A team of inspectors from the Care Quality Commission visited South Western Ambulance Service NHS Foundation Trust in June and July 2018 to check the quality of two core services: emergency and urgent care and the emergency operations centre. CQC also looked specifically at management and leadership to answer the key question: Is the trust well led?
Inspectors have found improvements, although there are still some areas where CQC has told the trust that further improvements are necessary to ensure that patients receive consistently safe care and ambulances reach them on time.
The trust is now rated as Good for the quality of its services. The trust is also rated as Outstanding for being caring, Good for being effective, responsive to people’s needs and well led and Requires Improvement for being safe.
The CQC Chief Inspector of Hospitals, Prof. Ted Baker, said: “South Western Ambulance Service NHS Foundation Trust has achieved a lot in the last two years. I am pleased to see that the team has implemented a number of changes since our last inspection in 2016 while still managing to retain an Outstanding rating for caring for a second time. However, there is still more work to be done in ensuring a culture of safety exists across the whole of the trust and patients are reached on time.
“We found that the senior leadership team had the ability to ensure improvements could be delivered and to address any risks to performance. We also recognised the board had reorganised the leadership and structure in frontline services but this change was relatively new and needed time to embed.
“The board now need to concentrate on the improvements we and they have identified and allow staff to continue to embed the operational improvements. We will return in due course to check their progress.”
Full reports including the latest ratings are available here.
In emergency and urgent care, inspectors found there was a drive to actively support the national priority to reduce admissions to hospital and help patients to get the right service for their needs. However, the service remains rated as Requires Improvement overall, and there was still work to do.
In the emergency operations centre, there were safe levels of staff and strong multidisciplinary team working. However, the needs of frequent callers were not always met and call audits needed to improve. The service is rated as Good in all key questions.
In both services, although responsiveness was good, complaints were not always responded to within target time frames, although responses were thorough. The board and senior managers were aware of this and there was a plan to ensure that this was an improving picture.
The leadership of frontline services in emergency and urgent care had the skills and experience to carry out their roles. There was good engagement with partners to improve and coordinate services. There were no barriers to innovation and development. In the emergency operations centre, risk was understood and managed and there was a proactive approach to reviewing and improving quality and safety. Morale had improved and there was a strong commitment to improving the quality of the service.
Inspectors observed several key improvements, but there were some problems unresolved, and others emerging in frontline services. Concerns included the trust failing to meet the standard response times to reach patients, although this was improving for the most urgent category. Vehicles and premises were not always secured in accordance with trust policies and procedures. Some medicines were found to not be in date or secured, and not always disposed of correctly. Not all patient records were always protected. Again, storage of some confidential medicine records failed to meet trust policy and legal requirements.
There was a high level of reported violence, bullying, abuse and harassment to staff from members of the public. This was now subject to an external cultural review initiated by the trust. However, staff acted with integrity, compassion and kindness towards their patients and went above and beyond on multiple occasions. This included playing music to help calm a distressed patient, arranging ‘meals on wheels’ for a socially isolated patient, and demonstrating integrity by abandoning breaks to attend emergency calls.