Response Ambulance Service

On this page

• 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

This is the first assessment for this service. This key question has been rated good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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.

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The service principles included doing the right thing and putting patients care at the forefront of everything they do. The service values were quality, integrity, support, confidentially, professional and courteous. These were available on the providers website and provided to all staff as part of their induction to the service.  

Staff were able to describe what the service values were and how they used them on a day-to-day basis when they were out and about supporting patients.  

We observed staff upholding these values both in their communication with patients, staff and leaders of the service. 

The service did not have a formal published strategy. Leaders told us the service was operating at a scale that aligned with intended plans and objectives. Staff had a clear understanding of their roles and recognised the contribution they made to the service.

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 did so with integrity, openness and honesty.

Leaders demonstrated the experience, knowledge, and capability required to run the service effectively. They showed a clear understanding of the service's operations and used their skills and expertise to provide effective oversight, support staff, and drive continuous improvement. 

Leaders had taken incidents seriously and knew how to deal with concerns when raised which promoted a positive culture in the service. Leaders undertook patient facing activities to assess for themselves how the service was running, for example working with staff transporting patients when required.  

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 these team meeting and  minutes.

Staff told us they could contact leaders at any time for support. They said leaders actively supported their development, encouraged them to build their skills, and fostered a positive, friendly working environment, making the service a good place to work.

We reviewed leaders files and found them to be fully complaint with fit and proper persons requirements (FPPR). Documentation was complete, up to date and demonstrated pre-employment checks, identity checks, references acquired and DBS clearance had been completed.

We observed friendly, respectful and professional interaction between leaders and staff, and staff to each other.  

People did not always feel they could speak up and that their voice would be heard.

The service did not have a formal freedom to speak up or whistle blowing policy in place for staff and leaders to consistently follow. The provider told us they acted after the inspection to address this. 

In the absence of formal processes 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. Staff were able to provide examples of when they have spoken to leaders about ideas for improving the service. One example was to have an end of day vehicle hand over sheet which staff would complete before leaving their shift. The ensured all equipment for the next day was in the correct place in the vehicle. 

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff could access the services equality, diversity and inclusion framework which was within the staff and self-employed contractor handbook. Policies were accessible via PDA’s or mobile phones. Staff were aware of their rights and leaders encourage open communication about individual needs. 

Leaders and staff told us open discussions were encouraged across the workforce, ensuring all staff had opportunities to share their views and contribute to the development of the service.

Leaders were aware the staff within the service covered multi faiths and cultures and ensured celebration of key dates within the service. Staff were provided with time and space at work to pray.

Leaders told us there was a stable workforce. Most staff told us there were treated fairly  and were proud in telling us how long they had worked for the service.  There had been no negative experiences reported for staff based on equality characteristics. 

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service operated effective governance processes through various meetings and on-site activities. The governance framework defined clear roles for managers and staff and linked to national frameworks.

There was a range of information collected, monitored and communicated internally at the relevant meetings. The provider met 6 monthly with the contractor to review performance and quality. Performance data was analysed 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. Where senior staff had designated tasks related to audit and monitoring quality of services, they understood what was required of them. 

Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required. However, some of the services policies had not been updated in the required annual timeframe. The provider told us that they had been updated following the inspection site visit.

Leaders made sure that accurate information was discussed and shared with key staff. For example, information was shared via staff meetings and minutes.

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 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, following findings from audit a field was added to the tracker system to record the time staff arrived at the final destination. 

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. 

Leaders and staff had access to the equipment and information technology needed to do their work. IT systems were effective with two way authentication in place to prevent unauthorised access. Leaders told us they would receive an alert on their mobile phones if an unauthorised person tried to access they system, which would then close down. 

Staff’s PDA’s all required individual sign with no sharing of passwords. There were enough PDA’s available for all staff on shift to have their own. 

Leaders locked all computers when not in use, ensuring no loss of confidential information.

Leaders recently enacted the business continuity process when a software update resulted in all PDAs and control room computers becoming unavailable, ensuring services continued to operate safely and effectively during the disruption. They were able to describe the steps they had taken to ensure the service continued safely. 

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They 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 patient safety bulletins, service updates and policy changes were shared. 

The contractor told us the service shared reports with them efficiently and effectively, maintaining effective contractual arrangements.

Staff told us the service provided was good and supported the local community. They said all patients were respected and treat with dignity with open, honest communication in place. 

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 office facilities were located in a not-for-profit community building as part of their giving back to the community approach. RAS used with wider community building to host business events and give support to people in ‘hard to reach’ community. 

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

There were processes for learning when things went wrong or of good practice, either locally or nationally. We were told about improvements in the IT systems used which had reduced waste, including paper, made the service more efficient, transparent and supported all staff. Staff rostering, access to policies and procedures and training were all included on the system.

There were systems in place to identify and escalate any vehicle or equipment issues to ensure action was taken to address prior to use.

Changes were made to the reporting process for safety incidents so that it included date, time, staff on the ambulance, and category of travel to make it easier to align the safety incident with the routine journey activity to provide a more effective review of the event.