CQC finds safety at EMAS is ‘inadequate’ because of lack of staff and vehicles

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The East Midlands Ambulance Service (EMAS) has been rated as “requiring improvement” by the Care Quality Commission (CQC) in a new report out today, Tuesday May 20.

As well as rating the ambulance service as requiring improvement, the report rated the service as “inadequate” for safety, stating that there were concerns over the lack of staff and vehicles needed to respond to patient needs.

The CQC inspected three core services at EMAS:

* Emergency and urgent services (across the East Midlands)

* Patient transport services (in north and north east Lincolnshire)

* Emergency operations centres (one in Nottingham and one in Lincoln)

EMAS Acting Chief Executive Richard Henderson said: “The Care Quality Commission complimented all of our staff for their passion and commitment to providing high quality, safe care for patients.

“Inspectors found that we were open and honest about the challenges we were facing and what we are doing to address them.

“The CQC report gives EMAS a ‘good’ rating for two of the five measures - caring and responsive, and highlighted several areas of outstanding practice and services our colleagues can rightly be proud of.

“The report recognises that we have been working really hard to improve response times to emergency calls. However there are concerns that ultimately relate to our lack of resource (staff and vehicles), made worse by the numbers often kept waiting at hospital, and lack of capacity to do things as quickly and as well as we need to.

“As a result we have been rated as ‘inadequate’ for safety. The report makes it clear that this relates to insufficient numbers of staff and vehicles – not to the quality of care provided by our staff. We are rated ‘requires improvement’ for the effective and well-led measures. We are sorry and disappointed that we have not met the required standard for these measures.

“EMAS is an emergency ambulance service and people in the East Midlands can assured that we always prioritise our response to our most critically ill and injured patients.”

The CQC key findings at the time of inspection include:

* All staff were passionate about and committed to providing high quality, safe care for patients

* There was an unrelenting demand for emergency services combined with a lack of staff and resources to meet the need

* There were insufficient staff and a lack of appropriate skill mix to meet the needs of patients in a timely manner

* Despite hard work to recruit, the service found it a challenge to retain staff; this is not unique to EMAS

* Frontline leaders did not have the capacity to fulfil their managerial responsibilities

* Many staff were not receiving performance development reviews (appraisals), and statutory and mandatory training rates were not achieved

* There was a clear statement of vision and values driven by quality and safety, and the Trust Board functioned effectively

* Without exception, the Chief Executive was held in high regard by staff for her visible, open approach

Mr Henderson added: “We are taking the CQC findings seriously and value the additional support that we will be getting from other NHS organisations. With their input we will be able to progress areas that we cannot fix quickly, or that are not within our immediate control, for example the delays we experience at hospitals when they are not able to accept a clinical handover from our ambulance crews.

“A key part of our Accident and Emergency 999 Contract awarded for 2016/17 is the agreement to carry out an independent strategic demand, capacity and price review.

“This will look in detail at the level of demand we have experienced, and the level of staff and vehicles needed, along with finance, to be able to respond. Together with the clinical commissioning groups that pay us to provide a service, we have agreed to implement the outcomes of the review, and this should ensure we are able to meet demand.

“Despite funding challenges during 2015/16, we have recruited over 300 new frontline staff since April 2015, and following the approval of a Business Case in March 2016 we will invest in an additional 68 ambulance vehicles this year.

“Another big challenge we face is retaining our staff and recruiting qualified colleagues to improve our skill mix. There are staff that report low morale, and the CQC acknowledge that is no surprise with the unrelenting pressure, combined with lack of resources to meet demand. There is a national shortage of paramedics and the better work life balance and pay rates for paramedics in other areas of the NHS (e.g. urgent care centres) makes it very difficult for us to retain colleagues.”

EMAS Chairman Pauline Tagg added: “We accept the CQCs report and welcome their observations following the inspection in November 2015. The CQC recognised that there is a clear vision in place and that our Trust Board operated effectively.

“I have confidence in our Acting Chief Executive, and the recent appointments of a chief operating officer and improvement advisor will help us to address the ‘must do’ actions identified by the CQC, and further strengthen and drive improvements already identified at EMAS.”