Care Quality Commission (CQC)
The Care Quality Commission (CQC), England’s independent regulator of health and social care ensures fundamental standards of quality and safety are met and sets out what good and outstanding care looks like. Then, through inspections, ratings and published reports, it encourages care services to meet those standards. The CQC inspect organisations through five Key Lines of Enquiry (KLoE) to determine whether:
- we are safe.
- we are effective.
- we are caring.
- we are responsive to people’s needs.
- we are well led.
In April and May 2022, the Care Quality Commission (CQC) undertook a comprehensive short notice announced inspection of emergency and urgent care (EUC) and emergency operations centre (EOC) core services between 5 April and 6 April 2022. CQC also inspected the well-led key question for the Trust overall between 4 May and 5 May 2022.
The CQC’s rating of the Trust improved with the Trust being rated as requires improvement overall, however it was recommended to NHS England and NHS Improvement (NHSEI) that the Trust remained in the Recovery Support Programme to ensure continued relevant support to make the changes identified during their inspection.
These changes are required to bring the service in line with legal requirements relating to the core services of Emergency and Urgent Care and Emergency Operations Centre with nine ‘must dos’ identified across these two services. Areas for improvement included; provision of mandatory training and appraisals to all appropriate staff, adequate staffing levels, continued development of staff engagement processes, response times and facilities/premises improvements.
In addition, there were seven actions the Trust ‘should’ take because it was not doing something required by a regulation, but it would be disproportionate to find a breach of the regulation overall, to prevent it failing to comply with legal requirements in future, or to improve services. The full report can be found at East of England Ambulance Service CQC report .
Following the comprehensive short notice announced inspection in 2022, the Trust identified 67 deliverable actions (44 aligned to the ‘must do’ recommendations and 23 to the ‘should do’) to address the issues. The actions are embedded within the Trust’s Continuous Improvement Assurance Framework, and focus on the following themes;
- Mandatory training.
- Staff engagement.
- Wellbeing/response to staff concerns.
- Facilities.
- Response times.
- Culture
Progress within the actions to date includes:
Mandatory training
We have un-bundled mandatory training modules and clarified which needs to be done at 1, 2 and 3 year intervals and converted key managers’ training to a mix of face to face and online to improve access.
Staffing
We have put a strategic workforce plan in place for frontline staff and EOC recruitment in line with our new Urgent and Emergency Care Strategy, developed a programme to ensure all call handlers receive appropriate training to become qualified, undertaken a review of our induction programme and appointed an Interim Chief Allied Health Professional to ensure registrants from all backgrounds are included within our workforce.
Appraisals
We made this a key priority for this year, published our Clinical Supervision Policy and begun to implement our clinical supervision model and reviewed possible digital solutions to enhance the appraisal process.
Estates
We have continued with our estates improvement programme to ensure facilities remains safe for staff.
Improving response times in line with national targets
We have introduced system provider ‘Access to the Stack’ to support appropriate alternative pathways and begun to expand our ECAT function to move towards a wider clinical assessment service. improvement in the management of C3-C5 calls directly into appropriate alternative pathways.
People engagement and wellbeing
We have continued with the ‘Time to Lead’ programme to help our leaders in supporting their people, made improvements within our staff survey results, implemented a task and finish group to take forward a range of improvements from the staff survey and a 3-year Inclusivity Plan which will address issues raised in our survey of BME staff, seen a reduction in the number of staff experiencing bullying and harassment, continued to deliver weekly Q and As at Trustwide and local level and adopted The Ambulance Staff Charity (TASC) initiative to provide our staff with access to a 24/7 ambulance staff crisis phoneline to provide immediate and ongoing suicide and mental health care.
As well as continuing with our Fit for the Future (FFF) engagement programme through monthly podcasts and blogs, refreshed our communication and engagement plans and developed our communications team in effective engagement processes.
As well as continuing to work on these actions, the Trust has begun a process regarding the lifting of the conditions which were imposed in 2020 following a core inspection, with some already being removed.
Culture
In relation to the culture of the organisation, the CQC recognised the improvements that had been made and stated that work should continue with the pace of addressing cultural issues – we are monitoring this in line with the Fit for the Future programme and our culture dashboard – work is on track to deliver this over the next 2 years.
Overall trust quality rating
Are services safe? Requires Improvement.
Are services effective? Requires Improvement.
Are services caring? Rating good.
Are services responsive? Requires Improvement
Are services well-led? Requires Improvement
Next Page: Department of Health Core Quality Indicators