UCS Medical

This Independent Ambulance service provided the following activities: personal care, transport services triage and medical advice provided remotely and treatment of disease, disorder and injury.

In the previous 12 months the service had not undertaken any EUC services for patients. Where evidence gathered from the Patient Transport Service (PTS) was directly applicable to EUC we have used this evidence to inform our assessment and report findings.

We looked for evidence that safety was a priority for everyone and that managers had embedded a culture of openness and collaboration; however, this was not demonstrated. Managers did not have effective systems for identifying and responding to safety risks, and the service lacked robust safety processes for the preparation of vehicles, equipment, and the patient journey between locations.

We identified serious shortfalls in staffing, recruitment, and safeguarding arrangements. The service could not be assured that staff were safely recruited, appropriately trained, or competent for their roles, as pre-employment checks, induction, mandatory training, supervision, and appraisal processes were inconsistent or absent. There were not enough staff with the right skills, qualifications, and experience to ensure high-quality care, and managers did not ensure staff received up-to-date training or regular appraisals.

The service did not demonstrate a strong learning culture; staff reported feeling unable to raise concerns, patient feedback was not always acted upon, and incidents were not consistently or thoroughly investigated. While staff understood local safeguarding arrangements, these were not supported by clear or effective systems and processes at service level.

There were significant concerns regarding the safety of patient care and transport, particularly for bariatric and high-risk patients, due to unsuitable vehicles, lack of appropriate equipment, and insufficient staff training. Vehicles and equipment did not consistently meet patients’ needs, as they were not always clean or well-maintained, and risks were not adequately mitigated. The care environment presented additional risks, including damaged and poorly maintained equipment, expired consumables, and inconsistent cleaning practices. Furthermore, medicines management and infection prevention and control systems were ineffective, increasing the risk of harm to both patients and staff.

This is the first assessment of the service and safe is rated as inadequate. Patients were not safe and protected from avoidable harm.

We looked for evidence that patients and communities achieved the best possible outcomes because their needs were effectively assessed. However, the service did not consistently assess, plan, or deliver care in a way that ensured it was effective or met people’s individual needs.

In the previous 12 months the service had not undertaken any EUC services for patients. Where evidence gathered from the Patient Transport Service (PTS) was directly applicable to EUC, including patient record keeping, governance arrangements, monitoring of outcomes, and consent processes, we have used this evidence to inform our assessment and report findings.

Patient assessments were not always thorough, timely, or clearly documented, and gaps in records meant leaders could not be assured that people’s health, wellbeing, communication, and support needs were fully understood or reviewed throughout their care. As a result, there was limited assurance that care, support, and treatment were consistently tailored to individual needs, including protected equality characteristics.

Staff did not always have access to up-to-date policies or evidence-based clinical guidance, and there were no effective audit processes in place to monitor the quality of assessments, care delivery, or clinical outcomes. Patient outcomes were not routinely monitored, and patient feedback was not collected, further limiting the service’s ability to assess effectiveness.

We also looked for evidence that managers had embedded a culture of continuous improvement, where understanding outcomes and applying best practice formed part of everyday work. Although staff generally worked well together and with external services to support continuity of care, governance systems were not effective. Many policies were out of date, training compliance in key areas such as consent and capacity was low, and documentation systems did not adequately support the recording of capacity assessments where required.

The service did not routinely monitor outcomes, patient experience, or health inequalities, which limited its ability to identify risks, drive improvement, and provide assurance of effective care.

This was the first assessment of the service, and the effective domain is rated as inadequate.

In the previous 12 months the service had not undertaken any EUC services for patients. Where evidence gathered from the Patient Transport Service (PTS) was directly applicable to EUC, we have used this evidence to inform our assessment and report findings.

The service did not always treat people as individuals or consistently promote independence, choice, and control. People’s complex needs were not always identified in advance, and reasonable adjustments were not consistently planned. Staff wellbeing was not always effectively supported, and some staff did not feel valued by managers or able to raise concerns, which limited assurance about the consistent delivery of person-centred care. Information was not routinely collected to support and monitor how people were treated as individuals or how independence, choice, and control were promoted.

This was the first assessment of the service, and the caring domain is rated as requires improvement.

In the previous 12 months the service had not undertaken any EUC services for patients. Where evidence gathered from the Patient Transport Service (PTS) was directly applicable to EUC, we have used this evidence to inform our assessment and report findings.

We looked for evidence that patients and communities were at the centre of how care was planned and delivered, including whether their needs were understood and whether they were actively involved in decisions about their care. However, the service did not consistently provide person-centred or inclusive care. Patients were not always involved in decisions about their care, and staff did not consistently understand or use systems to identify and respond to complex needs, including learning disabilities, autism, dementia, and mental health needs.

Feedback and complaints processes were ineffective, and leaders could not demonstrate how patient feedback was recorded, responded to, or used to improve care. In addition, the service did not monitor equity of access, experience, or outcomes, which limited its ability to identify or address health inequalities. Governance arrangements did not provide sufficient assurance that care was consistently responsive or driven by patient involvement.

However, staff were generally responsive when patients’ needs changed during journeys and usually ensured continuity of care for complex transfers.

This was the first assessment of the service, and the responsive domain is rated as requires improvement.

In the previous 12 months the service had not undertaken any EUC services for patients. Where evidence gathered from the Patient Transport Service (PTS) was directly applicable to EUC, including governance arrangements, risk management, and audit, we have used this evidence to inform our assessment and report findings.

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement, based on meeting the needs of patients and the wider community. However, this was not demonstrated. Many staff did not understand how their roles contributed to strategic objectives and reported feeling insufficiently supported or valued. Leadership oversight and engagement were inconsistent, and arrangements for staff feedback, freedom to speak up, and workforce equality were not robust, limiting staff confidence that concerns would be addressed. Opportunities for learning and development were limited.

We also assessed whether managers proactively supported staff and worked collaboratively with partners to deliver care that was safe, integrated, person-centred, and sustainable, and to reduce inequalities. Governance, management, and assurance systems were ineffective in supporting this. Policies were not routinely reviewed, audits were not undertaken, and risks were not consistently identified or mitigated. Roles and accountabilities were unclear, and leaders could not provide assurance that safety, quality, and sustainability were being effectively managed.

This was the first assessment of the service, and the well-led domain is rated as inadequate. This meant patients’ needs were not met through good organisation and delivery of care.