Lambda Medical Ltd

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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

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.

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.

The service was in breach of Regulation 17 Good governance.

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 had a vision for what it wanted to achieve. Leaders all had an understanding of how their work contributed to achieving the vision with a key focus on pro-active continuous development to provide high quality patient care.

Leaders recognised challenges in communicating the vision and values to all staff due to the high amount of bank staff who also held other commitments elsewhere. However, the team aimed for full face to face staff meetings annually and communicated with staff frequently through internal media forums such as specific groups set up on a messaging application for sharing information relating to service development.

We reviewed the agenda for the all staff meeting held in January 2025 and saw the future vision was set out with aims for the year and beyond. Leaders were able to articulate how they were consistently working to deliver high quality care. Leaders told us they had regular discussions to set goals and look at their future plans. However, the service was unable to provide a documented action plan to achieve these aims. Minutes from these meetings or discussions were not available.

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 had the skills, knowledge and experience to perform their roles. Leaders were from a range of backgrounds, for example, medical, NHS ambulance control and social care. Leaders were passionate and driven to share their knowledge and experience to support provision of high quality care.

Leaders understood the challenges for independent ambulance services and used their experience to lead teams.

Staff told us leaders were visible in the service and always approachable. Leaders listened to staff feedback informally, through formal processes and through annual staff surveys. Leaders made changes as a result of staff feedback, for example, the introduction of additional continuing professional development courses and changes to stock items such as patient single use linen.

The annual staff survey allowed for scoring aspects of the work and free text for ‘other comments or ideas for development’. However, this data was not used to compare results year on year to track areas of improvement or deterioration.

Leadership development opportunities were available, including opportunities for staff. Leaders described a forward thinking approach to creating new leadership opportunities and roles as the service grew and developed, for example a newly created post for a repatriation officer within the patient transport service.

Leaders strove to provide a culture that retained staff with the right skills. They had a clear understanding that there was a risk of loss of skills with high staff turnover. There was a focus on training opportunities that would support staff retention.

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

Staff could meet with members of the provider’s senior leadership team to give feedback.

Staff were encouraged to give feedback in a range of ways. Debriefs were held after any transfer that might have adversely affected staff, for example a prolonged journey or managing a person with complex needs. This allowed staff to feedback in an open a safe space and consider improvements that could be made.

There was a Whistleblowing Policy. This stated all staff would be treat fairly and concerns raised would be treat in confidence.

Concerns raised were formally recorded through the incident recording process allowing for review of concerns over time. For example, we saw staff attitude had been raised, listened to and acted upon.

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.

There was a Reasonable Adjustment Policy in place for staff training. This supported staff to have the opportunity to identify and make adaptations where there were barriers to achieving training required to be able to perform their role effectively.

There was a longer term aim to have an equality, diversity and inclusion lead in place as the service grew.

Staff were supported to work flexibly to meet individual needs, for example, prayer times were acknowledged and supported.

The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes.

The provider did not consistently demonstrate effective oversight of all policies. There was a risk that safe care would not always be provided without adequate oversight and management of policies. The provider had a range of policies in place covering clinical, corporate and human resource matters. Policies included version control and had recorded review dates.

Staff told us policies were agreed and signed off as a panel. There was some evidence of discussion regarding policies within senior leadership team meetings. Of the policies reviewed we did not see clearly documented evidence policies had been ratified jointly through panel decision. However, we saw that a newly formed governance group with representatives from a number of roles had been set up just prior to inspection. There was ongoing work to review each policy through this new group.

The service had multiple policies covering the same topics. For example, there was a Safeguarding Policy and a Safeguarding Guidance Policy. Both policies included duplicated information such as types of abuse. There was also a Work Related Driving Policy and a Driving Policy. There was a risk that information would be missed where policies overlapped. Leaders were able to explain the rationale for these multiple policies and identified that the newly formed governance group would be working to minimise duplication.

The format and content of policies was inconsistent. The Training Policy did not clearly stipulate the frequency of mandatory training for each staff group. The Deteriorating Patients Policy identified relevant training requirements, however, the Safeguarding Policy did not identify safeguarding training requirements.

The providers risk register included overall risks to the service as well as risks arising from incidents that had occurred, for example, a medication incident. Staff told us they could feed information into senior leaders to be considered for the risk register. Each risk had a score, mitigating actions, an owner and review date. However, oversight of the risk register was not always clear. The owner of some risks were recorded as the senior leadership team rather than an individual named person. The risk register was not reviewed within monthly team meetings. In addition, the Managing Risks Policy was brief and did not give clear guidance on use of the risk management framework.

Leaders were clear about the structure of the leadership team, however, the Governance Policy did not set out a clear framework for senior leadership or team meetings. Leaders explained that there were a number of methods for cascading information such as learning from incidents and complaints to staff.

We reviewed meeting agendas and minutes. We saw there was a set agenda for each monthly senior leadership meeting. Actions from previous meetings were reviewed and discussion was held against each standard agenda item. However, minutes were brief and did not have a standardised layout defining actions to be taken forward. Although, actions were included within some of the content of the minutes and completion of actions could be evidenced through future meeting minutes. The standard agenda for senior leadership meetings did not include a review of risks or incidents. There was no assurance that incident discussions were formally included on meeting agendas, for example, we saw there had been 3 medication incidents identified in the annual incident report. These incidents were not referred to in the senior leadership meeting minutes, although ‘medication errors leading to harm’ was included on the risk register. Changes were made following inspection to ensure a review of risks and incidents were included on the agenda and formally documented even if there were none to discuss.

We were told that monthly virtual meetings would be made available for all staff to attend and one face to face meeting quarterly would be planned where possible. We requested all team meeting minutes but were not provided with any for these meetings. Changes were made following inspection to ensure there was a standardised agenda and minutes kept of all staff meetings.

The providers Business Continuity Policy referenced ‘how staff should try and prevent external events impacting the service, and the detailed steps involved in restoring service…’. However, there were no potential events causing disruption or continuity procedures outlined in the policy. Business continuity action cards for common scenarios such as loss of communication or loss of vehicles were kept in a folder in the office for staff to access. These did not provide specific detail on actions to take, for example, loss of premises identified a move to pre-identified fall back premises. The specifics of alternative premises or how to identify these were not made clear in the business continuity action.

The staff files were not consistently maintained on one electronic system at the time of inspection. This meant information was hard to find and not always readily available. This meant that staff checks prior to jobs could be difficult and time consuming. Following our onsite assessment, action was taken to ensure all staff files were updated on the electronic system with consistent access to staff information all in one place including references, DBS and ID checks, application and interview forms.

Information governance systems included confidentiality of patient records.

We reviewed record keeping audits and saw that records were thoroughly reviewed and queries regarding detail or care provided raised as needed. However, we did not see any clear system of observing themes and trends in documentation concerns. Leaders consistently told us that concerns would be raised with individual staff members.

Staff had access to the equipment and information technology needed to do their work.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care. Key performance indicators and targets had been identified. At the time of inspection there was only one month of data provided and no comparison available for oversight of key performance indicators over time.

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.

The service worked collaboratively with local partners such as other local NHS ambulance services to support joined up working. Leaders were aware that staff worked in a number of different organisations as well as at Lambda. Leaders benchmarked against other local providers to support consistent ways of working.

Leaders worked with bed managers in hospitals prior to transfers to support partnership working.

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.

Staff and leaders identified learning from other organisations and transferred this to their own practice at Lambda. Staff were supported to bring new ways of working and ideas to the service. Leaders learnt from other organisations and sought out best practice areas from others for their own development.

Leaders described striving to enhance the care they provided in the pre hospital environment, for example, provision of mattress toppers to reduce risk of pressure ulcers during transportation.