Monks Brook was operated by Enhanced Care Services Limited (ECS), from a local headquarters which also housed vehicles and equipment. The service was run by two managing directors (one of whom was the registered manager) and a management team. The directors and all members of the management team were medically trained and some were experts in their field. Enhanced Care Service provided medical and paramedical services (to adults and children) at events of all types and sizes, which included urgent and emergency care and conveying of patients to acute hospital settings. Events were mostly sporting events but also included festivals and country shows. The service was designed to provide a higher level of care than is traditionally available at such events; this included enhanced and critical care. Services were provided directly to events and also as a ‘bolt on’ service. This meant they supplied medical professionals to other event medical companies, who were the main medical providers for the event. The CQC does not have powers to regulate medical and paramedical care and treatment provided at events. The report details our findings about the care and treatment provided to patients when conveyed from event sites to acute hospital settings.

We inspected this service using our comprehensive inspection methodology. We carried out the inspection on 19 March 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 areas of good practice:

• The service provided a remote clinical advice line (RCAL) which gave staff immediate access to a member of the senior clinical faculty. All staff without exception mentioned the advice line as the first way they would report incidents to management and receive ‘on the spot’ support and guidance.

• After every ‘significant’ patient there was an operational debrief. A significant patient was a patient who had received significant medical care. This ensured that information was discussed and shared to facilitate learning from the experience. This meant that future risks could be mitigated enhancing the safety and effectiveness of the service.

• There was a genuinely open culture in which all safety concerns raised by staff were highly valued as integral to learning and improvement.

• An extensive training program had been developed so that management could be assured that staff had the right training and skills to provide the high quality service they expected.

• The service had an infection control policy and managed infection risk well.

• The service held a large stock of equipment. All equipment bags were set out in the same format and with the same equipment, which supported staff to access equipment promptly.

• Detailed analysis was undertaken before each event to identify risks and requirements in terms of medical support and cover. Steps were taken to mitigate identified risk in advance of events.

• The provider had a set of policies that they reviewed on one, two or three yearly cycles depending on the type of policy.

• Robust recruitment procedures were in place.

• Staff spoke positively about the care of the service delivered by their colleagues and spoke of patients in a kind and respectful way.

• The registered manager planned staff numbers and skill mix in response to the type and size of the event and the requirements of the client. The service was able to control its own demand.

• The leadership was exemplary, creating an positive and supportive culture that ensured staff felt valued and respected.

• Staff felt fully engaged in developing the service.

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

• Staff appraisals were not fully completed

• Whilst staff had received high levels of appropriate mandatory training, there was no formal system in place for the provider to assure themselves that staff had received specific training regarding meeting patients’ individual needs in respect of dementia or learning disability.

• There was limited patient feedback; however, the provider was looking at ways of improving this.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. You can read about these at the end of the report.

Amanda Stanford

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