‘Sorry for unacceptable waits’: Ambulance trust chief on ‘requires improvement’ rating

The East Midlands Ambulance Service has once again been rated as ‘requires improvement’ following an inspection by the Care Quality Commission.

An inspection was carried out at the trust on February 21, 22 and 23 and on March 3 after a report in 2015 rated the service as ‘requires improvement’ overall.

The CQC’s new quality report, which was published on Tuesday, June 13, gave the trust a continued overall rating of ‘requires improvement’.

Individual results for each section of the inspection where:

• Are services at this trust safe? – Requires improvement
• Are services at this trust effective? – Requires improvement
• Are services at this trust caring? – Good
• Are services at this trust responsive? – Good
• Are service at this trust well-led? – Requires improvement

In July 2016 the trust was served a warning notice in which the CQC required the service to make significant improvements to the quality of health care provided.

Although the overall rating remains unchanged, safety for emergency and urgent care has been moved from an ‘inadequate’ status to ‘requires improvement’.

While a number of issues have been addressed since inspectors’ last visit, trust bosses were told ambulance response times were consistently behind national targets and some staff responsibilities and requirements were not well communicated.

In addition, inspectors noted they found “pockets of concern” about members of staff’s confidence in reporting potential bullying and harassment.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said: “We found action had been taken to increase the number of front line staff, standards of cleanliness had improved and the majority of equipment and vehicle checks were appropriately completed.

“The number of vehicles delivering emergency and urgent care services had increased and potential risks to the service were anticipated and planned for.

“There had been improvements in training and development opportunities and there was a high level of confidence in and respect for the acting chief executive. Staff were caring, professional, compassionate and patient focussed in challenging circumstances.

“However, we were concerned that response times for some identified calls fell short of the national target which meant patients were not receiving care as quickly as they should.

“There were variable standards of incident investigation and a lack of learning at an organisational level in relation to those incidents.

“Staff did not always know their responsibilities with regard to the Duty of Candour regulation. We found pockets of concern about potential bullying and harassment of staff, and instances where policies and procedures relating to staff wellbeing were not followed. The trust was also not compliant with the requirements of the Fit and Proper Persons regulation.

“We have told the trust where further work is required to ensure patients receive the service they should be able to expect. The trust leadership knows what it needs to do to bring about improvement and our inspectors will return at a later date to check on what progress has been made.”

Apology for long waits

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.

“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.”

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.”