A privately-run ambulance provider which holds NHS contracts in the North East is fighting the Care Quality Commission in the courts following an "inadequate" inspection report.
Specialist Medical Transport - North (SMT) - based on the Tyne Tunnel Trading Estate in North Shields - has already successfully challenged an urgent CQC order at a tribunal. The regulator had imposed an immediate restriction on its operations, which effectively forced it to stop work, in January. Now, following publication of an inspection report, it has been placed into special measures.
But SMT-North bosses have branded the CQC's behaviour as "unacceptable" and said the report was "deeply flawed and based on a fundamental misunderstanding of the service we provide". At a tribunal hearing in March, SMT's appeal was upheld, and in a ruling on behalf of the panel Judge Siobhan Goodrich was critical of the regulator's actions. Despite this, the CQC published its report in full last week, and now SMT bosses have said they plan to take further action.
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The published report highlighted a range of issues identified by the CQC inspection team. The service was rated "inadequate" for being safe, effective and well-led, with concerns raised about staff training, safeguarding and record-keeping.
It was also raised that "managers did not investigate incidents", but the tribunal ruling from Judge Goodrich found a notice of decision (NoD) given following the inspection and which saw a restriction imposed which prevented SMT-North operating "was inaccurate in the assertion that there was 'no evidence' of the investigation of incidents".
SMT-North is run by Specialist Medical Transport, based in Essex. The firm holds a number of contracts to provide hospital patient transport and carry patients being detained under the mental health act. The firm said it is now, following the inspection report's publication, "seeking further legal recourse".
The tribunal was held in March and its ruling was published in May. Judge Goodrich and two specialist members upheld SMT's appeal against an urgent notice requiring it to stop operations from SMT-North. The ruling said the CQC had not persuaded it that "the decision was necessary and proportionate".
The ruling also stated: "It is a stark fact that the condition imposed led to the immediate loss of work for 14 people and to a very significant loss of income for the Appellant company. It also led to the immediate disruption of a service that had seemingly been valued by the NHS Trusts and the ICBs, and for which, we consider it reasonable to infer, bookings had been planned."
Judge Goodrich continued: "The information before us in the draft inspection report is that of the 6,716 total number of journeys from January 2020 to December 2022 some 5,052 were patient hospital discharge transfers. The vast bulk of the [CQC] concerns related to [Mental Health Act] secure transfers. In our view the [CQC]’s decision was not 'targeted where it was needed'."
The ruling also referred to evidence heard during cross-examination at the tribunal, saying: "There was very little acknowledgement of the positive efforts that have been made by [SMT] to address the concerns raised."
At the tribunal hearing, SMT managing director Mick Byrne, "acknowledged in the appeal documents that various aspects of process and documentation needed improvement and were being addressed" and "has recognised the need to positively record and demonstrate how it meets the fundamental standards and assesses care needs and risk", according to the ruling.
Judge Goodrich also wrote: "In our view there is a paucity of evidence to show that the overall care provided by [SMT]'s employees had resulted in any, or any significant harm, to any of the 1,664 patients it transported between January 2022 and December 2022, some 440 of which had involved the patient being placed in a cell."
The Judge also highlighted being "unimpressed" by oral evidence from a CQC inspector who "did not demonstrate the measured, balance and objective approach which, in our experience, is usually displayed by CQC Inspectors" and "came across as dogmatic, and as a witness who lacked a balanced perspective".
Judge Goodrich added: "Even if we are wrong in our view that the risk of harm was low and that the decision was disproportionate as at 12 January 2023, we consider that the risk of harm today is clearly less 'today' i.e. as at the date of the hearing".
In a statement following the CQC report's publication, Mr Byrne said: "Patients across the UK rightly put their trust in the Care Quality Commission to uphold the highest standards in our health and care system.
“Sadly, that trust has been broken by the CQC’s unacceptable behaviour during their original inspection of our service and in their Court testimony. This was judged to be ‘dogmatic’ and lacking ‘a balanced perspective’.
"The CQC’s decision to publish a report ruled by Tribunal to be deeply flawed, and based on a fundamental misunderstanding of the service we provide, has had a direct impact on vulnerable patients who were unable to access vital transportation services during the height of the ‘winter crisis’ and over the last six months.
"We will be seeking further legal recourse as the CQC continues to flagrantly disregard the Tribunal’s ruling and sustain an unlawful assault on our reputation, our people, and the high-quality transportation service we provide."
A CQC spokesperson, said: "CQC has a statutory duty to publish a report following an inspection and ongoing tribunal proceedings would not affect this. The provider of Specialist Medical Transport – North did submit a factual accuracy response to the draft report which we reviewed and responded to in line with our usual factual accuracy process.
"As there is ongoing litigation we are unable to comment until this process has concluded.”
