CQC welcomes improvements at South East Coast Ambulance Service NHS Foundation Trust but further work is required.

England’s Chief Inspector of Hospitals has welcomed improvements at South East Coast Ambulance Service NHS Foundation Trust but says more work is needed following an inspection by the Care Quality Commission.

A team of inspectors from CQC visited South East Coast Ambulance Service NHS Foundation Trust between July and September 2018 to check the quality of three core services: emergency operations centres, emergency and urgent care, and resilience. CQC also looked specifically at management and leadership to answer the key question: Is the trust well led?

The inspection found that the new leadership team had been tackling challenges facing the trust with compassion and energy. But although some areas had improved it was too early at this stage to judge if the improvements were fully embedded or sustainable.  

The trust is now rated as Requires Improvement for the quality of its services. The trust is also rated Good for being caring and Requires Improvement for being safe, effective, well-led and responsive to people’s needs. The trust had previously been rated Inadequate following inspections in 2016 and 2017.

The CQC Chief Inspector of Hospitals, Professor Ted Baker, said: 

“Two years ago we found significant concerns about the performance of the ambulance service South East Coast Ambulance Service, with both staff and patients let down by their leadership.  

“It a service that almost five million people depend on, so I am pleased to report that there were signs of change across South East Coast Ambulance Service NHS Foundation Trust and this has led to an improvement in the overall rating. 

“It is clear that this board understand the importance of a culture that supports and values staff.    Although there has been progress in addressing the immediate issues, we felt that it is still too early to judge their effectiveness and for that reason I believe the trust should remain in special measures for now. 

“There remain number of concerns that we found during the inspection that the trust have  addressed since then, or provided us with further assurance.

“The trust must continue the good work, and focus on those areas where we have identified the need for further improvement.  

“We will continue to monitor the service closely and return in the future to check on progress.”

The inspection found that staff were motivated to deliver the best care,  treating patients with compassion, dignity and respect. Feedback from patients and those close to them was positive. However, there were staff shortages across both the emergency operations centre and emergency and urgent care core services this had an impact on both staff and patient safety. Staffing concerns were often around recruitment and retention which put pressure on existing members of staff to meet the demands of the public.

The trust was taking positive steps to show staff they were cared for. Staff had access to a new well-being hub which enabled staff to access support in a variety of areas. 

On emergency calls, the trust was above the national average for category 1 and 2 response times,  for people with life threatening injuries. However, some patients classified as category 3 or 4 (people who have fallen and long lying patients) were at an increased risk as a result of experiencing long delays. Staff did not always report this through the incident reporting system. However, inspectors raised this with the trust which took immediate action to audit and improve incident reporting.

The trust had made significant improvements since the last inspection to emergency and urgent care. There had been a positive shift in organisational culture, with new systems and processes that had a measurable impact on the service. 

There has also been significant progress since the last CQC inspection in the trust’s resilience services (specialist teams who deal with extreme emergencies) to ensure the service was able to provide an effective and timely response. The number of paramedics in the hazardous area response team had increased and all technicians were now qualified paramedics. 

Full reports and ratings for the core services are available at https://www.cqc.org.uk/provider/RYD