Staff told us that whenever possible they explained their actions to the patient, or parent /carer if present. They were also mindful of respecting patients’ privacy and dignity, within the constraints of the situation. We saw that patient record forms had been completed as required. Staff told us a copy of the record followed the patient when care was handed over, and the service retained a copy.

Staff told us that care and treatment was planned and delivered in a way that ensured the patient's safety and welfare. They told us all paramedics completed the critical care paramedic course. The doctors were required to have a specific set of skills relating to the care of critically ill patients.

There were robust systems in place for the management of medicines. Medication records were accurate and up to date.

Incidents and complaints were recorded, investigated and responded to appropriately.

Records seen were up to date and stored securely.

Due to the nature of the service provided, we were unable to speak with anyone who had used the service. We spoke with four paramedics and the clinical services administration officer.

We looked at patient records, and saw these were completed appropriately. The section relating to consent to treatment had been filled in.

We saw infection control and prevention measures were in place. Staff had an infection control policy to refer to, and one member of staff had the designated role of infection control lead. Systems were in place to check the cleanliness of the helicopter, and records supported routine cleaning was carried out. Audits were in place to ensure that the required checks and cleaning had been carried out.

Systems were in place to check that all equipment was in good working order. Equipment on the helicopter was checked daily and replaced as required. Additional supplies were available to staff as required. Equipment was maintained and serviced as required.

Staff told us they felt well supported by the staff team, as well as the provider. They received training appropriate to their role. Staff said they receive clinical supervision every six months, but they also have a debrief after all call outs, to reflect on how the situation was managed.

The provider reflected on the service provided, and reviewed how incidents had been managed. A range of audits were in place to ensure the service was being managed appropriately.

Derbyshire, Leicestershire, and Rutland Air Ambulance is operated by The Air Ambulance Service (TAAS), a registered charity, which also operates the Warwickshire and Northamptonshire Air Ambulance and the Children’s Air Ambulance. It provides a helicopter emergency medical service and a doctor/critical care paramedic service.

The service operates under a service level agreement with the local NHS ambulance trust, which activates the service based on emergency 999 calls.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 15 and 16 January 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.

The main service provided by this service was emergency and urgent care.

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:

• Clinical staff were knowledgeable about incident reporting and there were robust processes to report, investigate and learn from incidents, and strong track record on safety
• The service was doctor lead and highly skilled. It had a high level of paramedic critical care expertise, supported by an effective personal development system, a range of clinical skills development opportunities and specialist clinical standard operating procedures
• Aircraft and rapid response vehicles were visibly clean and tidy, and there were systems in place to ensure that equipment was suitable and maintained on a timely basis
• Clinical staff could access specialist advice when they were on a mission from a designated team of specialists
• There were sufficient staff, and arrangements for short notice cover if needed
• The service cooperated with and supported other emergency services, and communicated well with other health providers
• Clinical staff audited their work in line with best practice
• Staff understood the relevant consent and decision making requirements of legislation and guidance, including the Mental Capacity Act 2005 (MCA)
• Staff were professional, caring and compassionate, and involved relatives in patient care. Care was tailored to the individual patient
• The service analysed unmet need to develop new services together with the NHS ambulance provider. They also worked with them to improve helicopter and rapid response vehicle dispatch arrangements
• There had been no complaints in the last 12 months. Historical complaint investigations were thorough.
• Leaders were respected and had the skills, knowledge, experience, and integrity they needed.
• Strategic planning processes were effective and staff were engaged in service planning
• There was an open and learning culture and an ethos of continuous improvement.

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

• The safeguarding adults’ policy referenced out of date guidance. This was raised with the registered manager during the inspection who took immediate action to update the policy.
• Aircraft pilots had not had safeguarding training.
• The compliance with some mandatory training was low.

Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region), on behalf of the Chief Inspector of Hospitals