'One patient was waiting over 9 hours to be collected' - Care Quality Commission raises concerns over waiting times for community transport provider E-Zec Medical Transport Services Ltd
E-Zec Medical Transport - Bristol is operated by E-Zec Medical Transport Services Ltd. The service provides non-urgent, planned transport for adults and children with a medical need who need to be transported to and from NHS services, who are registered with a GP. The service provides approximately 71,600 patient transport journeys per year across Bristol, North Somerset and South Gloucestershire.
Inspectors carried out this inspection in January 2023 because they received information that raised concerns about the safety and quality of the services. The Care Quality Commission (CQC) assesses services in five areas:
Are services safe? Requires improvement
Are services effective? Inadequate
Are services caring? Good
Are services responsive to people's needs? Requires improvement
Are services well led? Requires improvement
The overall rating for this services is requires improvement.
You can download a full copy of the report below.
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Key findings
- Not all maintenance issues had been identified and storage of some chemicals was not safe.
- Some patients were subject to long waits for transport which was not acceptable and placed them at potential risk of harm. Some patients had missed vital hospital appointments and one patient had their treatment time reduced.
- Not all patients could access their transport when they needed it which impacted on their access to care and treatment at other health care providers.
- Not all staff knew how to manage complaints in line with the providers policy.
- There had been improvements with the recruitment practices of new staff, but systems and processes to check staff had a full employment history with gaps explored was not effective.
- There were no staff meetings at this location for managers to impart information to the whole team.
Feedback we received from patients who have used E-Zec Medical Transport Services Ltd. reflects these issues. We heard from one patient who was told they could only receive transport to one specific service, leaving them without transport to other vital appointments. Another felt his relative was not treated with compassion by staff.
However inspectors also found areas where the services was doing well. Staff treated patients with compassion and kindness and had the skills and experience to care for patients and keep them safe.
Are services safe?
Staff received and kept up to date with their mandatory training. They understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff were able to recognise and respond to patients who become ill during their journey, and would request an emergency ambulance is required.
The cupboard used to store chemicals covered by The Control of Substances Hazardous to Health (COSHH) was unlocked and sign had fallen off. The staff/visitor’s toilet in unit 4 required the toilet seat and toilet roll holder to be repaired. There was no light for when it was dark and no sign to warn about the hot water. The registered manager told us following the inspection this had been addressed.
Are services effective?
The service monitored but did not always meet the agreed response times and this did not facilitate good outcomes for patients. Some patients were waiting for unacceptable amounts of times to be collected and returned from appointments. This potentially placed them at risk of harm. They were using the findings to help make improvements.
During our inspection we were shown records for one-week in November 2022 which showed 15 patients were waiting over 3 hours with some having up to 8-9 hours wait. On another week in November 2022, the records showed there were 30 patient who waited over 3 hours, and one patient aged 89 years waited 8 hours and 9 minutes to be collected.
A patient told us during our inspection they had their dialysis time reduced because they were late for the start of their session. They also told us on another occasion, they had to wait 4 hours after their outpatient appointment to be collected from the department. This patient had their dialysis treatment reduced due to their transport being late which put them at risk of treatment not being effective.
Are services caring?
Patients were very happy with the standard of care provided, and said staff treated them well and with kindness. Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients' personal, cultural and religious needs. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
Are services responsive?
Not all staff were aware of the policy on meeting the information and communication needs of patients with a disability or sensory loss for NHS funded care. We did not see any communication aids on the vehicles. Staff told us the call centre staff include in the patients records if they had any disability or sensory loss. Some patients with specific needs were able to have a family member or carer travel with them.
The service did not have information leaflets available in languages spoken by the patients and local community. However, senior staff told us this was an area they were working on.
Are services well led?
Most staff felt positive and proud to work in the organisation. But several staff said they did not like it when they were sent out to use vehicles that were not fully working.
At the last inspection the service was issued with a requirement notice about recruitment practices as they were not obtaining all the required information for new staff prior to them starting work. At this inspection, we saw an improvement in the practices and information obtained. However, the service had not identified where staff interviewing the new staff had not explored employment gaps. In 3 of the 4 new staff records we examined, there were gaps in their employment history that had not been explored.
Actions the service must take
The service must ensure they address any issues with the environment and recruitment of staff to prevent staff, visitors and patients being placed at risk of harm.
The service must ensure the location is properly maintained and the identified issues with the toilet must be addressed. All chemicals covered by the COSSH regulations must always be stored securely to prevent the risks to staff and visitors.
The service must ensure patients are not subject to long waiting times either to be picked up or returned home from appointments to reduce the risks of harm.
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