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Chief Inspector of Hospitals finds North West Ambulance Service NHS Foundation Trust Requires Improvement  

England’s Chief Inspector of Hospitals has rated North West Ambulance Service NHS Foundation Trust (NWAS) as Requires Improvement after an inspection by the Care Quality Commission (CQC).
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CQC carried out an announced focused inspection at the trust between 23 and 26 May, with an unannounced inspection taking place on 6 June 2016. Inspectors visited three of the trust’s core services – the emergency operations centre, urgent and emergency care and patient transport services – and looked at the trust’s NHS 111 service provision.

As a result the trust is rated Requires Improvement overall. It is rated Requires Improvement for being safe and well-led and Good for being effective, caring and responsive.

Full reports including ratings for all of the provider’s core services are available at: http://www.cqc.org.uk/provider/RX7

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said: “Inspectors found a number of improvements were needed at North West Ambulance Service NHS Trust.

“The overall vacancy rate for the trust was 16% at the time of the inspection. This was a particular issue in Cumbria, the Trust was aware that the recruitment of additional staff was a managerial challenge and was using a number of initiatives to manage this deficit such as the employment of paramedics from other countries. The trust had already employed 35 new European paramedics in Greater Manchester at the time of our inspection. There were plans to recruit a further 36 with 24 of these being appointed to North Cumbria.

“There were concerns surrounding staff training and whether the service had enough staff to meet the needs of the service and patients. There were also concerns surrounding how safeguarding issues and incidents were reported, and the communication around complaints to the service.

“This is a busy ambulance service which receives over 1.3 million 999 calls each year, with emergency crews attending more than 952,000 incidents.; “At the time of our visit the trust had been experiencing challenges around the recruitment of staff, but it had recognised this and was taking action with regard to it. 

“It is vital that a busy service like NWAS has sufficient numbers of staff with the requisite knowledge and skills to meet patients’ needs and we will be monitoring the trust’s progress in securing additional staff as a matter of priority.

“It is encouraging that the urgent and emergency care service has had a clinical leadership model in place since 2012, with more focus on clinical quality than was previously the case. The leadership model includes having a consultant paramedic in each area and advanced paramedics in each sector. Staff reported that the new clinical leadership structure had been well received.

“The trust is working against a backdrop of increased pressure on all of its services and, while I am anxious to see the trust continue to monitor and improve staffing levels and share lessons learned from incidents and complaints, I’m confident that the areas of good practice can be maintained and further improvements made.

“Following our inspection we gave feedback to the trust leadership about where improvements were needed. The trust board knows what it needs to do to ensure those improvements are made and we will continue to monitor the trust and check on its progress. This will include further inspections. ”

There are a number of areas where the trust must make improvements, including:

  • Staff must be given adequate opportunity to report incidents and safeguarding issues and must receive the required level of mandatory and safeguarding training
  • Trust procedures relating to the assessment of a person’s capacity under the Mental Capacity Act (2005) were not compliant with the Mental Capacity Act (MCA) code of practice. This must be addressed to ensure vulnerable people’s needs are met.
  • Ensure the complaints policy reflects timescales for investigations and that complainants are given information in relation to how to take action if they are not satisfied with how the trust has managed their complaint.
  •  The service must ensure staff are given adequate opportunities to report incidents and safeguarding issues and that staff are reporting all adverse incidents in line with NWAS policy.
  •  The service must ensure that vehicle log books are completed fully and that checks undertaken by managers reflect the true content of the log books. The service must make sure that all equipment used in the delivery of patient care is subject to the appropriate and required checks, including that held by the community first responders.

Inspectors also identified several areas of outstanding practice, including:

  • The Hazardous Area Response Teams (HART) in Manchester and Merseyside were delivering an excellent service to patients. They were proactive in gaining new skills and forging relationships with other emergency services. The trust’s arrangement for using the fire service training headquarters in Merseyside provided staff with unique training opportunities and ensured they were equipped to deal with and manage a wide range of hazardous emergencies.
  •  The trust shared information across services and ensured ambulance clinicians were aware of pre-existing care plans for patients being managed by community services. This included when it was most appropriate for patients to be treated at home, involve other professionals or convey people to an alternative care setting other than an emergency department. .
  •  The community engagement manager was in the process of implementing an app called ‘Good SAM’. The app could be downloaded onto mobile devices to alert users who have been vetted and checked to a nearby cardiac arrest. Through this  the locations of all the defibrillators in the North West had been/were being mapped and , this information was being made available to call centre staff who  could then  direct members of the public dealing with a person suffering a cardiac arrest to the life-saving equipment.
  • North West Ambulance Service NHS Trust  has 109 ambulance stations across the North West of England , three emergency operations centres, one support centre, three patient transport service control rooms, and two Hazardous Area Response Team (HART) buildings  – one being shared with Merseyside Fire and Rescue). It also provides, along with urgent care and out of hour’s partners, the NHS 111 Service for the North West region which operates from five sites across Greater Manchester, Merseyside, Lancashire and Cumbria.

CQC will present the findings of its inspection to a local quality summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the quality summit is to develop a plan of action and recommendations based on the inspection team’s findings.