Prior to providing services to a particular event an assessment was conducted to determine what the care, treatment and support needs at the event were likely to be. These assessments would consider factors such as the likely number of people attending, what activities would be taking place on site and their accompanying health risks, as well as practical matters such as crowd control and access to the site.

All staff were trained in what to do in a medical emergency (to at least Basic Life Support level). Where the nature of an event was such that there was an increased risk of a serious incident, staff with more advanced training would be deployed, such as healthcare professionals with Advanced Life Support training.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and responded to it appropriately.

Appropriate checks were undertaken before staff began work. All staff undertook mandatory training and refresher courses in core subjects such as life support, safeguarding and infection control. Staff could receive various levels of training within the organisation, from being a first-aider to Emergency Transport Attendance staff and the level of mandatory training undertaken by staff rose with each level.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

We conducted this review by interviewing staff over the phone and reviewing information that we asked to be sent to us.

People were able to complain about the service. These were investigated by staff and responded to appropriately. Complaints were also reviewed to see if anything could be learnt from them and this information was provided to staff.

People were cared for in a clean, hygienic environment. There was training in infection control policies and procedures. Appropriate cleaning took place in ambulances and records were kept of this. There were regular checks by staff on the cleaning of ambulances.

We haven’t been able to speak to people using the service as there was no one available on the day of the inspection. However, in the written feedback that we saw people using the service rated it positively.

St John Ambulance London Region is part of St John Ambulance, a national first aid charity. St John provides a variety of services, including contracted emergency and urgent care, non-emergency patient transportation, bariatric transfers, paediatric and neonatal transport and first aid cover at events. The strategic direction of the organisation nationally is to provide an effective and efficient charitable first aid service to local communities. The services provided by St John Ambulance involve both employed and volunteer staff.

St John Ambulance London region provides emergency and urgent care for one London NHS ambulance trust and paediatric and neonatal transport services for two NHS hospitals. They provide a small ad-hoc patient transport service. St John Ambulance London Region has contracts with a number of organisations, which hold events in the local area and provides first aid at these events including the provision of an ambulance.

We inspected St John Ambulance London Region on 15, 16 and 19 November 2016. This was an announced comprehensive inspection, part of our national programme to inspect all independent ambulance services. We visited two locations, those being the head office and, Park Royal station, whereby, we attended emergencies and urgent care with an ambulance crew. We also attended a large event and spoke with staff and inspected equipment and vehicles. Patient transport services formed a very small part of the service; however, we attended a shift with crew to inspect patient care.

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 areas of good practice:

• We saw staff providing compassionate and kind care to patients and were supportive of their needs. Patients received dignified care and their privacy was respected. Staff were kind and provided emotional support to relatives and carers.
• There was a good system for staff to report incidents and for investigations to take place. The learning from incidents was fed back to front line staff. Lessons learnt showed actions were taken to change behaviours and provide support and training for staff.
• There were established processes for staff to follow to protect patients from the spread of infection. We saw staff using good infection control procedures and vehicles were kept clean and tidy and were well stocked.
• We saw good multidisciplinary team working and the sharing of information to provide consistent good care for patients. Staff knew the scope of their role and when to escalate concerns so patients’ needs were met quickly and efficiently.
• All staff both employed and volunteers received good induction training and were able to access further training for their role.
• The planning of services was managed well and cover for contracted and event work was provided only if the suitable qualified staff were available. The service planned ahead to meet delivery and meetings between contract providers ensured the service ran as smoothly as possible. After events, meetings were held with organisations, which allowed for reflection and shared discussion so improvements could be made for future events.
• The organisation had a national vision and strategy, and regional and national support helped the strategy to be implemented locally. The organisation recognised the need to review their service and make changes to the structure if necessary.
• Staff were supportive of the leadership both regionally and locally and felt they could voice their opinions and were listened to.

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

• Staff were not trained to the required safeguarding children level expected for them to perform their role. The safeguarding training for staff was not in line with the Safeguarding Children and Young Peoples: Roles and Competencies for Health Care Staff Intercollegiate document: March 2014. We were informed all staff were trained to safeguarding level one. We were told this applied to staff across the whole organisation.This concern has been identified as an organisation-wide issue and we have requested that St John’s Ambulance inform us of how they intend to address it.The organisation have since provided us with a plan which details the actions they have taken to address the concerns we raised.   

• The monitoring and recording of controlled drugs was slightly disjointed. We found an alteration to a recording with no reason given or signature to explain why the alteration had been made. A more streamlined system of having one book would allow for better tracking and tracing.
• We found some patient records were not being kept in the secure folders when we accompanied crew on their shifts. Some records were kept behind sun visors and this posed a risk to patient confidentiality.

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