or monitor observed practices amongst call centre staff and dispatchers.
• When crews were not made aware of specific infection risks by hospital staff they did not escalate them beyond the service.
• Crews did not always have up to date information about patients’ resuscitation decisions as part of the booking form and other key information such as mobility status was sometimes missing or incorrect.
• Best practice guidance had been used to develop some policies and procedures but staff had no awareness of any best practice guidance beyond this.
• The service was consistently missing some key performance indicators for renal dialysis patients and oncology patients.

• Data provided in Clinical Commissioning Group reports did not reflect the actual number of cancelled journeys that were attributable to Arriva and there were discrepancies in data.

• Some data related to serious incident reporting was not accurate and did not give assurances all information used to monitor and manage quality and performance was accurate.
• There were no communication aids or information for patients who were visually impaired, hard of hearing or who had learning disabilities.
• The governance framework and management systems did not provide assurance that all third party providers had been reviewed for assurance of Disclosure and Barring Service checks (DBS), driving licences and vehicle insurance.
• There were no individual risk assessments to support decisions to not carry out disclosure and barring service checks (DBS) for roles that were not eligible for DBS checks, including the financial director and some call centre staff.
• Staff had been involved in the development of the Arriva values although some staff were unaware of them.

• A senior manager acknowledged they needed to be more aware of the requirements of the registered manager post they had applied for.

However, we found the following areas of good practice:

• A new incidents and complaints manager had been employed to oversee the quality, communication and was starting to share learning from incident investigations.
• A computer system allowed all vehicle defects to be monitored both centrally and at a local level.
• A new recruitment coordinator had reduced staffing vacancies and produced weekly monitoring reports of recruitment progress.
• There was an effective business continuity plan that prioritised patients with the greatest needs.
• Crews were dedicated and resilient when faced with adverse weather and worked to get to patients with greatest needs.
• The service had recently implemented a day before and on the day text messaging service and was monitoring its effectiveness as part of its engagement with the CCGs.
• Significant changes had been made in transport for patients for renal dialysis that included a coordinator and dedicated vehicles.
• The service was achieving its target in five out of six key-performance indicators (KPI) for renal dialysis patients.
• The service was achieving its target in four out of six KPIs for oncology patients.
• Most operational staff had received an appraisal in the 12 months to October 2017, and all ambulance stations met the company target of 85%.
• Staff were respectful to patients and kind in their interactions with patients, taking time to confirm names and destinations.
• Staff ensured they did all they could to maintain patients’ dignity.
• Staff accommodated additional family members or carers for the most vulnerable patients including children.
• Staff understood the eligibility criteria and made sure patients understood who was eligible for non-emergency patient transport services and why.
• Staff talked with patients during their journeys which patients said ‘made their day’.
• The service engaged with commissioners and there was evidence of service improvements for the dialysis group of patients as a result.
• The service was working towards two Commissioning for Quality and Innovation (CQUINs) targets and had recently implemented a day before and en-route text service for some patients.
• Most complaints were responded to within the 25-day target company target.
• Senior managers had a realistic strategy for achieving their vision and priorities in order to deliver good quality care, and understood the key drivers for providing effective non-emergency patient transport service.
• The governance framework and management systems had recently been reviewed and improved following a lapse in governance that had led to disciplinary action and restructure.
• There were comprehensive assurance and service performance measures, which were reported and monitored. Action was taken to improve performance.
• We saw that assurances for volunteer car drivers for DBS, insurance, vehicle roadworthiness or MOT and licence to drive were effective.
• Most staff we spoke with felt respected and valued and those we were able to speak with felt that managers demonstrated openness and honesty. Organisational change was handled openly.
• Most full and part time staff felt actively engaged so that their views were reflected in the planning and delivery of services and in shaping the culture.
• Most leaders and managers had the capacity, capability and experience to lead services effectively.
• Leaders tried to ensure that people who used services, those close to them and their representatives were actively engaged and involved in decision-making and improving the quality of services.
• All staff we spoke with were focused on continually improving the quality of care. When leaders considered developments to services or efficiency changes, they used both quantitative data and patient experience to inform the change.
• Leaders and staff strived for continuous learning, improvement and innovation. The service sought to innovate and explore new ways of working with CCG and other stakeholders.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with five requirement notices that affected patient transport services. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals

On behalf of

The Chief Inspector of Hospitals