E-Zec Medical Transport - Staffordshire is operated by E-Zec Medical Transport Services Ltd. The service provides routine and high-dependency patient transport services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 24 and 25 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.

At the time of this inspection; we regulated this service but did not rate it. This is because we issued a provider information request to gain data prior to the inspection before 2 July 2018. Inspections where provider information requests are sent to independent ambulance services after 2 July 2018 will be rated.

We found the following issues that the service provider needs to improve:

• Vehicles checked were found to be unclean; patient areas were dusty; with spilt liquids on seats and stretchers. We saw unsecured clinical waste on vehicles and a dirty, stained patient blanket behind a folded chair. Vehicle cleanliness was not audited by local managers.

• Medicines stored on the bases were not temperature controlled or monitored. The service medicine management policy did not specify this requirement.

• Mandatory training levels were below 50%. The service did not have a structured plan with set actions to achieve compliance.

• Incidents were not always reported in line with the provider’s incident reporting policy.

• The service was underperforming in seven out of nine key performance indicators as of April 2018.

• Supervision and appraisal rates were poor; and the quality of appraisals was substandard.

• Staff morale was poor in areas; the culture of the service was one of fear to speak up. Staff team meetings were rare; and generally not formally recorded or structured.

• We found there was no overall service improvement plan. Learning from any feedback was not embedded and used to improve the service. Where ideas were generated; there were no formal action plans or objectives. Following the inspection; the provider gave us action plans for improving specific areas of business including renal patient key performance indicators.

• The risk register was outdated and missing key risks.

We found the following areas of good practice:

• Staff presented as passionate about their role in supporting patients; and were caring and respectful.

• Paramedic specific competencies were monitored and in date.

• Supervision and development of staff was being undertaken within the bookings team.

• The service sought to accept every booking made.

• Staff were aware of their safeguarding requirements; and had the means and knowledge to report concerns. Concerns were dealt with appropriately.

• Feedback from staff indicated that the new local managers structure was already making positive changes with regards to staff engagement.

• During the inspection we observed effective teamwork and communication between staff.

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 one requirement notice. Details are at the end of the report.

Victoria Watkins

Head of Hospital Inspection (Central West) on behalf of the Chief Inspector of Hospitals