Helimed house

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of patients who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question outstanding. At this assessment the rating has remained outstanding. This meant patient’s needs were met through good organisation and delivery.

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

We scored the service a 4. The evidence showed an exceptional standard. The service had a clear shared vision, strategy and culture that built on the organisational vision and strategy. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of patients and their communities.

The service had a vision for what it wanted to achieve and a strategy to turn it into action. The service had a 5-year strategy with the strategic intent ‘Together with our supporters, we will push the boundaries in pre-hospital emergency medical care to measurably improve patient outcomes across East Anglia’. The strategy was based upon 3 strategic themes underpinned by key enablers to achieve the 5-year goal. There was a focus on ‘raising the ceiling, not the floor and how to develop values for the future that were meaningful.

The current strategy was 4 years old and senior leadership told us that they were currently reviewing it to develop a new one to meet the changing needs locally. The new draft strategy outlined East Anglian Air ambulance (EAAA) service’s purpose ‘Pioneering life-changing care. Powered by people. Always ready’. These were supported by strategic drivers that the leadership team would focus their time and resource on over the next 5 years. These were aligned to behaviours so all staff could operate as a team to deliver on the planned service purpose and strategy.

Staff appraisal questions were based on the values of the charity values ‘RAISE’; Reasoned, Accountable, Integrity, Synergy and Evolution. Employee behaviours were linked to the organisational values which transformed the abstract principles to concrete actions connected to everyday tasks to achieve the broader mission and purpose ‘Pioneering life-changing care, powered by people, always ready’. Staff were consistently focused on the needs of patients receiving care and delivering a high quality of service.

The service had an open culture where patients, their families and carers as well as staff could raise concerns without fear. The service were continuously reviewing learning from incidents, complaints and missions to address shortfalls. There was a strong emphasis on creating a working environment that allowed all staff to make suggestions and comments to drive improvement. This was supported by both clinical and non-clinical staff we spoke to, as well as action taken by senior leaders. For example, we saw incidents were reviewed and where necessary equipment was taken out of use and learning was shared across other services to prevent future harm for all patients.

Staff felt respected, supported and valued by the leadership team and each other and described an inclusive culture. Relationships between staff were positive, with strong teamwork and collaboration.

The service had a recognition policy which supported staff to be recognised for their achievements. Team and individual staff achievement, and success was recognised and celebrated by the charity commendation for excellence in work or demonstrated a set of behaviours that supported the charity values, which is above and beyond that expected of their role. The service held 2 main recognition events a year to thank staff for their work
The service did not have an equality, diversity and inclusion policy at the time of the assessment. However, staff we spoke to told us that leaders promoted equality and diversity in daily work and provided opportunities for career development.

We scored the service a 4. The evidence showed an exceptional standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty and understood the impact their behaviours and leadership had on patient outcomes and experience.

The registered manager and nominated individual were highly experienced and qualified for their roles. They understood the importance of robust systems, health care regulation and support to achieve safety and positive outcomes for the patients they served.

Leaders understood and managed the priorities and issues the service faced. Leaders were visible and approachable in the service for patients, stakeholders and staff. Staff felt the leaders supported them to develop their skills and felt comfortable raising concerns.

Leaders took incidents seriously and knew how to deal with concerns when raised and promoted a positive culture of learning in the service. Leaders undertook patient facing activities to assess for themselves how the service was running. The registered manager worked frontline alongside clinical staff and encouraged reviews of complex case by wider team displaying the openness and honest expected within the organisation.

Staff were invited to team meetings and could directly access the registered manager to ask questions or make suggestions. Information was cascaded to staff via team meetings, monthly temperature checks, clinical governance and committee meetings. However, staff told us that they were able to meet outside of the structured meetings if needed.

Staff and patient survey results were acted upon for example following the 2 staff surveys in 2023, leaders developed an action plan which was shared with staff on how they were committed to act on their feedback. We saw progress against actions and where actions were in progress there was detail on the action required with named individuals accountable for each action.

We scored the service a 3. The evidence showed a good standard. The service fostered a positive culture where patients knew they could speak up and their voice would be heard.

Freedom to Speak Up (FTSU) is generally not legally required for all charity organisations, as it is a specific framework designed for NHS and healthcare-related bodies in England to foster a culture of raising concerns. However, the principles behind it, safe whistleblowing and reporting are highly recommended for all charities to ensure proper governance and accountability. The service had 1 FTSU guardian in post since 2025. There was a plan to have a deputy FTSU to provide additional level of support and resilience for the guardian.

Staff and leaders acted with openness, honesty and transparency. Staff were encouraged to raise concerns and offer ideas; the culture allowed staff to be confident their voices were heard.

Staff told us when they had raised valid concerns or felt they would be able to, were or would be supported, without fear of detriment. The service held a consultant away day to review the culture and working relationships as a team. Staff were encouraged to be vulnerable, open, respectful and curious. Actions were taken from the day to sustain the progress made and these were followed up after 3 months and measured through an anonymous 360 feedback questionnaire completed by staff. Feedback from consultants and paramedics was positive.

Senior leadership communicated a ‘Can we do business better’ mindset. It gave clinical staff the opportunity to feedback to leaders and make suggestions. For example, staff were consulted on changes in policy and future purchasing of clinical equipment to ensure that all staff were involved in improving quality of care and innovation within the service to benefit patients and staff.

Patients, their families and carers were provided with information to explain how they could raise a concern and how this would be investigated. Senior staff were encouraged to respond to immediate concerns or complaints with a view to resolution. There were policies to support the complaints process, we saw evidence of action taken to complaints made in line with policy.

We reviewed information which showed there had been 1 matter raised via the speaking up process in the past year. At the request of the person who spoke with the guardian no further action was taken in relation to staffing and workforce planning decisions.

We scored the service a 3. The evidence showed a good standard. The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for everyone.

The service did not have an equality, diversity and inclusion (EDI) policy in place at the time of the assessment. We saw the equal opportunity statement, developed in September 2023 which ensured equal opportunities, fairness of treatment, and elimination of all forms of discrimination in the workplace.

The service had recently appointed a new Director of People and Culture and there was a commitment to develop an EDI strategy and policy. The service gathered and analysed equality and diversity data to ensure that they achieved the diversity and inclusion aims and commitments, as set out in the Equal Opportunities Statement. An executive leader told us there was a need to support and address diversity within the workforce to represent all the community they served and make it accessible for people to join. Leaders acknowledged the new strategy, and policy would ensure a robust system to remove bias from practices to ensure equality of opportunity and experience for the workforce within their place of work, and throughout their employment.

Staff told us they had opportunities to apply for project work, new roles and to undertake external studies through an open application process.

The service acted to prevent and address bullying and harassment at all levels and for all staff, with a clear focus on those with protected characteristics under the Equality Act and those from excluded and marginalised groups. Leaders took appropriate action to address reported behaviour or attitudes which were negative in style. We saw evidence of this during our assessment.

Staff with disabilities were offered reasonable adjustments to support them to carry out their roles well. As part of Neurodiversity celebration week, staff were invited to a 1-hour online workshop focussed on promoting and supporting neurodiversity in the workplace.

Staff led on service improvement ideas. For example, staff led on conducting market research, selection and trials by staff to purchase a single ventilator that would provide appropriate ventilation strategies to patients.

We scored the service a 4. The evidence showed an exceptional standard. The service had clear responsibilities, roles, systems of accountability and effective governance. Staff used these to manage and deliver high-quality, sustainable care, treatment and support. Staff always acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The service operated effective governance processes through various committees and on-site activities. There were clear responsibilities among staff which interconnected and ensured governance was fundamentally strong. The service used data and best information to ensure it understood its risks, performance and outcomes. Senior leaders managed performance well and took appropriate action to managing risk. For example, clinical staff attended morbidity and mortality meetings at the local NHS trust. Incidents of out of hospital cardiac arrest were discussed with the intention of reviewing practice and potential improvement such as decision making and communication.

There was a range of information collected, monitored and communicated internally at the relevant committee meetings and was fed upwards to the board of Trustees. These were evidenced in meeting minutes we reviewed.

Performance data was consistently analysed and compared within the provider organisation and where improvements were needed at the location level, action plans were developed to make this happen.

Staff at all levels were clear about their roles and accountabilities. Staff had job descriptions, and these set out expectations and responsibilities. The executive team had a current action log which clearly detailed designated staff tasks related to the overall governance of the service.

Staff could find the data they needed, to understand performance, make decisions and improvements. The information systems were integrated and secure.

Leaders understood their roles and responsibilities in providing data and notifications to external organisations. It provided information and reports to external bodies, including the Care Quality Commission (CQC), NHS ambulance service and Medicines and Healthcare Products Regulatory Agency following a thermal burn. The service provided feedback and shared information with external clinical forums and system partners to ensure it was up to date with best clinical practice. System partners told us that the service were supporting them to be effective in their delivery of safe care.

Leaders made sure that accurate information was discussed and shared with key staff. For example, when the new digital governance system was developed, there was a clear roll out of training and QR code for staff to offer feedback, with clear objectives on how the system will support different functions of the organisation.

Risks were clearly identified and a formal log of these was used to keep oversight and manage mitigations and/or bring to resolution. Staff contributed to decision-making to help improve sustainability and improve quality of care.
Audit processes, research and the outcomes were used to ensure quality of services was maximised. Where improvements were required, leaders ensured action plans and the monitoring of these led to positive changes, for example staff were reminded of the importance of delivering timely antibiotics in open fractures where compliance fell below the target of 90%.

The service had plans to cope with unexpected events and had a business continuity plan, which included major incident plans.

The service had not reported any data breaches and systems were secure. Patient identifiable information was handled correctly.

We reviewed several service level and provider policies and found these were up to date and readily available to staff. There was leadership oversight of the accuracy and validity of each policy. However, policies were not subject to equality impact assessments to ensure they did not disadvantage people with protected characteristics or those who were more vulnerable.

The service had a detailed risk register which identified, assessed and prioritised clinical, financial and operation risk to improve patients’ safety and organisational performance. It tracked mitigation actions and was supported by policies to ensure transparency, regulatory compliance and inform decision making. The board of Trustees were informed of changes to the risk register for review and oversight. Top 3 risks during our onsite assessment included the recruitment and deployment of advanced critical care paramedics, IT infrastructure and risk of cyber-attack and impact on service and the administrative workload for maintaining readiness for CQC assessments as the medical director also acted as the CQC registered manager with no specific administrative support for CQC activities.

Executive leaders and trustees were sighted on the increased costs per mission due to the supply chain demand. There was a clear strategic focus on fundraising to ensure a sustainable service. The new strategy gave consideration for the need to future proof donations as the charity was dependent on income generation and the charitable funds. The service aimed to continue to be identified as an area of excellence to recruit the best staff to support the delivery of high-quality care.

We scored the service a 4. The evidence showed an exceptional standard. The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for patient. Staff always share information and learning with partners and collaborate for improvement.

Staff and leaders at the service collaborated with relevant external stakeholders and agencies to improve care and treatment for patients using the service. For example, they communicated workforce changes within the service and shared reporting templates with other providers to promote consistency across air ambulance emergency service (HEMS) providers.

The service met with external stakeholders and regional networks to understand the needs of the community and the provider ambitions. Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. For example, the service committed to addressing the disparity between women receiving Cardiopulmonary Resuscitation (CPR) in comparison to men. They led on media coverage for training with female manikins, provided blogs and resources, worked with charities and resuscitation organisations to improve out-of-hospital cardiac arrest (OHCA) survival in the region.

The service met quarterly with other regional air ambulance services and the contracted NHS ambulance trust to review clinical and operational updates and performance. This aimed to improve care coordination, enhanced network collaboration and offered opportunity to discuss any local or national updates.

The senior leadership were supporting new hospital programs on the construction and design of new helipad infrastructure as well as supporting regional trauma networks in improving treatment on scene through robust effective pathways such as stroke and silver trauma. This in turn would support the critical care desk to deploy the HEMS services to correct missions.

We scored the service a 4. The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. Staff often encouraged creative ways of delivering equality of experience, outcome and quality of life for patient. Staff actively contributed to safe, effective practice and research.

The research, audit, innovation and development (RAID) team supported the service in its vision to improve patient outcomes by developing new treatments, equipment and skills through trials, extensive research and using the latest innovation evidence in Pre-Hospital Emergency Medicine (PHEM). It collaborated across UK air ambulances, the NHS and universities to improve the field of PHEM. Staff had attended various UK and international events where they shared learning from these initiatives with other HEMS.

The RAID team met weekly to discuss audit data and feedback to monthly governance steering group to identify themes and trend and drive improvement in performance and clinical outcomes.

The service led innovative research to support early diagnosis and treatment in patients. Studies such as ERICA-Arrest and BRAIN-FIRST projects were examples of how the service was striving for innovative research to drive improvement in the quality of PHEM.

The service had a quality improvement (QI) methodology and there were examples of QI in practice. Staff told us that they were actively encouraged to be a part of quality improvement projects. The service evidenced current QI projects and their effectiveness such as Direct to CT pathway for EAAA trauma patients taken to a NHS hospital.

Staff were committed to continually learning and improving services. Clinical staff were fully engaged with research to save lives. Staff described it as part of the ethos of the organisation they worked for and was a part of their values.

There were processes for learning when things went wrong and recognising good practice, either locally or nationally. All projects for research were reviewed through the clinical governance steering group. Projects were triggered in several ways such as changes in best practice standards, new technology as well as clinical performance and staff wanting to develop best practice. For example, research had identified patients with a low blood pressure in cardiac arrest were less likely to survive. As a result, the service used invasive technology to monitor patient’s vital signs in real time to respond to any deviation immediately to reduce patient harm and improve patient outcomes.

Leaders supported staff to have the time to develop their skills around improvement and innovation and to pursue areas of interest and research within the service. Projects for research were triggered in many ways such as current best practice standards and new technology. Leaders encouraged innovation and participation in research, and we heard about the following examples including consulting on the replacement of new ventilators and saw evidence of feedback from clinical staff on their functionality during the trial period. The service had coproduced a bespoke bracket to enable the ventilator to be securely stored on board the air ambulance.

Staff and leaders were committed to excellence that centred on the patient experience and best outcomes from lifesaving treatment. In 2024/2025 the service received 82 clinical feedback forms from patients and their families scoring 5 out of 5 for satisfaction with the treatment they received. They received 63 Aftercare feedback forms covering 3 key questions about the support received with an overall satisfaction of 4.82 out of 5. The service told us that they have not needed to make any changes to their service in the last 12 months in response to patient feedback. However, they were continuing to collect and analyse data to identify where improvements could be made based on patient experience.