Echo HQ

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

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

This Independent Ambulance service provided transport services, triage and medical advice provided remotely as well as treatment of disease, disorder, or injury. The undertake contract work for local NHS services. The service had a good learning culture, with both staff and patients feeling able to raise concerns. Managers investigated incidents thoroughly. Patients were protected and kept safe because staff understood local safeguarding arrangements. There were enough staff with the right skills, qualifications and experience in the service to ensure high quality care. Managers made sure staff received training and had regular appraisals to maintain high-quality care. Staff managed medical gases safely. Staff identified and reacted to unexpected deterioration in a patient’s condition. Staff understood and managed risks from the environment. The vehicles and equipment met the needs of patient, were clean and well-maintained and any risks were mitigated.

We have not awarded this service a score for Safe.

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

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service demonstrated a positive learning culture where staff felt able to report concerns, incident and contribute to continuous learning. Staff told us that incidents could be reported several ways including by email, completing a form or speaking to a team leader in person or by telephone.

All incidents were added to the incident tracker and reviewed by managers.

Staff were able to identify and report risks, secure in the knowledge these would be addressed. For example, two incidents had been reported in the last 12 months, both relating to slips and trips. Where there was an immediate risk of harm to patients or others, staff felt confident to intervene to prevent harms occurring.

Incidents that occurred while the service was operating under a subcontracted agreement were reported directly to the contracting NHS ambulance trust, which held responsibility for receiving, reviewing and investigating those incidents. The provider cooperated fully with processes by supplying staff statements, patient records forms (PRFs) and any additional information requested. When learning was identified, the provider implemented changes and shared updates with staff to support best practice.

Staff understood how to report incidents and could describe the process.

Vehicle related incidents were reported through the appropriate helpline and acted upon.

Incident themes and trends were monitored and discussed through governance structures. Learning from incidents was cascaded to all staff through internal communications, staff boards and safety briefings. Staff were able to give examples of changes made following incidents and we saw evidence of learning being used to improve practice.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if and when things went wrong. Staff received feedback from investigation of incidents, both internal and external to the service.

The service’s recruitment policy outlined expectations around staff’s statutory and mandatory training. Staff had to complete this within 8- weeks during their induction as part of the statutory and mandatory training.

Clinical staff completed training on recognising and responding to patients with for example, patients with mental health needs, learning disabilities and dementia.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service operated within the private ambulance provision for paramedic emergency, urgent care (EUC) and patient transport service (PTS) under a formal service level agreement (SLA) on behalf of the NHS ambulance trust. The scope of activity included emergency responses, urgent care, admissions, discharges, transfers and outpatient appointments across the contracted geographical area.

We found that the patient transport service had clear and effective systems in place to support assessment, treatment and transfer of patients.

Safety and continuity of care was a priority throughout people’s care pathway. Patients were assessed prior to arranging their transport needs. There was a clear criterion for accepting patients as suitable for the available vehicles and resources.

There were systems and processes to ensure the correct patients were collected and transferred between locations

The transfer of patients between locations was done so safely. Staff had appropriate driving skills and experience. Suitably skilled staff accompanied patients during the journey and safety equipment was used throughout.

When overall responsibility for the care and treatment of a patient moved to a different service provider, such as transfer to the NHS, there was effective communication, which allowed for seamless transfer.

Care and support was planned and organised with people, together with partners and communities in ways which ensured continuity after transfer to the destination.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

All staff were trained in safeguarding children and adults at levels 2 and 3 in line with the intercollegiate framework. The service had a designated safeguarding lead (DSL) who had completed level 4 safeguarding training.

The service had clearly defined safeguarding arrangements with named leads for safeguarding adults, children, child sexual abuse and exploitation, mental capacity and liberty protection. These roles ensured staff had access to specialist advice and support and clear escalation pathways for complex safeguarding concerns.

Staff could recognise a safeguarding concern and understood how to report.

All safeguarding concerns were submitted through the trust safeguarding protocols/processes when operating on behalf of the NHS ambulance service and the provider maintained records of the action taken for each case.

All staff including those on zero-hour contract had an enhanced disclosure and barring service (DBS). The provider had an effective system in place for monitoring and alerting staff when an update or renewal was required.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Patients and referrers could access the service directly via telephone or through an online booking form. The provider used a standardised patient transport assessment of needs form to ensure all relevant information was captured prior to booking. This formed the foundation trust of safe triage, correct resource allocation and appropriate crew skill mix. The assessment process captured essential information including patient demographics, next of kin details, allergies and estimated weight. A structured mobility assessment identified whether the patient was independently mobile, required assistance or was bed bound and needed a stretcher, ambulance chair or patients own chair or electric mobility scooter.

The booking process also captured communication and language needs, infection prevention and control (IPC) status, mental health or behavioural support needs, dietary requirements and any oxygen or other clinical requirements that might necessitate a higher dependency transfer.

Collection and destination details were recorded. Escort arrangements, wait and return requirements and any luggage were also documented.

This ensured the service had all relevant information to allocate the correct vehicle, equipment and crew skill mix which supported a safe patient journey.

The service was preparing to transition from paper patient records to an electronic patient’s records (EPR) system which would integrate with the NHS ambulance trust.

The service had a clear standard operating procedure (SOP) to support non-clinical PTS in recognising and responding to a deteriorated patient. Staff were trained to identify early signs of deterioration such as changes in a patient condition or the patient reporting that the felt unwell.

The process guided staff to ensure risks were managed safely. Staff were required to stop the vehicle in a safe location and assess the patient was breathing. If the patient was not breathing, staff were instructed to call 999 immediately, confirm cardiac arrest and commence basic life support in line with their training.

When a patient was breathing but appeared unwell, staff were directed to pull over safely, contact the control room for clinical support, and call 999 if they were unsure about the severity of the deterioration. Staff were instructed to make the patient comfortable, monitor them closely, and prepare for the possibility of cardiac arrest.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use equipment and to manage different types of waste safely.

The service had effective operational contingency arrangements in place, including access to additional vehicles and equipment, to ensure continuity of service. The provider maintained a fleet of reserve vehicles, enabling crews to respond promptly to callouts when required.

Staff completed daily safety checks of vehicles and specialist equipment to ensure they remained safe and fit for use. Crews undertook morning vehicle inspections using vehicle daily inspection (VDI) sheets. Any defective equipment identified during these checks was removed from service, clearly labelled with a red tag and placed in a designated area within the crew room. Replacement items were obtained from stocked 'good to go' shelves, ensuring vehicles remained operationally ready. The make-ready team replenished equipment through an ongoing vehicle restocking process.

Records showed that all vehicles were serviced in line with manufacturer guidance, had current MOT certificates and were roadworthy and safe for operational use.

Staff told us that equipment was checked regularly and maintained to a high standard. The provider outsourced the maintenance and testing of electrical medical equipment to a specialist external contractor, helping to ensure compliance with relevant safety standards. We reviewed maintenance records and functional safety test reports that confirmed electrical medical devices had been appropriately serviced and tested.

We reviewed station audit records from January to April 2026, which showed routine checks were completed consistently. Audits included verification that medical devices were stored correctly, portable appliance testing (PAT) had been undertaken, fire safety logbooks were completed, and first aid equipment was available. Audit records were signed and dated by the person completing the checks.

However, we found that training equipment was stored alongside spare operational equipment and was not clearly identifiable. This increased the risk of training equipment being selected for operational use. We raised this with the provider during the assessment.

Staff told us about an issue with the side door of an ambulance, which had been reported. When we raised this with the provider, leaders were aware of the defect and the repairs had already been arranged. The repair was completed whilst inspectors were onsite, showing that identified vehicle defects were acted upon through the providers established maintenance arrangements.

Vehicles were equipped with the emergency equipment required for their scope of practice. Staff checked drug bags at the start of each shift.

All PTS vehicles carried essential equipment, including:

• An automated external defibrillator (AED).
• A basic response bag containing oxygen, a bag-valve mask (BVM), dressings and basic airway adjuncts.
• Consumables such as vomit bowls, wipes and gloves.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and support.

The service employed paramedics, technicians, apprentices, emergency care assistants. ambulance care assistants (ACAs) trained to First Response Emergency Care (FREC 3) and some had progressed to level 4 pre-hospital care qualifications.

Staffing levels and skill mix were planned to ensure full compliance with contractual requirements for service delivery.

On this assessment, we found the service followed safe recruitment processes. We reviewed three personnel files, including those for an apprentice, a zero-hours paramedic and a full-time paramedic. Records demonstrated that the required pre-employment checks had been completed before staff commenced employment.

The provider had effective systems in place to ensure staff completed mandatory and statutory training. All staff had achieved 98% statutory and mandatory training compliance which exceeded the providers target of 80%.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service managed infection risks well. Staff used equipment and controlled measures to protect patients, themselves, and others from infection. They kept equipment and the premises visibly clean.

There was access to a local infection, prevention and control policy (IPC) and supporting guidance was accessible to staff. Staff received training on IPC.

We observed crews completing vehicle checks correctly and in line with the provider's procedures.

We reviewed 14 months of infection prevention and control (IPC) audit data, which demonstrated audits had been completed consistently. Records showed that where actions had been identified, these had been addressed and completed by the provider.

A programme of six-weekly deep cleaning was in place for all vehicles. Records showed these deep cleans were completed in addition to routine daily cleaning schedules.

During our assessment, we observed vehicles to be clean, tidy and well maintained. The internal environment appeared visibly clean, and equipment was stored appropriately to support effective infection prevention and control practices.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Oxygen was used onboard vehicles. Cylinders were stored safely. All staff were appropriately trained and had completed medical gas administration training as part of their FREC3 course qualification.  

The service completed monthly controlled drugs audits. We reviewed audit records covering the period February 2025 to February 2026, which demonstrated that regular monitoring of controlled drugs management was undertaken.