Archived: EMED Surrey Heartlands

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

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

This was the first inspection for this service. This key question has been rated requires improvement. The service did not have a clear shared vision, strategy, and culture. Not all leaders understood the context in which the service delivered care, treatment, and support. They did not always embody the culture and values of their workforce and organisation. People did not always feel they could speak up and that their voice would be heard. However, the service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them. The service had clear responsibilities, roles, systems of accountability, and governance. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborate for improvement.

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.

We scored the service as 2. The evidence showed some shortfalls. The service did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

The organisation had overarching group objectives and priorities which were presented annually to staff via a roadshow. However, the response from frontline staff was mixed as to whether they could tell us about the objectives and priorities or how their work contributed to these being achieved. Locally they were focused on delivery of the requirements of their local contract.

We heard staff did not always feel anything changed after raising issues or concerns. Although staff generally felt able to raise concerns with their seniors, they did not feel they received feedback or saw things change.

EMED had a shift changes management team who met to consider what shifts required amending and why. They ensured staff had the opportunity to be involved in this via a consultation process. Managers were in the process of a consultation regarding rotas and shift patterns at the Guildford location.

We heard of cultural issues at one of the EMED Surrey Heartlands sites. This was reportedly related to the TUPE process and staff from different organisations with different pay and annual leave coming together as one organisation. Managers were aware of this and worked to close the gaps. For example, one manager started a breakfast club for crews. This was to ensure staff had some time to socialise with others in their team. They had a plan to start staff rep meetings shortly. They increased benefits for those staff on lower pay.

We scored the service as 2. The evidence showed some shortfalls. Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

EMED Surrey Heartlands had a clear leadership structure with reporting lines across the region. Staff understood their roles and accountabilities.

Frontline staff told us senior team members, and the executive team were not always visible unless they participated in online virtual meetings. Crews spoke mainly with their team leaders who, in turn, spoke with the site operational managers. There was a disconnect between frontline staff and managers across the service.

Some steps had been taken to ensure leaders were visible. The chief executive of EMED presented quarterly to operational leads. This included reflections on the provider’s vision and statement, patient complaints, patient safety, fleet concerns, etc. The presentation was cascaded to staff via the company’s online HR platform. The managing director held a fortnightly question and answer (Q&A) event, which was open to everyone and could also be accessed virtually. Once every year the executive team visited each contract to meet with the teams and talk through the business plan and conduct a Q&A session.

The provider planned to introduce a management acceleration programme through an apprenticeship development course, scheduled for quarter 2 of the financial year.

We scored the service as 2. The evidence showed some shortfalls. People did not always feel they could speak up and that their voice would be heard.

The service had a Freedom to Speak Up (FTSU) Guardian and other external routes for staff to speak up. However, not one member of staff we spoke with, either frontline or managerial, could tell us who fulfilled this role. As part of our data request following the on-site assessment, we requested further information, but we were informed a policy had not been adopted and there were other ways staff could speak up.

The service displayed posters across both sites with the contact details of a third party 24/7 whistleblowing service. However, most staff did not appear to know of this option to raise concerns anonymously. We heard staff were encouraged to speak with their line manager if they had any concerns. Alternatively, if they did not feel comfortable, to speak with a different manager. However, staff told us they did not receive feedback or saw things change.

Numerous staff felt they could approach their line manager with any concerns. We heard staff speak about an operations manager who was highly respected by everyone, they were “one in a million” and “so respected by all the crews”.

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

The mobilisation and change team headed up and drove the provider’s equality, diversity and inclusion (EDI) agenda. The EDI agenda was new and was in its infancy. The provider had an action plan and a statement to support their development in this area. EDI champions had been introduced, and they had received focused training and support meetings were in place.

The provider demonstrated an established EDI framework aligned to Workforce Race Equality Standard (WRES) principles and had begun collecting workforce data to inform strategic EDI actions. Data related to nationality, age and gender, but also incorporated additional categories, such as gender identity. We heard managers supported staff with protected characteristics; for example, they arranged for some staff to work from home to help them remain at work. The organisation had a Flexible Working policy in place, which outlined the types of flexible working on offer and how staff could apply. Managers told us there were various members of staff currently going through the formal flexible working application process.

The service had a comprehensive and up-to-date equality, diversity & inclusion policy, outlining both the employer’s and the employee's rights and responsibilities.

We scored the service as 2. The evidence showed some shortfalls. The service did not always act on the best information about risk, performance and outcomes. The service had clear responsibilities, roles, systems of accountability and governance. They used these to manage and deliver good quality, sustainable care, treatment and support.

The service had a risk register, and the operational team had responsibility for maintaining and reviewing this. The risk register was a standing item on the agenda for the Governance and Performance Review Meeting (GAPR). We reviewed 2 sets of GAPR minutes and there was no documented discussion about risk. The risk register included a description and impact of risk, and action plans to manage and downgrade risks. All risks were graded in terms of original and target risk. The risk register contained 4 risks. These focused on operational matters and were not a comprehensive set of risk relating to all aspects the service delivery. Not all of them matched what staff had told us; for example, there was no risk relating to cultural concerns.

Following a series of incidents involving wheelchair users, senior managers engaged directly with frontline staff across the Surrey sites to reinforce expectations around wheelchair safety. As well as these assurance visits, managers developed toolbox talks and practical learning sessions around wheelchair safety.

We heard from various staff members that EMED Surrey Heartlands was data driven; however, there appeared to be a disconnect between collecting data, using it to provide assurance about performance, to drive change.

The service had a structured audit system which covered health and safety and the quality of the service. The Health and Safety manager carried out monthly safety audits, such as alarm systems, fire doors, and the roof, using a drone. The service had a third-party provider for their estate and facilities who they called upon if anything needed fixing. Managers at each site had responsibility for conducting all audits locally, such as call audits.

The service conducted call audits. Team leaders randomly selected 2 calls per crew member every month to look at the quality, style, and effectiveness of communication, and booking quality. The pass mark for the call audits was 80 per cent. Team leaders gave staff feedback on their call audits. The call centre manager audited the team leaders. Call audit results were kept in personnel files; information from the audits was not reported to other managers or the executive team and it was therefore unclear how it was used to provide assurance on the quality of the service provided. We reviewed 10 call audits, and all received a pass.

The service had a lead implementor of emergency preparedness. EMED Surrey Heartlands had recently passed 3 standards from the International Organisation for Standardisation (ISO - ISO is an independent, non-governmental organisation that develops and publishes international standards). These included business continuity management system, auditing management systems, and environmental management systems.

We reviewed documents of disruptive business events; for example, a power outage impacting phone lines. We saw actions were put in place immediately as per emergency preparedness plans. The service took part in emergency preparedness exercises, such as power outage workshops run by external providers.

The service conducted quality meetings led by the quality and governance team. They discussed data such as incidents, complaints and compliments, investigations, and outcomes. The quality and governance team held fortnightly meetings across regions and contracts to update relevant operational managers on any ongoing incidents, or safeguarding concerns. The provider held a Patient Safety Committee every 2 months, attended by the CEO and overarching regional operational manager. At a fortnightly Patient Safety Forum, the quality and governance director and medical director met to discuss any updates on PSIRF investigations, safeguarding concerns, and other matters.

All staff could access the company’s policies and procedures on the risk, quality and compliance software platform. The organisation’s policies were all comprehensive, up to date, with clear review dates recorded.

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 work seamlessly for people. They shared information and learning with partners and collaborate for improvement.

Managers reported they had a good relationship with the ICB. They wanted to understand the risk to the delivery of the contract and ensure open discussions were held on a regular basis. The service met with the ICB monthly to discuss their key performance indicators (KPI). There was an action log to capture discussion points and EMED actions from the meetings with the ICB.

Managers presented their performance data to each acute NHS hospital trust monthly.

The service logged all stakeholder concerns/complaints and collected themes to drive improvement. At the time of the on-site assessment, the service had 31 open stakeholder concerns, the oldest being from January 2025.

The provider had a dedicated national communications and engagement manager who engaged with a variety of external stakeholders; for example, Healthwatch, Alzheimer's Society, Age UK, etc. Through these partnerships, the service ensured they were informed of patient’s voices. They had various ideas to improve services for people with dementia or renal patients. The service had introduced local engagement champions for internal issues. They gathered feedback at local sites to drive improvement.

EMED Surrey Heartlands worked with other ambulance providers when they required additional resources. The service carried out assurance visits to these providers. EMED Surrey Heartlands worked in partnership with various community providers, which was part of the contract agreement with the ICB. This included, for example, the local councils.

At the beginning of the contract in Surrey Heartlands, the service received feedback from their community partners. They felt they had not received as much information from and about the provider as the acute NHS trusts had. EMED managers ensured they met with their community partners and provided them with specific points of contact.

The provider planned to arrange education days on each acute hospital site for hospital administrators, ward clerks, and nursing staff.

EMED Surrey Heartlands had 2 dedicated discharge vehicles per NHS hospital to aid with both planned and unplanned discharges. Hospital staff accessed EMED Surrey Heartland’s online booking training, which consisted of videos on how to make, amend, or cancel bookings. Alternatively, HALOs at each hospital site offered on-site training. In addition, hospital staff had access to dedicated training sessions every 3 months. EMED’s website offered online guides, leaflets and posters for printing. Staff we spoke with at hospital sites told us the online booking system was easy and quick to use, and they received immediate confirmation and a reference number when making bookings.

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. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people.

Senior operational managers had introduced quality improvement strategies to improve the service. For example, they introduced ‘call aheads’ where the hospital site teams printed off a patient list for the next day. HALOs called each patient to check whether the patient was still attending the appointment, check their address, and any changes in mobility. The main aim of this strategy was to reduce the number of journey aborts and improve KPIs. Managers told us since the introduction of this quality improvement on 15 May 2025, they found less cancellations per day across all 4 acute hospital sites.

One manager introduced a web-based platform to store and share information regarding patient handovers from the acute hospitals. Prior to this, hospitals had shared each handover in a separate email, and the introduction of this new platform ensured smarter working.

The service was in the process of planning patient forums to introduce a structured way for patients to voice their opinions, concerns, and suggestions regarding the operations and care they received.