Hoes Farm is operated by Platinum Ambulance Service Ltd. They are an independent ambulance service based in Shipley, Horsham. The service provides repatriation, event medical cover and patient transport services for both adults and children. Paramedics, Technicians and emergency care assistants are used to staff services. The service had undertaken 26 patient transport journeys and three transports from events during the reporting period, from January 2017 to January 2018. It is these journeys that fall within the scope of registration with the CQC.

In England, the law makes event organisers responsible for ensuring safety at the event is maintained, which means that medical cover comes under the remit of the Health & Safety Executive (HSE). Therefore, the Care Quality Commission (CQC) does not regulate services providing ambulance support at events and this is not a regulated activity. The main service was event work, which the CQC does not regulate. Therefore, these services were not inspected.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 28 February 2018; during the course of this we saw that the service was carrying out unregulated activity of treatment of disorder disease and injury. The service was notified of this and they submitted an application to be registered for this activity within 24hours. We approved the service for this activity and returned to inspect this element with an unannounced visit on 30 April 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.

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:

• A culture of reporting incidents was not embedded as we found examples of incidents that were not reported.

• Not all audits were recorded, for example, the service carried out swab testing to monitor vehicle cleanliness but did not record results. This meant the provider could not identify themes or monitor trends.

• Not all policies and procedures had a planned review date and updates were not clearly recorded, without regular reviews and clearly recorded updates, the provider could not be assured the policy was current and accurate.

• The provider did not complete hand hygiene audits. This meant we could not be assured the provider had oversight of hand hygiene compliance among their staff.

• The service did not have a policy for safeguarding adults and children that was individualised for Platinum Ambulance Service. The policy the service referred to was available as a web link that could not be reached. This meant the service could not be assured staff had access to a current and up to date safeguarding policy for both adults and children.

• The service did not have child seatbelts available for the transport of children who accompanied patients.

• The service did not have a resuscitation policy that detailed the protocol to be used when commencing cardio pulmonary resuscitation.

• The service did not have a major incident plan. This meant staff may not have known their role in the event of a major incident.

• The service had a very basic staff survey in place that was not anonymised. This meant staff may not have felt able to give honest feedback.

• There were no mental capacity forms present on the ambulance. This meant the provider could not be assured that capacity assessments were undertaken in line with best practice and national guidance.

• The leadership structure was not fully embedded and concerns were not always raised through the appropriate channels; clinical leads did not have sufficient oversight of their areas of responsibility.

However, we also found the following areas of good practice:

• Patient individual care records were written and managed in a way that kept people safe. The service had recently created and introduced a new patient report form. The new lay out was clear and the staff found it easy to use.

• Staff were competent in their roles and had up to date training. At induction, the provider issued a multiple-choice knowledge test to employees and staff were suitably trained to carry out driving duties safely.

• All feedback from patients was positive and showed care was supportive, compassionate and considered people’s needs.

• Staff were happy working for the service and felt there was a positive open culture. Staff all spoke fondly of one another, including senior leaders, and were proud to work for the service.

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. Details are at the end of the report.

Amanda Stanford

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