CQC: Restraint and sexual safety among transport service failings

The care watchdog wrote to all providers of non-emergency patient transport earlier in the summer, warning of concerns identified at recent inspections about use of restraints, sexual safety, physical health needs, vehicle and equipment safety standards, and unsafe recruitment practices.

The letter, seen by HSJ, stated: “We know there are many independent ambulance providers providing a good standard of care. Unfortunately, our recent inspections suggest that this is not always the case.

“We expect providers to deliver on their commitment to provide safe, high-quality care and we will do everything within our powers to ensure this happens.”

The CQC said it identified a series of breaches of regulations, including failure to ensure adequate Disclosure and Barring Service checks and safety of vehicles and equipment, and lack of training in identifying physical and mental health needs and signs of self-harm, plus failures to ensure staff are trained in, understand and apply safe restraint methods.

The vast majority of patients transported by non-emergency services to and from inpatient or secure facilities are NHS-funded, although a small number are independent providers.

As a result, the CQC’s warnings have been circulated to mental health trusts, acute providers, independent hospitals and NHS ambulance trusts. NHS England and the Local Government Association have also been briefed on the concerns.

One trust, West Midlands Ambulance Service, carried out a safety audit following the letter and fed back results at its July board meeting.

A report was produced to review each concern the CQC identified and provide assurance that WMAS complied with the regulation, and where it did not, an action plan would be drawn up.

It follows a series of damning inspections at independent services, including LSA House in Berkshire, where regulators identified two instances of possible abuse and staff were unable to show restrictive practices were done in a “safe and appropriate way”.

Another service, whose staff failed to spot a grandmother’s decline as she was dying, had its registration cancelled earlier this year.

Peggy Copeman, who had been diagnosed with paranoid schizophrenia and dementia, died while being transferred to Norfolk from Somerset in 2019 by Premier Rescue Ambulance Service. 

Just last week, a Lincolnshire-based independent ambulance service, Mobile Medical Cover, was rated “inadequate” for a second time and among the concerns was a lack of risk assessments for people’s mental health.

Sean O’Kelly, CQC’s chief inspector of hospitals, told HSJ  its recent inspection and monitoring of the non-emergency patient transport sector has identified emerging concerns.

He said: “These relate to the safety of patients receiving secure and mental health services, while in the care of non-emergency patient transport providers. 

“Common issues we have found include failure to comply with vehicle equipment safety standards, staff not being supported with the right training, poor adherence to safeguarding protocols, and a lack of appropriate recruitment checks.

“Where we have found concerns, we have held those individual ambulance providers to account, making clear where improvements must be made. But we want to do everything we can to support good practice nationally.”

Feedback has so far been positive and the CQC will be keeping such services under close review, a spokeswoman added.