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Troubled ambulance service set to be placed in special measures

PUBLISHED: 09:02 29 September 2016 | UPDATED: 09:02 29 September 2016

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A damning CQC report found Secamb inadequate for providing services that are safe and well-led

The troubled ambulance trust which serves patients in Kent is at risk of being placed in special measures, a damning report has warned.

A turbulent year for the South East Coast Ambulance Service (Secamb) appears to have peaked following the latest inspection by the Care Quality Commission (CQC), in which it found the service inadequate for providing services that are safe and well-led and requiring improvement for being effective and responsive to people’s needs.

A warning notice was issued to the trust, identifying several areas of concern.

The health body found systems in place to ensure enough staff are deployed appropriately were not effective and the trust was not meeting national performance targets for response times.

Low staffing levels were having an impact on both performance and fatigue of staff and the trust did not have access to information to review the mix of staff or safe staffing levels, it found.

The report also found NHS 111 calls were not always responded to in a timely and effective manner and while the trust recognised that their performance in meeting the expected standards was not good enough, they had only identified limited actions to improve their performance, stemming from a lack of strategic leadership.

Processes to ensure that equipment is properly maintained and secured were not adequate and safeguarding arrangements within the trust were weak, resulting in a lack of accountability, and investigation which in turn meant that the trust leadership had a poor understanding of safeguarding issues.

It also found the systems in place were not operated safely and effectively and that the trust had allowed staff to develop practice outside national guidelines which put patients at risk, and that governance arrangements were also not operated effectively.

It is the latest blow for the trust in recent months, following a scandal of delaying sending help for certain calls to allow extra time for patient assessments and revelations of computer system failures during emergency callouts.

Chairman, Tony Thorne, resigned in March, before chief executive Paul Sutton also left the trust two months later.

One positive conclusion from the inspection was that the trust was rated ‘Good’ for delivering services that are caring

Professor Sir Mike Richards, Chief Inspector of Hospitals, said following the publication of the report on Thursday: “South East Coast Ambulance Service NHS Foundation Trust has been through a period of significant upheaval following changes in its senior leadership.

“It is to the credit of the staff that they have continued to provide a vital service to the people of Kent, Surrey and Sussex – dealing with almost a million emergency calls a year alone.

“Throughout our inspection we heard how staff were giving their best, treating patients kindly, with dignity, care and compassion.

“It was apparent that the leadership had not been supporting staff to do their jobs effectively.

“Staff told us there was a culture of harassment and bullying.

“We found in many cases there weren’t enough properly trained staff, or that the proper equipment wasn’t available to them.

“At the time of the inspection, we found evidence that senior executives were not always pulling in the same direction.

“However, improvements are being formulated by an experienced interim chair and the executive has been recently strengthened by new appointments.

“While we have significant concerns about the performance of the ambulance service, I want to provide some reassurance.

“Once care arrives, it is of a good standard – with dedicated and caring call handlers, ambulance crew, paramedics and other frontline staff working hard to ensure this.

“Secondly, the trust are taking urgent steps needed and some improvements have already been made - to ensure that everyone who relies on this service receives excellent, timely care.

“I am recommending that Secamb be placed into special measures to ensure the service gets the support it needs to improve.

“I hope that support from external partners including the NHS Improvement and NHS England will give the trust a clearer sense of direction and support the introduction of the improvements which are so clearly needed.”

Last month, Secamb was forced to deny claims it was to merge with another trust as it announced an agreement of “formal collaborative working”.

A deal was struck with the neighbouring South Central Ambulance Service (SCAS), which operates in Berkshire, Buckinghamshire, Hampshire and Oxfordshire, to ensure more expertise and best practice will be shared.

Both Secamb and SCAS say they will explore further opportunities to work together to reduce costs, accelerate improvements and maintain high quality services for patients.

Agreed by mutual consent by both organisations’ boards, full accountability for all decisions will remain with the two separate unitary statutory boards.

Bosses were clear that the collaboration is not the start of a merger between the trusts, however it is understood such a move may not be off the table altogether in future.

Speaking in response to this week’s report, the trust said it welcomes the additional support placement into special measures would offer.

Acting chief executive, Geraint Davies said: “While we are pleased that the dedication and care of our staff is highlighted as good in this report, we are sorry that we have not met the standards expected in a number of other areas.

“Following initial feedback from the CQC we have already been working on and implementing a number of improvements.

“I would like to reassure everyone we serve that I, along with my senior team, am committed and focused on ensuring these necessary changes continue.

“We are determined to implement the changes required to restore confidence in our service.”

“I would also like to take this opportunity to point to the enormous amount of excellent work undertaken every day by our staff across our region, often in challenging circumstances, to respond to and treat patients, be it responding to a major road collision or saving the life of a patient in cardiac arrest.

“I fully recognise that this is a challenging time for the trust and accept that these are serious concerns which we must address.

“We understand the seriousness of placement into special measures but would value the additional support that this would offer us.

“We expect that the move will mean the work we have already started can continue at pace.”

Steve Inett from Healthwatch Kent, an independent organisation set up to champion the views of patients and social care users across the county, said: “Naturally we are extremely disappointed to hear today’s announcement.

“Our ambulance trust has hit the headlines on several occasions in recent months and not for positive reasons.

“It is now imperative that the trust works with patients and local Healthwatch to make immediate improvements and that the public are reassured.”

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