HANDOVER delays which have left patients waiting on ambulances outside hospitals have been contributed to West Midlands Ambulance Service losing its outstanding rating with the CQC.

The Care Quality Commission has today (Friday February 23) published a report on its findings following inspections in August and October 2023 and it has given the trust a rating of good overall.

Inspectors looked at the trust’s emergency operations centre (EOC), its frontline emergency operations and how well-led the trust was overall as part of the CQC’s regular checks on safety and healthcare services.

The overall rating of the emergency operations centre improved from good to outstanding but the urgent and emergency care service saw its overall rating drop from outstanding to good – with the rating for whether the service is effective plunging from outstanding to requires improvement.

Charlotte Rudge, CQC deputy director of operations in the Midlands, said: “We found leaders had the skills, knowledge and experience to run services well.

"However, external challenges across the healthcare system meant that ambulances were queuing for hours at accident and emergency departments due to handover delays at hospitals, which impacted on people’s care and wellbeing.

“This resulted in longer response times for people calling an ambulance, it also had a negative effect on staff, who were doing their best to provide safe care and treatment to people.

“We found the trust was working hard to improve its culture, so people using the service, their families and staff could raise concerns without fear. The trust had improved staff wellbeing and freedom to speak up guardian services. However, during the inspection, some staff told us they still felt unable to speak up and be listened to. The trust must continue to address this issue, as we know services which don’t have an open culture, has a negative impact on people’s care.”

She said in the trust’s two emergency operations centres the service was “the best in the country for answering 999 calls” and she said inspectors were reassured “staff understood the emotional impact the situation had on people’s wellbeing and on those close to them, particularly when the service was experiencing delays”.

Inspectors found the trust was treating around 18 per cent of people with clinical teams over the phone - five per cent higher than the England average. They also found the service usually managed safety incidents well and staff recognised and reported incidents and near misses appropriately; and when things went wrong staff apologised and gave people honest information and suitable support.

But inspectors also noted areas of governance where the trust did not demonstrate learning when things went wrong. As well as the overall rating dropping, the ratings for being effective, responsive and well-led were downgraded from outstanding to good, while the trust was re-rated good for being safe and re-rated outstanding for being caring.

Trust chief executive, Anthony Marsh, said: “The overall rating has dropped from outstanding to good, which is disappointing given how hard our staff work every single day, but we are delighted that the inspectors continue to believe that the caring domain remains outstanding.

“In addition, the inspectors have now rated our Emergency Operations Centres as outstanding; the only one in the country. As the report notes, we have the best call answering in the country and treat more patients over the phone than any other trust.

“However, the biggest change the inspectors noted was in our effectiveness, which has dropped from outstanding to requires improvement. The report is very clear that the route cause of this change is as a result of hospital handover delays that see our crews stuck outside hospitals for hours on end, unable to respond to patients in the community. They also note the hugely negative impact these delays have on our staff and their wellbeing.

“Given this inspection happened at perhaps the most challenging time within the history of the NHS, there is much to be proud of.”

He said the report acknowledged work done to ensure staff feel able to speak up and that colleagues treat each other with respect and he added: “While it is pleasing that the CQC noted the progress that we have made, we absolutely accept there is further work to be done.”

The CQC said it would continue to monitor the trust, including through future inspections, to ensure improvements are made.