On the day of our visit the service had nine vehicles and 30 ambulance staff on call to deliver services. The service mainly provided emergency medical cover at events.

We spoke with two people who used the service. Both spoke very highly of EMC Medical. One said “I let them know what we need and they accommodate every time. I tell them what we plan to do and we discuss the appropriate medical cover". Another said "I have used them for events for some years now. They are very good". Both people we spoke with told us they felt involved in the service EMC Medical provided.

We spoke with two ambulance staff who told us they liked working for the service and felt well trained to do their job. We asked them about safeguarding children and vulnerable adults. Both staff demonstrated a good knowledge of abuse and what to do if they suspected abuse was happening. Training records confirmed all ambulance staff had been appropriately trained. This meant people were safe from the risk of abuse.

The provider had appropriate recruitment and selection procedures in place. Background checks were conducted and references were sought. Ambulance staff also received an induction programme of training. Ambulance staff also declared they were fit to carry out their job.

The provider monitored the quality of service it provided. The opinions of people who used the service were sought and complaints and comments acted upon.

EMC Medical services provides a range medical cover from first aiders to paramedics at events. They are also registered to provide transport. At the time of our inspection this aspect of the service was in development.

The provider had a range of vehicles to ensure that they always had appropriate transportation for patient transport services and for manoeuvring around event sites. We looked at one of the ambulances and saw that it was fully stocked with appropriate equipment. It had also been deep cleaned and each part tagged to state what had been cleaned and when.

People were informed of the treatment suitable for their injuries and given appropriate advice. Good, clear records of both patient transport and event treatments were kept.

Correct numbers of appropriately qualified staff were available for each patient transport request or event. This was driven by a comprehensive risk assessment and communications with the event organisers.

Staff members had received a variety of training including safeguarding and Mental Capacity Act courses. They were ale to demonstrate a good understanding of abuse issues.

The provider had an effective system in place to regularly assess and monitor the quality of service that people receive.

EMC Medical Services-Blewbury is operated by EMC Medical Services Limited and was registered with the Care Quality Commission (CQC) on 15 May 2011. It is an independent ambulance service provider based in Blewbury, Oxfordshire. The service provides patient transport services (PTS), first aid, medical training, event medical cover, fire, and health and safety training. The provider is registered to provide the regulated activities: transport services, triage and medical advice provided remotely; treatment of disease, disorder and injury; and diagnostic and screening procedures. The patient transport service was staffed by ambulance care assistants and operates twenty-three hours a day, five days a week and on Saturdays 10am to 8pm.

We inspected the patient transport service using our comprehensive inspection methodology. We carried out an unannounced inspection on 6 November 2018 and a further announced visit on 16 November 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 provider had made significant steps towards improvement since the inspection in 2016, to address the areas of poor practice identified in the CQC report (9 January 2017). A registered manager had been in post since 18 August 2017 and was introducing systems and improvements to governance.

Our rating of this ambulance service as Good overall.

We found the following areas of good practice:

• The staff had a clear ethos of putting the patient first and caring for them in a professional and compassionate manner.
• EMC Medical Services had a multidisciplinary approach and worked well with the acute NHS hospitals and the acute ambulance service.
• The staff were responsive and applied their knowledge, experience and common sense to find practical solutions to the day to day challenges they faced.
• The service provided mandatory training in key skills to all staff. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The service controlled infection risk well. Ambulances and equipment were visibly clean. They consistently followed good infection control practice.
• The service had enough staff, with the right qualifications and skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
•  The service took account of patients’ individual needs.
• The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

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

• There was no clear audit program to monitor the quality and effectiveness of the service. We were unable to interrogate the risk register to gain assurance all identified risks were captured, mitigated and reviewed.
• Staff informed us while they saw and knew the registered manager, they did not often see the directors.
• Some staff did not have a form of personal identification such as a name badge.
• Not all staff were happy with the induction they had received and felt that it had been kept to a minimum.
• While staff talked about being open and honest they did not all demonstrate an understanding of the term and requirement of duty of candour. Significant improvement had been made in duty of candour training in the last year, however there had been inconsistent delivery of the material.
• Although EMC Medical Services had a number of contingencies including spare devices and WIFI access in areas of poor signal. Staff were using their own phones as a back up to personal digital assistants (PDAs) as they were unaware of this contingency.
• The wall-mounted glove storage system on the new ambulances, was not secure and there was no evidence of any remedial action although staff had reported this as a safety concern.
• There was no system for the safe storage of waste on the vehicles.
• There was no system for the management of information with out of date paper copies of policies in the office and risk assessment on the internet.

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 been breached, to help the service improve.

Nigel Acheson

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