Following inspections, the Care Quality Commission (CQC) continues to have concerns about the quality and safety of independent ambulance services.
In a report published last week (7th March 2019), the care watchdog said that some individual services had made improvements and that there were “pockets of good practice,”, but concerns remain about how safe and effective the care provided is in general.
They called on services, commissioners and the wider system to act.
The CQC completed its comprehensive inspection programme of independent ambulance services in England in March 2018. The programme included independent ambulance service providers registered with the CQC at the end of December 2016.
The report reveals that the quality and safety of care provided varies greatly across different services.
The CQC identified common underlying problems, such as a poor understanding of governance. This often resulted in weak recruitment processes and they found that relevant checks for employment references, Disclosure and Barring Service (DBS) certificates and driving licence categories were not consistently enforced.
Many providers also failed to provide appropriate staff training. In particular, CQC inspectors noted that there was a lack of emergency driver response, safeguarding and mental health training.
In addition, while some services had robust policies to support the safe handling and administration of medicines, others seemed to lack understanding, particularly in regards to controlled drugs. Some services also lacked the required Home Office licence for the procurement and storage of controlled drugs.
In some cases, inspectors also found that vehicles were not being regularly serviced and had missing or faulty equipment. This sometimes included paediatric apparatus used for transporting children in emergencies. There was also an absence of regular equipment checks.
The independent ambulance providers inspected by the CQC mainly offer specialist patient transport services and non-emergency responses. Some, however, do also provide 999 emergency responses to help support NHS ambulance trusts, either routinely or during times of peak demand.
The CQC has now raised concerns about the wider sector, which includes independent ambulance services that are not registered with and regulated by the CQC, such as those providing medical cover at temporary events.
The watchdog fears that this lack of oversight is potentially putting people at risk and they are now working with local authority event licensing boards and other relevant bodies to ensure they understand their responsibility for the safety of patients in these circumstances.
The CQC has also spoken to the Department of Health and Social Care to recommend that this current regulatory gap be addressed.
Providers have been instructed to make improvements where necessary and the CQC has also called for NHS England, clinical commissioning groups and others that commission independent ambulance services to ensure they make safety and quality a priority. The quality ratings awarded by the CQC to independent ambulance providers can be used to inform commissioning decisions.
The CQC is also strengthening its assessments of how NHS hospital trusts that sub-contract ambulance services from independent providers ensure they have continued oversight of performance and quality.
The CQC’s Deputy Chief Inspector of Hospitals and lead for ambulance services, Ellen Armstead, explained: “We have found and highlighted pockets of good practice in individual services, with compassionate one-to-one care from ambulance staff, and evidence of improvements in some services when we have been back to reinspect. But we remain concerned about the overall standard of care across the independent ambulance sector.
“Providers have a responsibility to ensure that people within their care receive appropriate treatment, that the vehicles used to transport patients are fitted with the right equipment, that staff are appropriately trained and supported to carry out their roles, risks and incidents are reported and addressed, and that medicines are stored securely. This was not the case in many of the services we inspected.
“It is wholly unacceptable for people using these services to be put at risk and where we have identified concerns we have held those providers to account by making clear where improvements must be made – using our enforcement powers where needed to protect people.
“Those who deliver and commission care must learn from the services that are getting it right so that people are protected from risk and can have confidence in the quality of care they receive from independent ambulance services across the country.”
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A Health and Social Care Trainer at FRT explains: “Any service that provides care and support to people must ensure it is doing so safely, effectively and compassionately. The CQC will always ensure that services are meeting required standards and are not putting people at risk.
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Download the CQC’s state of care in independent ambulance services report online.