Echo HQ

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

We looked for evidence that patients and communities had the best possible outcomes because their needs were assessed. We checked that patient’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring patient were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work

At our last assessment we rated this key question good. At this assessment the rating has remained good.

We have not awarded this service a score for Effective.

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

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Crews carried out comprehensive assessments of every patient they attended using established clinical guidance and structured tools to determine clinical need, risks and acuity.

Staff assessed patients throughout their care, recognising deterioration and escalating concerns using clear pathways.

During the assessment we attended and directly observed crews attending urgent care calls. We found that staff carried out comprehensive assessments, used structured clinical judgement and made appropriate decisions to determine whether patients required conveyance to hospital. Crews explained their reasoning clearly to patients and documented their decisions accurately.

Crews considered communication needs as part of the initial assessment. Vehicles were equipped with multilingual communication booklets and digital translation software to support non-English speaking patients.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff followed up to date policies to plan and deliver high quality care according to best practice and national guidance.

Crews who worked on the EUC contract at the NHS ambulance trust had access to the Joint Royal College Ambulance Liaison Committee (JRCALC) guidelines in assessing a patient’s clinical presentation. The JRCALC guidelines are a nationally recognised body which produces clinical guidelines for ambulance professionals.

Clinical practice was supported by JRCALC and National Institute of Clinical Excellence (NICE) guidance which were embedded into governance processes, clinical reviews and staff education. Clinical documents such as medicines standard operating procedures (MSOPs) and PGDs were reviewed periodically to ensure alignment to national standards.

We reviewed three patient care records while observing urgent care crews. Crews documented their assessments clearly and appropriately.

Crews complete shift logs to record timings, job details and issues affecting patient care, supporting operational oversight and performance monitoring.

Audit data from March 2025 to 2026 showed that crews consistently documented assessments including NEWS2 scores, mental capacity assessments, drug administration and any referrals. This aligned with the service clinical supervision framework which required PRFs to be reviewed periodically to ensure compliance with national guidance. Where improvements were identified, staff received feedback and an action plan with a review date aligned to the next audit cycle. Staff were expected to address the actions during their next operational deployment, demonstrating a structured approach to learning and improvement.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff worked well together and demonstrated a clear understanding of each other’s roles.

The service intentionally mixed and matched crews across shifts rather than assigning fixed pairings. This approach promoted an inclusive team culture.

Crews communicated effectively during patient assessment and handovers ensuring information was shared promptly and accurately.

We observed good multidisciplinary team working between the crews, emergency department teams and urgent care services.

Handovers were thorough yet concise. Feedback from system partners was positive.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported people to live healthier lives by embedding prevention and early intervention into everyday practice. They used a making every contact count (MECC) approach to provide brief meaningful interventions, offering advice on physical and mental wellbeing, safeguarding awareness and signposting people to appropriate local support services. Staff were trained to recognise wider determinants of health and early help needs within the community, ensuring people were referred to relevant support services where additional needs were identified.

Several vehicles displayed signage for a nationally recognised charity that provides confidential emotional support and helps prevent suicide through human connection, and a men’s mental health charity that encourages open conversations and early help. These initiatives promoted awareness of confidential support and encourage people to seek help at an early stage and helped to reached people in the most challenged communities.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service operated under the NHS ambulance trust contracted framework, which included monitoring through ambulance quality indicators (AQIs) and clinical outcome measures. However, the provider did not have access to the trust's monthly performance data. Key performance indicators (KPIs) were monitored solely by the NHS ambulance trust, meaning the provider was unable to independently review its performance, track trends, or identify areas for improvement based on contractual performance measures.

Despite these limitations, the provider had established internal quality assurance processes to monitor performance and support service improvement. Monthly audits were undertaken across a range of areas, including PRFs, station checks, IPC, and medicines management. These audits enabled the provider to identify levels of compliance and areas requiring improvement, with actions implemented where necessary.

This meant leaders had limited oversight of external performance measures and could not fully evaluate service outcomes against commissioned requirements. However, they used internal audit findings to identify risks and support continuous improvement.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff followed clear polices and legal frameworks when obtaining consent. The provider had a Mental Capacity Act (MCA) 2005 policy and a Mental Health Act 2007 (MHA) conveyance policy outlining the ambulance service`s responsibilities when transporting patients detained under the MHA.

Staff completed mandatory training in the MCA 2005 including deprivation of liberty safeguards (DoLs) and the MHA 2007.

PRF audits confirmed that crews consistently documented whether patients had or lacked capacity and recorded when capacity assessments were undertaken.

Staff demonstrated a good knowledge of consent and mental capacity. When questioned, they were able to clearly explain how they would assess capacity, what steps to take when a person lacks capacity, and how to make decisions in a patient’s best interest.