St John Ambulance South East Region is part of St John Ambulance, a national first aid charity. St John Ambulance provides a number of services including first aid at events, emergency and non-emergency patient transport services and first aid training. The objective of the organisation nationally is the relief of sickness and the protection and preservation of public health. Both volunteers and employed staff are involved with the services provided by St John Ambulance.

St John Ambulance South East Region provides an ambulance service across a number of counties in the south east region through a contract with two local ambulance trusts and a local NHS hospital. There is also an events service that provides first aid support, at public events. St John Ambulance South East 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 South East Regions on 6 and 12 October 2016. This was an announced comprehensive inspection. We visited five different locations during the visits but were unable to visit any events where St John Ambulance South East Region were providing cover during this inspection.

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 provided compassionate care for patients. They ensured patients’ privacy and dignity was maintained. Patients and their families were involved in decisions about their care. Staff understood the importance of respecting and responding to patients’ specific and individual needs.

• Staff followed infection prevention and control procedures to reduce the spread of infection to patients. They kept vehicles clean, tidy and well stocked. The system for servicing vehicles was effective, with accurate records kept.

• We saw good multi-disciplinary team working with other emergency services and during handovers at hospital. Staff working for the service were competent in their role and followed national guidance when providing care and treatment to patients. They knew when to escalate concerns so patients’ needs were responded to promptly.

• The service only provided cover for contract or event work if it had sufficient staff to do so safely. Managers worked with contract providers and commissioners for events to enable services to be delivered which meet the needs of local people. Debriefs were held to identify changes which could be made.

• All staff, both employed and volunteers, had an induction and could access further training for their role.

• The service had systems in place for reporting and investigating incidents and complaints. Staff could describe changes to practice after managers had investigated these.

• There was a national vision and strategy in place, which the service had implemented locally. Additional key performance indicators were being used regionally and nationally to support the quality monitoring of the service. Some of these had not been fully adopted at the time of our inspection.

• Staff felt able to make suggestions on how the service could be improved and developed. They felt the leadership of the service were supportive and accessible.

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

• The provider’s safeguarding children training for staff did not show how it met and was in line with key national documents and recommendations on safeguarding children. Therefore, we were not able to confirm staff had completed the correct level safeguarding children training for their role.
• We found one of the two ambulances used for the neonatal transfer and retrieval service did not lock. Staff had reported the vehicle defect but the service had taken no action until after our inspection. The processes to keep patients safe had not been followed.
• The majority of volunteers had outstanding mandatory training to complete. Also, there was no performance review for staff who worked for the service on a casual basis to ensure they remained competent in their role.
• On ambulances responding to emergency calls, there were no suitable restraints to secure children during transfer to hospital. The service recognised this as a risk and a review was taking place. There were also no paediatric defibrillator pads so staff could use the defibrillator safely on children.

• There was limited provision on vehicles to support people who were unable to communicate verbally or who did not speak English.

Information on the actions we have asked the provider to take are listed at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals