The Care Quality Commission (CQC) has told the North East Ambulance Service (NEAS) that improvements are needed to reduce risks to patients.
The CQC has rated the service as 'requires improvement' following an unannounced inspection in September, carried out as part of ongoing checks on healthcare services.
The report expressed particular concern with ambulance crews responding to patients with a shortage of medicines.
In response to the findings, NEAS said the service has faced "unprecendented pressures" over the last 12 months and they are "committed to making improvements".
The CQC inspections concentrated on the trust's emergency care, emergency operations centre (EOC), the NHS 111 service, and its leadership.
Inspectors found the following during this inspection:
The overall rating for the trust dropped from good to requires improvement.
The overall rating for emergency and urgent care dropped from good to inadequate.
The overall rating for the NHS 111 service dropped from good to requires improvement.
The overall rating for the emergency operations centre dropped from good to requires improvement.
The trust’s well-led rating dropped to inadequate.
Inspectors found there was a lack of sufficient availability of life saving medicines, discrepancies in the number of medicines, missing medicines and incorrectly tagged medicines bags.
The report also stated that patients did not always receive pain relief soon after it was identified they needed it, or if they requested it.
In the staff survey conducted as part of this inspection, staff said they felt under pressure and did not feel as though they have enough support to conduct their work.
Sarah Dronsfield, CQC’s deputy director of operations in the north, said: "We found a deterioration in the services being provided, especially in urgent and emergency care where this had potential for people to be placed at risk of harm.
"It was particularly concerning that staff didn’t always have access to critical medicines needed to treat patients and some crews didn’t have time to complete vehicle medicine checks, resulting in treatment delays.
"Staff told us they frequently responded to emergencies without the sufficient quantities of standard medicines they needed to treat common or life-threatening conditions, including morphine and seizure medication."
At the Emergency Operations Centre (EOC), inspectors found that there were not enough staff members to manage 111 non-emergency calls.
Since then, the service introduced a new recruitment plan which has seen a significant increase in the number of staff.
The report did highlight positives in that staff across the board worked together to prioritise patients and deliver the best care possible to their patients.
Ms Dronsfield said: "Staff took time to interact with patients in a respectful and considerate way and they maintained their dignity throughout their journey and when being transferred to hospital.
"Through engagement with the trust we know they have taken our concerns seriously and have put in measures to address our findings."
In response to CQC's report, Helen Ray, NEAS chief executive, said: "Providing the best possible care to all our patients remains our top priority. We are all committed to making improvements until we and the CQC are confident that the concerns raised have been fully addressed
"In the six months since the first inspection, we have taken swift action and subsequently provided additional assurance to the CQC that the work will ensure effective systems are in place to keep patients safe. We recognise there is more to do and are committed to longer term change as well as a short-term response.
"I am pleased that throughout the report the dedication, care and commitment provided by all our staff is recognised and acknowledged by the CQC. Our teams continue to deliver the best care possible in these exceptional times.
"It is well documented that no ambulance service in the country is achieving national performance standards. Despite that, NEAS remains one of the best performers for response times, particularly to the highest-level life-threatening incidents.
"We recognise there is more to do and are committed to longer term change as well as a short-term response."
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