CQC say that North West Ambulance Trust are focused on quality

England's Chief Inspector of Hospitals has published his first report on the quality of care provided by North West Ambulance Service NHS Trust.

Overall the CQC inspection found that the trust provided safe and effective services which were well-led with a clear focus on quality.

North West Ambulance Service NHS Trust is the first ambulance trust to be inspected under radical changes which have been introduced by CQC to provide a more detailed picture of healthcare than ever before. A full report of the inspection is available here.

The inspection team included CQC inspectors, doctors, nurses, paramedics, patient experts by experience and senior managers. The team spent four days visiting the trust’s three emergency operations centres covering Cheshire and Merseyside, Greater Manchester, and Cumbria and Lancashire, and shadowing ambulance crews and paramedics during August. They visited 50 of the 100 ambulance stations within the trust. They also visited local A&E and Outpatient departments to talk to patients and staff about their experience of the ambulance service.

Inspectors examined the care and treatment provided by the trust, reporting in detail on access to the service, emergency and urgent care and patient transport services.

Patients who met inspectors were overwhelmingly positive about the quality of their care, and inspectors saw staff treating patients with compassion, dignity and respect. Staff showed a caring, committed and compassionate manner, whatever the environment or challenges they faced.
In comparison with England’s nine other regional ambulance services, inspectors found that the performance of NWAS varied in some areas of clinical quality:

This year 71.9% of the trust’s patients who had suffered a stroke, arrived at a hyper acute stroke centre within 60 minutes of the original 999 call; this performance was the second best of all ambulance trusts.

But a significant number of people who dialled 999 hung up before they got through and compared with all other trusts, NWAS was the most likely to send an ambulance rather than deal with an emergency caller by finding alternative solutions.

Over the whole year, the trust was better than the national average in responding to 75.9 per cent of patients with immediate life threatening conditions within eight minutes.

The inspection team found several areas of good practice.

• Patients who called more than twice in seven  days or four times in 28 days were recognised as frequent callers, and helped by a specialised team that  liaised with the caller, their GP and other social care providers to ensure that the person’s health and social care needs would be met.
• Clinical staff performance was monitored and all paramedics’ results were published within the team so that each of them could compare their performance against their colleagues. At the time of the inspection, 55% of staff had completed their training in ‘Prevent, which is part of the UK government’s counter-terrorism strategy.
• The trust encouraged the ongoing education of their staff at all levels. The commitment and enthusiasm for the use of volunteer community first responders and their support was evident. They received a comprehensive 6-month package of training, and then continuing training and support.

There were also areas for improvement:

• Getting the most appropriate vehicle to the patient –whether it be, community first response, Paramedic rapid response or air ambulance. The trust aimed to achieve this 60 percent of the time. However, this had only been achieved in 40 percent of cases from July to September 2014.
• The service took a high number of patients to hospital when alternative services may have been more appropriate in meeting their needs. The trust was the worst performing nationally in this area.
• The trust needs to make sure its staff receive appropriate supervision and appraisal.

Professor Sir Mike Richards, Chief Inspector of Hospitals, said:

“We rely on our ambulance services to be there whenever we need them – but there is so much more to a good service than simply arriving on time.  The key to providing an excellent ambulance service is in first managing all the calls that come in to ensure that patients in need  get the best possible service – whether it is from a paramedic at the scene, or in being advised to attend a walk in centre, if that’s appropriate.

“Overall, we found services provided by North West Ambulance Service NHS Trust were safe, well led with a focus on quality.

“Although it did achieve all key national ambulance targets for response times last year, I note that the picture has been mixed so far this year. In terms of clinical quality, and patient outcomes, I am sure that NWAS will keep a close watch on its performance against the other ambulance trusts, to understand how it can improve its service to patients.

“While I can only commend the staff for their dedication and effort, I will continue to watch their progress in these areas.”