Due to the type of service we were unable to speak with people to get their views and experiences about the quality of the service they had received. The primary purpose of this service was transporting people to and from hospital.

We gathered evidence of people's experiences of the service by reviewing compliment cards received by Medicar Ltd. Comments included “What a good service we’ve received from Medicar” and “Thank you for the kindness shown to us.”

We found that the service assessed people’s needs prior to transportation to ensure they could meet those needs and did not accept anyone who was not medically fit.

Records showed that the vehicles were maintained and fit for purpose.

The provider did not have effective systems in place to monitor and review the quality of the service provided. There were no staffing records available to review compliance in relation to recruitment of persons employed and their suitability for the role or how the provider supports persons employed.

We carried out an announced inspection visit of Medicar Limited (Clacton on Sea) on 7 November 2016 and an unannounced inspection on 21 November 2016.

We were not committed to rating independent providers of ambulance services at the time of this inspection. However, we highlight good practice and issues that service providers need to improve.

We found the following areas of good practice:

• Staffing was sufficient to meet patient need.

• All staff were up-to-date with appraisals and mandatory training.

• Staff had access to the information, support and supervision they needed to carry out their roles effectively.

• Staff worked closely with each other and external providers to best meet the patient’s needs.

• Staff were caring in their approach and had a highly patient-centred attitude, and patient feedback about the service was consistently positive.

• Staff reported the working culture was positive and they felt engaged with the service.

• The service was proud of the fact that a registered nurse escorted every patient during transfer.

• The service was responsive to the concerns we raised and we found that much improvement had been made in relation to these concerns by the time of our unannounced inspection. For example, we raised safety concerns about the equipment, because the stretcher did not have all of the manufacturer’s recommended straps in place to secure patients during transport, and there were no handle grips or foot restraints on the carry chair. These had been addressed by the time of our unannounced inspection.

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

• There was a lack of clear systems or procedures to ensure, if an incident occurred, that lessons would be learnt.

• There was no risk register for the service. However, by the time of our unannounced inspection one had been developed, though this was not yet embedded.

• There was a lack of formal or documented risk assessments for the vehicles and for patients being transported.

• There was a lack of formal, clear record keeping. For example, daily vehicle checks, deep cleaning of vehicles, patient transfer forms, and driver competencies were not always well recorded.

• There was no flagging system to clearly indicate if a patient was living with dementia or learning disabilities.

• There was no system in place to indicate if a patient had been assessed as lacking capacity and how best to meet their needs.

• The governance systems were not effective, which meant we were not assured that concerns issues would be identified and mitigated. The risks identified during our inspection had not been identified as issues by the management team.

Information on our key findings and action we have asked the provider to take are listed at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals