Mariner Medical and Driving Services Ltd is operated by Mariner Medical and Driving Services Ltd. The service provides mainly event cover, which is not a regulated activity and transport of patients from event sites which falls within our scope of registration.

We inspected this service using our comprehensive inspection methodology. We carried out the announced inspection on 17 November 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.

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 during our announced inspection that the service provider needs to improve:

• The provider was not always completing pre-employment checks as detailed in its recruitment policy. The provider did not have evidence of references, identity checks, professional registration, where appropriate, for paramedics and volunteers.
• The provider did not have an effective system to ensure staff allocated to work had the necessary competence to undertake their role.
• Not all staff had undergone an appraisal or a formal review of their performance.
• Evidence of mandatory and external training completed by staff was not fully reflected in training records, so that training completion could not be fully assessed against best practice standards.
• There was no clear process for incident reporting and using this learning to improve practice.
• Standard care bundles were not in place for the transportation of patients.
• The provider did not have an effective system for cascading and sharing any lesson learnt from complaints.
• The provider had not developed a vision and strategy for the service. The provider did not formally engage all staff, to ensure that the views of all staff were noted and acted on. There was a lack of governance within the service. Some policies were absent or where present had not been reviewed and adapted for the service.
• Service user records were not always managed effectively and patient report forms were not always stored securely.
• The provider did not have a risk register and the provider was unable to demonstrate how risks were identified and escalated in order to protect patients. Audits such as infection control were not undertaken and therefore learning did not take place from review of procedures and practice.
• The provider did not have an effective system in place to ensure all vehicles were well maintained and safe for use.

However; we found the following areas of good practice:

• There was a positive culture within the service to learn and improve.
• The service had recently implemented improved systematic processes such as deep cleaning checks on vehicles.
• The provider had engaged with its partners and encourages them to provide positive or negative feedback.
• Staff and managers we spoke with understood the duty of candour regulations and the requirement to be open and honest.

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 four requirement notices details of which are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North Region), on behalf of the Chief Inspector of Hospitals