Archived: St John Ambulance London Region

Updated 10 March 2017

St John Ambulance London Region is part of St John Ambulance a national charity which provides first aid. St John Ambulance became a separate legal entity and subsidiary of The Priory of England and the Islands of the Order of St John in 1999. St John provides first aid across the country and services include emergency and urgent care, non-emergency patient transport, and event first aid ambulance provision. The aim of the organisation is to offer first aid to those who need it and to ensure communities are provided with first aid trained staff. Both employed and volunteer staff work within the organisation.

St John Ambulance London Region provides contracted emergency and urgent care for one NHS trust. Currently through the contract, St John Ambulance London Region provides four ambulances for emergency and urgent (including bariatric) care. The service is operated from two locations, the main hub being Park Royal and a smaller hub based at Crystal Palace. St John Ambulance provides a paediatric neonatal transport and retrieval service for two NHS hospitals. The service has seven bespoke ambulances and one paediatric support unit. The prime purpose of the service is the management and safe transportation of medical teams, paediatric patients, and relatives to and from district general hospitals to other paediatric intensive care environments under emergency conditions. St John Ambulance provides a small ad-hoc patient transport service and first aid support at public events. Specific vehicles for first aid events are based at various locations across London.

The London Region was formed in 2012, following an organisation restructure. Little changed geographically, but the management structure was streamlined and the regional management team was developed to provide a more people and patient care centred approach, which included key outputs of increasing quality and controlling finances. The Ambulance Operations became its own function and a new management team was recruited to cover four sectors, North West and West Midlands, North East and East Midlands, South East and South West and London and East.

The organisation is undergoing a review and restructure of their senior and regional management team to support their strategic delivery.

We visited head office and their main emergency and urgent care station at Park Royal. We completed interviews with senior management at head office and the duty station manager at Park Royal. We travelled with the emergency ambulance crew who attended emergency and urgent care patients. We visited the neonatal and retrieval services based at two NHS hospitals. We visited an event and checked both emergency operation ambulances and those being used in events. We travelled with a crew for the transport of patient’s service.

We inspected St John Ambulance Service London Region on 15 and 16 November 2016 and inspected an event on 19 November 2016. This was an announced comprehensive inspection to check whether the service at this location was meeting the legal requirement for regulated activities associated with the Health and Social Care Act 2008 and to ensure the service was safe, effective, caring, responsive and a well-led service.

Updated 10 March 2017

St John Ambulance London Region is part of St John Ambulance, a national first aid charity. St John provides a variety of services, including contracted emergency and urgent care, non-emergency patient transportation, bariatric transfers, paediatric and neonatal transport and first aid cover at events. The strategic direction of the organisation nationally is to provide an effective and efficient charitable first aid service to local communities. The services provided by St John Ambulance involve both employed and volunteer staff.

St John Ambulance London region provides emergency and urgent care for one London NHS ambulance trust and paediatric and neonatal transport services for two NHS hospitals. They provide a small ad-hoc patient transport service. St John Ambulance London Region has contracts with a number of organisations, which hold events in the local area and provides first aid at these events including the provision of an ambulance.

We inspected St John Ambulance London Region on 15, 16 and 19 November 2016. This was an announced comprehensive inspection, part of our national programme to inspect all independent ambulance services. We visited two locations, those being the head office and, Park Royal station, whereby, we attended emergencies and urgent care with an ambulance crew. We also attended a large event and spoke with staff and inspected equipment and vehicles. Patient transport services formed a very small part of the service; however, we attended a shift with crew to inspect patient care.

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and issues that service providers need to improve.

We found the following areas of good practice:

• We saw staff providing compassionate and kind care to patients and were supportive of their needs. Patients received dignified care and their privacy was respected. Staff were kind and provided emotional support to relatives and carers.
• There was a good system for staff to report incidents and for investigations to take place. The learning from incidents was fed back to front line staff. Lessons learnt showed actions were taken to change behaviours and provide support and training for staff.
• There were established processes for staff to follow to protect patients from the spread of infection. We saw staff using good infection control procedures and vehicles were kept clean and tidy and were well stocked.
• We saw good multidisciplinary team working and the sharing of information to provide consistent good care for patients. Staff knew the scope of their role and when to escalate concerns so patients’ needs were met quickly and efficiently.
• All staff both employed and volunteers received good induction training and were able to access further training for their role.
• The planning of services was managed well and cover for contracted and event work was provided only if the suitable qualified staff were available. The service planned ahead to meet delivery and meetings between contract providers ensured the service ran as smoothly as possible. After events, meetings were held with organisations, which allowed for reflection and shared discussion so improvements could be made for future events.
• The organisation had a national vision and strategy, and regional and national support helped the strategy to be implemented locally. The organisation recognised the need to review their service and make changes to the structure if necessary.
• Staff were supportive of the leadership both regionally and locally and felt they could voice their opinions and were listened to.

However, we also found the following issues that the service provider needs to improve:

• Staff were not trained to the required safeguarding children level expected for them to perform their role. The safeguarding training for staff was not in line with the Safeguarding Children and Young Peoples: Roles and Competencies for Health Care Staff Intercollegiate document: March 2014. We were informed all staff were trained to safeguarding level one. We were told this applied to staff across the whole organisation.This concern has been identified as an organisation-wide issue and we have requested that St John’s Ambulance inform us of how they intend to address it.The organisation have since provided us with a plan which details the actions they have taken to address the concerns we raised.   
• The monitoring and recording of controlled drugs was slightly disjointed. We found an alteration to a recording with no reason given or signature to explain why the alteration had been made. A more streamlined system of having one book would allow for better tracking and tracing.
• We found some patient records were not being kept in the secure folders when we accompanied crew on their shifts. Some records were kept behind sun visors and this posed a risk to patient confidentiality.

Information on our key findings and action we have asked the provider to take are listed at the end of the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 10 March 2017

We do not currently have a legal duty to rate independent ambulance services but we highlight good practice and issues that service providers need to improve.

We observed staff providing kind and compassionate care and patient’s privacy and dignity was respected. Staff attended to patient’s individual needs and were thoughtful and considerate in their approach. Staff were able to support those patients who were vulnerable and provided emotional support to patient families.

Staff followed guidelines relevant to their role to provide effective patient care and treatment. The organisation met with other providers to ensure services were planned to meet the needs of local people.

There was a good training system and a comprehensive induction programme. Staff were required to complete annual competency assessments to ensure they were up-to-date with latest guidelines and were competent to provide care and treatment within the scope of their role.

The environment and equipment was visibly clean and staff followed guidelines to control the spread of infection, such as following good hand hygiene practices and wearing personal protective equipment when necessary.

There was a national vision and strategy, which reflected the values of the organisation. Staff understood the vision of the organisation.

The organisation recognised the need for restructure and reorganisation to improve the quality of the service. There was recognition for the need to improve the quality of data being collected.

However:

The safeguarding training for staff was not in line with the nationally recognised safeguarding children training levels. Staff were not trained to the correct level for their role. However, staff were able to describe signs of abuse and how they would refer safeguarding incidents.This concern has been identified as an organisation-wide issue and we have requested that St John’s Ambulance inform us of how they intend to address it.The organisation have since provided us with a plan which details the actions they have taken to address the concerns we raised.   

We found a recording in the controlled drugs book had been altered with no explanation why. The service had two controlled drugs books, which made the system slightly disjointed.

Staff we observed on an emergency shift did not keep the patient records in the zipped wallet provided by the service. Records were kept behind the vehicles sun visor and we found confidential documentation dating back from June 2016 in the glove box of the cab compartment of the vehicle.