When we carried out our unannounced visit to St John Ambulance North West Region we were not able to speak to people using the service because ambulances that were in use were away from the offices. However we saw that the provider made arrangements for every person who used the service to provide them with comments if they wished. We saw that these were highly complimentary particularly about the crew who staffed the ambulances. They were described as “polite and efficient”, “excellent”, and “kind and professional”. We saw that some of the organisations which commissioned services from the provider had also made positive comments about the service.

During our inspection we spoke to two members of ambulance crew as well as to staff who managed the service. We looked around the buildings and at equipment as well as at the ambulances. We checked records.

We found that the St John Ambulance North West Region took care to ensure that people consented to the care and treatment offered to them. We found that arrangements were in place to make sure that services were provided in a way that took account of people’s individual needs and requirements and with vehicles and equipment which were appropriately maintained.

We saw that there were sufficient staff available to ensure that the service was provided safely. The provider had taken steps to make sure that these staff were aware of their safeguarding responsibilities. We saw that good records were maintained and that these were stored securely.

When we carried out our unannounced visit to St John Ambulance North West Region we were not able to speak to patients using the service because no ambulances were close enough.

We did see the results of the provider’s own patient satisfaction surveys, compliments and complaints and it was clear that people were happy with the service provided. Some people were very complimentary and we read about examples of staff acting to high professional and personal standards.

We saw that care and treatment was provided against written protocols and there were systems in place to audit this.

The ambulances used by the service were suitable and appropriately maintained.

Staff were recruited using a robust system of assessment and they were trained and their competency assessed through a formal training programme.

There were effective systems in place to promote and support staff development but while supervisory arrangements were now in place they had not been effective during a recent period of reorganisation.

The provider had a complaints system in place and received a low level of complaints. We saw a high level of compliments meaning that people knew how to contact the service.

St John Ambulance North West Region is an independent ambulance service with a regional headquarters based in Stockport, Manchester and has ambulance operations bases at Liverpool, Chester and Chorley.

The main service provided by this ambulance service was emergency and urgent care services. Where our findings on emergency and urgent care services for example, management arrangements also apply to other services, we do not repeat the information but cross-refer to the emergency and urgent care section.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 13 and 14 February 2018 along with one unannounced visit to the service on 28 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 issues that the service provider needs to improve:

• There were systems for the management of confidential patient sensitive information, however, there was no formalised or routine system of tracking that the information had been either sent or received which meant there was a risk of unauthorised persons being able to access sensitive information.

• Patient records were not consistently completed.

• Medicines were not locked away in ambulances. The process in place for checking medication pouches meant that only stock levels of medicines that had been administered were checked on a daily basis.

• Staff that we spoke with did not have a good understanding of patients’ mental capacity and consent and records reviewed reflected this.

However:

• There were high levels of compliance with mandatory training.

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. All staff had received level one and two safeguarding training.

• Shifts were adequately staffed with the right staff skill mix on board ambulances.

• The service had suitable premises and staff looked after them well.

• There was good multidisciplinary working between ambulance crews and other NHS staff when treating patients.

• Staff we saw on the inspection were caring and treated people with dignity and respect at all times.

• Staff demonstrated an awareness of involving patients, and their relatives or carers, in any decisions that were made about their care.

• The service worked with local commissioners, such as the NHS ambulance trusts, to provide services that met the needs of local people.

Ellen Armistead

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