Medics UK (North East) Limited is operated by Medics UK (North East) Limited. The service provides mainly event cover and off shore medical assistance, which is not a regulated activity. The service provides transport of patients from event sites, which falls within CQC registration.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 30 January 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:

• The service had limited systems to monitor the quality and safety of the service.
• Governance arrangements to monitor the quality and safety of the service were not robust.
• The service did not carry out any audits to measure the quality and effectiveness of the service delivered. There were potential risks to staff and patient safety, through lack of observation and monitoring of performance.
• The service did not have systems to ensure all staff were up-to-date with mandatory training requirements.
• The managing director did not know if staff remained competent after their induction as mandatory training was not monitored and there was no evidence staff had appraisals.
• The medicines management policy delegated the procurement, management and storage of medicine to the paramedics. However, the provider did not have an effective system to monitor the use of controlled drugs.
• The service did not have an effective recruitment policy. Appropriate criminal records checks through the disclosure and barring service (DBS) had not been carried out.
• Appraisals had not been carried out.
• The service did not have evidence to show staff had completed safeguarding training to an appropriate level. This was a concern because this was not reflective of national guidelines for safeguarding, specifically the safeguarding children: roles and competences for health care staff – Intercollegiate Document (2014).
• The service did not have a system in place for Infection control audits to be carried out to ensure that cleaning was effective, any contaminates were removed and appropriate action taken to reduce the risk of cross infection.
• Not all staff had received training on the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards.
• The service did not engage with service users to monitor the quality of services

However, we found the following areas of good practice:

• The service had an effective accident reporting and investigating procedure and ensured that the learning from any accidents was shared with staff.
• There was a standardised form for recording information related to each patient that had been transported on the ambulance. These forms were completed well and included the time taken to transport each patient.
• The service had a safeguarding policy which included the legal requirement for reporting incidents of female genital mutilation (FGM) and the ‘PREVENT’ strategy for identify and preventing terrorism.
• Staff adhered to relevant national and local protocol for their role, when assessing and providing care for patients of all ages, including children.
• Staff told us they were able to make dynamic assessments of the needs of patients prior to transfer and make adjustments where necessary.
• Staff were committed to providing the best quality care to patients. Staff displayed a caring and compassionate attitude and took pride in the service they were providing.
• Staff took time to engage with patients.
• Staff maintained patients’ privacy and dignity.
• The service had policies and procedures for patients with learning disabilities and dementia.
• Staff had access to a communication handbook and an emergency phrasebook for service users who had difficulty communicating.
• Staff were well supported by the management team; they told us the management team were friendly and approachable.
• The leadership structure was clear and staff knew who was responsible for co-ordinating the work of the ambulance crew.
• The process for checking driving licences was robust. These checks were completed prior to commencement of employment. We found staff had a record of the completion of a driving licence check.
• There were arrangements for ongoing checks for driver competence, such as spot checks or ‘ride outs’ by a driving assessor. The driving assessment was provided by an external provider. We saw records which showed the outcome of the assessment was discussed with the drivers.

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

Ellen Armistead Deputy Chief Inspector of Hospitals (North of England) on behalf of the Chief Inspector of Hospitals.