The Essex and Herts Air Ambulance Trust is operated by Essex and Herts Air Ambulance Trust, and is a charity providing a free life-saving Helicopter Emergency Medical Service (HEMS) for the critically ill and injured of Essex, Hertfordshire and surrounding areas. Each HEMS Team consists of a pilot and co-pilot, a pre-hospital care doctor and a critical care paramedic. Pre-hospital emergency medicine focuses on caring for seriously ill or injured patients in urban, rural, or remote settings before they reach hospital, and during emergency transfer to hospital or between hospitals. The HEMS teams use helicopters, during daylight hours and rapid response vehicles (RRVs) during times of diminished natural light, to reach the scene of an incident with life-saving support equipment to deliver advanced clinical care.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 30 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 urgent and emergency 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:

• The service had effective processes in place to report, investigate incidents, and share learning.

• There were robust processes to ensure staff assessed risks to themselves and others for safe care and treatment at all times.

• The service ensured all equipment and consumable items including medicines were safely monitored, stored and administered.

• The service ensured that staff received the appropriate training and that the right skill mix was available for shifts.

• The service had major incident and business continuity plans in place and undertook scenario based training for major incidents to ensure staff understood their roles.

• Highly qualified staff delivered treatment based on nationally recognised guidance and best practice and were encouraged to undertake research and share learning.

• The service performed well against compliance of its own key performance indicators (KPIs) and actively sought ways to record outcomes.

• Staff co-ordinated well with all other services involved and displayed effective multi-disciplinary working.

• Staff treated patients with kindness, dignity, and respect and feedback comments were very positive. Patients and relatives were particularly appreciative of the patient liaison manager support.

• Services were organised and planned so that they met the needs of the local population to ensure that patients had timely access to urgent and critical care treatment.

• The service had effective leaders in place who had the skills, knowledge, experience, and integrity they needed to ensure the service met patient needs.

• Staff knew the service vision and strategy and displayed the values of the service.

• There were established processes in place to ensure effective governance and monitor the quality of service to identify areas of improvement.

• There was a corporate risk register in place and the service had identified the need to monitor and review risks at a local level and was taking steps to address this.

• The culture within the organisation was extremely supportive and positive with staff describing it as being ‘part of a family’.

• The service was committed to continuously improve and developed a number of sustainable innovations and improvements to the service.

Heidi Smoult

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

Given the nature of this service we were not able to talk with people who had received treatment from staff at Essex and Herts Air Ambulance Trust (EHAAT). However we read a number of complimentary letters received in the last year by EHAAT and noted the following comments from people; “The two paramedics gave me the most amazing attention and care I could ask for, and the top pilot who managed to land in the small close outside”. Another person had written, “We would like to thank all the crew who were on the EHAAT air ambulance. X (patient) is still recovering from his injuries which were fractures to his pelvis, scapula and ribs but without the intervention of the highly skilled emergency personnel, the outcome would have been very different.”

We spoke with one senior hospital sister who knew the service well. She told us, “The staff’s skills are excellent and the quality of their patient handover is always clear and detailed: they speak to the whole room. I spent a day out with them last year and brought back lots of good practice ideas to the ward as a result”.

Staff we spoke with told us they enjoyed their work and received good training and support for their role.

We found that EHAAT was compliant in all the outcomes we assessed. Evidence showed that people were treated by well trained and supported staff; that infection control and medications procedures were robust; and that equipment was well maintained.

We saw examples of the ‘Patient Report Forms’ (PRF) that were used to record the care episode. We saw that these had been fully completed and reflected all the interventions that had been carried out. This meant that people experienced care, treatment and support that met their needs and protected their rights. The provider’s PRF showed us that people were appropriately handed over to other services when their condition stabilised and that all the staff were aware of their roles and responsibilities to work collaboratively in the best interests of the person who needed emergency treatment. This was because the provider worked in co-operation with others.

We saw that there were systems in place to ensure that all the equipment used was safe, available when needed and suitable for purpose. This meant that the people who used this service were protected from the risks associated with unsafe or unsuitable equipment. We saw that the provider had robust systems in place for the recruitment training and support of all their staff. This demonstrated to us that people were cared for by staff who delivered care and treatment safely and to an appropriate standard.

Evidence was seen that showed us that the provider had comprehensive systems in place to ensure that they met the needs of people who needed emergency care and treatment. This showed us that the provider had an effective system to regularly assess and monitor the quality of service that people receive.