ShowMed is operated by The Risk Practice Ltd. ShowMed supplies doctors, nurses, paramedics, emergency medical technicians, emergency care assistants and first aiders to organised sporting and public events.

The main service provided by this service which falls under the scope of CQC regulation was patient transport.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 27 and 28 of February 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:

• There was a robust electronic staff booking system, overseen by a workforce planning co-ordinator. This enabled the service to utilise the right levels of skilled staff and resources to meet the needs of the service safely.

• The service had comprehensive policies and processes to identify, assess and monitor risks and to improve quality and safety. Staff were knowledgeable about how to record incidents and had ready access to incident reporting forms. We saw evidence and examples of incident reporting, reviews and learning from incidents to drive improvements.

• The service had developed an effective recruitment system. This ensured the service had sufficient numbers of suitably skilled staff and accurately monitored whether all staff had the qualifications and skills needed to provide safe and high quality care. The service carried out skills assessments, qualifications checks and ensured the suitability of staff by conducting Disclosure and Barring Service (DBS) background checks.

• There were comprehensive systems in place to facilitate multidisciplinary and multiagency working. A collaborative approach was evident in the pre-planning for events and in the delivery of a safe urgent patient transport service.

• The feedback from staff was overwhelmingly positive. They spoke with enthusiasm and passion about the service and its culture. They described management as being visible and approachable. Staff also spoke of a commitment to providing the best possible care and treatment to patients.

• The leaders of the service had a clear vision and strategy, which underpinned their desire to provide high quality health care and to be seen as ‘the caring face of events.’ The management appeared open and inclusive. This was evident in the morale of the staff and in their comments.

• The service was excellent at finding ways to engage with their staff and in providing information to a workforce that was casual by nature. They had sought numerous ways to do this to ensure that information was readily accessible at all times, including the use of a duty emergency point of contact.

• We saw evidence that showed the service were actively seeking to improve their services, such as considering the introduction of BS 76000, a management standard that provides a framework for organisations to value people.

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

• Staff completed training in safeguarding children and adults; however this was not always to a sufficiently high and skilled level for their roles.

• The service performed and documented regular monthly deep cleaning of their ambulances. However, they did not have a robust system to identify that vehicles had been cleaned prior to transportation, in between conveyances, or as and when required. Since routine cleaning was not recorded there was no means to identify if vehicles had been cleaned and were ready for use.

• There was no formalised process for checking the contents of paramedic bags and for the service ensuring that the correct items, such as blood glucose meters were present, correct and in date. The paramedic bags were also not identifiable as being ready for use or requiring restocking.

• The systems for managing equipment and medical gases were not robust. We found that oxygen cylinders were not stored appropriately and there was no means to identify and segregate full, part used and empty cylinders. The service used a vehicle equipment checklist, which did not include checks for expiry date or function. This meant that the service could not ensure itself that medical gases and other equipment on the ambulance were in date and functioning before the point of use.

• The completion of the patient report forms were not always to a sufficiently high standard particularly with the lack of documenting and witnessing consent.

• The service was registered to provide urgent transport services to the whole population; however we did not see specific policies, equipment, skills assessments or competencies relating to the needs of children and young people.

• The service did not currently check that relevant staff had been vaccinated for infectious diseases such as Hepatitis B and that they had achieved immune status, which may be appropriate for their role.

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 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.