We previously inspected Remote Medic UK LTD in March 2014 and found them fully compliant with requirements relating to workers, management of medicines, care and welfare and also safety, availability and suitability of equipment. We carried out a further announced inspection on 20 March 2015 in response to anonymous information of concern raised regarding recruitment practices, management of equipment and medicine management. We found no evidence to support any of these concerns.

We spoke to eleven staff including doctors, paramedics, first aiders and emergency medical technicians who all spoke highly of the organisation, safety practices and the quality standards set by the senior management team. There were effective recruitment procedures and equipment was maintained appropriately although periodic servicing of some equipment were not always actioned in a timely manner.

The provider protected patients against the risks associated with the unsafe use and management of medicines, by making appropriate arrangements for the obtaining, recording, handling, using, safe keeping, dispensing, safe administration of medicines used.

The organisation had a system in place to regularly assess and monitor the safety and quality of service. Mechanisms for engaging staff and developing services were being actioned as the company expands to ensure the quality of service was maintained at all times.

During our inspection we spoke with the registered manager and with staff members.

We were unable to speak with people who received or had received services from the provider. However, we saw feedback documents sent to the service commending the provider for the care and services they provided.

People were supported and cared for by a qualified professional team of staff that were appropriately skilled and trained. We found that arrangements were in place for the management of medication and the provider had in place policies and practices that advocated good care and treatment.

People that used the service were consulted about the care and treatment they received. This was recorded on appropriate report forms which contained consent for treatment and details of care and treatment provided by doctor's, paramedic's, emergency medical technician's and first aiders that the service employed. Treatment provided followed national guidelines. For example, the Joint Royal College Ambulance Liaison Committee (JRCALC) and the National Institute for Health and Care Excellence (NICE).

We examined an ambulance that was present at the time of our inspection and found it to be clean, safe and appropriately stocked. The equipment that we looked at was safe and suitable and had been serviced according to manufacturer's requirements.

Appropriate checks were undertaken before staff began work and the service provided a comprehensive induction programme for staff.

Remote Medic UK Ltd is operated by Remote Medic UK Limited. The service supplies paramedics, doctors, emergency technicians and first aiders to provide first aid and medical cover. The service works with a local charity to supply medical staff on a mobile unit in town centres on Friday and Saturday nights on an SOS bus. The SOS bus is a charity based project, with the aim of providing a safe haven and medical support to people who need it. Facilities include a treatment room and assessment area. Remote Medic UK Ltd have been providing medical cover for the SOS bus since March 2017.

The service also supplies paramedics at organised events such as festivals and music concerts. On occasions, the service will provide emergency and urgent care transport from events to a hospital or suitable care facility.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 16 November 2017, along with an unannounced visit to the service on 27 November 2017.

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.

The main service provided is first aid and event medical cover; however, this is not within our scope of regulation. We inspected this service under our emergency and urgent care framework. As the service has transferred patients from event sites via ambulance to local urgent and emergency care centres between November 2016 and October 2017, and provides medical care, delivered by healthcare professionals on SOS buses, the service falls within our scope of regulation.

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:

• There was an up to date incident reporting policy in place and staff knew how to report incidents.

• Staff described what constituted a safeguarding concern and how to escalate concerns appropriately.

• Medicines were in date and stored securely.

• Records were completed accurately and stored securely, with completed mental capacity assessments forms where indicated.

• Staff always had access to senior clinical advice in the event of requiring advice in patient management.

• The service had a comprehensive set of policies which were based on national guidance, in date and accessible to staff.

• The service was passionate about developing their own staff, with the provision of training in extended skills such as wound closure and suturing.

• Staff described a positive culture within the service and told us that they felt supported and valued.

• The service had a clear governance structure in place. Members of the senior management team had dedicated key roles and responsibilities.

• The service was patient focused with an emphasis on providing effective pre-hospital care to patients, to reduce hospital admissions and therefore reduce the impact on the NHS.

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

• The service was unable to demonstrate that regular checks had taken place on a carry chair and stretcher.

• We found out of date consumable items within the ambulance. However, we raised this with the registered manager who took immediate action to ensure that there was an effective process in place to check consumable items were within their expiry date.

• The service did not have a formalised risk register in place.

Heidi Smoult

Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals