The Care Quality Commission (CQC) has rated South East Coast Ambulance NHS Foundation Trust as requires improvement following an inspection in August. Previously the overall rating for the trust was good.
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 that had received an inadequate grading, down from the previous good rating. Ratings for other areas were suspended until this inspection had been completed.
Although inspectors recognised staff on the front line were doing their best to provide safe and effective care they said 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 has declined.
Inspectors also heard that resilience team staff didn’t feel respected, valued or supported. There was low morale within the service and staff told said they didn’t feel appreciated by management at a senior level.
The resilience team did not have enough staff to keep patients safe. Managers were open about the staffing challenges that the department had faced. Hazardous area response teams (HART) were expected to be made up of six HART operatives which included an operational team leader. The trust had made a decision to allow teams to continue to operate with a minimum of four HART operatives when required and these teams would be backed up by a second team, which provided a safer system of work. However, between January and July the trust had breached their staffing policy on 10 occasions.
The urgent and emergency service had been under additional pressure from staff sickness and COVID-19-related absence. Data showed from February and July 2022, the overall sickness rate for staff working in urgent and emergency care was just over 10%.
Many staff were working beyond their hours and not always getting breaks on time in what were already long shifts. Data showed from February to July 2022, 86% of ambulance crew took their break from their own dispatch location and 41% of crew actually took their break in their allotted break time. In the same time period just over 1% of staff did not have a break in their shift. In the previous six months 10% of staff finished their shift an hour after their shift finished.
Staff learned from safety alerts and incidents to improve practice. But, ambulance crews did say any updates or safety alerts involving medicines were shared via email and marked as important. However, staff also said that they received a high volume of emails marked as important and they did not have time to read them all.
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.
“Additional pressures on the service”
Deanna Westwood, CQC’s network director, 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 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.”
“Taking concerns seriously”
SECAmb Interim Chief Executive Siobhan Melia, who was appointed in July this year, said: “I am really pleased that the excellent care provided by our staff has once again been recognised and rated as ‘Good’ by the CQC, despite the huge pressures they face every day. I am very proud of the high-quality care and compassion provided by our staff.
“We have already taken concerns around our culture and leadership extremely seriously and we are committed to making further improvements to ensure we improve our response to patients and the working lives of our staff. I know that there is much to do to get the Trust to where it needs to be and we are working closely with staff as well as partners both regionally and nationally to make the necessary improvements highlighted in the report.”
SECAmb has outlined an improvement plan focusing on four main areas; Quality Improvement, Responsive Care, Sustainability, and People and Culture.
Work includes improving learning from incidents as well as further recruitment and greater retention of staff. It also involves growing the Trust’s voice within the wider NHS system to support improved patient pathways, reduce hospital handover delays and develop new partnerships.
The full findings of the reports can be found on the CQC website.