We received information about Heathrow Air Ambulance (HAA) from two embassies and one airline operations department. Each used HAA for medical transfers and repatriations, predominantly to and from the Middle East. They said they received appropriate information on behalf of patients being transported or transferred. They told us communication with HAA was very good and the comments they received from the patients they were responsible for had always been positive. This confirmed patients who used the service were given appropriate information and support regarding their care or treatment.

People who commissioned ambulance services from HAA told us the service was safe, effective, responsive and well-managed. We read one e-mail of commendation from a patient's representative praised the way HAA had managed several negotiations on their behalf during a complex repatriation. This showed patients received safe and co-ordinated care, treatment and support where more than one care provider or organisation was involved in the course of their journey.

We discussed the daily and periodic cleaning schedule for vehicles with staff. This included the high-lift vehicle and ambulances. We found the ambulances were clean. They were equipped with the necessary cleaning materials and equipment to maintain cleanliness and reduce the risk of infection. There were supplies of personal protective clothing, for example gloves, readily available to staff. Appropriate hand gel was available on the vehicles we saw which allowed staff to maintain good standards of hand hygiene.

We found whilst there were otherwise effective recruitment and selection processes in place, not all appropriate checks had been undertaken before staff began work. This meant patients were not fully protected from the potential employment of unsuitable people.

We saw risk assessments were in place for specific risks; for example, the safe handling of bariatric patients. We talked to five ambulance staff who demonstrated a good understanding of the risks involved in carrying out their role and how these could be eliminated or managed. This showed the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of patients who used the service and others.

The people we spoke with who used the service were very positive about the standard of staff and the quality of service received. "I would not use anybody else from choice" was one comment received. They told us the attention to detail of the service was excellent.

We were told Heathrow Air Ambulance carried a full range of equipment to meet the various transfer needs of people. For example bariatric chairs and stretchers. This showed people’s needs were assessed and care and treatment was planned and delivered in line with their individual care requirements.

We saw the routine cleaning regime for the service's air-base and ambulances. This included deep cleaning on a planned basis, with appropriate daily and weekly schedules of cleaning undertaken. This ensured people were protected from risks associated with cross infection.

We looked at recruitment records and found appropriate checks were undertaken before staff began work.

We saw records of the service documentation for ambulances and equipment. These showed the provider took steps to ensure vehicles and equipment were properly maintained, mechanically sound and functioning correctly.

On this occasion we did not speak to people about the service.

Heathrow Air Ambulance HQ operates Heathrow Air Ambulance. The service provides a patient transport service. The service employed trained ambulance technicians.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 25 July 2017, along with an unannounced visit on 7 August 2017.

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 service provided was patient transport services

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 issues that the service provider needs to improve:

• General governance was not robust and did not demonstrate a monitoring of the quality of the service.

• The service did not have an effective system in place to identify, limit and control clinical and non-clinical risks.The manager was able to identify a limited number of risks; however, there was limited evidence to demonstrate that all risks had been identified.

• Whilst there was a formal process for the reporting of patient incidents, we did not have assurance the service was following their own policy for reporting, investigating and learning from incidents.

• Not all staff were trained to the required level two in children’s safeguarding. However, three staff were trained at level three.

• Not all policies reflected the service or the roles and responsibilities of the staff. We saw one policy was in the name of another provider.

• At the announced inspection, there was no appraisal process, which the manager acknowledged prior to our visit. The lack of appraisal process resulted in staff having unmet training needs such as medication administration. We were however; assured at the unannounced visit appraisals were in progress.

• Although staff reported they had received the necessary training, the actual documented staff-training matrix was incomplete. There was no clear system for the monitoring of staff attendance at training.

• There was not a robust medicines management system. However, during inspection the decision was made to remove all medicines, as these were not essential to the service provided.

However, we found the following areas of good practice:

• Staff we spoke with held the manager in high regard, enjoyed working for the service and felt well supported.

• The service managed infection prevention and control well and followed their policies and procedures.

• We found all vehicles were in good condition, well maintained visibly clean and tidy.

• Medical gases were stored safely and securely and equipment was maintained, clean and in good working order

• The service had a clear purpose and identification for example their staff uniforms and ambulances clearly displayed the service’s name.

• Staff received mental capacity act training and showed awareness of consent issues.

• Staffing levels were sufficient to meet the patient and service’s needs.

• The staff planned journeys considering patient safety using information provided at the time of booking.

• The service uses its vehicles and resources effectively to meet patients’ needs.

• Staff understood what their safeguarding responsibilities are and what constituted as abuse.

• Staff described a compassionate, empathetic and caring attitude towards patients, putting patient’s best interests at the heart of their work.

• Staff were clear about how they would respect patient’s dignity, independence and privacy.

• Staff focused on providing person centred care and enjoyed working for the company.

• The service has retained the same contracts with embassies and insurance companies for over 25 years.

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 that affected patient transport services. Details are at the end of the report.

Professor Edward Baker

Chief Inspector of Hospitals