Care Quality Commission Report: EMAS still ‘requires improvement’ to be safe and effective

The Care Quality Commission (CQC) has published its report today on East Midlands Ambulance Service (EMAS) following its inspection carried out between 21 and 23 February 2017. 

 

CQC key findings were as follows:

  • The trust had made significant improvements as required by the July 2016 warning notice. However we remained concerned about response times.
  • Response times for Red 1, Red 2 and A 19 calls were consistently below the national target and patients were not receiving care in a timely manner.
  • There were variable standards of incident investigation, limited recommendations, lack of learning at an organisational level and a lack of evidence that recommendations had been actioned.
  • There was a lack of consistency in the management of risk due to trialling a revised risk register proforma.
  • Staff did not know about the Duty of Candour requirements or their responsibilities under it and the trust had not consistently fulfilled their responsibilities under the Regulation.
  • We found pockets of concern about the potential bullying and harassment of staff who were not confident to report this. We found instances where policies and procedures relating to staff wellbeing were not followed in practice.
  • Not all staff had been trained on the use of and supplied with filtered face piece masks (FFP3). Those that had been supplied with a mask did not always have them available for immediate use.
  • The trust were not compliant with the requirements of the Fit and Proper Persons Regulation.
  • Whilst the trust had a clear vision and strategy, frontline staff were not aware of these.
  • Whilst training completion rates for statutory and mandatory training had significantly improved, mandatory training completion rates for equality and diversity and risk management modules were too low and there were challenges in two specific divisions around completion rates in general.
  • The trust had taken appropriate actions which had been successful in increasing the number of front line staff.
  • Standards of cleanliness had improved.
  • The majority of equipment and vehicle checks were appropriately completed.
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The CQC inspection looked at:

 

  • The safety and effectiveness of Emergency and Urgent Care Services – rated ‘requires improvement’. This is progress on the ‘inadequate’ rating in May 2016.
  • The safety and effectiveness of the Emergency Operations Centre – rated ‘requires improvement’.
  • Safety, effectiveness and well led at provider level – rated ‘requires improvement.

EMAS Chief Executive Richard Henderson said: “During its inspection the Care Quality Commission found that patients were overwhelmingly positive about our caring and compassionate staff across all levels and specialities of our service.

“Despite sustained challenges, the CQC recognised that we have made significant improvements since the November 2015 CQC inspection and I am pleased that the CQC has identified no new areas of concern, whilst identifying several areas of outstanding practice at EMAS.

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“EMAS was not commissioned to meet the national performance targets during 2016/17, and therefore was not resourced to do so, however during the year we got to more people faster than ever before – 1,264 more Red 1 (the most life threatening) patients received a response within eight minutes compared to the previous year, and a further 9,950 more Red 2 patients within eight minutes.

“I am sorry that some patients experienced unacceptable waits. During the year we have invested in new ambulance vehicles and our electronic patient record system, recruited more staff to our frontline, and improved the clinical outcomes for many of our patients.”

Outstanding areas of practice identified by the CQC at their February 2017 inspection include:    

  • Caring, professional staff delivering compassionate, patient focused care despite challenges due to continued demand.
  • Joint working arrangements with other NHS and blue-light organisations improving accessibility of patient services, particularly those located in remote areas and for patients who require mental health care.
  • A Sepsis pilot in North and North East Lincolnshire is providing prompt lifesaving treatment.
  • A highly effective recruitment campaign which has received a national award for equality and diversity in recruitment.

EMAS Merger Talks Could Create 'World's Largest Ambulance Service'Areas for improvement include:

  • Meet national and locally contracted response time targets for Red 1 and Red 2 categorised calls, and improve call taking response times.
  • Continue to work with other providers and commissioners to reduce handover delays and improve timeliness of resource allocation in Emergency Operations Centre.
  • Continued provision of sufficient clinical mentors for newly qualified staff.
  • Ensure staff receive, read and understand information when there are updates to trust policies, procedures or clinical practice.
  • Improve staff awareness of the legal duty of candour.
  • All staff access and attend mandatory training with particular focus on compliance rates for equality and diversity and risk management training.
  • Ensure all staff know how to report incidents and learning is shared and accessible.
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EMAS Chairman Pauline Tagg added: “We know what needs to be done at EMAS and we continue to progress our improvement plans. Strains on the health and social care system directly impact on our ability to address all the concerns highlighted by the CQC; whilst not within our control to fix them, we continue to play our part. The CQC Quality Summit on 20 June gives us an opportunity together with regulators, commissioners and hospitals to identify further actions to improve care for our patients and staff.

This includes what can be done in response to an independent strategic demand, capacity and price review that looked at the level of demand we have experienced, and the staff, vehicles and finance needed to be able to respond.”

Here is the full CQC report – June 13, 2017 – EMAS