Millennium House is operated by Health Connections PTS Limited. The service provides a patient transport service specifically for patients with mental health illnesses.

We inspected this service using our comprehensive inspection methodology. This was the first inspection of the service. We carried out the first part of the inspection on 8 January 2019, along with a second visit to the service’s operational site in Hastings, Sussex on 18 January 2019. Both of these visits were conducted with a short-notice (48 hours) announcement to the service to ensure there would be staff, vehicles and managers present in order to carry out the inspection.

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.

We rated the service as good because:

• The service had a comprehensive booking system which incorporated an individualised risk assessment for each patient.

• There were systems and processes in place for the management of incidents, safeguarding concerns, complaints and vehicle maintenance.

• Staff were aware of their infection prevention and control (IPC) responsibilities, and routine and deep cleaning for each vehicle was recorded and up to date.

• Vehicles were maintained and serviced appropriately to ensure they were safe for use.

• The service used a tailored set of referral and admission criteria. Bookings included comprehensive risk assessments to ensure the safety of patients during transfer.

• Staffing levels were appropriate to meet patient demand and risk and staff rotas were planned to ensure staff received sufficient time off.

• The service had an effective and secure system for transporting patient records between providers as required, to maintain patient confidentiality. The service’s own booking forms were audited continuously.

• Policies and procedures were based on national guidance, legislation and best practice. Staff were familiar with them and received updates on any changes.

• The service used a clinical dashboard to monitor their performance. The service was performing well against their targets, including for dispatch and response times.

• Staff were competent to fulfil their roles effectively and supported by managers to do this.

• There was good understanding of consent and mental capacity. The service worked closely with approved mental health professionals (AMHP) to manage situations of fluctuating capacity or best interest decisions.

• There was a strong patient focus, and examples of compassionate care, and maintaining patients’ privacy and dignity during transfer.

• During bookings, the service ensured patients felt involved in and understood the process and took the time to alleviate any anxiety the patient might have.

• Care was personalised to the individual patients and there were initiatives to meet their needs, such as different communication techniques and allowing patients to choose their own music.

• There were effective systems for reporting and managing complaints, although there had not yet been any raised during the service’s six months of operation.

• Service leads were visible and focused on supporting staff and delivering high quality care; staff spoke highly of the leadership.

• There was a clear vision, strategy and set of values for the service based on a ‘least restrictive’ approach to transporting patients with mental health difficulties, which was shared by operational staff.

• There were appropriate governance and risk management systems in place and staff felt empowered to escalate concerns if needed.

• Staff were positive about the working culture and felt engaged in their work and there was evidence of staff reward and inclusion.

• The service had processes and initiatives for continuous learning, improvement and development, including plans for a dedicated control room, and gradual investment in more staff and vehicles.

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

• The service transported children under 12 on occasion (as passengers with adult patients rather than as patients themselves) but did not have their own paediatric equipment on vehicles. Although staff would use appropriate equipment such as booster seats provided by the provider making the booking, and we saw this was documented as part of the booking process, it was not formalised in a service level agreement to assure themselves that the equipment was safe and fit for use.

• There was no policy or procedure to set out the process for cleaning and replacing uniforms when contaminated, although the service did have shower facilities and keep spare uniforms at their Hastings site.

• There were some training modules with low compliance.

• At the time of inspection there was no formal arrangement for communicating with patients whose first language was not English so staff were relying on online translators, or on staff at the relevant provider if available.

• Only one manager had access to the risk register at the time of inspection, which meant it could not be updated or reviewed by any of the managers based in Norfolk. However, when we raised this the service were proactive in changing the system to ensure all managers had access.

• The service had not yet completed their registration process to register the Hastings operational site as a separate registered location, although they were already taking steps towards this by the time of our inspection.

Following this inspection, we told the provider that it should take some actions, even though a regulation had not been breached, to help the service improve. We did not issue the provider with any requirement notices.

Amanda Stanford

Deputy Chief Inspector of Hospitals (area of responsibility), on behalf of the Chief Inspector of Hospitals