Alliance-Pioneer Ambulance Ltd Also known as APG

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 means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. We checked that leaders actively supported staff and worked with partners to deliver care that was safe, well‑coordinated, person‑centred, and sustainable, while also helping to reduce inequalities.

This is the first inspection for this newly registered 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.

Description: We have a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

The evidence showed a good standard. 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.

Leaders established a clear and shared vision and strategy focused on sustaining a business model that met the needs of the community while delivering high-quality care. Leaders ensured staff across all areas understood and supported the organisation’s values and strategic goals, and how their individual roles contributed to achieving them. There was ongoing uncertainty regarding contract work with the NHS ambulance service. Although staff found this unsettling, they felt reassured by leaders’ transparency and openness in addressing these issues. Leaders demonstrated a strong awareness of the challenges and were taking proactive steps to mitigate them.

Staff and leaders demonstrated a positive and compassionate listening culture that promoted trust and understanding between them and the people using the service. Staff described an open and supportive culture in which concerns could be raised without judgement, feedback was encouraged and shared, and learning needs were identified and acted upon.

Description: We have inclusive leaders at all levels who understand the context in which we deliver care, treatment and support and embody the culture and values of their workforce and organisation. They have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

The evidence showed a good 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 did so with integrity, openness and honesty.

Senior leaders were experienced healthcare professionals with specialist knowledge of the services they managed. They were able to clearly describe how their teams worked to deliver high-quality care. A duty manager was always available to provide help and support, and staff reported that senior leaders were approachable and responsive to clinical concerns.

Leaders were visible and led by example, consistently modelling inclusive behaviours. Staff told us leaders supported them with safeguarding issues and provided compassionate support following clinical incidents.

Staff spoke positively about leadership, describing it as highly supportive, with leaders who went above and beyond to help. Staff described an open-door culture, which ensured everyone was treated equally and enabled leaders to understand and respond to personal circumstances affecting staff wellbeing and performance. Staff shared examples of feeling comfortable approaching leaders with concerns.

Staff reported feeling respected, supported and valued, describing the leadership culture as inclusive. Feedback highlighted a “close-knit, family-oriented team” and “the best place I’ve ever worked culture-wise.” Relationships between colleagues were positive, with staff describing a workplace where friendships were formed and everyone could rely on each other.

At the time of our assessment the service had a registered manager who was responsible for managing the regulated activity. They understood their responsibilities as a registered manager.

Description: We create a positive culture where people feel that they can speak up and that their voice will be heard.

The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff and leaders acted with openness, honesty and transparency. Staff had access to Freedom to Speak Up Guardians. Freedom to Speak Up Guardians are professionals that support staff in raising concerns and speaking up about any issues they encounter. Staff understood the speaking up process, and felt confident any issues they reported would be addressed.

The provider had an up‑to‑date policy to support staff with whistleblowing and freedom to speak up concerns. There was also a clear process that enabled staff to raise concerns confidentially with the management team or externally when appropriate. Staff reported feeling confident about raising concerns to senior leaders.

Description: We value diversity in our workforce. We work towards an inclusive and fair culture by improving equality and equity for people who work for us.

The evidence showed a good standard. 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.

Leaders took action to continually review and improve the culture of the organisation in the context of equality, diversity and inclusion. A member of the leadership team had been appointed as the service’s Inclusivity Officer. They had completed additional training in diversity and inclusion, covering workplace culture and how to embed diversity within it, as well as inclusive approaches to recruitment, career progression, and the implementation of reasonable workplace adjustments.

The recruitment policy demonstrated the organisation’s commitment to promoting equality of opportunity in employment. Leaders maintained an equality and diversity matrix to monitor workforce demographics, and staff had completed training in equality and diversity.

The service’s Equality and Diversity policy outlined their responsibilities to promote equality, fairness and respect for all, in line with the requirements of the Equality Act 2010.

Staff told us they felt they were treated fairly and equally by the leadership team. We heard examples of leaders making adjustments to working arrangements to support staff in meeting their individual needs.

Description: We have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. We act on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.

The evidence showed a good standard. 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.

There were clear and effective governance, management and accountability arrangements. A recruitment policy outlined the process for appointing staff, and there was a clear and effective approach to supporting and managing staff whose performance fell below expected standards.

Monthly governance meetings were held to address matters relating to quality, clinical governance, and risk management. Although regular team meetings were not held due to the challenges of coordinating them around staff shifts, communication with staff was maintained through verbal updates, emails and a messaging service. Staff told us this worked effectively, and managers would accommodate a face to face meeting when required for any concerns.

Regular communication was maintained with commissioners regarding contracted work. The service monitored timeliness and reviewed performance through governance meetings. The service recorded Ambulance Quality Indicators (AQIs), which are standardised performance measures used by the NHS to assess the timeliness, safety, and clinical effectiveness of emergency medical services.

The service maintained a risk register, which identified current risks and detailed corresponding mitigation measures. This was subject to regular review at monthly governance meetings.

Audits were carried out to monitor quality and safety. Records confirmed they were completed in line with the established audit schedule, with appropriate action taken to address any issues identified. This included providing feedback to the staff members involved.

Patient information and data were managed securely, in line with the service’s Information Governance policy.

Description: We understand our duty to collaborate and work in partnership, so our services work seamlessly for people. We share information and learning with partners and collaborate for improvement.

The evidence showed a good standard. 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 were open and transparent, and they collaborated with relevant external stakeholders to improve care and treatment. There was regular communication with commissioners, providing opportunities to raise concerns, share updates, and review performance. The service used standardised performance measures to support constructive discussions with the NHS ambulance service. Incident investigations and safeguarding referrals were carried out in collaboration with external stakeholders when required. The service worked with the local Integrated Care Board when developing Patient Group Directions (PGDs), which provide a legal framework for authorised practitioners to supply and/or administer specified medicines without a prescription.

Staff and leaders worked in partnership with key organisations to support care provision, service development and joined up care.

The service recently participated in a multi-agency major incident exercise at a local racecourse alongside emergency services, the local council, and the local university. We were told how the realistic simulated explosive incident enabled the service to test its emergency response arrangements, strengthen preparedness, and work closely with partner agencies. The exercise also helped identify learning opportunities to improve readiness for potential real-world incidents if called upon by the commissioning service. In addition, it provided valuable practical experience for paramedic students in responding to high-pressure emergency situations.

The service supported the local community by visiting primary and specialist schools with vehicles, helping to reduce children’s fear and anxiety, making emergency vehicles and staff feel more familiar and less intimidating.

Description: We focus on continuous learning, innovation and improvement across our organisation and the local system. We encourage creative ways of delivering equality of experience, outcome and quality of life for people. We actively contribute to safe, effective practice and research.

The evidence showed a good standard. 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.

Staff and leaders had a good understanding of how to make improvements happen. There was a strong culture of learning and continuous improvement across the service. Quality was regularly monitored, with clinical audits, medication compliance, journey data, incidents, complaints, and compliments reviewed at regular governance meetings. An experienced doctor undertook a monthly audit of all electronic patient care records. This was based on the Royal College of General Practitioners Urgent Care Clinical Audit Toolkit. This is a resource designed to support consistent clinical audits across urgent and emergency care settings.

Leaders encouraged staff to speak up with ideas for improvement and innovation, and actively invested time to listen and engage. Staff reported that leaders encouraged them to share ideas for improvement and created an environment where this could be done openly without fear of judgement. Staff described how suggestions were supported, developed, and considered by leadership for potential implementation and resourcing where appropriate.

We were told of an example where staff proposed the creation of a Team Leader role to provide additional hands-on support to operational teams and assist the Duty Manager with the daily deployment of vehicles. Although the proposal was not progressed due to later uncertainty surrounding NHS ambulance service contract arrangements, leaders were described as being open and receptive to the suggestion, actively encouraging staff to contribute ideas for service development and inviting a formal proposal for consideration.

Several recent improvements were highlighted, including the launch of a new internal website. QR codes displayed in vehicles and at headquarters provided staff with quick access to key resources, such as incident reporting, vehicle defect reporting, and equipment defect reporting. We also heard about recent developments within the Make-Ready Team, including the transition from paper-based processes to digital recording for vehicle cleaning and preparation activities.