We visited the premises, spoke with the registered provider and reviewed documentation. Due to the type of service they provided we were not able to speak with individuals who had received assessment and first aid. We received information from one of the organisations that Patient Transport Colindale provided services on behalf of; including London Ambulance Service (LAS) service.

Staff from one of the organisations told us that they were satisfied with the services provided by Patient Transport Colindale. They commented that people received a reliable service and that the transport arrived at the time that had been requested and confirmed that they had not received any complaints about Patient Transport Colindale.

We reviewed the processes that were in place for the hygiene of equipment. We found that transport vehicles and equipment were clean and stored in a way that prevented them from being soiled.

Staff had received the training and support they needed to carry out their roles effectively.

There were no patients using Patient Transport (Colindale) available to talk to us during the day of our inspection. Equipment used and provided was maintained and up to date. Vehicles were no older the six months. Appropriate cleaning procedures ensured that the risk of infection was minimised. We were told that patients were given a choice of where to sit during transport that was safe and appropriate to their condition.

Information given to the ambulance crew was appropriate and sufficient, to transport patients safely.

Staff were skilled and experienced and were provided with regular periodic training.

Patient Transport Colindale is an independent ambulance service providing patient transport services as a subcontractor to main contractors (identified as commissioners in this report). The main contractors who commission services from Patient Transport Colindale liaise directly with NHS providers. Patient Transport Colindale provides services as a subcontractor to two main commissioners working with the NHS. The service also carries out private work. However, private work is limited as the priority is to fulfil their contracts. The service also transports patients detained under the Mental Health Act 1983. Patient Transport Colindale does not undertake emergency and urgent transfers such as high dependency transfers.

We visited the ambulance service for a two day announced inspection on 21 and 22 September 2016 as part of our comprehensive programme of inspections.

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and issues that service providers need to improve.

We found the following issues that the service provider needs to improve:

• There was a lack of incident reporting and complaints monitoring within the service.

• The service did not carry out local audits as a way of monitoring performance and making improvements.

• We found expired oxygen cylinders in storage and on one of the vehicles we inspected. This vehicle was not in use.

• Staff did not always follow the service’s infection control policies.

• Most staff had a limited understanding of the principles of duty of candour.

• There was minimal reference to best practice and national guidelines by staff.

• There was no monitoring of key performance indicators (KPIs) against the commissioners’ contracts as a way of measuring performance in order to make necessary improvements. The operations manager told us the service was not given access to KPI information by their commissioners and could not measure their service’s performance against this data.

• It was not always possible for staff to communicate with patients who did not speak English. While the service employed multilingual staff who control staff could allocate to patient journeys accordingly in order to aid communication, this was not always possible. The managing director told us staff used language translation applications on their mobile phones in order to aid communication but this was not reflected in our interviews with staff. There was no provision for patients who had other communication difficulties.

• There was a clear vision for the service but there was no formal strategy for achieving that vision.

• There was little staff engagement to obtain their views and experiences in order to improve the service.

However, we found the following areas of good practice:

• Disclosure and Barring Service (DBS) checks had been applied for in relation to all staff before staff commenced employment. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups.

• Staff had a good understanding of safeguarding processes and there was evidence of safeguarding referrals being made.

• The completion rate for mandatory training was 100% and all staff we spoke with except one had been appraised.

• All vehicles inspected were visibly clean.

• There was good coordination between the service and its commissioners in planning the delivery of the service.

• During our inspection, all observations of care provided by the ambulance service showed patient dignity being maintained. Patients were treated kindly and compassionately. We observed positive and courteous interactions between staff and patients.

• The same crews transported the same patients wherever possible in order to maintain a degree of continuity in patient care.

• Staff had received training around dementia, mental health, and learning disability.

• All staff we spoke with were happy to work for Patient Transport Colindale and spoke positively about the leadership of the service.

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