E-Zec Medical Wellington

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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.

This is the first assessment for this service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was an increased risk that people could be harmed.

Patients were subject to delays, which risked compromising the continuity and consistency of care. Performance monitoring data showed the service was not meeting several key timeliness targets. Although collaborative improvement efforts with stakeholders were underway, these had yet to produce measurable results. This was a breach of regulations in relation to Safe Care and Treatment, and Good Governance.

Patients were involved in their initial assessments, and their needs and preferences were considered during the booking process. Staff carried out dynamic risk assessments if information about a patient was not accurate and would proceed with the transfer if it was safe or cancel the journey if it could not be carried out safely. We received positive feedback on the patient transport liaison officers (PTLOs), who were working to ensure communication between services was effective. However, stakeholders still had instances when they could not get patients transported within their required timelines.

Although the provider’s assessment indicated sufficient staffing to meet contractual obligations, several staff expressed concerns that current levels were inadequate for the workload.

Staff received the right amount of training to undertake their roles. Although staff received regular appraisals, some staff told us they did not receive regular one-to-ones and did not feel supported by management.

There was a good incident reporting culture, and processes for learning to be shared electronically, via bulletins and informal discussions. However, some staff we spoke with felt learning from incidents was not being adequately communicated to them.

The main base was clean, tidy and secure. The vehicles we inspected were also clean and in good condition. There was a process for logging vehicle faults, and issues were raised by staff representatives in team meetings. Although we saw evidence of vehicle defects being discussed in team meetings, some staff felt there was a lack of communication regarding updates on vehicle defects.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. 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.

Staff knew how to report incidents. The incident reporting policy set out the workflow, responsibilities and timelines for incident reporting. We reviewed 4 recent incident investigations, all of which were triaged as per the provider’s policy and investigated by senior staff.Learning from incidents was shared with staff. However, some staff felt this was not effective. As per the contractual requirement under the NHS England Patient Safety Incident Response Framework (PSIRF), the service had a Patient Safety Incident Response Plan (PSIRP), which set out how learning was to be shared with staff. We saw learning bulletins containing overviews of recent incidents, as well as a recent ‘toolbox talk’ covering the safe transportation of patients in wheelchairs. Toolbox talks are short, informal discussions about specific health and safety issues. There was also a noticeboard on site displaying a safety alert regarding the use of hospital porter wheelchairs.

At a recent patient safety committee meeting, an improved approach to safety communication was adopted.

We scored the service as 1. The evidence showed significant shortfalls. The service did not always work well with people and health system partners to establish and maintain safe systems of care. They did not make sure there was continuity of care, including when people moved between different services.

Most patient bookings came via the Patient Transport Advice Centre (PTAC). This is an NHS service that assesses eligibility for non-emergency patient transport services (NEPTS) and passes patient details on to the most appropriate NEPTS provider. There was also an online booking portal for processing bookings directly from health care professionals. The control room staff assigned journeys to the appropriate crew, based on location and transport requirements.

A data validations administrator phoned patients the day before to check if the information held was correct. However, several ACAs told us the information they received via the booking process on their mobile personal digital assistant devices (PDAs) was not always sufficient or accurate. Sometimes details were missing, such as the patient’s weight, or whether the patient had dementia. They were not sure if the erroneous information was coming from PTAC or the local booking system but told us this was a common occurrence. Although staff were able to perform a dynamic risk assessment in these circumstances, they felt this sometimes added unnecessary delays and cancellations. The service provided additional information which showed only 0.2% of 10,667 journeys were aborted due to booking issues, 91.9% of patients received a pre-journey verification call, and 47% of patients received text message confirmations. Also, in July 2025 91% of patient bookings included weight information, and 95% included information on dementia and disability.

Not all patients arrived in good time for their appointment. Data on monitoring of performance indicated people were being affected by the service falling short in several key performance targets relating to timeliness. Between February and July 2025, 72.5% of non-renal patients arrived before their appointment time, against a target of 95%, and 73.3% of renal patients arrived on time for their appointment against a target of 100%. Only 46.6% of service users were collected within 60 minutes of their agreed discharge time against a target of 90%. This had the potential to impact the continuity and consistency of patient care. EMED were working closely with the ICB, the trust, and NHS England by means of an initial Rapid Quality Review meeting to identify concerns, then ongoing Quality Improvement Group meetings. This demonstrated a commitment to progress; however, these efforts had not yet yielded the intended outcomes.

We saw notes from a recent reset meeting, in which it was noted that the current staffing roster did not align with the needs of renal patients. A consultation was in progress with staff to propose changes to the staff rotas. Concerns were also raised by EMED regarding the amount of journeys being booked by stakeholders with less than 2 hours notice, as well as high abort rates, both of which were affecting capacity issues.

Staff in the Trauma and Orthopaedic department at the local trust told us communication with E-Zec Medical Wellington was sometimes difficult, although the patient transport liaison officers (PTLOs), who acted as a communication bridge between patients, healthcare professionals and ambulance crews, offered great support.

We scored the service as 3. The evidence showed a good standard. 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.

There was a good safeguarding culture. The safeguarding adults, children and young people policy defined staff responsibilities and training requirements and detailed how to report safeguarding concerns. It also contained details of support mechanisms for staff who may have been affected by any aspect of the process.

Most staff we spoke with knew who the safeguarding lead was, and this was highlighted on a poster at base.

Staff compliance met the required benchmark. Level 2 training in safeguarding for adults and children was 98.9%. We saw 5 examples of safeguarding referrals that had been made between June and July 2025. These were dealt with in line with policy.

However, some staff also told us they did not receive any feedback after raising concerns.

We scored the service as 3. The evidence showed a good standard. 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 were involved in their initial assessments when they used the service. We saw examples of how patients’ needs and preferences were considered in the booking process, for instance if the patient suffered with pain or anxiety, if they had specific mobility needs, or if they had to get home for a certain time for childcare purposes.

If the ambulance crew found any difficulties with the transfer upon arrival, they would phone the control team who would arrange for a home assessment to be undertaken, to ensure the information was accurate in the future.

We scored the service as 3. The evidence showed a good standard. 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 base was safe, spacious and fit for purpose. All areas were clean, tidy and locked for security purposes. Fire exits were clear. The stock of consumable equipment, such as gloves, face masks, spill kits, and first aid kits was all in date, as were fire extinguishers and the portable appliance testing of electrical equipment. Posters on the wall showed who the first aiders and fire wardens were.

There was a process for logging defective equipment, which was stored in a locked cupboard, with a cordoned-off overflow area for larger items.

The vehicles we inspected were clean and in good condition, with all the necessary equipment available, including emergency equipment. Ambulance crews completed a daily check of the vehicles before taking them out on the road.

Vehicle defects were reported and logged electronically. We saw an extract of the last 6 months of vehicle faults, which showed the vehicle reference, location, description of defect, and whether the issue had been resolved. The Operations Manager oversaw vehicle maintenance and servicing.

Issues with faulty reverse cameras were raised in a staff representative meeting, and actions were noted by the Regional Senior Operations Manager. However, some staff told us there was a lack of communication regarding vehicle defects, and they felt this represented a safety concern.

The service often transported multiple passengers in their vehicles. The booking and dispatch system ensured that only appropriate vehicles were assigned to these journeys. If the ACAs encountered an unexpected situation when they arrived, they were trained to perform a dynamic risk assessment and follow the company’s abort or cancellation process. We received an example of audit data for a vehicle which showed that out of 529 journeys undertaken in July 2025, 52 involved multi-occupancy and all these journeys aligned with the appropriate vehicle configuration.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure staff received effective support.

Staffing levels were defined in the contract. Data we reviewed showed ACA staffing levels had been consistently met since January 2025, and third-party staffing had reduced from 420 hours per month to 40 hours per month between January and May 2025. However, several staff we spoke with felt staffing levels were not commensurate with the workload for both ambulance crews and control room staff.

We saw some examples of one-to-one conversations, which gave staff the chance to reflect on their feelings about work, raise any issues, and receive updates from their manager. However, some staff we spoke with said they did not receive regular one-to-ones, and they did not feel supported by the management.

Staff were either directly employed or hired by an external agency. Both followed the same recruitment process. Recruitment files were checked and found to contain proof of identification, Disclosure and Barring Service (DBS) checks, references and employment history. Annual checks of driving licences were completed.

We saw an example of the induction record covering the initial training requirements for the ACA role, as well as a 12-week probation review. This brought together theoretical and practical elements of the role, and opportunities for learning and reflection between the staff member and the preceptor.

There was a qualification matrix which laid out the mandatory training modules necessary for each staff group. Data we reviewed showed compliance with mandatory training for ACAs was 95.1% against the service target of 85%.

Most staff had received a recent appraisal. Data we reviewed showed that 52 out of 55 staff had received an appraisal in the last year, and there was an explanation as to why the other 3 could not be completed.

We scored the service as 3. The evidence showed a good standard. 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 vehicles we checked were clean and in good condition. Equipment supplies were regularly checked. All vehicles contained sterile supplies, emergency equipment and sharps bins. However, some staff we spoke with felt the vehicle cleaning equipment was worn and no longer fit for purpose, and some of the vehicles were not properly deep-cleaned.

The main ambulance base was clean and tidy. Different sets of cleaning equipment were designated for different areas, such as toilets, kitchen/crew area and ambulance interior. The garage area contained cleaning products, eye wash, gloves, clinical and non-clinical waste bins, and a cage for dirty laundry. The toilets were clean.

We saw posters on the staff noticeboard promoting hand hygiene and the safe disposal of sharp objects.

We saw evidence of a recent infection prevention and control audit, which showed 91% compliance against local requirements. From this, action plans were created to improve performance in hand hygiene audits, IPC mandatory training compliance and daily site housekeeping checks.

We scored the service as 3. The evidence showed a good standard. 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 happened.

The service followed good practice in medicines management. Although staff did not administer medicines, there were policies for staff to follow when transporting end-of-life patients and for when patients deteriorated in transit.

Oxygen cylinders were in date and stored securely in line with national guidance