Archived: British Red Cross Abingdon

Updated 13 April 2016

The British Red Cross is part of the International Red Cross and Red Crescent Movement, the world’s largest independent humanitarian organisation. Within the UK, the Red Cross is split into three regions and each region has a number of areas. The British Red Cross Abingdon is part of the Thames Valley area.

The British Red Cross Abingdon provides an ambulance service in Oxfordshire and Berkshire through a contract with the local ambulance trust. Through this contract, British Red Cross Abingdon is involved with the emergency transfer of patients to the accident and emergency department or the appropriate hospital department or ward. In addition, the service transfers patients between hospitals, if the patient needs to be admitted to a different ward for continuing care. There is also an events service, which provides first aid support, at public events. The British Red Cross Abingdon has contracts with a number of organisations, which hold events in the local area. The Red Cross operates ambulances as a means by which the organisation can provide humanitarian support and assistance to those who need it in a crisis.

The service provides cover seven days a week, for its contract work. There are five eight-hour shifts each weekday, which cover the period 8.30am until 11pm. Two shifts each from Reading and Slough, with one shift from Abingdon. At the weekend, there is one shift from Abingdon and one from Reading. Cover for event work is predominantly at weekends. The British Red Cross Abingdon has a mix of employed staff and volunteers.

We visited three locations Abingdon, Reading and Slough and accompanied staff on ambulances to observe care given to patients.

We inspected British Red Cross Abingdon on 4-5 November 2015. This was a pilot comprehensive inspection to test our new methodology for inspecting independent ambulance services. Therefore, we did not rate this service.

Updated 13 April 2016

The British Red Cross is part of the International Red Cross and Red Crescent Movement, the world’s largest independent humanitarian organisation. Within the UK, the Red Cross is split into three regions, within which are a number of areas. The British Red Cross Abingdon is part of the Thames Valley area.

The British Red Cross Abingdon provides an ambulance service in Oxfordshire and Berkshire through a contract with the local ambulance trust. There is also an events service that provides first aid support, at public events. The British Red Cross Abingdon has contracts with a number of organisations, which hold events in the local area. The Red Cross operates ambulances as a means by which the organisation can provide humanitarian support and assistance to those who need it in a crisis.

We inspected British Red Cross Abingdon on 4-5 November 2015. This was a pilot comprehensive inspection to test our new methodology for inspecting independent ambulance services. Therefore, we did not rate this service.

Our key findings were as follows:

Is the service safe?

• Staff did not always make sure they stored patient records securely after they completed them.
• Staff raised concerns around the lack of radios on vehicles. Staff relied on mobile phones to raise concerns and seek additional support.
• Staff knew how to report a safeguarding concern and completed safeguarding adults and children at risk training. However, staff were not always confident about what would be considered a safeguarding concern.
• Cupboards on some ambulances were not labelled which made it difficult to locate items in an emergency. There was no standard equipment list on the ambulance so staff could check all items were available. However, all ambulances were well stocked.
• Staff reported incidents and senior staff investigated these. The sharing of learning and action points took place locally and nationally.
• Staff completed their statutory and mandatory training.
• Staff followed infection prevention and control procedures. Vehicles in general were clean and tidy, with regular deep cleans taking place to reduce the risk of infection.
• The environment and equipment at the three locations visited and on the ambulances was well maintained. Vehicles had a current MOT, insurance and regular servicing took place.
• A new medicines management system was in the process of being introduced which would improve stock control, traceability and storage of medicines.
• There were effective systems to manage staffing requirements for contract and event first aid work, to ensure the appropriate number of skilled staff were on duty.
• Staff participated with other services in response training for major incidents.

Is the service effective?

• Staff provided care to patients in line with national guidance. Staff were able to seek additional clinical advice, if needed, whilst caring for patients.
• Staff completed relevant training for their role, and the majority of staff (85%) had received an appraisal in the last year.
• Ambulance staff raised concerns that the restrictions of the contract limited their scope of practice and did not utilise all their clinical skills. Staff assessed and provided pain relief for patients as needed.
• We saw good multidisciplinary team working between ambulance crews and other emergency teams.
• We saw patient consent was obtained before undertaking treatment or observations.
• Staff did not demonstrate a clear understanding of the codes of practice for the Mental Capacity Act (2005) or Mental Health Act (1983).

Is the service caring?

• Staff provided compassionate care to patients and their families and maintained patients’ privacy and dignity at all times.
• Nationally feedback from the Friends and Family Test was positive, with most patients extremely likely or likely to recommend the service.
• Staff explained the care and treatment they needed to provide in a way their patients could understand.
• Patients were encouraged to be partners in their care and involved in decisions about their care and treatment.

Is the service responsive?

• The service worked effectively with the contract ambulance trust and commissioners for event first aid work, to ensure they planned services to meet the needs of local people.
• Managers investigated complaints and provided a written response to the complainant. Managers considered learning from complaints, but it was not evident that this learning was shared with all staff, to improve services.
• Services were accessible to all and staff had training to support patients in vulnerable circumstances. However, language and communications guides, which were on the equipment lists , were not found on all vehicles, to support patients who had additional communication needs.

Is the service well-led?

• There was a local vision for the service, which reflected the national values of the organisation.
• Governance arrangements were being developed nationally and locally, with greater attention given to monitoring and reviewing the quality of the service, against a number of key outcomes. The contract provider monitored response times for ambulance crews and discussed performance at monthly meetings with the service.
• Staff told us leaders were competent, approachable and visible. Staff felt well supported by their immediate manager.

• Staff told us British Red Cross Abingdon was a friendly and caring place to work. However, staff raised concerns around their personal safety and welfare, due to there being no panic alarm on ambulances.
• The service encouraged feedback from patients and staff through the use of surveys.
• The service had identified ways to develop and sustain its services.

However, there were also areas of poor practice where the location needs to make improvements.

The location should:

• Ensure all patient records are stored securely at all times.
• All staff should receive training on duty of candour in order to understand the principles of this and their role.
• Review the effectiveness of the safeguarding adults and children at risk training so that staff are clear about what constitutes abuse and when to report a concern.
• Review the current communication channels and process for requesting support in an emergency, for example if the staff are attacked.
• Provide all staff with training on the mental capacity act and mental health act and ensure staff understand how to use the codes of practice appropriately when caring for patients.
• Ensure all vehicles contain the language and communication guides, to support patients with language difficulties and ensure safe care and treatment.
• Consider providing complaints information on all vehicles.
• Review the provision of equipment for the safe transportation of children.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Updated 13 April 2016

This was a pilot inspection to test our new methodology for the inspection of independent ambulance services; therefore, no ratings were applied.

Two information governance breaches around safe storage of patient records were identified during the inspection. Completed patient records were found in a first aid bag, which was ready for use, and on unsupervised open ambulances potentially putting patient confidentiality at risk.

Staff had completed safeguarding training, but lacked confidence to identify potential safeguarding concerns. Staff raised concerns around being unable to escalate concerns promptly about deteriorating patients. Staff had to rely on the use of mobile phones to seek help, as there was no radio on the ambulance. There were sufficient numbers of suitably trained staff. Staff followed relevant procedures for reporting incidents and infection prevention and control.

The environment and equipment were well maintained. Vehicles were well stocked. The provider had started to introduce a new system for medicines management, to improve the stock control, storage and traceability of medicines.

Staff followed relevant national guidance to provide effective care for patients. Staff worked effectively with all healthcare professionals, involved in a patient’s care, to ensure care was planned and co-ordinated to meet the patients’ needs. Staff did not feel confident in the use of the codes of practice for the Mental Capacity Act (2005) and Mental Health Act (1983), when caring for patients and in relation to consent for treatment.

Patients received compassionate care that respected their privacy and dignity. Patients were involved in decisions about their care. Staff were caring, understanding and supported patients emotionally. Staff provided care which was person centred.

The needs of local people were considered when planning and monitoring services. Staff delivered care, which considered all the needs of the patient, not just their medical needs. However, language and communication guides were not available on all vehicles. Complaints were investigated and responded to, but learning was not widely shared with frontline staff.

The service had a local vision, which focused on the organisation strapline ‘Refusing to ignore people in crisis’. There were governance arrangements in place to monitor quality and risk, but improvements were needed to ensure action plans and risks were reviewed. The service was active in seeking feedback from patients, volunteers and staff. Senior staff identified ways to ensure sustainability and development of the service. Staff spoke of a positive caring culture, with good leadership. Staff did however raise concerns around their personal safety, due to there being no panic alarm on ambulances.