GOVERNMENT funding of South Western Ambulance Service is "simply inadequate to reach the standards we all want" according to Unison, responding to recent inspection findings that the the service "required improvement".
South Western Ambulance Service has been judged as "requiring improvements" following inspection by the Care Quality Commission (CQC).
England's chief inspector of hospitals has told South Western Ambulance Service NHS Foundation Trust it must make improvements to some of its services following an inspection in June by the Care Quality Commission.
Overall the trust has been rated as "requires improvement" – however, its services were rated "outstanding" for caring, and "good" for being responsive.
The areas the trust required improvement for were in safety, effectiveness and being well-led.
A team of inspectors looked at six core services, including emergency operations centres, emergency and urgent care, the Hazardous Area Response Team (HART) and patient transport services.
Full reports for each service have been published at http://www.cqc.org.uk/provider/RYF
South Western Ambulance Service NHS Foundation Trust, one of 10 ambulance trusts in England, provides emergency medical services to a population of around 5.3 million people, in an area served by 18 acute hospital trusts.
But Chief Inspector of Hospitals Professor Sir Mike Richards said South Western Ambulance Service was "at the forefront of national improvements in the ambulance service".
He said it was "exploring better ways to deal with emergency calls so that people get the attention they need, in the right place and at the right time".
Mr Richards added: "As demand for emergency care grows year by year, our ambulance services have never been busier.
"The trust has a strong and stable leadership team, which has put quality and safety as key priorities and has organised the staff and resources well across a wide geographic area, responding well, on the most part, to the most urgent calls.
"We found staff in the emergency operations centres and emergency and urgent services to be outstanding in the way they supported people who were distressed or overwhelmed in often highly stressful situations."
However, Mr Richards said they also found "some variation in quality across the services inspected".
He said: "There were significant gaps in mandatory training and we found the levels of staffing were not always sufficient to provide relief when staff were training, or on leave.
"I am concerned that not all staff were reporting incidents, particularly when they were verbally abused by callers.
"Some felt that they did not have time to report all incidents, so losing the chance to learn from them and take appropriate action in future.
"During the inspection we identified a number of areas for improvement which we have passed on to the trust and to local commissioners. Our inspectors will return at a later date to check on their progress."
Inspectors found there was good organisation and distribution of staff and services to manage specific areas of the region.
In the 19 months until January 2016, the trust was better than the national average for responding within eight minutes to "Red I" calls, meaning calls to the service which were immediately life threatening such as cardiac arrest.
Outstanding areas of practice highlighted by the report were:
- There was, at times, outstanding professionalism under pressure among the emergency medical advisors in the Bristol and Exeter emergency operation centre (clinical hub) teams. Although staff may be criticised, shouted at, or threatened, they remained calm, and handled the callers with courtesy and patience.
- Staff in the emergency operations centres showed outstanding compassion and understanding to people in difficult and stressful situations. Staff made a genuine connection with patients and others who were scared or anxious and developed an, albeit temporary bond, with the person trying to help them.
- There was an outstanding and commended programme to manage frequent callers to the service. This was helping to release the organisation's limited resources to more appropriate situations. There was strong multidisciplinary working to support frequent callers with the service promoting the issue among the wider community and partner organisations.
- At the time of the inspection the trust had just embarked on 12-week pilot programme aimed to improve response times to critically ill patients, making sure the best response was sent to each incident first time and with the appropriate degree of urgency. The trust was one of two ambulance services nationally participating in this trial.
Areas of practice highlighted by the report as requiring improvement were:
- The trust must ensure work intensity and fatigue is monitored and actions put in place to mitigate risks to staff
- Governance meetings at local levels must contain a strong focus on quality and safety. This will include performance reports on training, appraisals, patient outcomes, complaints and incidents relevant to the local level.
- The trust must ensure a system is put into place which informs patient transport service crews of any important clinical information relating to the patients they convey, such as when a patient has diabetes.
- Heathcare assistants who undertake initial clinical assessment of patients must be assessed as competent before working independently
- The trust must ensure partly administered controlled medicines which are no longer required are disposed of in accordance with the service standard operating procedures and that medicines are stored securely in the back of ambulances and cars when the crew is not present.
Co-secretary for Unison South Western Ambulance Service branch Chris Nelson said: "All our staff in the ambulance service are working flat-out to maintain standards across the board.
"Our members are committed public service workers who want to see the best possible care for their patients. Their caring and dedicated work in an incredibly challenging environment was rightly praised by the CQC.
"While services can and should improve, funding is simply inadequate to reach the standards we all want.
"Staff will continue to make the best of what they've got, but without additional resources into ambulance services, demand on our members is just too high.
"The report highlights mental and physical health problems among ambulance service workers. Unless the government allocates more funding and staffing, there's a risk that quality will take another hit.
"World-class public services need real investment in the people who carry them out, not ever-increasing demands on overstretched staff.
"We have already started planning in partnership with management and the CQC to deal with issues in the report, despite the government's refusal to provide enough funding."
On September 30, the CQC presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies.
The purpose of the Quality Summit was to develop a plan of action and recommendations based on the inspection team's findings.