St John Ambulance North East Region is operated by St. John Ambulance. The service mainly provides emergency and urgent care.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 31 October 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.

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 that they were able to meet their needs.

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

• Vehicles and stations were visibly clean and tidy, with evidence of regular deep cleaning of vehicles.

• 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 provider had developed systems to accurately monitor whether all staff had the qualification and skills needed to provide high-quality care; a national, skills assessment system ensured that feedback from staff was acted on to improve the range and quality of training offered by the provider.

• The provider had made a commitment to continuously improving the quality of the service. There had been a range of organisational restructuring activities and the implementation of standardised processes. Staff understood the rationale for these activities and cited examples of how this had led to improvements in their day-to-day practice.

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

• The service had a system to monitor the accuracy of patient records through the use of an audit system. However, patient report forms had only been audited for one of the two NHS ambulance trusts that the service worked with.

• The service did not yet have a system for monitoring the clinical outcomes of patients who had been treated while under the care of the provider. There was evidence that some consideration had been given to initiating this type of monitoring, but this was not in place at the time of our inspection.

• The service did not routinely monitor the promptness of their service, for example, in terms of handover times, for all patients, although this was in place for some patients. Staff performance was monitored in terms of handover times for one NHS trust that the service worked with. However, the same level of monitoring was not used for work with a second NHS trust.

• Vehicles were equipped to monitor patient’s health status during patient transfers. However, some paediatric-specific equipment, such as harnesses and pulse oximeters were not available on all vehicles. This meant that risks to children using the service could either not be assessed or had not been sufficiently identified and mitigated.

• There were systems to manage confidential patient sensitive information, but these were not always effective. Staff posted completed patient report forms through the postal system with no formalised or routine system of tracking that the information had been either sent or received.

• Staff feedback was usually well managed. However, staff meetings with frontline staff at one of the locations had not taken place for eight months. This had led to some concerns remaining unaddressed.

• There was a comprehensive staff training programme. However, we found that only 14% of clinical staff were compliant with equality and diversity training at the time of the inspection.

• All operational ambulance staff had received some safeguarding training, however the named, regional safeguarding lead had not completed training to an appropriate level 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. We also issued the provider with two requirement notices that affected emergency and urgent care services. Details are at the end of the report.

Ellen Armistead

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

St John Ambulance North East Region has two base control centres; the main one in Ossett and the other in Newcastle. The Yorkshire region provides mainly patient transport services sub-contracted through the Yorkshire Ambulance Service NHS Trust (YAS). In the north of the region work is sub-contracted through North East Ambulance Services NHS Foundation Trust (NEAS) to provide mainly emergency response cover. Events work is undertaken across the region.

At this inspection we visited the regional office in Ossett. We spoke with the registered manager, three regional managers and three ambulance staff.

Ambulance staff we spoke with described how they involved people in decisions about their care and maintained people's privacy and dignity. We saw there were policies, procedures and guidance for staff about obtaining consent from people about their treatment and support options. We found there were limited systems in place for people to feed back their experiences about how the service was run.

Ambulance staff we met with described how they assessed and monitored the health needs of people they were transporting. They demonstrated a good understanding and knowledge of the different clinical needs and symptoms people may present with and how these would be met. We saw there were robust systems in place for the management of incidents.

We found there were comprehensive safeguarding policies, staff had received training and showed a good understanding of abuse and knew what to do if it was reported or suspected.

We found the premises were suitable for purpose, well maintained and secure.

There were robust staff recruitment processes in place which ensured staff were safe and suitable to work with people who used the service.

We did not have an opportunity to meet with people who had used the service. This was because people did not visit the office and treatment was in the main provided at events and transportation by emergency ambulance to hospital.

We spoke with other providers that contracts work on a both regular and ad hoc basis with St John Ambulance. They spoke positively about the service being provided, stating that the service was well organised and responsive to requests. They told us good links had been built with them and that regular contact was made with a named link person within St John Ambulance Service.

We spoke with managers and staff and checked the systems and records maintained. We found that staff received relevant training and were well supported. Those records we checked were maintained accurately and were up to date. We found that the service had a good management structure which ensured the service was monitored and audited well.