West Norfolk's ambulance service still not good enough say inspectors
The East of England Ambulance Service has been told that once again it "requires improvement" by the health service watchdog, the Care Quality Commission (CQC).
The report released today found the service provided by the EEAST as lacking in many areas when the inspection of three of the trust’s core services – emergency and urgent care, resilience and patient transport services – took place in April and May.
The trust board has recognised that there are a number of areas for improvement in the well-led aspect, which was rated as inadequate.
The report did commend the care, commitment and dedication of hard-working staff.
But it also said: "The services still did not have enough staff to care for patients and keep them safe despite a focus on recruitment and retention.
"Not all staff consistently received mandatory training and although the trust provided updated information after our inspection that demonstrated some improvements, this was a continued breach of regulations. There was a continued breach of regulations in relation to medicines being managed safely.
"Staff did not receive regular appraisals and systems in place to ensure that staff were competent for the roles continued to be inconsistently applied across services. People continued to wait too long for services and response times although improved, continued to be worse than the England average.
"The rating for well-led had declined from requires improvement to inadequate. There continued to be a mixed culture at the trust and not all staff felt that concerns were listened to. There was instability within the senior leadership team with some key leaders in interim positions.
"The recently implemented strategies and initiatives developed to improve performance, governance and staff welfare were yet to be embedded. Whilst the quality of services had not declined and there were signs of improvement in specific areas there were continued breaches of regulations."
Inspectors said: “Despite factors such as high service demands and frequent callers, staff strived to always provide care that was compassionate, respectful, supportive, never time-rushed and met patients’ needs.”
They also noted that the trust’s emergency service consistently performs better than the national average on the NHS Friends and Family Test, scoring between 95 per cent and 100 per cent.
The trust maintained an overall rating of ‘Requires improvement’. The trust’s rating for Responsive was improved to ‘Good’ and it maintained its ‘Outstanding’ rating for the compassion and kindness staff show to patients and their families.
The trust’s resilience team was praised for exceeding targets and rated as ‘Good’ (with an area of ‘outstanding’ practice) while the Patient Transport Service improved its rating to ‘Good’.
CQC inspectors commented that leadership was more visible, resilience was good and steps had been taken to reduce hospital handover delays.
They also heard from staff that the culture of the Trust is changing and that the interim chief executive, Dorothy Hosein, has engaged extensively and addressed many of their key concerns. They were positive about the impact that she and the leadership team is now having and the pace at which improvements are taking place.
However, the CQC reported that further work is needed to be done to embed those improvements. This includes improving response times, boosting recruitment and making sure the way medicines are stored, administered and prescribed is consistent.
The board afterwards said it will be focusing on creating a stable leadership team including recruiting a permanent chair and chief executive, embedding governance and risk processes across the trust, further improving staff engagement and the trust culture, including successful safety huddles and strengthening the HR function.
Nigel Beverley, interim chairman of EEAST, said: “I am pleased to have joined EEAST at such an important stage in its improvement journey. There has been turnover within the Trust Board in the last few months. However, we are strengthening the leadership and rebuilding the senior team over the next 12 months.”
Mrs Hosein, interim chief executive, said: “I am delighted to see that this report rightly pays tribute to the outstanding care that our staff and volunteers deliver to patients on a daily basis. I am pleased that the inspectors noted the positive changes underway.
"Over the coming months my commitment is to ensure that our patients and staff really feel the impact of these improvements.”
UNISON, the public service union, said it was disappointed but not surprised at the CQC findings.
Sam Older, regional organiser, said: "UNISON knows how hard the job is for our members and it is a credit to the staff that they remain overwhelmingly dedicated to providing the best care they can.
"Since the inspection in April there have been a number of changes within the senior leadership team and UNISON would urge these new leaders to listen to their staff, to lead well and improve the rating in this section from its current rating of being 'inadaquate'.
One of the big issues that needs to be addressed is the embedding of proccesses that help suport staff welfare.
"Many UNISON members are frustrated that the Trust has not been able to improve recruitment and retention to have enough staff to provide a safe and responsive service to patients."