North East Ambulance Trust responds to CQC Report rating it as "Requires Improvement"
The report - released this morning - rated the North East Ambulance Service as "Requires Improvement"
CQC inspectors have told North East Ambulance Service NHS Foundation Trust that improvements are needed following an inspection in September.
The service provides an emergency ambulance service 24 hours a day, 365 days a year across Tyne and Wear, County Durham, Teesside and Northumberland.
The inspection was carried out as part of CQC’s programme of ongoing checks on the safety and quality of healthcare services.
CQC inspected emergency and urgent care, the emergency operations centre and the NHS 111 service.
An inspection was also carried out focusing on the leadership of the trust.
Following this inspection, the trust was issued with a warning notice due to concerns found regarding medicines management within urgent and emergency care and the culture and governance systems within the organisation.
Significant improvements were needed to reduce risks to patients.
Following the inspection:
• The overall rating for the trust dropped from good to requires improvement.
• The overall rating for emergency and urgent care dropped from good to inadequate
• The overall rating for the NHS 111 service dropped from good to requires improvement
• The overall rating for the emergency operations centre dropped from good to requires improvement.
• The trust’s well-led rating dropped to inadequate.
Sarah Dronsfield, CQC’s deputy director of operations in the north, said:
“When we inspected North East Ambulance Service NHS Foundation Trust, we found a deterioration in the services being provided, especially in urgent and emergency care where this had potential for people to be placed at risk of harm.
“It was particularly concerning that staff didn’t always have access to critical medicines needed to treat patients and some crews didn’t have time to complete vehicle medicine checks, resulting in treatment delays.
“Staff told us they frequently responded to emergencies without the sufficient quantities of standard medicines they needed to treat common or life-threatening conditions, including morphine and seizure medication.
“In addition, we were concerned the trust was not always thoroughly investigating incidents and may have made decisions based on limited information, reducing the ability to identify learning and prevent reoccurrence.
“Although staff were focused on the needs of patients receiving care, they did not always feel respected, supported and valued.
“We did, however, also see some positive areas of work. Staff took time to interact with patients in a respectful and considerate way and they maintained their dignity throughout their journey and when being transferred to hospital.
“Through engagement with the trust we know they have taken our concerns seriously and have put in measures to address our findings. We are mindful that ambulance services are operating under increased pressure and we are pleased the trust is keen to make the necessary improvements.
“We will continue to monitor the trust closely to ensure the necessary improvements are made to keep people safe, and we will expect to see sustainable improvements the next time we inspect.”
Inspectors found the following during this inspection:
• There was a lack of sufficient availability of life saving medicines, discrepancies in the number of medicines, missing medicines and incorrectly tagged medicines bags.
• We were concerned that emergency and urgent care did not have effective systems or processes to seek and act upon feedback from staff.
• Some staff told us they did not feel they could raise concerns and the trust did not have effective systems to seek and act upon feedback from staff and other relevant persons.
• Patients did not always receive pain relief soon after it was identified they needed it, or if they requested it.
• In the staff survey conducted as part of this inspection, staff said they felt under pressure and did not feel as though they have enough support to conduct their work.
• The 111 service did not have enough staff in post to facilitate the provision of care and treatment at the right times.
• Staff said although they had the opportunity to contribute to continuous improvement initiatives, they expressed concerns about the slow pace of delivery and lack of outcome.
However:
• All staff worked together to prioritise access for high acuity patients and deliver the best care possible to their patients.
• Absence and well-being plans have been developed to guide how staff can be best supported. Well-being leads had been appointed within the trust and flexible workforce options made available prior to our inspection,.
• When patients could not give consent, staff made decisions in their best interest, considering patients’ wishes, culture and traditions.
• The NHS friends and family test survey results for all services inspected were mostly positive.
• Most station areas were clean and had suitable furnishings which were clean and well-maintained.
• The trust had a robust recruitment plan in place which has seen a significant increase in the number of staff.
The service has responded to the report, with Helen Ray, the NEAS chief executive, saying:
“Over the last 12 months the ambulance service and the NHS as a whole has faced unprecedented pressures, the likes of which we’ve never experienced.
“Providing the best possible care to all our patients remains our top priority. We are all committed to making improvements until we and the CQC are confident that the concerns raised have been fully addressed
“In the six months since the first inspection, we have taken swift action and subsequently provided additional assurance to the CQC that the work will ensure effective systems are in place to keep patients safe. We recognise there is more to do and are committed to longer term change as well as a short-term response.
“I am pleased that throughout the report the dedication, care and commitment provided by all our staff is recognised and acknowledged by the CQC. Our teams continue to deliver the best care possible in these exceptional times.
“It is well documented that no ambulance service in the country is achieving national performance standards. Despite that, NEAS remains one of the best performers for response times, particularly to the highest-level life-threatening incidents.
“Critical to our success as we progress our actions is a clear investment in our workforce to deliver, both clinically and corporately. We are now beginning to see the results of the significant investment in resources made by commissioners in 2022.
“This is evidenced through reduced call response times, growth in our workforce numbers and a wider commitment to further growth in clinical staffing numbers.
“We also recognise that the key to sustainable improvement is service transformation and we welcome the opportunity to work with system partners to deliver this.”