LIVES Headquarters

Updated 22 January 2024

LIVES Headquarters provides medical response to emergency situations across Lincolnshire. All work (including community first responders work) was allocated through the local NHS ambulance service.

The service had two commissioned services. The Community Emergency Medicine Services (CEMS) which operates from 8 am to 8 pm daily, brings the Emergency Department to the patient, meaning patients could be treated at scene and often avoided having to go to hospital. They also had a Falls Response Unit which responded to calls from 6am to 2am daily. This service provided assistance for falls and related injuries, delivered by non-qualified health care professionals.

The service also had a team of voluntary staff (approximately 300 at the time of our inspection) who made up the community first responders: Levels 1-4. They logged on from their own homes and travelled in their own vehicles to patients allocated by the local NHS ambulance service. They were split based on their geographical locations into 24 districts across the county. There were different grades (also referred to as levels) of these staff. This went from level 1 who were in their mentorship period and had some competencies signed off. Level 2 who were community first responders. Level 3 who had a year’s experience and had completed FREC level 3. Level 4 who were FREC level 4 trained. Levels 5-8 were medical first responders. Within the community first responders there was also MEDIC50 team which comprised a more highly skilled volunteers who had critical care skills. This team covered evenings and was looking to expand to cover weekend daytimes. These have a dedicated vehicle and would only respond in a team of two. Work was allocated based on individual skills and competencies.

From November 2022 to October 2023 the service had 4017 CEMS call outs, 2255 Falls team call outs, 704 medical responder call outs and 4140 community first responder call outs.

The service is registered with CQC for the regulated activity transport services, triage and medical advice provided remotely, and treatment of disease, disorder, or injury. The service is also registered for the regulated activity of diagnostic and screening procedures and surgical procedures.

The service has a Registered Manager who has worked at the service since 2016.

We previously inspected the service in 2018, however we did not rate the service at this time. We carried out an unannounced inspection on 14 November 2023, using our comprehensive inspection methodology. We inspected this service after receiving information of concern.

Updated 22 January 2024

We rated this location as requires improvement because:

• Staff records were not always easy to find or review because of the multiple systems that were in use. The service had high turnover and sickness rates.
• The service did not submit any required safeguarding notifications to us.
• There was no staff infection, prevention control audits in place.
• Staff did not always complete and update risk assessments for each patient.
• The service did not have an in date home office licence for controlled drugs at the time of our inspection.
• The service also did not provide any training for staff in restraint. The service did not mandate that staff completed training in recognising or responding to patients with mental health needs.
• Clinical audits were not always completed consistently. Staff did not consistently record patients pain scores.
• Work was not always allocated in a timely way by the ambulance trust.
• There had been a recent period of instability in leaders in the service. Not all staff felt respected, supported, and valued. At the time of our inspection the service did not have a business continuity policy that reflected current service provision.

However:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The design, maintenance and use of facilities, premises, vehicles, and equipment kept people safe. Staff managed clinical waste well.
• The service managed patient safety incidents well.
• The service provided care and treatment based on national guidance and evidence-based practice. The service monitored and met agreed response times so that they could facilitate good outcomes for patients.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development. All those responsible for delivering care worked together as a team to benefit patients.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families, and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Staff understood the service’s vision and values, and how to apply them in their work. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.
• The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 22 January 2024

We rated this service as requires improvement because it required improvement in safe, effective, and well led. However, it was good for caring and responsive.