Ambulance Service Placed into Special Measures by the CQC

England’s Chief Inspector of Hospitals has rated SSG UK Specialist Ambulance Service – South as Inadequate and placed the service into special measures following its latest inspection by the Care Quality Commission.

A team of inspectors from the Care Quality Commission visited SSG UK Specialist Ambulance Service – South at Wickham Road, Fareham, Hampshire during August and September 2018 in response to concerns received relating to medicines, staffing, overall management of the service and one of the provider’s ambulances being involved in a road traffic collision.

SSG UK Specialist Ambulance Service – South provides both emergency and urgent care and patient transport services throughout the south-east. These services are commission by local NHS trusts.

Key Concerns 

• Inspectors found that the overall management of medicines was not safe or line with legislation. Controlled drugs were not managed safely and as there were no regular audits SSG 
• Records of medicines that were destroyed were incomplete and the provider could not provide any assurance that this was undertaken in line with legal requirement and the service’s guidance. 
• The service could not provide an accurate count of staff who were employed or worked as bank staff, but thought there were around 650 staff recruited with 300 of these working on a regular basis.
• There was no assurance that all staff working for the provider held a current disclosure barring service check and active professional registration.
• Not all managers had the necessary skills, knowledge or experience to lead and develop the service. There was limited evidence they understood the challenges to service quality and overall sustainability of the service.
• One of the secure vehicles used for the transport of mental health patients was not fit for purpose. The area that was used to transport patients, had a metal bench with no padding on the seat, this was rusty and patients had to sit directly on the metal.
• There was limited evidence on how there was assurance that staff followed the restraint policy and protected patients from the risks of harm. The nine records for secure patients where restraint had been used showed that staff did not follow the full process.
• There were no risks assessments completed and staff did not record a clear rationale for the use of restraint.

CQC Deputy Chief Inspector of Hospitals, Dr Nigel Acheson, said "“We are all well aware that our ambulance services are under a tremendous amount of pressure and scrutiny. However, when we inspected SSG UK Specialist Ambulance Service – South in August, we were extremely concerned at the disconnect we identified between the senior team and the staff working on the frontline. We saw no sign of a clear vision and strategy and a lack of response to the concerns we had previously raised."

“On the basis of this inspection, we have placed this provider into special measures. That means that SSG UK Specialist Ambulance Service – South will be inspected again within six months. We are currently engaging with the provider and monitoring the service very closely. If insufficient improvements have been made, we will take action in line with our enforcement procedures.”

New Government Funding Released to Support Electronic Prescribing

13 NHS trusts will receive a share of a £78 million fund to support electronic prescribing and medicines administration (ePMA) to improve patient safety.

New electronic systems will help hospital trusts move away from handwritten prescriptions:

• reducing potentially deadly medication errors by up to 50% when compared with the old paper systems 
• building up a complete electronic record 
• ensuring fast access to potentially lifesaving information on prescribed medicines 
• reducing duplication of information-gathering 

The 13 NHS trusts have been chosen because they provide a mixture of acute, mental health and community services. They will receive a share of £16 million funding for 2018 to 2019.

The roll-out of full ePMA across healthcare organisations is designed to improve efficiency in the healthcare system by:

• making the most effective use of medicines 
• increasing the use of digital systems to generate additional data sets 

This will help clinicians gain a greater understanding of the management of diseases.

Andrew Davies, Director of Hospital Pharmacy, NHS Improvement said "There is evidence that electronic prescribing and medicines administration systems will improve safety for patients, reducing the risk of harm and ensuring high-quality efficient patient care which is as safe as possible.

I’m delighted so many trusts have submitted successful bids to accelerate the introduction of these systems to provide safer, better quality patient care. We are now looking for more trusts to bid for funding by the end of January."

The first regional allocations are as follows:

• Bolton NHS Foundation Trust - £1,020,000 
• The Rotherham NHS Foundation Trust - £750,000 
• Mid Yorkshire Hospitals NHS Trust - £1,600,000 
• Humber NHS Foundation Trust - £300,000 
• Northern Lincolnshire And Goole NHS Foundation Trust - £940,000 
• Kettering General Hospital NHS Foundation Trust - £820,000 
• University Hospitals of North Midlands NHS Trust - £2,190,000 
• Barts Health NHS Trust - £1,700,000 
• East London NHS Foundation Trust  - £740,000 
• East Kent Hospitals University NHS Foundation Trust - £1,450,000 
• Frimley Health NHS Foundation Trust - £1,170,000 
• Buckinghamshire Healthcare NHS Trust - £1,620,000 
• East Sussex Healthcare NHS Trust - £1,700,000 

Small and Medium Size Businesses Offered Free Support to Grow Their Digital Exports

Baroness Fairhead, Minister of State at the Department of International Trade, has announced a new partnership between the Exporting is GREAT campaign and Google, which will see the Digital Garage deliver an exporting education series for 2000 SMEs in 2019.

Focusing on helping businesses grow their digital export operation, the events will be hosted in Manchester, Edinburgh and on university campuses around the UK. The training will be split into three modules which focus on:

• finding new global opportunities, 
• setting up new export operations,
• and marketing.

Ronan Harris Google MD UK and Ireland said "We firmly believe everyone should be able to benefit from the opportunities that technology brings and we want to give people the skills they need to grow their confidence, career or business.

Looking forward to 2019, there is tremendous potential to envisage what we can achieve from working with the Department for International Trade to roll out a brand new training offering to small and medium enterprises providing valuable insight to support their export operations."

A recent Google business survey found that 70% of SMEs said that they lacked the skills needed to find the best overseas markets to enter.

The new partnership builds on an existing relationship which saw the Department for International Trade and Google working together to build a new online ‘Market Finder’ tool which allows companies to find overseas opportunities at the click of a mouse.

Care Home Fined £30,000 by CQC For Failing to Protect People in its Care

A care home provider has been fined £300,000 for allowing a man in its care, with a history of sexual assaults, the freedom to prey on vulnerable people.

The Care Quality Commission brought the case against Hillgreen Care Limited for not providing the constant, one-to-one supervision required for the man, failing in its duty to protect people in its care and exposing them to the risk of sexual abuse.

Highbury Corner Magistrates’ Court was told that on 1 November 2015, an autistic man was assaulted at Hillgreen’s care home at Colne Road, in Enfield, north London. At the time there were only two care staff on duty to look after six people.

One of the residents, who was described as non-verbal, with limited mental capacity, was followed up to his room and, allegedly, raped. The incident was eventually reported to the police, but partly because of the alleged victim’s mental capacity and a lack of evidence, no prosecution ensued.

The alleged perpetrator had been under the care of Hillgreen Limited for 10 years. Mr Paul Greaney QC, representing CQC said that: “XX is a predatory and opportunistic sex offender” and was a risk to both sexes. Numerous allegations involving vulnerable adults and children had been made against XX dating back to his childhood.

The court heard from expert witness, Chartered Clinical Psychologist, Dr Neil Sinclair, who said that it should have been apparent to Hillgreen Care Limited that there was an extremely high risk of XX committing sexual offences. XX needed to be monitored at all times.

Dr Sinclair said that if that monitoring been carried out, the alleged attack would probably never have happened. Residents at Colne Road were exposed to potential and actual harm.

A number of care workers who had worked at Colne Road gave evidence - although nobody from the senior Hillgreen management team.

A support care worker, who said she had not been given any instructions about watching XX, said that she walked in on XX while he was assaulting another service user, described as YY, on 1 November 2015.

Following the alleged sexual assault Colne Road Home Manager, said that the home was no longer a place he wanted to work after the incident. He said that staffing levels were inadequate and that he had raised the matter with senior Hillgreen management, but that nothing had been done about it.

Paul Greaney QC said: “YY plainly needed to be protected from abuse. One only needs to think for a moment about the situation that existed in that care home, a vulnerable man, in an environment in which a predatory sexual offender was largely free to roam, to realise that YY needed protection.”

Andrea Sutcliffe, CQC's Chief Inspector of Adult Social Care, welcomed the judgment and sentence: "As the judge has made clear, Hillgreen Care Limited utterly failed in their duty of care for the people they were responsible for supporting. YY should never have been exposed to the potential of sexual abuse from XX and the impact on him and his family is heartbreaking. My thoughts are with them today.

"It has taken a long time to bring this prosecution to a conclusion but the outcome proves that it has been worth the effort and dedication of CQC's inspection and legal teams. Providers should be clear that if people are exposed to harm through their failure of care we will take every step we can to hold them to account."

70% of People Agree That UK Universities Are Among The Best in the World!

BritainThinks poll, conducted on behalf of Universities UK, looked in detail at public perceptions of higher education.

The poll of 2,063 UK adults showed just 9% of the public feel negative towards universities, with 48% saying they feel positive. 66% of people agreed with the statement that they would encourage their children to attend university.

There were other positive markers of public opinion too:

• 58% of people believe that universities have a positive impact on the UK.
• 55% of people agreed that people who go to university can get better jobs than those that don’t.
• 70% of people agree that UK universities are among the best in the world.
• 55% of 18-24 year olds and 44% of 25-34 year olds said universities have had a positive impact on them personally, compared to 35% of people aged 65+.
• 34% of 18-24 year olds said universities have had a positive impact on their local community, compared to 26% of those aged 65+.
• Young people are much more likely to disagree with the statement “university degrees do not equip graduates with the skills they need to be successful in the workplace” (35% of 18-24 year olds disagree, compared to 24% of those aged 65+). 
• BAME adults are much more likely to say that universities have a positive impact on their family than white adults (60% compared to 43%). 
• BAME adults are more likely to say that universities have a positive impact on the UK as a whole than white people (68% compared to 57%).

Professor Dame Janet Beer, President of Universities UK and Vice-Chancellor of the University of Liverpool, said: “There is a myth that the public are sceptical about the merits of universities – and that an increasingly large number of young people think higher education is a waste of time. In fact, as this research shows, the opposite is true. The public are hugely positive towards universities and see the benefits of a university education. Crucially, this is most true of those with direct experience of university – existing students and recent graduates. That is one of the reasons why demand for university places has remained high despite there being fewer 18-year-olds in the population.

“Politicians need to work with the higher education sector to extend the number of people accessing universities and to give more support for flexible learning, promoting pride in what is a world-class sector, rather than creating new obstacles.”

CQC Launches New Web Based Resources Focusing on Using Technology to Improve Care

A new resource section has been added to the CQC’s website focusing on how technology can be used to improve care.

Pages will be added as new topics are addressed by the CQC and will explore the use of technology in care.  Looking at the benefits of innovation and updating previously published information on surveillance.

Technology can:

• give people more control over their health, safety and wellbeing
• support them to be more independent or feel less isolated
• link them to services which are important for them
• enhance the care or treatment providers offer
• help them communicate with families, professionals and staff
• help staff to prioritise and focus their attention on people who need it most
• capture and compare data, and share good practice with peers.

To use technology well, the interests of the person using the service must be at its heart.  People's safety, dignity and consent must be at the centre of decisions about their care. This applies to decisions about the use of new technology. Being clear about people's rights, privacy and choice must always come first.
Updates will look at what providers will need to consider as they develop new ways of working with technology.

The 'technology in care' pages already include:

• Using surveillance in your care service 
• Appropriately handling personal information 
• Understanding 'informed consent' 

Visit the Technology in Care page by clicking here.

Welsh SMEs Urged to Claim £2500 Government Funding to Boost Broadband Before it is Too Late

Businesses from Wales are being urged to make use of a £2500 voucher from the UK Government for gigabit broadband speeds before the scheme closes due to high demand.

The UK Government’s Gigabit Broadband Voucher Scheme has already helped more than 7000 UK businesses and surrounding homes, who have used the vouchers to contribute to (and in many cases fully fund) the installation cost of a full fibre gigabit capable connection.

The £67 million scheme was initially expected to run until March 2021, but high demand for vouchers means that funds are now expected to be committed a year earlier, and perhaps even sooner if the current success of the scheme continues to grow.

To date, 58 vouchers have been issued to premises in Wales and the UK Government is calling on businesses and residents to apply for the voucher before the scheme comes to an end.

UK Government Minister for Wales, Nigel Adams said "Improving connectivity for homes and businesses is a central pillar of the UK Government’s efforts to strengthen the Welsh economy.

The UK Government’s broadband connection voucher scheme is proving to be tremendously popular. Homes want to benefit from superfast broadband speed and businesses need to be properly equipped for all the challenges of the digital world in which we live. I urge all eligible businesses and home owners to apply as soon as possible to make sure they don’t miss out on the fantastic offer."

These vouchers provide practical and immediate help to firms struggling with slow broadband speeds.  To ensure as many businesses and homes benefit, the maximum value of the voucher has been reduced from £3000 to £2500. The government hopes this will encourage neighbouring businesses to “pool” their vouchers.  This will enable the scheme to reach more properties without the need for any additional funding. 

The scheme is part of a series of Government initiatives to build a Britain with nationwide full fibre broadband coverage by 2033, making sure no communities are left behind. In addition to the voucher scheme, the Chancellor recently announced £200 million for an ‘outside-in’ approach that will see full fibre broadband rolled out in the hardest to reach rural locations at the same pace as the rest of the country. The Borderlands, Cornwall, and Welsh valleys will be amongst the first areas to be targeted.

More information on the Gigabit Voucher Scheme, including details on how businesses can apply can be found here

CQC Update Equally Outstanding Learning Modules

A year ago the CQC published Equally Outstanding, a resource which shows how a focus on equality and human rights can improve care quality – even in times of financial constraint.

One year on, they have updated Equally Outstanding with a new e-learning module,
extra case studies from outstanding providers
and an updated pdf version based on feedback.

These resources are designed to help people working in health and social care to:

• understand the different reasons why a focus on equality and human rights can improve care quality
• make the case for equality and human rights in quality improvement work
• learn from providers who have worked on equality and human rights to deliver outstanding care
• reflect on the common success factors in outstanding providers using equality and human rights to improve care
• think about how a focus on equality and human rights can help meet challenges in times of financial constraint

Why pay attention to equality and human rights?

The Ethical Case

Paying attention to equality and human rights improves care as it gives people the outcomes they want.  Human rights cover the FREDA principles of:

• fairness
• respect
• equality
• dignity
• autonomy

Outstanding providers have tackled this by putting better outcomes for people at the heart of their service development.

Person-centred care is essential because it is based on respect and autonomy meets individual needs so helps achieve equality.

The Business Case

• There is a link between equality and inclusion for health and social care staff and quality of care.
• Improving workforce equality can reduce costs by reducing staff turnover, absenteeism and disciplinary action.
• A diverse workforce adds value to the organisation.
• For people using the service, addressing equality and human rights can both improve the quality of care and save costs. For example: sending information in appropriate formats or languages could reduce missed appointments; environmental adaptations in social care services can increase autonomy; welcoming, easily accessible services can lead to earlier diagnosis and treatment.  
• The CQC sees links between quality ratings and how providers perform on equality and human rights.

The Economic Case

A focus on equality and human rights can save the country money.  For example: ill health, or a deterioration in people’s health, can be prevented if health inequalities or barriers to accessing services are tackled; ill health leads to lower productivity and higher welfare costs so services can help enable people to participate socially and economically.

The Legal Case

Considering equality and human rights is often a legal requirement.

CQC regulations are designed to ensure that people using services have their human rights upheld.

The Mental Capacity Act 2005 gives specific human rights protection to adults who may not be able to make particular decisions.

Service providers must comply with equality legislation

Find out more at Equally Outstanding: Equality and human rights - good practice resource