Ambulance service rated inadequate
The Care Quality Commission (CQC) has rated South Central Ambulance Service NHS Foundation Trust inadequate
It follows an inspection undertaken in April and May.
The inspection was prompted by concerns CQC received about the quality of the trust’s governance and its staff training.
CQC assessed the trust’s leadership, its emergency operations centre (EOC), and the urgent and emergency care it provides to people.
The EOC receives and triages 999 calls from members of the public and other emergency services. It provides advice and dispatches ambulances to the scene as appropriate. The EOC also provides assessment and treatment advice to callers who do not need an ambulance response, which is a service known as “hear and treat”.
The urgent and emergency care service covers the assessment, treatment and care of patients at the scene by ambulance crews with transport to hospital, as well as the assessment, treatment and discharge from the care of the service.
CQC found issues with the trust’s governance which undermined the quality of care it provided to people.
To focus the trust’s attention on addressing these issues, CQC has served a warning notice requiring immediate and significant improvements are put in place.
Following this inspection, CQC’s overall rating for the trust and its ratings for how safe and well-led it is have dropped from good to inadequate. CQC rating for how responsive to people’s needs the trust is, has deteriorated from good to requires improvement, while its ratings for being effective and caring remained good.
For the core services within in the trust that CQC inspected, the rating for the EOC has dropped from good to requires improvement, and the rating for emergency and urgent care has deteriorated from good to inadequate.
Denna Westwood, Director of CQC’s South Network, said:
“We initially carried out this inspection of South Central Ambulance Service NHS Foundation Trust in response to concerns about the quality of the trust’s governance and training.
“However, as the inspection progressed, we identified further issues - particularly around shared leaning from serious incidents and allegations against staff not being appropriately addressed. We also found safeguarding wasn’t being given the priority it deserved, which is something we had already identified to the trust in November 2021.
“As a result of our concerns, we have issued the trust with a warning notice so it’s clear about the areas it immediately needs to address to ensure people’s safety.
“Despite the issues which undermined the quality and safety of care the trust provided, staff on the front line were doing their absolute best to provide safe and effective care and treatment of patients - despite, in some cases, feeling overwhelmed and having a sense of ‘compassion fatigue’. They should be applauded for the job they are doing, especially in light of the additional pressures on the service caused by the COVID-19 pandemic.
“But while staff were doing their very best to provide safe care to patients and support to each other, leaders sometimes appeared out of touch and were not fully sighted on issues that impacted the overall effectiveness of the care they were providing.
“We also found there were frequent and prolonged delays in reaching people who had requested emergency assistance, and this resulted in poor outcomes for some people. Some of these issues are as a result of long waiting times outside of hospital to admit their patients, but there is action the trust can take to mitigate the impact of this on people. We would also encourage system leaders to work with the trust, as they cannot solve all of these problems alone.
“Staff described a dismissive attitude from trust leaders when they raised concerns and also told us people who raised concerns were treated badly as a result, and it was evident that the trust did not adhere to its own policy for whistle-blowers.
“I want to thank the staff who spoke up and praise them for being brave enough to come forward. Speaking up in these circumstances is not easy, but it is important that it happens because it can support safer and more effective patient care and treatment.
“We will continue to monitor the trust closely to ensure people’s safety whilst they are making the improvements we have told them to.
“If at any stage we find the trust’s patients are at immediate risk of harm as a result of unsafe care, we will not hesitate to take immediate further action.”
Inspectors found:
Safeguarding was not given enough priority. There was insufficient assurance that processes were protecting people, despite CQC raising concerns with the trust in November 2021.
Inspectors received information from a whistle-blower raising concerns about negative experiences at the trust; they said that the concerns applied especially to student paramedics. The whistle-blower said concerns had been raised with senior leaders, the Freedom to Speak Up guardian and the organisational development team - but there was no evidence concerns were being addressed. This correlates with reports from staff across the organisation who felt that the focus of the Freedom to Speak Up guardian was solely about patient safety issues and that other concerns were not recognised by leaders as being within the Freedom to Speak Up guardian’s remit.
There were concerns regarding ambulances having to wait outside of emergency departments with a patient onboard for several hours before the hospitals had capacity to accept them into the department. It was recognised that this took ambulances off the road and that people suffered harm when ambulance availability outstripped demand. There was no evidence of action being considered by the trust to manage this risk, for example taking patients to quieter hospitals with capacity to provide more timely care and treatment where there was little or no difference in journey times.
The trust’s board’s extreme positivity about its performance and the organisation’s culture could feel dismissive of the reality to frontline staff. This was borne out in the CQC’s survey of the trust’s staff, where one person stated they were ‘concerned about the culture of problems being swept under the rug, in particular within the management team.’
However, inspectors also found:
In emergency and urgent care, patients were treated with kindness and compassion. Staff frequently checked to ensure patients were comfortable. Most patients said staff were very good and had provided assurance when they arrived.
We saw and heard about examples where staff had been particularly kind and gone the extra mile to meet the needs of patients and their families.
There were numerous examples of innovative practice that supported people getting the right care, in the right place.
South Central Ambulance Service NHS Foundation Trust (SCAS) has issued a statement:
Will Hancock, Chief Executive, said: “The CQC has highlighted some serious concerns which we must, and will, fix as a matter of urgency. I want to reassure everyone that we have already taken swift action, but I recognise we have more to do. Providing the best possible care to all our patients remains our top priority.
“We have an extensive improvement plan and we are committed to making things better. We will keep focused on putting things right until we and the CQC are confident all the concerns have been fixed.
“It is vital that every member of our team can raise concerns with the confidence they will be dealt with quickly and effectively. We are also working with our partners across the NHS to manage the on-going pressures so we can improve response times and hospital handover times.”
Immediate actions taken include:
• Reviewed all outstanding safeguarding referrals, increased resources for safeguarding team, external safeguarding review completed, and new training programme developed
• Increasing capacity in ambulance crews and call centres
• Improved processes for handling serious incident reviews
• Enhanced equipment checks on all 660 vehicles
• Weekly deep cleans of sites put in place to address infection prevention concerns
• Approved increased investment for Freedom to Speak Up function
• Established women's staff network and programme addressing sexual safety
• Full governance review underway by NHS England specialist.
Professor Sir Keith Willett, Trust Chair, said: “Since joining SCAS in the Spring, I have seen the enormous dedication and pride across all our teams. Their commitment to providing the best possible care to patients throughout the pandemic and during the continued pressure on the NHS has been outstanding. I am reassured this commitment has been recognised in the CQC's report; and is also being applied to addressing their concerns.
“This rating is a huge disappointment to everyone. The board takes responsibility for that and we will work with colleagues across the Trust and our partners to put things right. In doing so I’m confident SCAS will become a better Trust that it has ever been, both for our patients, staff and volunteers.”
Alongside their concerns the CQC inspectors say:
• Frontline staff were working hard to deliver compassionate care to people with whom they had contact. They were proud of their work and how they had managed throughout the pandemic.
• We saw and heard about examples where staff had been particularly kind and 'gone the extra mile’ to meet the needs of patients and their families.
• There were numerous examples of innovative practice that supported people getting the right care, in the right place.