We visited the St John Ambulance headquarters and spoke with five regional and two ambulance staff team leaders. We also spoke with two ambulance staff and service commissioners by telephone. We viewed a sample of customer feedback comments related to event work. Comments included “the staff I saw were fantastic, professional and efficient” and “all the crew were excellent.”

We found the service was going through a period of significant change which meant the local county based services were centralised in to one region. This had introduced new structures and ways of working to the organisation. We heard from one staff member “I know where we are going as an organisation and I can recognise the benefit of these changes.” We focussed specifically on the patient transport services . These services were provided by staff employed by St John and not by volunteers.

We found the staff sought consent from patients before transporting them and patients who required treatment were consulted and involved. One member of staff said “I talk to the patients and ask them about what they need to travel safely.”

We saw there was a good level of understanding of safeguarding issues and a comprehensive network in place to deal with any allegations of concerns.

We found staff received sufficient training to enable them to work safely, we heard from one team leader “I am able to use appropriately qualified staff for the work required, if I cannot cover it then I turn it down.” One service commissioner told us “we work very closely with St John and they always provide a professional service.”

The provider had a complaint process in place which was made available to people who used the service.

There had been a national restructure within St John Ambulance which started in March 2012. The programme included governance and management restructure from forty-one counties to eight regions. This meant some locations were no longer registered with the Care Quality Commission in the South West as these were now managed from the regional office in Bridgwater.

We visited the regional office. We spoke with the registered manager and three members of staff. We had also previously visited three St John Ambulance locations, where we were able to view patient records and ambulances. We also spoke with staff working for patient transfer services or as part of an ambulance crew during these inspections.

When we carried out our inspection to St John Ambulance South West Region we were not able to speak with people using the service. This was due to the transient nature of the service and people were not treated from the office. There were no ambulances based at the regional office.

We did see the provider's own patient satisfaction surveys, compliments and complaints and it was clear that people were satisfied with the service provided. Many of the comments were very complimentary about the service and support they had received from St John Ambulance Service.

People could be confident that there were robust systems in place in respect of recruitment, training and clinical governance.

St John Ambulance South West Region is operated by St John Ambulance. St John Ambulance provides emergency and urgent care at events and a patient transport service from events to hospital.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 8 and 15 January 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 organisation understood and complied with the Mental Capacity Act 2005.

The main activity provided by this service was emergency and urgent care, with no routine patient transport activity taking place. We have therefore reported on all our findings under the single core service of emergency and urgent care.

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 organisations need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• There were strong, comprehensive and embedded systems, processes and procedures to keep people safe.

• There were reliable systems to monitor and maintain standards of cleanliness and hygiene which was well documented.

• The environment was secure and suitable for safe storage of ambulances and equipment.

• The organisation had comprehensive documentation and accreditation of ISO 9001:2008 (a quality management system where an organisation demonstrates its ability to consistently provide products that meets customer and applicable statutory and regulatory requirements). Organisations used the standard to show it provides products and services that meet customer and regulatory requirements.

• The organisation had an excellent data management process with all paper patient report forms scanned and input into a secure electronic system.

• There was a genuine commitment to volunteers and value placed on the contributions they made to the organisation.

• There were comprehensive governance arrangements, which allowed the organisation to work in line with best practice and deliver high quality care. Patient care was at the centre of everything the organisation and staff did.

• Frontline staff and senior managers were passionate about providing a high quality service for patients with a continual drive to improve the delivery of care.

• There was excellent local leadership of the organisation. The registered manager had an inspiring shared purpose and was committed to the patients who used the organisation, as well as to staff.

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

• The organisation must have a more secure method of posting the patient report forms to the electronic data management company.

• Ensure lessons learned from incidents are entered on the incident log.

• Level two safeguarding training should be completed by March 2018, as in the action plan.

• Terminology within the Safeguarding policy should be changed to reflect current legislation.

• Issue local safeguarding telephone numbers to staff.

• Consider a more structured approach to provide safeguarding feedback to staff.

• Improve compliance with volunteer development reviews.

• Ensure lessons learned from complaints are entered on the complaints log.

• Consider auditing daily checks of ambulances.

• Consider introducing an early warning score system for the monitoring of patient’s vital observations during transfer to hospital to detect deterioration.

Following this inspection, we told the organisation that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We issued the organisation with one requirement notice that affected emergency and urgent care services. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals