Archived: St John Ambulance East Midlands Region

Updated 24 January 2020

St John Ambulance East Midlands Region is operated by St John Ambulance. The service was first registered in 2011. It is an independent ambulance service based in Chesterfield, Derbyshire. The service primarily serves the communities of Derbyshire and Nottinghamshire. St John Ambulance East Midlands Region is part of St John Ambulance, which is a national charity providing first aid and other ambulance services. St John Ambulance became a separate legal entity and subsidiary of The Priory of England and the Islands of the Order of St John in 1999. St John Ambulance primarily provides first aid across the country and services include emergency and urgent care, non-emergency patient transport, and first aid and ambulance provision for events. St John Ambulance East Midland Region provide first aid cover for events and patient transport services (PTS) to take patient to and from hospital on behalf of a local NHS ambulance trust. The provision of first aid at events is not in the Care Quality Commissions (CQC) scope of regulation. However, if a patient needs to be transferred to another provider from an event for continuing care needs then the treatment and care given to the patient during transport is subject to CQC regulation. The Care Quality Commission also has responsibility to regulate patient transport services. The service is staffed by trained paramedics, ambulance technicians and ambulance care assistants.

The aim of the organisation is to offer first aid to those who need it and to ensure communities are provided with first aid trained staff. St John Ambulance East Midlands Region is registered to provide the following regulated activities:

• Transport services, triage and medical advice provided remotely.

• Treatment of disease, disorder or injury.

The service has two registered managers for the regulated activities. Their focus is split between emergency and urgent care and patient transport services.

The management strategy and leadership model of the service is the same for both the emergency and urgent care service and the patient transport service although each have their own dedicated manager. Some staff deliver both the emergency and urgent care service and the patient transport service. Where our findings on emergency and urgent care service, for example, management arrangements, also apply to the patient transport service we have not repeated the information but cross-referred to the patient transport service core service.

We inspected this this service in 2017 but at that time did not have the power to rate the service provided

At the last inspection the service was given the following actions:

The provider must ensure all premises and equipment are secure at all times – since the last inspection the provider has made sure that the location was now secure.

The provider must ensure there are effective systems and processes in place to maintain security of patient records. Since the last inspection the provider has a process in place to ensure patient records are secure.

The provider should ensure staff follow organisational policies with regards to the disposal of clinical waste. Since the last inspection the provider has ensured that staff follow the disposal of clinical waste policy.

The provider should ensure there is a standard operating procedure in place to support staff making decisions as to whether an equipment or vehicle fault should result in a vehicle being taken off road. Since the last inspection the provider has a process in place to ensure appropriate decisions are made if a vehicle is to be taken off road.

The provider should ensure that medical gases are securely stored at all times. Since the last inspection the provider has ensure all medical gases are securely stored.

The provider should ensure there is an effective stock control system in place for medical gases. Since the last inspection in 2017 the provider had introduced a process to manage the stock control of medical gases, however four clinal staff we spoke to could not tell us about it.

The provider should consider investigating the causes of the culture identified within some ambulance stations including low morale, poor management practices and inconsistent leadership amongst, in relation to regulated activity. Since the last inspection staff told us the culture within the service had improved.

Updated 24 January 2020

St John Ambulance East Midlands Region is operated by St John Ambulance. The East Midlands Region is part of the East of England & East Midlands Area within St John which covers 12 counties. This inspection and report covered the East Midlands region only. The main service provided by this ambulance service is emergency and urgent care. The service also provides a patient transport service for the local NHS ambulance trust. Where our findings on emergency and urgent care, for example, management arrangements, also apply to other services, we do not repeat the information but cross-refer to the emergency and urgent care section.

We inspected this service using our comprehensive inspection methodology. We carried out the a short-notice announced inspection on 7 and 8 August 2019.

During our inspection we rated the service using our five key lines of enquiry. We looked at if the service was safe, effective, caring, responsive and well led. We were unable to rate caring for the emergency and urgent care service as we didn’t see any regulated activities being carried out

The St John Ambulance service has both paid staff and volunteers working within the service. Throughout the report when staff are referred to it means both staff and volunteers.

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 provider understood and complied with the Mental Capacity Act 2005.

We rated it as Good overall.

• The service had enough staff to care for patients and keep them safe. Staff received appropriate training which the service ensured they completed.

• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care.

• Staff kept detailed and up to date care records.

• The service had an open culture and staff felt able to raise concerns and were assured that their concerns would be acted on.

• Information about how to give feedback or raise concerns was easily accessible in multiple formats.

• Facilities, premises, vehicles and equipment kept people safe. Staff were trained to use equipment appropriately. Staff managed clinical waste well.

• The service-controlled infection risk well.

However,

• The service did not have a patient group directive in place for one medication. There was a lack of audit to monitor prescribing practice.

• The managers did not have full oversight of medicines management procedures and processes within the service at the time of the inspection but took action to address this.

• There were no systems to routinely collect patient feedback.

• Not all staff knew about the communications aids available to ensure patients’ needs are met.

• There were gaps in the management and support arrangements for volunteers, such as no mandatory formal volunteer development review.

• Data was not easily available for the East Midlands Region as this was collected and collated as part of the East of England and East Midlands Area. This data was not routinely split to regional level to allow review at local level.

  Following this inspection, we told the provider that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

  Heidi Smoult

  Deputy Chief Inspector of Hospitals, on behalf of the Chief Inspector of Hospitals

Updated 24 January 2020

Patient transport services were a small proportion of activity . The main service was u rgent and emergency services . Where arrangements were the same , we have reported findings in the urgent and emergency services section .

The patient transport service was a new service contracted by the local NHS ambulance trust started in February 2019. At the time of the inspection there had been 124 journeys since the service began.

Updated 24 January 2020

St John Ambulance is a national charity that is split into four regions. This service sits in the east region and provides first aid cover for events and transfer from site to another provider. Urgent and emergency services were the main activity. The service carried out 116 emergency and urgent service patient journeys from July 2018 to July 2019.

Where arrangements were the same across both urgent and emergency services and patient transport services, we have reported findings in the urgent and emergency services section.

Staffing, equipment, vehicles and most processes were the same for both the urgent and emergency services and the patient transport services.

We have rated this service as good overall. At the time of the inspection, the provider did not ensure that all governance and risk management processes and procedures were in place to meet the needs of patients and make improvements to the service.