We did not talk with people who had received support and treatment from the service during our inspection, but we did see quality assurance questionnaires from people using the service and their representatives. All were complimentary about the service and said staff were "well-trained" and "competent and highly professional."

We found the service maintained patient's privacy and dignity whilst being transported. The records showed us patients were involved in their care and offered appropriate choices in relation to their treatment.

The care provided was tailored to meet the specific needs of each individual and ensured their safety and welfare. Staff followed appropriate infection control procedures to ensure the health and safety of patients, staff and the general public.

The ambulances were clean and well maintained.

We found the staff were supported by management and undertook appropriate training to enable them to meet the needs of their patients.

The service had effective systems in place to monitor levels of customer satisfaction.

We found that records were stored safely and people's confidentiality was ensured and protected.

There were no patients using HSAS available to talk to us during the day of our inspection. Equipment used and provided was maintained and up to date. Vehicles were cleaned and maintained regularly.

Appropriate cleaning procedures ensured that the risk of infection was minimised. We were told that patients were given a choice of where to sit during transport that was safe and appropriate to their condition.

Information given to the ambulance crew was appropriate and sufficient, to transport patients safely.

Staff were checked appropriately for their suitability to work with vulnerable people.

Robust complaints procedures ensured that all complaints were dealt with and investigated thoroughly, this ensured that patients were satisfied with the service provided by HSAS.

We visited Harley Street Ambulance Services Ltd on 24 January 2012 as part of a review of compliance. This review of compliance did not include a visit to the service.

Harley Street Ambulance Service is operated by Harley Street Ambulance Service Limited. The service was registered with the Care Quality Commission (CQC) on 13 May 2011. The service provides patient transport services (PTS) and emergency and urgent care (EUC) services. EUC patient transfers are between hospitals. The provider is registered for the regulated activities: transport services, triage and medical advice provided remotely and treatment of disease, disorder and injury.

Harley Street Ambulance Service (HSAS) operates as a subcontractor to main contractors (identified as commissioners in this report). The main contractors who commission services from HSAS liaise directly with NHS providers. A small part of its work is private and for this work HSAS liaises directly with the private hospitals or private organisations.

HSAS transports patients (adults and children) across the whole of the United Kingdom and works across different boroughs and populations.

The service has six ambulances equipped for and used for both PTS and EUC.

We carried out an unannounced inspection of both the PTS and EUC core services using our comprehensive inspection methodology on 29 and 30 January 2019.

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 HSAS was PTS. Where our findings on EUC – for example, management arrangements – also apply to PTS, we do not repeat the information but cross-refer to the PTS core service.

We last inspected this service in July and November 2016 but at the time we did not have the legal duty to rate independent ambulance services. However, following this inspection we rated the service good for both core services.

We rated this service good overall because:

• Staff treated patients and relatives with compassion, kindness, dignity and respect.

• The provider had systems, processes, and practices to keep people safe and safeguard them from abuse. Staff were aware of and knowledgeable about these processes.

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.

• Staff reported a positive working culture within the service.

• The service kept patient data safe and secure and this was an improvement from the previous inspection in 2016.

• The service had enough staff, with the right qualifications and skills, training and experience to deliver effective care, support and treatment.

• We observed effective multidisciplinary working between HSAS staff and staff at the various hospitals they worked with.

• Staff understood the relevant consent and decision-making requirements of guidance and legislation including the Mental Capacity Act 2005.

• There were effective recruitment and training processes to ensure staff were appropriately qualified and trained to deliver good quality care.

• Policies and procedures were in date and reviewed in line with set review dates.

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

• Only 50% of staff had received an appraisal at the time of our inspection.

• The provider did not have access to translation services which meant they relied on staff or relatives who spoke the same language to communicate with patients.

• There were no regular staff meetings as part of the service’s governance arrangements.

• The provider did not have systems and processes to ensure that ambulance staff declared working arrangements outside of the service and monitor this to make sure staff were not working excessive hours that may adversely impact on the care being provided.

• There was limited formal engagement with staff and not all staff were aware of the service’s vision, strategy or values.

• Commissioners did not always make the service aware of patients’ pre-existing conditions or risks and the provider did not have a policy or system to manage this.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Nigel Acheson

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