London Ambulance Service NHS Trust Newapproachcomprehensive Report

London Ambulance Service NHS Trust Quality Report 220 Waterloo Road London SE1 8SD Date of inspection visit: 7-9 February and 17 24-25 Tel:020 7921 5100 February 2017 Website: www.londonambulance.nhs.uk Date of publication: 29/06/2017 This report describes our judgement of the quality of care at this trust. It is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from patients, the public and other organisations. Ratings Overall rating for this trust Requires improvement ––– Are services at this trust safe? Requires improvement ––– Are services at this trust effective? Good ––– Are services at this trust caring? Outstanding – Are services at this trust responsive? Good ––– Are services at this trust well-led? Requires improvement ––– 1 London Ambulance Service NHS Trust Quality Report 29/06/2017 Summary of findings Letter from the Chief Inspector of Hospitals London Ambulance Service NHS Trust covers the capital the June 2015 inspection. We did not rate the August city of the United Kingdom, over an area covering 2016 inspection because we did not consider all of the approximately 620 square miles. The service is provided key lines of enquiry due to the focused approach of the to a population of around 8.6 million people, and over 30 inspection. million annual visitors. London Ambulance Service NHS We inspected LAS as part of our planned, comprehensive Trust (LAS) was established in 1965 from nine previously inspection programme. Our inspection took place on 7, 8 existing services, and became an NHS Trust on 1 April & 9 February 2017, with unannounced visits on 17,24 & 25 1996. February 2017. We looked at three core services: access The trust provides an emergency and urgent care (EUC) via Emergency Operations Centres (EOC), EUC, and the service to respond to 999 calls, which are received and Emergency Preparedness, Resilience and Response managed by the trusts emergency operations centre (EPRR), which included its two hazardous area response (EOC). Staff working in EOC provide clinical advice over teams (HART). The 111 service provided by the trust had the telephone, and dispatch emergency vehicles where been inspected recently, and we did not inspect the required. The LAS also provides resilience and hazardous patient transport services on this occasion. The area response teams (HART), which all NHS organisations commercial training services were not inspected as these have been required to have since April 2013. LAS plays a do not form part of the trust’s registration with the Care crucial role in the national arrangements for emergency Quality Commission (CQC). preparedness, resilience and response,(EPRR), During the inspection we visited ambulance premises as contributing to a co-ordinated and planned response to well as hospital locations in order to speak to patients major incidents through the local health resilience and staff about the ambulance service. partnerships (LHRPs). There are two LAS Hazardous Area Response Team (HART), one based in Hounslow and the Overall, we rated this trust as requires improvement. other in Tower Hamlets. In addition, LAS provides a We rated the trust as being good for providing care which patient transport services (PTS). was effective and responsive to the needs of the Services are managed from the trust’s main headquarters population it serves. We rated safety and the well-led in Waterloo, and annexes in Bow and Pocock Street . domain as requires improvement. The trust also offers the following services: First Aid People reported and we observed staff go the extra mile. Training to organisations and the public, and Community There were examples when people reported the care they First Responders (volunteers trained by LAS to provide received exceeded their expectations. life-saving treatment). There was a strong, visible person-centred culture. Staff The trust uses a command and control Computer Aided were highly motivated and inspired to offer care that was Dispatch (CAD) system to manage all calls into the kind and promoted people’s dignity. Relationships Emergency Operations Centre. In the year 2015-2016, LAS between people who used the service, those close to received 1.86 million 999 calls into its two operations them and staff was strong, caring and supportive. Staff centres. recognised and respected the totality of people’s needs. They always took people’s personal, cultural, social and The trust had previously been inspected in June 2015, religious needs into account. For these reasons, we rated where we rated Emergency and Urgent Care (EUC) and the trust outstanding for the caring domain. Resilience Planning as inadequate. The Emergency Operations Centre was rated as requires improvement. A Our key findings were as follows: follow up inspection undertaken in August 2016 found Safety: progress had been made with regard to the requirements we had set out in a warning notice issued as a result of 2 London Ambulance Service NHS Trust Quality Report 29/06/2017 Summary of findings • Whilst there had been improved mechanisms for were sometimes paired together and solo first identifying, reporting and investigating incidents, there responders were not always paramedics. As a result remained a level of inconsistency in staffs perception patient care and treatment was delayed when backup of what constituted an incident and the reporting of support was required. such in all three services. As a result the trust was not • Patient records provided detailed information to always able to capture important data, which could support handover at local hospitals, as well as an identify trends and common themes across the audit trail from call handler on-wards. Records were organisation. accurately kept and stored securely. • Learning from incidents had improved but, was happening in an ad-hoc way, and as a result was not Effective: not yet fully embedded in practice across all areas of • Significant improvements had been made in the service. Whilst the executive team had clear Emergency Preparedness Resilience and Response, methods for communicating learning, staff reported demonstrated through staff adherence with its agreed they did not always have time to read updates. formal framework, and compliance with national • Mandatory safety training for non-clinical staff was not standards. Response times to incidents classified as a meeting the trusts own targets, and as a result, there HART response had been met. was a risk of staff not being updated with regard to the • Staff ensured patients consented to treatment and latest safety practices. care where able, and recognised where the best • The systems and processes for safeguarding people interests of the patient had to be considered where the who were vulnerable as a result of their circumstances situation indicated a response from staff without were clearly set out, and staff we spoke with were formal consent. aware of safeguarding and how to recognise and • Staff had good induction procedures and access to report abuse or neglect. training. The trust was supporting staff to enhance • Infection prevention and control measures had been their roles through additional responsibilities and established. Despite this, standards of compliance expanded roles, such as clinical team leader and with protocols varied across the organisation. This was advanced paramedic practitioner. The introduction of compounded further by the lack of staff awareness of the in-house academy provided an opportunity for standards, possibly attributed to non-completion of staff to progress to the paramedic role. required training, and a lack of basic essential items to • Staff were supported to access training and support practices. development opportunities, and had their skills and • A number of ambulance vehicles needed internal competencies assessed. The performance review of repair, which prevented a good level of cleanliness staff through an annual appraisal levels had improved, from being achieved. although the completion rates did not yet meet the • There was some inconsistency in undertaking the trust target. required safety checks of vehicles and equipment, • Staff used evidence-based guidance to ensure patients some of which was attributed to time factors at the were appropriately assessed, risks were identified and start of shifts. managed. The provision of care, advice and treatment • Significant improvement in medicine management reflected national clinical and medical guidance had been achieved over the past few months. There standards. For example, there were pathways of care remained an issue related to the tracking and tracing to assess and respond to deteriorating patients. These of medicines, which was still not sufficiently robust included suspected stroke, chest pain, and trauma. with regard to safe storage and tracking. However, • Whilst significant work had been undertaken to • The trust was not meeting the national performance increase front-line ambulance staff, we were not targets for highest priority calls attended to by assured all ambulance crew were allocated to emergency and urgent care crew. Although outside response vehicles appropriately. Inexperienced crew 3 London Ambulance Service NHS Trust Quality Report 29/06/2017 Summary of findings factors of handover delays at emergency departments, • A small number of ambulance crew who were waiting and increased activity contributed towards this, with patients to hand them over to nursing staff in

Load more