The NHS ambulance trust that serves Brighton and Hove “requires improvement”, according to an official report published today (Wednesday 26 October).
The Care Quality Commission (CQC) said downgraded the South East Coast Ambulance NHS Foundation Trust from “good” overall to “requires improvement” after an inspection in the summer.
The CQC, the official health and care watchdog, said: “Inspectors carried out two comprehensive inspections in August to look at the trust’s urgent and emergency care and resilience teams as well as check the trust’s progress in meeting the requirements from a well-led inspection in February.
“At the February inspection CQC downgraded the well-led rating from good to inadequate and suspended other ratings until this inspection had been completed.
“Following this inspection, the trust’s overall rating has moved from good to requires improvement overall.
“The ratings for how safe, effective and responsive the trust are have moved from good to requires improvement. Caring remains rated as good.”
The CQC’s network director Deanna Westwood said: “During our inspection of South East Coast Ambulance NHS Foundation Trust, our inspectors found that staff on the front line were doing their utmost to provide safe and effective care to people across Kent, Surrey and Sussex.
“However, additional pressures on the service, which included an increase in staff sickness and increased delays in handovers from partner organisations, meant that the quality of care we saw being delivered had declined.
“It was for this reason that we have changed their overall rating from good to requires improvement.
“Leaders were very aware of our concerns in relation to the trust’s performance and have showed a real sense of urgency in prioritising the issues which had been identified which is encouraging.
“As flagged in the CQC’s report published last week, State of Care, the south east like many other areas, has a health and social care system that is gridlocked.
“The trust can’t solve all of their issues, such as handover delays, alone – and I encourage the whole system to work together to find a resolution.
“We did have other more specific concerns that we have told leaders about. For example, they need to have better oversight on how often restraint was used and if it was done safely.
“Although staff knew what incidents to report and how to report them, they weren’t always reporting when somebody had been restrained.
“We also spoke with staff within the resilience team who were frustrated and didn’t feel respected, valued or supported.
“There was low morale within the service and staff told us they didn’t feel appreciated by management at a senior level.
“We continue to monitor the service closely and will be returning to check on the progress of improvements that the trust has been told to make.”
The CQC said that it had downgraded its rating of the trust’s “emergency and urgent care” to “requires improvement” because
- The service provided mandatory training in key skills to all staff but not everyone had completed it. The service did not share learning from incidents with staff and staff often did not get feedback from incidents they had reported.
- There was a lack of training for medicines management, specifically for patient group directions.
- The service did not always support staff to develop their skills. Managers and staff told us that any additional training courses had to be self-funded and completed in their own time.
- Managers did not routinely appraise staff’s work performance or hold supervision meetings with them to provide support and development. Managers did not always make sure staff were competent.
- Staff did not receive training in patient restraint techniques. The trust did not have oversight regarding how often restraint was used and whether it was done safely. The trust did not have a restraint policy.
- The service did not always make it easy for people to give feedback. People could not always access the service when they needed it and patients often experienced delays in receiving treatment.
- There were additional risks for patients from handover delays for ambulance crews at emergency departments which were unable to take patients due to their lack of capacity.
- The NHS contractual response times for ambulances to attend patients were not being met and some were exceptionally long, ambulances were waiting at emergency departments due to the increased demands and capacity pressures in hospitals and other parts of the health and social care system.
- Leaders did not have the capacity or support to run the service well. Not all staff felt respected, supported and valued.
- Staff felt there was an overall lack of a strategy and vision for the service. Staff felt there was a lack of urgency and ownership of responsibilities within the service.
- There was not an effective communications system to ensure staff had read and understood key information.
- Staff were not clear on the roles and responsibilities of managers. For concerns requiring action from senior leaders in the organisation there were often delays in getting a response impacting on the ability of local leaders to deal with issues and concerns at a local level in a timely way.
- Managers did not have enough time to dedicate to the welfare, professional development and training of the staff they managed. There was conflicting and changing demands placed on all levels of managers from the senior leadership team and there was a lack of cohesive working.
- There was evidence of staff under such pressure that it was having a detrimental effect on both their mental and physical wellbeing. Most of the staff described feeling exhausted and burnt-out by the job with the current pressures. Not all staff felt that staff welfare was given sufficient priority.”
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The CQC report also said: “The service was struggling to meet national targets for response times and there were many instances when there were no ambulances to attend to high-risk patients due to crews awaiting patient handovers at emergency departments.
“The trust measured the number of hours lost when patients waited on ambulances outside emergency departments (ED), known as delayed admissions. They also measured the time it took for crews to hand patients over at emergency departments.
“Handover start time is defined as the time the ambulance arrives at the ED, with the end time defined as the time the patient is handed over to the care of ED staff.
“National ambulance standards indicate handover should take place within 15 minutes of arrival at the ED.
“Data from (Tuesday) 1 February 2022 to (Sunday) 31 July 2022 showed there were 6,253 handovers of 60 minutes or more.
“In the same time period on average 38 per cent of all handovers were completed within 15 minutes and the average handover time was 21 minutes.
“Data showed for the previous three months a total of 4,208 hours were lost due to delayed handovers.
“Access to the service for patients was severely affected by rising demand and handover delays in emergency departments.
“This was not an issue exclusive to this trust and many hours were being lost nationally.”
To read the report, click here.
