EMS (Hurst) provides a patient transport service in Berkshire and Buckinghamshire delivered through a contract with an NHS ambulance Trust provider. The service provides patient transport service to renal patients from their home to the local hospital. The service also provides private emergency first aid and medical cover to sporting venues and equestrian events; however this was not covered under this inspection.

We carried out an announced routine comprehensive inspection of EMS (Hurst) on 5 October 2016, followed by a routine unannounced visit on 17 October 2016. We inspected against the following key questions: are services safe, effective, caring, responsive and well-led?

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and issues that service providers need to improve.

Our key findings were:

• There was no evidence of an effective governance system.

• Staff did not receive written feedback on the incidents, complaints and patient feedback.

• Staff did not understand the principles of the duty of candour and how this impacted upon their role.

• We had some concerns with the infection control practices. For example, the service did not carry out any infection control audits.

• Staff received patient identifiable information via their personal email accounts. There was no way of monitoring if staff deleted these job sheets from their personal email address and this raised data protection concerns.

• The service did not have systems in place to routinely monitor how the service was performing against the key performance indicators (KPI’s) within the contract.

• The service did not have a robust system for handling, managing and monitoring complaints and concerns.

However,

• All staff had completed their statutory and mandatory training and ambulance drivers were appropriately trained.

• Vehicles were well maintained and had up to date Ministry of Transport (MOT) tests.

• Staff had a strong focus on providing caring and compassionate care.

• Staff felt valued and supported by their peers and the local management team.

• Staff were competent in carrying out their responsibilities and felt they received appropriate training and support for this.

• Staff respected the needs of patients, promoted their well-being and respected their individual needs. Patient dignity, independence and privacy were well respected by staff in the service.

• Staffing levels were sufficient to meet patient needs. Staff were confident in assessing and managing specific patient risks and processes were in place for the management of deteriorating patients.

• Staff were able to plan appropriately for patient journeys using the information provided by the IT-based booking system.

• The service was planned to meet the needs of its contractual arrangements with health service providers. The service utilised its vehicles and resources effectively to meet patients’ needs.

• There was a vision and strategy for the service.Although not documented, the strategy for the service was to stabilise the current service and sustain the work they currently had.

• Staff told us the registered manager was approachable and visible.Staff felt well supported by the registered manager.

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

• Ensure systems are in place to ensure the principles of Duty of Candour process are fully understood and applied when necessary.

• Ensure systems are in place to receive, record, handle and respond to complaints.

• Ensure systems are in place for sharing learning and feedback with all staff following complaints, incidents, patient feedback and investigations to reduce the risk of reoccurrence.

• Ensure system for sharing patient records is safe, secure, and in line with current legislation.

• Ensure that governance processes and quality assurance measures and processes improve to provide effective oversight of all aspects of the service.

Information on our key findings and action we have asked the provider to take are listed at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals