Review of

compliance
South Central Ambulance Service NHS Trust
Provider

Region: South East

Units 7-8, Talisman Business Centre

Provider address:
Talisman Road
Bicester
Oxfordshire
OX26 6HR
Type of service: Ambulance services

Date the review was completed: November 2010

South Central Ambulance Service NHS Trust

Overview of the service:
(SCAS) provides emergency response and
SCAS employs over 2,400 staff. This includes
approximately 1,200 clinical practitioners and
300 people working in three emergency centres.
The service provides an accident and
emergency care and patient transport. It has
access to two helicopters, motorcycles and
double and single-crewed paramedic
ambulances. Operational staff include

Page 1 of 24
Review of
compliance
ambulance care assistants, emergency care
assistants, ambulance technicians, paramedics,
control room staff and emergency care
practitioners. In addition, there are ambulance
nurses and clinical support desk practitioners.
The service also uses Community First
Responders - a large group of volunteers
formed to provide the first response in some
emergencies. In addition, about a third of the
workforce are employed for patient transport
services.

Page 2 of 24
Summary of our findings
for the essential standards of quality and safety

What we found overall

We found that South Central Ambulance Service NHS Trust was

not meeting one or more essential standards. Improvements are
needed.

The summary below describes why we carried out the review, what we found and
any action required.

Why we carried out this review

We carried out this review because concerns were identified in March 2010 in
relation to three outcomes:
• Care and welfare of people who use services
• Cooperating with other providers
• Supporting workers

The Care Quality Commission (CQC) issued an improvement letter to the trust in
relation to these three outcomes, as follows:

Regulation 9, Outcome 4, Care and welfare of service users

The trust must provide evidence to the CQC of actions being taken to manage
and mitigate the ongoing risk to service users represented by the continued
inability to meet contractual service requirements.

Completion date: 31 July 2010.

Regulation 23, Outcome 14, Supporting Workers

The trust must provide evidence to the CQC that it has taken reasonable
action to ensure that all staff employed by the trust have had an annual
appraisal by 30 September 2010, and evidence to demonstrate that identified
training needs are responded to appropriately.

Completion date: 31 October 2010.

 Regulation 24, Outcome 6 Cooperating with other providers

The trust must provide evidence to the CQC on the work underway to improve
working relationships and communication with commissioners and partner
provider organisations in the planning, monitoring and delivery of ambulance
services.

Completion date: CQC 31st July 2010

How we carried out this review

We reviewed all the information we hold about this provider in relation to these three
outcomes, carried out a visit on 8 October 2010 and talked to staff.

What people told us

Patients and service users were not interviewed for this particular review, due to the
nature of the ambulance operation. However, a review of patient views, undertaken
in February 2010, showed that overall quality of service was viewed as excellent. In
the majority of cases, vehicles were seen as being comfortable and suitable to
needs, in all cases there was total confidence in the ambulance staff and in the
majority of cases patients reported that pain was controlled.

What we found about the outcomes we reviewed and how well

South Central Ambulance Service NHS Trust was meeting them.

Outcome 4
People should get safe and appropriate care that meets their needs and
supports their rights

Overall, we found that South Central Ambulance Service (SCAS) NHS Trust was
meeting this essential standard but, to maintain this, we have suggested that some
improvements are made.

The trust is addressing the key concern that we had with performance, through
agreeing a contract with its commissioners, and meeting the national response
indicators. The contract has required both the trust and its commissioning Primary
Care Trusts (PCTs) to implement initiatives to improve demand management and to
deploy staff more effectively. There is evidence that progress has been made in
extending the more successful initiatives, such as the Make Ready scheme for
vehicles, the falls referral scheme, GP triage and the clinical support desk. Whilst
these initiatives have helped the service to employ ambulance crews more
appropriately, demand for emergency services continues to rise and there is a risk
that these initiatives will not release enough staff to maintain the improvements in
response rates.
National response indicators are now being met for immediately life-threatening calls
and the trust is monitoring clinical outcomes through a set of clinical performance
indicators. There is concern however over the sustainability of this improvement in
response times. There is generally a greater demand for emergency services over
the winter and the current performance is only just above target, allowing very little
contingency. Also, training postponed from August and September has been
scheduled for the last two quarters of the year, which will take staff off the road in the
winter period. In addition, when the results for response times are viewed by area,
people in rural areas are still not receiving an improved level of service.

Outcome 6
People should get safe and coordinated care when they move between
different services

Overall, we found that South Central Ambulance Service NHS Trust was meeting this
essential standard.

The trust is committed to developing effective working relationships with its

commissioning PCTs and partner organisations providing healthcare. We have seen
evidence that performance information is shared regularly and that the trust actively
seeks opportunities to discuss its strategic aims and delivery issues with its partners.

Outcome 14
Staff should be properly trained and supervised, and have the chance to
develop and improve their skills

Overall, we found that improvements are needed for this essential standard.

The trust’s recording mechanisms for training and induction are not yet robust due to
a change in systems, and from the data we viewed, it is not clear whether all new
starters have received an induction. Not all staff have received statutory and
mandatory training in the past year. Some staff report undertaking training in their
own time. Operational pressures to meet performance measures can lead to the
postponement of training. The trust has however instigated a new programme of
clinical training and has developed innovative ways of delivering this.

Not all staff have had appraisals in the past 12 months. The improvement letter sent
in April 2010 required the trust to take reasonable action to ensure that all staff had
had an annual appraisal by 30 September 2010. Although the trust has increased the
percentage of staff appraised from 35% to 70% there is still a high proportion of staff
who have not had an appraisal by the agreed timescale. There is wide variation in
the percentage of staff who have been appraised across the resource centres. Staff
we interviewed reported that the appraisal process is generally effective and valued.
Feedback from staff indicates that training needs are discussed at appraisals and
that they are enabled to access training courses for their own development, relevant
to the work they undertake.
Action we have asked the service to take

We asked the provider to send us a report by 10 December 2010 setting out the
action they will take to improve, and information was received by this deadline. We
will check to make sure that the improvements have been made.
What we found
for each essential standard of quality
and safety we reviewed
The table below shows our judgement on each of the essential standard outcomes
we reviewed.

Compliant means that people who use services are experiencing the outcomes
relating to the essential standard.

A minor concern means that people who use services are safe but are not always
experiencing the outcomes relating to this essential standard.

A moderate concern means that people who use services are safe but are not
always experiencing the outcomes relating to this essential standard and there is an
impact on their health and wellbeing because of this.

A major concern means that people who use services are not experiencing the
outcomes relating to this essential standard and are not protected from unsafe or
inappropriate care, treatment and support.

Outcome Judgement for the service

Outcome 4:
Care and welfare of people who Minor concern
use services
Outcome 6:
Cooperating with other Compliant
providers

Outcome 14:
Minor concern
Supporting workers

The following pages detail our findings and our regulatory judgement for each
essential standard and outcome reviewed, linked to specific regulated activities
where appropriate.

More information about each of the outcomes can be found in the Guidance about
compliance: Essential standards of quality and safety.
Outcome 4:
Care and welfare of people who use services

What the outcome says

This is what people who use services should expect.

People who use services:

• Experience effective, safe and appropriate care, treatment and support that
meets their needs and protects their rights.

What we found

Our judgement

There are minor concerns with outcome 4: Care and welfare of people who use
services

Our findings

What people who use the service experienced and told us

Patients and service users were not interviewed for this review.

Other evidence
The trust provided documentary evidence to show the actions it had taken to
achieve compliance. CQC compliance inspectors also interviewed staff at three
ambulance resource centres during a visit on 8 October 2010, in Southampton,
Newbury and Oxford, to assess whether these actions were being implemented
effectively. A range of staff were interviewed including operations managers,
operations supervisors, emergency care practitioners, paramedics, technicians,
emergency care assistants, clinical supervisors, trainees and patient transport
services staff.

The June 2010 trust board minutes document board approval of the 2010/11
contract with the Primary Care Trusts (PCTs) commissioning the SCAS services.
These minutes, and the earlier board minutes from May 2010, refer to the key issues
for debate within the contract, including the need for improved partnership working
to achieve a reduction in demand management. The contract includes performance
measures and specific clauses to reduce demand. Reducing demand is the key
priority for the trust and the contract with commissioners includes targeted
reductions in demand for each quarter. The commissioners have agreed to reduce
999 call demand by an average of 8.8% in the first year. Trust performance against
the contract is monitored on a regular basis, and this process is recorded in monthly
board minutes.

In line with the terms of the contract, the trust has provided evidence of how it is
supporting initiatives to reduce demand for its emergency services, under the
banner of the Whole Systems Care (WSC) model. The August 2010 update on this
model lists the initiatives in place to reduce demand for emergency journeys,
showing accountabilities, measures, implementation details and benefits. From this
it is clear that some initiatives are in place in specific parts of the region, but that
others have been, or are being, rolled out more widely. Initiatives already in place
across the region include the scheme to refer patients who call the service after a
fall to the falls prevention team for future advice and support. This is reducing the
likelihood of a repeat call. Front line staff from all three stations commented that this
was a valued service, now established in their area. The clinical support desk, a
service where clinicians provide telephone assessment, advice and referrals for
patients and assistance to emergency crews, was considered by staff in Oxford to
have been particularly useful. Staff commented that further benefits would be
realised if this service operated longer hours. Staff were not familiar with all the
initiatives listed in the WSC, and the need for improved access to mental health
crisis teams was a common issue raised by staff. Some staff expressed concern
with the pilot where two emergency care assistants are sent on some calls. This
arrangement is recognised to be for transport journeys only, but staff involved in this
new way of working are reporting that they need more support. Staff in Southampton
and Newbury stations commented that GP triage, where patients are referred to
their own or the out-of-hours GP, is proving to be a beneficial service.

The trust is monitoring the delivery of national delivery performance measures. It is

currently required to meet Government set indicators for category A calls
(immediately life threatening) and category B calls (serious but not life threatening).
These indicators state that the service must reach 75% of category A calls within
eight minutes (A8) and 95% of category A calls within 19 minutes (A19). 95% of
category B calls must be reached in 19 minutes (B19). In August 2010, the trust
reported achieving year to date performances of 76.16% for A8 calls, 94.76% for
A19 calls and 89.47% for B19 calls. By September 2010, the trust had achieved
over 77% for A8 and 95.5% for A19 and it was therefore delivering above the
national target levels. B19 call performance is below the national target, at 90.38%,
but this level of performance is within the terms of the locally agreed commissioning
contract. This monitoring data was evidenced in the daily performance table and
within the balanced score card reports for June and July 2010. The balanced score
card is reported to the trust board each month for monitoring and discussion. The
daily performance reports provide very detailed data on primary and secondary
response times, by division and by area and by journeys, again for monitoring
purposes. Performance results are also publicised on the trust’s website, and in
November 2010, the year to date performances are 77.31% for A8, 95.15% for A19
and 90.73 for B19, showing performances have changed marginally since April
2010.
Although the trust is now meeting national indicators for A8 and A19 calls, there is
local variation in performances and Buckinghamshire PCT reports that less than
70% of category A calls are responded to in 8 minutes and both A19 and B19 are
below target. Similarly, localised performances by area show that response times to
A8 calls in rural Hampshire are low, with only 53% of calls responded to in 8 minutes
(in Quarter 1, 2010/11). Concern about ambulance response times in rural areas
has been expressed for some time, and this prompted a review by three health
overview and scrutiny committees in the SCAS region. In February 2010 the
Buckinghamshire, Hampshire and Oxfordshire health overview and scrutiny joint
review group published a report of their investigations into the performance of rural
ambulance services. This included recommendations for improving responsiveness,
quality of care and accountability for the service generally and for performance in
rural areas specifically. SCAS introduced a ‘root cause analysis’ system in July 2010
to investigate every instance where the A8 response times exceed 30 minutes and
A19 and B19 response times exceed 60 minutes. The commissioner has since
commented that this approach is working well in identifying trends and areas for
improvement.

Staff reported that they recognise that response times to calls are a measure of
quality, and that the trust is measuring these closely. Staff at Oxford and
Southampton reported that mechanisms to improve turnaround times at hospitals
had been effective. For example, time-monitoring terminals have been installed and
liaison officers appointed in hospital A&E departments. The ambulance and hospital
trusts have agreed escalation routes to follow when ambulances are held up at
hospitals. This is a key issue and the trust provided evidence on how it is working
with acute hospital trusts and PCTs to minimise delays for their ambulances.

Staff also said that the focus on achieving response performance measures has a
significant impact on the management of the service. Management staff are required
to take operational shifts if quarterly indicators are at risk. All training in September
was postponed, apart from further education training, and courses for staff moving
from emergency care assistants to technicians, to ensure quarter 2 indicators were
met.

Staff also state that response time is not the only measure for quality and that
clinical performance indicators, audits and feedback from patients and hospital staff
provide other mechanisms for assessing the quality of care provided. The trust is
monitoring and reporting on clinical performance through clinical performance
indicators for stroke, cardiac arrest, asthma, hypoglycaemia and heart attack. The
report from the August 2010 quality and safety committee demonstrates that these
clinical outcomes are monitored in detail. The trust is performing well against two of
the five clinical performance indicators, asthma and hypoglycaemia. Data provided
for May to September 2010 shows that the trust continues to improve its clinical
performances. For this period, the trust is ranked first out of all ambulance trusts for
clinical performance indicators. Some staff were able to quote how their station
performed against these measures. Staff also valued the clinical pathways that have
been introduced and the clinical guidelines.
The trust's new clinical strategy is linked to the Whole System of Care model, and
the strategy was provided as evidence of the trust's commitment to establishing a
delivery model centred on the care and welfare of patients. This strategy, dated April
2010, is still under consultation with the Strategic Health Authority and PCT partners
before final agreement.

Clinical information is circulated to stations for staff to read, including clinical

updates and directives. Staff reported that they are advised of safety alerts. Staff
were also able to describe how they would respond to and report on incidents, and
they also stated that they felt they were supported by their managers in reporting
incidents.

The trust has provided documentary evidence for projects in place across the region
to improve efficiency. These include increasing the number of co-responders in the
region and extending the Make Ready scheme to ensure vehicles are cleaned,
stocked and fit for purpose for the crews. This scheme removes any downtime for
crews for preparing their vehicles. The Make Ready scheme is highly valued by
staff, and almost all staff commented that the vehicles are now kept clean and well
resourced. The level of cleanliness of vehicles is also monitored effectively and
reported on weekly. In satellite areas, however, staff commented that there are not
enough Make Ready staff in place to ensure the scheme works effectively. Co-
responder schemes across the region are reported to be important in supporting
performance measures. These are partnership schemes where fire and rescue,
coastguard and the military services provide a rapid emergency response, usually
where they are in a better place to do so than the ambulance service.

Our judgement
Overall, we found that South Central Ambulance Service (SCAS) NHS Trust was
meeting this essential standard but, to maintain this, we have suggested that some
improvements are made.

The trust is addressing the key concern that we had with performance, through
agreeing a contract with its commissioners, and meeting the national response
indicators. The contract has required both the trust and its commissioning Primary
Care Trusts (PCTs) to implement initiatives to improve demand management and to
deploy staff more effectively. There is evidence that progress has been made in
extending the more successful initiatives, such as the Make Ready scheme for
vehicles, the falls referral scheme, GP triage and the clinical support desk. Whilst
these initiatives have helped the service to employ ambulance crews more
appropriately, demand for emergency services continues to rise and there is a risk
that these initiatives will not release enough staff to maintain the improvements in
response rates.

National response indicators are now being met for immediately life-threatening calls
and the trust is monitoring clinical outcomes through a set of clinical performance
indicators. There is concern however over the sustainability of this improvement in
response times. There is generally a greater demand for emergency services over
the winter and the current performance is only just above target, allowing very little
contingency. Also, training postponed from August and September has been
scheduled for the last two quarters of the year, which will take staff off the road in
the winter period. In addition, people in rural areas receive a level of service below
the national standard. Response times in Hampshire’s rural areas have are still
significantly below national target.
Outcome 6:
Cooperating with other providers

What the outcome says

This is what people who use services should expect.

People who use services:

• Receive safe and coordinated care, treatment and support where more than
one provider is involved, or they are moved between services.

What we found

Our judgement

The provider is compliant with outcome 6: Cooperating with other providers

Our findings

What people who use the service experienced and told us

Patients and service users were not interviewed for this review.

Other evidence
The trust has taken action to improve its communications and working arrangements
with other organisations and members of the public. Effective partnership working is
one of the trust’s key strategic goals, as it needs to be able to demonstrate this
when it applies for Foundation Trust status. It also recognises that improvements in
performance are dependent on improved relationships with its acute trusts and
commissioners. SCAS has appointed a Director of Communications & Public
Engagement who has drafted strategies for public engagement, stakeholder
engagement and media management.

To support this, the trust has established bi-weekly conference calls for senior
managers to coordinate, and feedback on, engagement activity in their areas. These
conference calls provide a forum for sharing progress internally on the whole system
of care activity and progress with partners. At a divisional level, relationships have
been built with local PCTs and trusts. Senior staff reported that building relationships
with acute trusts has helped resolve issues with, for example, ambulance turnaround
times. At the John Radcliffe Hospital there has been a sustained reduction in
turnaround times over a number of months as a result of the hospital, PCT and
SCAS working together, and making individual commitments to address the issues.

SCAS has set up a range of ways to improve communication with other

organisations and members of the public. It sends letters to its partner organisations
each quarter, providing an analysis on performances and summarising progress on
key projects. PCT boards and representatives for the SHA and acute trusts have
visited SCAS to observe how the organisation operates, with the aim of improved
mutual understanding and hear about the work they have been doing on demand
management and partnership working. The trust website has been updated and
provides a better forum for sharing information.

The trust has appointed leads as commissioning contacts and monthly meetings are
in place with the commissioners. We have received positive feedback from
commissioning PCTs that the trust is working hard to share information and to
involve its partners in planning and reviewing activity. Also, that it provides
information packs on performance and attends PCT board meetings when
requested. SCAS project leads also work effectively with the PCTs to assist in the
whole system care initiatives. We have also seen evidence of a range presentations
made to, for example, GPs, explaining the whole system care and demand
management agenda.

When required by stakeholders to produce responses to specific reviews or queries,

the trust has not always been prompt in producing the necessary information or
reply. The review of rural performances, carried out by a joint review group and
reported in February 2010, gave rise to a range of conclusions and
recommendations. There has been no specific action plan drawn up in response,
and shared with the overview and scrutiny committees involved. Similarly, the South
Central Specialised Commissioning Group have asked for specific business
proposals for next year’s contract, and the trust has not responded in a timely way.

Our judgement
Overall, we found that South Central Ambulance Service NHS Trust was meeting
this essential standard.

The trust is committed to developing effective working relationships with its

commissioning PCTs and partner organisations providing healthcare. We have seen
evidence that performance information is shared regularly and that the trust actively
seeks opportunities to discuss its strategic aims and delivery issues with its partners.
Outcome 14:
Supporting workers

What the outcome says

This is what people who use services should expect.

People who use services:

• Are safe and their health and welfare needs are met by competent staff.

What we found

Our judgement

There are minor concerns with outcome 14: Supporting workers

.

Our findings

What people who use the service experienced and told us

Patients and service users were not interviewed for this review.

Other evidence
The trust is monitoring appraisals and all emergency staff interviewed could recall
having had an appraisal in the past year. Most reported that these were planned
events, carried out in protected time that provided opportunities to discuss training
and development, as well as objectives. Most, but not all managers had been
trained in carrying out appraisals. The patient transport staff felt the appraisal
process had not been constructive, although some staff reported that training had
been agreed as a result of the process.

The trust provided monitoring reports showing the percentage of staff who had
completed their annual appraisal, by directorate, division and role. An average of
70% of staff had completed their annual appraisal by October 2010. Operations staff
make up the bulk of the workforce, and within operations, 79% of staff at resource
centres have had appraisals. Some resource centres are struggling to achieve an
acceptable level of appraisals however, and the percentage completed ranges from
23% to 100%. 88% of Hampshire resource centre staff have had appraisals,
compared with 70% in the Oxfordshire/Buckinghamshire division. Some managers
reported having difficulty finding the time to carry out appraisals, since they are often
required to attend emergency calls. Managers however also said they plan to
complete all staff appraisals by the end of March 2011.

Staff generally reported that training needs were identified at appraisals although not
all were aware of a specific training plan. Training and appraisals were postponed in
August and September 2010, due to operational pressures, and although staff
obviously regretted this, there was recognition that these events would be
rescheduled. All training in September was postponed, apart from further education
training, and courses for staff moving from emergency care assistants to
technicians, to ensure quarter 2 indicators were met.

The trust provided examples of completed staff appraisal records, showing requests
for specific training. Evidence of how the trust responded to these training needs, by
authorising specific courses, was provided. These showed that the trust facilitates
training through university and college courses to develop both clinical and
managerial skills. Staff are aware of the initiative to develop the emergency care
practitioner role within SCAS, through degree course training. Some staff expressed
concerns, however, that degree based learning is not always accessible for staff and
that once qualified, their high level skills may not be used to best effect within the
organisation.

Concern was expressed by some staff that they had to take responsibility for their
own training, and that they sometimes had to complete this in their own time. Staff
did say however that they were encouraged and supported by their managers. Not
all staff could recall having had mandatory training. Some reported not having had
this since induction, and others reported having ‘on-the-job’ training in, for example,
moving and handling and infection control. Recently recruited staff could recall their
induction and reported that the induction process was effective. Their mandatory
and statutory training was delivered at induction.

The trust’s October 2010 Education report outlines the reasons for postponing the
training in August and September. Training planned from October includes the roll
out of statutory and mandatory training across all three divisions. The report also
states that completing statutory and mandatory training is a priority for the trust. The
training matrix states that at the end of August 2010, 82% of staff had completed the
‘clinical development 1’ course, which includes mandatory training. For patient
transport services, however this figure is only 65% and no mandatory training has
been delivered to this group since February 2010. Only 35% of staff have received
conflict resolution training. The report for induction for new starters shows that only
64% received their induction in the past year. It is not clear from the monthly
reporting whether staff who do not receive induction in their first month, receive it at
a later date.

The database used for monitoring training by resource centre has not been fully
populated, and reports generated by the quality and safety committee do not provide
an accurate picture of the percentages of staff who have received training.

Training programmes are organised separately across the three divisions. The trust
has instigated a clinical training programme to ensure all clinical staff receive initial
or refresher courses. This programme was tailored to the needs and preferences of
the staff in the three divisions, as the divisions requested different methods of
teaching. In Oxford, Buckinghamshire and Berkshire, the training was delivered via
the Cinema Project in October 2010. These sessions were delivered to large
numbers of staff, with up to 110 in some venues. In Hampshire, the course was
delivered alongside other training in 61 small, face to face, sessions. In addition, a
specific training conference was arranged at the John Radcliffe Hospital in Oxford as
a refresher and enhanced course for more experienced staff.

Our judgement
Overall, we found that improvements are needed for this essential standard.

The trust’s recording mechanisms for training and induction are not yet robust due to
a change in systems, and from the data we viewed, it is not clear whether all new
starters have received an induction. Not all staff have received statutory and
mandatory training in the past year. Some staff report undertaking training in their
own time. Operational pressures to meet performance measures can lead to the
postponement of training. The trust has however instigated a new programme of
clinical training and has developed innovative ways of delivering this.

Not all staff have had appraisals in the past 12 months. The improvement letter sent
in April 2010 required the trust to take reasonable action to ensure that all staff had
had an annual appraisal by 30 September 2010. Although the trust has increased
the percentage of staff appraised from 35% to 70% there is still a high proportion of
staff who have not had an appraisal by the agreed timescale. There is wide variation
in the percentage of staff who have been appraised across the resource centres.
Staff we interviewed reported that the appraisal process is generally effective and
valued. Feedback from staff indicates that training needs are discussed at
appraisals and that they are enabled to access training courses for their own
development, relevant to the work they undertake.
Action
we have asked the provider to take
Improvement actions
The table below shows where improvements should be made so that the service
provider maintains compliance with the essential standards of quality and safety.
Regulated activity
Treatment of disease,
disorder or injury
Transport services, triage
and medical advice
provided remotely
Diagnostic and screening
procedures
Regulation Outcome
9 4
Why we have concerns:
Overall, we found that South Central Ambulance
Service (SCAS) NHS Trust was meeting this
essential standard but, to maintain this, we have
suggested that some improvements are made.
The trust is addressing the key concern that we had
with performance, through agreeing a contract with its
commissioners, and meeting the national response
indicators. The contract has required both the trust
and its commissioning Primary Care Trusts (PCTs) to
implement initiatives to improve demand
management and to deploy staff more effectively.
There is evidence that progress has been made in
extending the more successful initiatives, such as the
Make Ready scheme for vehicles, the falls referral
scheme, GP triage and the clinical support desk.
Whilst these initiatives have helped the service to
employ ambulance crews more appropriately,
demand for emergency services continues to rise and
there is a risk that these initiatives will not release
enough staff to maintain the improvements in
response rates.
National response indicators are now being met for
immediately life-threatening calls and the trust is
monitoring clinical outcomes through a set of clinical
performance indicators. There is concern however
over the sustainability of this improvement in
response times. There is generally a greater demand
for emergency services over the winter and the
 current performance is only just above target,
allowing very little contingency. Also, training
postponed from August and September has been
scheduled for the last two quarters of the year, which
will take staff off the road in the winter period. In
addition, people in rural areas receive a level of
service below the national standard. Response times
in Hampshire’s rural areas are still significantly below
national target.

The provider must send CQC a report about how they are going to maintain compliance
with these essential standards.

This report is requested under regulation 10(3) of the Health and Social Care Act 2008
(Regulated Activities) Regulations 2010.

The provider has already provided us with a report that we are reviewing currently.

CQC should be informed in writing when these improvement actions are complete.
Compliance actions
The table below shows the essential standards of quality and safety that are not
being met. Action must be taken to achieve compliance.
Regulated activity
Treatment of disease,
disorder or injury
Transport services, triage
and medical advice
provided remotely
Diagnostic and screening
procedures
The provider must send CQC a report that says what action they are going to take to
achieve compliance with these essential standards.
Regulation Outcome
23 14
How the regulation is not being met:
Overall, we found that improvements are needed for
this essential standard.
The trust’s recording mechanisms for training and
induction are not yet robust due to a change in
systems, and from the data we viewed, it is not clear
whether all new starters have received an induction.
Not all staff have received statutory and mandatory
training in the past year. Some staff report
undertaking training in their own time. Operational
pressures to meet performance measures can lead to
the postponement of training. The trust has however
instigated a new programme of clinical training and
has developed innovative ways of delivering this.
Not all staff have had appraisals in the past 12
months. The improvement letter sent in April 2010
required the trust to take reasonable action to ensure
that all staff had had an annual appraisal by 30
September 2010. Although the trust has increased
the percentage of staff appraised from 35% to 70%
there is still a high proportion of staff who have not
had an appraisal by the agreed timescale. There is
wide variation in the percentage of staff who have
been appraised across the resource centres. Staff we
interviewed reported that the appraisal process is
generally effective and valued. Feedback from staff
indicates that training needs are discussed at
appraisals and that they are enabled to access
training courses for their own development, relevant
to the work they undertake.
This report is requested under regulation 10(3) of the Health and Social Care Act 2008
(Regulated Activities) Regulations 2010.

The provider has already provided us with a report that we are reviewing currently.

Where a provider has already sent us a report about any of the above compliance
actions, they do not need to include them in any new report sent to us after this review
of compliance.

CQC should be informed in writing when these compliance actions are complete.
What is a review of compliance?

By law, providers of certain adult social care and health care services have a legal
responsibility to make sure they are meeting essential standards of quality and safety.
These are the standards everyone should be able to expect when they receive care.

The Care Quality Commission (CQC) has written guidance about what people who
use services should experience when providers are meeting essential standards,
called Guidance about compliance: Essential standards of quality and safety.

CQC licenses services if they meet essential standards and will constantly monitor
whether they continue to do so. We formally review services when we receive
information that is of concern and as a result decide we need to check whether a
service is still meeting one or more of the essential standards. We also formally review
them at least every two years to check whether a service is meeting all of the essential
standards in each of their locations. Our reviews include checking all available
information and intelligence we hold about a provider. We may seek further
information by contacting people who use services, public representative groups and
organisations such as other regulators. We may also ask for further information from
the provider and carry out a visit with direct observations of care.

When making our judgements about whether services are meeting essential
standards, we decide whether we need to take further regulatory action. This might
include discussions with the provider about how they could improve. We only use this
approach where issues can be resolved quickly, easily and where there is no
immediate risk of serious harm to people.

Where we have concerns that providers are not meeting essential standards, or where
we judge that they are not going to keep meeting them, we may also set improvement
actions or compliance actions, or take enforcement action:

Improvement actions: These are actions a provider should take so that they
maintain continuous compliance with essential standards. Where a provider is
complying with essential standards, but we are concerned that they will not be able to
maintain this, we ask them to send us a report describing the improvements they will
make to enable them to do so.

Compliance actions: These are actions a provider must take so that they achieve
compliance with the essential standards. Where a provider is not meeting the
essential standards but people are not at immediate risk of serious harm, we ask them
to send us a report that says what they will do to make sure they comply. We monitor
the implementation of action plans in these reports and, if necessary, take further
action to make sure that essential standards are met.

Enforcement action: These are actions we take using the criminal and/or civil
procedures in the Health and Adult Social Care Act 2008 and relevant regulations.
These enforcement powers are set out in the law and mean that we can take swift,
targeted action where services are failing people.
Information for the reader

Document purpose Review of compliance report

Author Care Quality Commission
Audience The general public
Further copies from 03000 616161 / www.cqc.org.uk
Copyright Copyright © (2010) Care Quality Commission
(CQC). This publication may be reproduced in
whole or in part, free of charge, in any format
or medium provided that it is not used for
commercial gain. This consent is subject to
the material being reproduced accurately and
on proviso that it is not used in a derogatory
manner or misleading context. The material
should be acknowledged as CQC copyright,
with the title and date of publication of the
document specified.

Care Quality Commission

Website www.cqc.org.uk
Telephone 03000 616161
Email address enquiries@cqc.org.uk
Postal address Care Quality Commission
Citygate
Gallowgate
Newcastle upon Tyne
NE1 4PA