Met Medical Ltd is an independent ambulance service. The service provides patient transport services to private patients and some NHS healthcare providers, mainly in Hertfordshire and surrounding areas.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 20 March 2018, along with an unannounced visit to the service on 03 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:

• The provider did not have effective systems and processes in place for recording controlled drugs in line with the Misuse of Drugs Regulations 2001. The systems that were in place were not being followed. This was escalated to external agencies following our inspection.

• The provider did not have robust processes in place to monitor and assess patient outcomes and the quality of the service.

• The provider did not have a clear policy and governance process in place to support the identifying, recording, reporting and investigating of all incidents. Not all incidents had been reported or discussed.

• The provider did not have a documented patient eligibility criteria and exclusion criteria in place for the transportation of patients. There was also no formally documented criteria for which skill mix of staff were required for different types of patients.

• The provider did not have robust governance processes in place to support the identifying, recording and management of risks to patients, staff and the service. Not all risks had been identified and some risks had not been recorded or acted upon.

• The provider did not have effective systems and processes in place to develop and review policies. Not all policies were reflective of the service and not all policies were adhered to.

• The provider could not be assured staff had the appropriate level of life support training for adults and children. Systems and processes were not in place to collect and monitor this information.

However, we found the following areas of good practice:

• Patient records had detailed risk assessments and were legible. Patient records were stored securely.

• Most staff had completed mandatory training. There was evidence of an induction process for new staff.

• Effective safeguarding adults and children procedures were in place and were understood by staff.

• Audits were undertaken in relation to medicines and infection prevention and control.

• Patient care was observed to be kind and compassionate. Patient feedback was positive.

• A fire safety risk assessment had been completed.

• The service had received no formal complaints from March 2017 to February 2018.

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. We issued the provider with two requirement notices that affected patient transport services. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Central Region)