E-zec Medical Transport Bristol is operated by E-zec Medical Transport Services Ltd. The service is contracted to provide non-emergency patient transport services. They are commissioned by the clinical commissioning group to serve the communities of Bristol, North Somerset and South Gloucestershire. E-zec Medical Transport Bristol had been awarded the patient transport contract in April 2017, therefore at the time of inspection had been operating in Bristol for under one year.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 20 and 21 March 2018, and held a drop in session with staff on the 19 March 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 issues that the service provider needs to improve:

• There was a basic governance structure. This was not effectively used to monitor service performance and identify areas for improvement.

• There was a lack of evidence of the responsibility, overview and scrutiny by the board.

• There was no local management meeting.

• There was no assurance third party providers, who were providers completing patient transport work on behalf of E-zec, had appropriate recruitment checks or training. There had been a reliance on these third party providers, to include other independent ambulance providers and taxi firms, to help deliver the patient transport contract.

• There was no evidence staff references had been received and reviewed when recruiting new staff.

• There was not a strong or positive culture. There was a disconnect between management and staff, and between staff groups. The mechanisms to engage staff were ineffective.

• Staff were not suitably trained and assessed to carry out driving duties safely. Staff told us driving assessments were completed at the point of interview, which involved a short drive, they did not feel this prepared them for the role.

• There was not a culture of learning from incidents. Staff told us they did not receive feedback or the lessons learnt from the incidents they reported. This was discouraging staff from reporting incidents, and therefore there was a risk staff would not report incidents.

• The provider was unable to tell us their compliance against mandatory training, and did not hold a local record to report on performance. However, the managers were informed by the human resources department when staff training was due to expire.

• Staffing recruitment and retention had been a challenge since the start of the patient transport contract. Although the provider was nearly at full staffing, the staff were mostly new and inexperienced.

• The provider did not consistently provide a good service. They measured their effectiveness of delivering a timely patient transport service using measures set by the commissioner called key performance indicators. These key performance indicators were not always being achieved.

• Staff were not aware of the available translation and interpretation services which could be used to meet peoples individual needs. Staff told us escorts were used to translate for the patient, this is not best practice.

However, we found the following areas of good practice:

• Staff were observed to provide good care to patients, which was kind and respectful.

• Safeguarding was well understood by staff and they were confident about how they would respond if there was a safeguarding concern.

• The provider maintained good working relationships with stakeholders to ensure coordinated working.

• Patient transfer liaison officers were a valuable role to link between E-zec and hospitals to support the flow of patients.

• Information was clearly recorded so staff could access special notes and patient needs.

• Standards of cleanliness and hygiene were well maintained and there were systems to prevent and protect people from infection.

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 two requirement notices that affected the patient transport service. Details are at the end of the report.

Amanda Stanford

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