E-Zec Medical Wellington

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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 requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

Staff were able to raise concerns internally and via an independent, external service. However several staff we spoke with felt unable to speak in confidence, with some staff saying that personal information was not kept confidential. This was a breach of regulations in relation to Good Governance.

All managers underwent Leadership and People Management training, and results from staff surveys were analysed with the aim of improving staff engagement. However, some staff felt the managers lacked people skills, and we heard examples of staff being strongly spoken down to by managers. Staff felt work needed to be done to improve morale.

The service made efforts to share the company’s vision with staff. Team meetings were attended by staff representatives. However, some staff we spoke with said information from team meetings was not relayed to them.

However, there were clear governance, management and accountability arrangements. We saw evidence of structured meetings at all levels.

Risks were identified, and the quality of care was monitored through a comprehensive audit programme. There was regular communication with stakeholders

The service ensured it acted upon its responsibilities to provide equality and respect for all, including in its recruitment procedure

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 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 made efforts to share the company’s vision and strategy with staff. The Executive Team conducted a roadshow each year, in which the corporate strategy was shared with staff at every provider location in the country.

Staff representatives attended regular meetings with management. We saw minutes from the last 3 staff meetings. These were attended by at least 2 staff representatives, who raised several matters including vehicle issues, staff rotas, pay, annual leave and communication.

There was a consultation in progress to propose changes to the staff rotas. This came about following an activity and demand review with the ICB involvement. This determined that renal patients were being delayed due to increases in early morning demand, which had a knock-on effect throughout the day. We saw an initial letter sent to staff detailing the proposed changes and offering the opportunity of one-to-one meetings with appropriate representation if required. Staff we spoke with understood the service had to meet the needs of patients, but some were concerned about the changes and felt the process was not being managed well.

We scored the service as 2. The evidence showed some shortfalls. The leaders did not always embody the culture and values of their workforce and organisation. They did not always lead with integrity, openness and honesty.

Some staff we spoke with felt the managers lacked experience and people skills. We heard an example of a staff member being spoken down to with the use of expletives. They felt work needed to be done to improve morale. Some staff said they received little recognition or thanks, and they felt people had left because of poor management and communication. The service provided further information highlighting that all managers underwent Leadership and People Management training, supported by Human Resources (HR) and Regional Operations Leads, alongside participation in reviews and EMED’s Management Advancement Programme (MAP).

We were told there used to be an open office between the managers and the control room, but the areas had become separated. Some staff we spoke with felt this had resulted in poorer communication. Also, some staff felt managers did not visit the satellite base very often.

However, some staff were happy and felt they could raise any concerns to the Team Leaders and Operations Managers. The Regional Senior Operations Manager felt there used to be barriers but was trying to create an environment in which staff felt able to talk.

Management reviewed results from staff surveys and took actions to improve engagement, communication and wellbeing by setting up regular engagement sessions with the Managing Director, completing shifts on the road, and by arranging team building events.

A key action from a recent patient safety committee meeting was to improve the effectiveness of safety communication. A multi-channel approach was adopted, including, bulletins and emails. We saw examples of learning bulletins, and a toolbox talk presentation about safely transporting patients in wheelchairs.

We scored the service as 1. The evidence showed significant shortfalls. People did not feel they could speak up and that their voice would be heard.

There were established processes for staff to raise concerns, but several staff we spoke with felt unable to speak in confidence, with some staff saying that personal information was not kept confidential.

Staff told us they could also raise concerns or suggest ideas for improvement to staff representatives or via suggestion boxes, but some staff told us they did not receive any updates.

The service had a whistleblowing policy which documented the routes staff could take to raise concerns. There was a Freedom to Speak Up Guardian, who was based at another location and was independent to the service. There was also an external whistleblowing service available. Concerns were triaged to an appropriate manager for investigation within a designated timeframe.

Some staff we spoke with were not aware of the speak up process and were unsure who to escalate concerns to. However, we saw posters advertising the speak up process and the name of the EMED Freedom to Speak Up Guardian.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The Equality and Diversity policy laid out EMED’s responsibilities to provide equality, fairness and respect for all, referencing legal requirements under the Equality Act 2010.

There was a Safer Recruitment policy, which covered EMED’s duty to meet legislative requirements on recruitment, including reasonable adjustments and not discriminating on grounds such as race, ethnicity, gender or age.

EMED had signed up to the UK Government's Disability Confident scheme, which demonstrates a company's commitment to recruiting, retaining, and developing disabled people, and signals a willingness to learn and grow their disability employment practices.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

There were clear lines of accountability at both local and corporate level. There was a Key Roles and Responsibilities poster at the base, which highlighted the additional roles held by corporate level staff, such as Safeguarding lead, Freedom to Speak Up Guardian, and Infection Prevention and Control (IPC) lead.

There was a contract with the ICB that clearly documented staffing and vehicle requirements and the types of journeys covered.

Staff in the control room knew how to escalate resource issues to team leaders and operations managers, who would then consider additional resources. We saw policies that covered EMED’s process for procuring third party providers, including due diligence audit (an in-depth investigation of a company's financial and operational aspects to assess its value and potential risks before a significant transaction, such as a merger, acquisition, or large investment) and their supplier code of conduct, which explained EMED’s expected standards and behaviours.

Staff in the control room raised concerns about the increased demand, and recent audits highlighted the volume of calls and the need for a permanent control room supervisor. The Regional Director told us they were actively looking to recruit someone to this role.

Managers told us performance, cancellations and journey time data were discussed with crews, but the staff we spoke with said they did not receive any feedback on performance.

There were structured meetings at all levels, including monthly contract review meetings with the ICB, patient safety committee meetings and management meetings. We also saw minutes of bi-monthly team meetings between February and July 2025 that were attended by staff representatives. Several staff we spoke with said team meetings were sporadic, and some staff said although representatives do attend meetings, they did not feel like their questions were being answered, which indicated a communication problem.

The service had a risk register, which highlighted current risks to the service and any controls that were in place to mitigate risks. This was formally reviewed monthly by the management team, including the Quality and Governance lead.

There was a comprehensive audit programme, covering aspects such as health and safety, information governance, business continuity, and fire risk assessment. This was managed by the Quality and Governance lead. Any issues raised because of an audit resulted in the creation of an action plan, with tasks assigned to staff to complete. The audit could not be closed on the system unless all actions were completed.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

There was regular communication between the service, the ICB and the local trust. We saw evidence of a recent reset meeting, which gave the opportunity to highlight several contract concerns including a backlog of user complaints, resourcing, delays to renal patients, inadequate PTLO cover, and assurances of learning culture within the service. It was also an opportunity to discuss recommendations for improvement actions. We also saw the Key Performance Indicators (KPI) methodology pack, which defined how to measure and track progress towards targets. There were regular Quality Improvement Group meetings to monitor progress, and monthly contract meetings.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system.

The service gathered data and identified the top 3 incident themes to create their Patient Safety Incident Response Plan (PSIRP), which was discussed with the ICB with the aim of learning from incidents. The PSIRP also set out how learning was to be shared with staff electronically, via huddles, after-action reviews and toolbox talks. We saw 2 learning bulletins from April and May 2025 that highlighted learning from incidents and complaints, and a toolbox talk presentation about the safe transportation of patients in wheelchairs. Patient Safety Committee meetings also provided a forum for identifying improvement actions.

The Regional Senior Operations Manager told us of improvement projects, such as new satellite navigation devices that had been purchased for some of the vehicles. They were also awaiting approval to begin a mentorship programme in the South region.

Some staff we spoke with felt they could put forward ideas for improvement, for instance by raising to a staff representative, but some were not confident they would be taken note of. Some staff were not aware of any improvement projects which indicated a potential communication issue.