HTG-UK East – Norwich

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

We looked at 10 care records and listened to 3 referral recordings to evaluate how well staff identified and responded to the individual needs of patients. While a structured system was in place and care plans were present in many cases, the quality and depth of records varied significantly.

Staff did not consistently complete thorough health assessments. While information was recorded, additional detail, particularly for patients living with dementia, was often lacking, and there was little evidence of follow-up. This limited the ability to tailor care packages and plan for risks. The impact was reflected in the number of aborted jobs, incidents reported by staff, and formal incident records.

This trend was reflected in the provider’s performance against contractual standards. The target for aborted journeys was less than 5% of total monthly journeys, yet this consistently exceeded 6.52% in October 2024, 6.43% in August 2025, and 6.00% in July 2025, resulting in a year-to-date average of 6.0%. The most frequent reasons were patients making their own way (221 cases) and not being ready (240 cases), both of which could potentially be addressed through improved communication and scheduling. Other causes included wrong mobility (67 cases) and wrong vehicle or equipment (11 cases), indicating operational or assessment errors that could have been mitigated through training or process review.

Overall, while there were elements of good practice, such as the presence of care plans and a structured recording system, gaps in assessment and referral processes may have contributed to wider systemic issues. These impacted both the quality of care and the provider’s ability to meet contractual requirements.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Leaders did not consistently recruit staff with the appropriate level of clinical skills and training to meet the needs of the patients being transported. Despite high activity levels and the complexity of some patients, no paramedics or medically qualified staff were employed, and only 2 members of staff held First Response Emergency Care (FREC Level 4) qualifications. National guidance for Non-Emergency Patient Transport Services (NEPTS) highlights the importance of appropriate clinical oversight and staffing to ensure safe care, particularly for patients with complex physical or mental health needs.

Staff reported feeling unprepared to manage clinical situations safely, especially when transporting high-dependency patients. There were no medically trained staff available to oversee crews, and staff had no direct access to clinical advice. Leaders relied on escalation to emergency services, a reactive approach that falls short of national expectations for routine clinical leadership and informed decision-making.

Leaders did not consistently deploy staff with complementary skills, resulting in mismatched crews. Examples included mental health staff supporting patients with cardiac conditions, and physical health staff managing mental health crises. Such practices raised concerns about the provider’s ability to deliver safe, responsive, and person-centred care.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

The service did not always work effectively with other services. People’s care and treatment outcomes were affected by delays in patient transport, particularly for those requiring time-sensitive renal treatment. Incident data showed recurring issues with timeliness, capacity, and communication, which impacted patients’ ability to access care as planned.

Leaders worked closely with the local integrated care board (ICB), who supported them in monitoring and progressing against key performance indicators. Leaders also engaged with local healthcare providers to address operational issues and resolve concerns as they emerged. While these relationships were generally constructive, partners reported that there were sometimes challenges and not all feedback we received from partner organisations was positive. Some information shared with us indicated differing levels of confidence in the service, with one provider identifying the service as a potential risk to patient safety. These concerns were not universal but reflected areas where partnership working remained important to strengthen mutual assurance and trust.

Staff told us that regular and effective multidisciplinary meetings were not taking place. Regular staff meetings could have supported multidisciplinary discussions and shared learning.

Staff used handheld digital devices to share up‑to‑date information about people’s needs. This allowed teams and services to communicate quickly and keep each other informed about patient care.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Due to the transport‑focused nature of the service, staff had limited opportunities to support people to live healthier lives, and the evidence reflected this.

Staff supported patients to attend essential care safely, supporting continuity of treatment and overall wellbeing. By facilitating access to care for those unable to travel independently, staff contributed to helping people live healthier lives through timely treatment and reduced health risks.

However, referrers told us that delays in transport sometimes resulted in late access to critical appointments. These delays highlighted the need for continued focus on improving timeliness to prevent adverse impacts on patient outcomes.

We scored the service as 2. The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Patient transport did not consistently meet expected standards for timeliness and reliability. Incident volumes rose significantly in October 2024, which was anticipated as this marked the start of the new contract and required a bedding in period. The highest number of incidents occurred in November 2024, with 40 reported issues. Although volumes reduced between December 2024 and July 2025, a further rise was observed in August and September 2025, with 29 and 28 incidents respectively.

Most incidents (88) were associated with delays and lateness, which was particularly concerning given the time-sensitive nature of renal treatment. Additional issues included capacity and resource constraints (12) and communication challenges (12), reflecting broader challenges in service coordination and patient engagement. These factors compromised patients’ ability to access care promptly and effectively. Referrers told us delays sometimes resulted in late access to important medications and missed critical appointments, including cancer treatments.

Local stakeholders raised concerns about delays in collecting patients from hospital, which affected timely access to medication and care calls from social care staff. Patients often experienced long travel times to and from dialysis units across the region which impacted on their wellbeing and time spent with family. Hospitals also experienced logistical challenges caused by late arrivals, and occasional overcapacity at units due to transport delays, even though dialysis sessions themselves were not missed.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service had up-to-date policies and processes to support staff in gaining informed consent. Staff understood and could explain how to gain consent from adults and children.

Staff received training in the Mental Capacity Act, Mental Health Act and consent. Staff understood their responsibilities where a person lacked capacity to make decisions.

The booking process captured information where a carer or advocate was needed to support a person during transport. The service used this information to plan care.

The service transported people detained under the Mental Health Act, and staff understood their responsibilities to ensure they had legal authority to transport patients.