Given the nature of this service we were not able to talk with people who had received treatment from St John Ambulance members (members is the term used to describe both paid employees and also volunteers). However, we did speak to a number of people who commissioned their service and we received very positive comments. The manager of an A&E department, where St John Ambulance (SJA) members were employed to look after patients waiting to go onto the wards told us, “They have a good level of professionalism and have become part of our team. They fit in well and quietly get on with their work”. One events’ organiser commented, “We can’t fault them, the staff are professional, knowledgeable and work well with our stewards. They also have great communication and radio systems in place”.

We looked at the results of a survey in relation to SJA’s patient transport services between March and December 2013. This showed that people rated the service highly. They found that staff were courteous and well presented, that the ambulance was clean and tidy, and that they were taken to their appointment promptly. Feedback from an on-line survey that SJA carried out with people who commissioned its service showed that, on average, 97% of people would recommend them to others. We also read a number of recent compliments letters received in the last year by SJA and noted the following comments from people, “They (SJA members) were superb in dealing with the lady, they showed kindness and caring attention to her, they were reassuring and thorough in everything they did”. Another person had written to say, “The treatment was carried out with the competent cheerful efficiency that I had noticed on a previous incident as well”.

SJA members we spoke with told us they enjoyed the variety of their work and that they received good support and training from their managers. One SJA member told us that communication within the organisation had improved greatly in the last year, with the publication of both fortnightly and monthly newsletters.

We found that St John Ambulance (SJA) was compliant in all the outcomes we assessed. Evidence showed that people were treated by well trained and safely recruited. Infection control procedures were robust and equipment management was good.

Given the nature of this service we were not able to talk with people who had received treatment from St John Ambulance volunteers and employees. However we did speak to a number of people who commissioned their service and we received very positive comments. A representative from the East of England Ambulance service told us, “For a voluntary service they are very reliable and instil me with confidence. Their staff are always well briefed and properly trained”. A senior hospital moving and handling advisor told us, “We work really well with St John Ambulance, in fact they converted one of their ambulances especially to meet the needs of our bariatric patients. Staff’s moving and handling techniques are always excellent and I can confirm they always use good practice. Staff have really good rapport with the patients they convey”. The medical director for one major events organisation told us, “They are absolutely 100% reliable and I have no concerns about staff’s clinical practice. Staff are always co-operative with us and I thoroughly recommend the service.”

We found that St John Ambulance was compliant in all the outcomes we assessed. Evidence showed that people were treated by well trained and supported staff, who had the equipment they needed to do their job.

St John Ambulance East of England Region is operated by St. John Ambulance. The service provides patient transport services.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 31 October 2017, along with an unannounced visit to an organised event supported by the service on 3 November 2017.

St John Ambulance East of England Region is part of St John Ambulance, a national first aid charity. St John Ambulance provides a number of services including first aid at organised events for example firework displays and professional football matches, emergency and non-emergency PTS, and first aid training. St John Ambulance East of England Region uses a blend of employees and volunteer staff. The objective of the organisation nationally is the relief of sickness and the protection and preservation of public health.

St John Ambulance East of England Region provides ambulance services across a number of counties in the East of England Region, through a contract with a local NHS ambulance trust. The service also provides an Acute Neonatal Transfer Service (ANTS), commissioned through a local hospital trust. St John Ambulance East of England Region provides first aid at organised events in the local area. Events are not within our scope of regulation and we do not inspect events. However, at some events, the provider transfers patients from an event for further medical treatment. Patient transport falls into our scope of regulation and thus require inspection.

During our inspection, we visited three ambulance stations (Chelmsford, Ipswich, and Cambridge) as well as the ANTS at a local NHS hospital. We also attended one organised event where St John Ambulance East of England Region staff provided cover.

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 by this service was Patient Transport Services (PTS).

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:

• Vehicles and ambulance stations were visibly clean and tidy, with evidence of regular deep cleaning of vehicles.
• Servicing routines, Ministry of Transport (MoT) and insurance for ambulances were all up to date.
• Staff knew how to report incidents. The provider had a system in place to report incidents, and made changes because of incident reviews.
• Staff demonstrated a good understanding of their responsibilities around safeguarding.
• Staff carried out structured patient assessments and clinical observations, appropriate for their level of competence.
• 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.
• The majority of staff within the organisation had received a recent appraisal.
• All staff received training on the Mental Capacity Act and the Deprivation of Liberty Safeguards as part of their induction. During our inspection staff asked patients for consent before starting treatment.
• St John Ambulance had recently launched the national continuing professional development (CPD) portfolio to ensure staff had up to date skills and knowledge to carry out their roles effectively.
• We observed good multidisciplinary working between ambulance staff and other NHS staff when treating patients. We noted good co-ordinated care and transfer arrangements when handing the care over to NHS staff.
• Staff showed compassion, kindness, empathy and treated patients with dignity and respect throughout their treatment or care
• Staff had access to translation services for patients who may not speak English as their first language.
• The provider had a national vision, strategy, and values, which most staff were aware of and shared.
• The provider had a publicly accessible website, which contained information for the public including details of services offered and how to make a complaint.

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

• Staff did not complete safeguarding training to required levels.
• Audits and reviews of patient journeys did not take place for one of the NHS services.

Following this inspection, we told the provider that they should take some actions even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

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