London Ambulance Service NHS Trust London Ambulance Service NHS Trust Quality Report

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

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