Response Services Group UK Ltd is operated by the provider, which is also called Response Services Group UK Ltd. The company provides emergency and urgent care and a patient transport service. They also provide medical cover at public and private events. We did not inspect this part of the service as it is not currently a regulated activity.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 18 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.

The main service provided was patient transport services. Emergency and urgent services were a small proportion of activity; therefore we have reported our findings in relation to the urgent and emergency services in the patient transport services section.

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:

• Staff were committed to providing the best quality care to patients. Staff displayed a caring and compassionate attitude and took pride in the service they were providing.

• Staff checked patients’ requirements prior to transporting them to ensure they were able to meet their needs.

• Staff operated comprehensive systems to make sure all vehicles and equipment were safely managed and fit for purpose.

• The provider had instigated a training programme for all staff and developed systems to accurately monitor whether all staff had the training needed to provide high-quality care.

• Staff followed evidence-based care and treatment and nationally recognised best practice guidance. All staff had access to the Joint Royal College Ambulance Liaison Committee (JRCALC) guidelines 2016.

• Staff were well supported by the management team; they told us the management team were friendly and approachable.

• The management team had taken action to improve governance and risk management systems within the past six months.

• There were effective policies and procedures for safeguarding issues to be identified and referred for investigation by relevant, external organisations.

• There were effective systems for reporting and investigating incidents; the provider learnt from incident investigations, for example, by making changes to equipment or care protocols.

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

• The provider had obtained supplies of a controlled drug without the correct licences and governance procedures in place. There was no standard operating procedure for monitoring how private paramedics working for the company obtained, stored, managed and disposed of controlled drugs.

• There were a range of infection control protocols in place. However, we identified some gaps in the systems, for example, in relation to the segregation of clinical waste, the management of sharps, the use of personal protective equipment, and the laundry of cleaning equipment. Further action was required to minimise risks to staff and patients.

• There were some arrangements in place to observe staff practice in relation to their caring skills and driver competence as part of a staff induction process. However, in the absence of a formal appraisal system, there was limited evidence that the provider carried out ongoing or periodic supervision of staff to make sure that their competence was maintained.

• The provider did not currently check that all relevant staff had been immunised with selected vaccines, such as Hepatitis B, which may be appropriate for their role.

• The provider had not implemented the use of a risk register and business continuity plan to minimise risks to patients and staff.

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, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice that affected the patient transport and urgent and emergency services. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North), on behalf of the Chief Inspector of Hospitals

Response Services Group UK Ltd is an independent ambulance service based in Unit 7, Acorn Phase 3, High Street, Grimethorpe, Barnsley, S72 7BD.

We carried out an unannounced focussed inspection on 9 August 2017. The focus of this unannounced inspection was in relation to the transport of patients with mental ill health. This was in response to specific concerns raised regarding this part of the service.

The provider`s main service was medical cover at public and private events. We did not inspect this part of their service at this 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? For this inspection we inspected the safe, effective, responsive and well-led domains of the service.

Throughout the inspection we took account of 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:

• We saw evidence of the provider’s response to an incident involving a patient who displayed challenging behaviour. The provider had introduced body-worn CCTV cameras for staff to wear when dealing with potentially violent patients or those who may require restraint.
• The station environment was spacious, clean, tidy and well laid out. It was fit for purpose.
• We found that all vehicles were in good condition and that they were visibly clean and tidy.

We found that a sufficient number of staff had been deployed in order to care for patients safely.We found the following issues that the service provider needs to improve:

• There was no evidence that the safeguarding induction input would equip staff with the knowledge or ability to identify or make a safeguarding referral.
• There was no evidence the provider had sufficient numbers of trained competent staff or systems in place to ensure safeguarding issues could be identified or referred expeditiously to the appropriate authority
• The relevant legislation was not being met because RSGUK staff were not recording their risk assessments when the patients were transferred into their care.
• RSGUK did not maintain an accurate or complete record of the patients in their care. There was an over reliance upon the information and risk assessments from the provider that subcontracted the service.
• A lack of a recorded risk assessment meant that timely care planning did not take place which therefore did not ensure the health, safety and welfare of the service users.
• Staff told us that they only reported incidents in relation to physical intervention when a member of staff or patient had been injured.
• RSGUK did not monitor the frequency of use of physical intervention or types of intervention used. Therefore, no themes or trends had been identified or potential for lessons learnt identified.
• During our inspection there was no evidence of there being a system in place to monitor safety and use of results. The evidence we saw showed the provider appeared to be reactive rather than proactive.
• During our inspection there was no evidence of RSGUK gathering and reviewing data in order to enable any benchmarking or setting of performance improvement goals.
• There was no staff induction input in relation to the Mental Health Act 1983, Mental Capacity Act 2005, Deprivation of Liberty Safeguards or use of restraint.
• During our inspection there was no evidence of any formal process regarding access to special notes, Advance Care Planning (ACP’s) and do not attempt cardiopulmonary resuscitation orders (DNACPR).
• There was evidence of a company vision with a set of values. However, there was no evidence that quality and safety were included as the top priority.
• The company vision only referred to event cover. There was nothing included about the other services provided or quality or safety.

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, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices that affected patient transport services. Details are at the end of the report.

Ellen Armistead

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