St John Ambulance North Region

On this page

• 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

The environment was clean and well maintained and was safe for use and staff were trained to use equipment. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Medicines were stored correctly, and staff were trained in the safe use of medicines.

Staff received safeguarding training and knew how to raise concerns. Staff described a culture where they could raise concerns, and they learnt lessons from incidents. The service had systems in place to monitor infection prevention and control. We saw minutes of team meetings where concerns had been raised, and the actions taken to mitigate them.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff knew what incidents to report and how to report these. Staff followed the services incident management policy. We looked at two incident investigation reports involving emergency ambulance operation crews. One incident involved a collision and the other related to staff culture, conduct and performance issues. The reports showed prompt action had been taken and meetings were held in response to incidents and included considerations for staff welfare.
For our detailed findings refer to the patient transport service (PTS) report for further information about how the service managed incidents and duty of candour.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff kept people safe. The service had safeguarding policies in place. The service supported its volunteer ambulance crew and volunteer healthcare professionals to transfer the same training from their employed roles, often in the NHS, to save them repeating training which was the same. Staff had completed the appropriate levels of safeguarding training. Records showed 99% of ambulance crew staff had completed introduction to safeguarding training. Most staff (97%) had completed adult safeguarding training (level 2) and 94% children’s safeguarding training (level 1 and 2). Training compliance was within the services training compliance targets.

For our detailed findings refer to the patient transport service (PTS) report for further information about how the service managed safeguarding.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

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 service had suitable facilities to meet the needs of patients. Both Stockport and Warrington hubs had sufficient office space and garage facilities for the ambulance vehicles to be kept securely within the premises. The premises were alarmed and equipped with CCTV monitoring. The vehicles were locked when not in use and vehicle keys were kept securely in a locked cabinet inside the station. We saw how risks were mitigated, for example if there was a fault with an ambulance vehicle, the key was placed in a separate box to minimise risk of staff inadvertently accessing the vehicle with issues. The mechanics had access to this box, and the key was restored once the vehicle is deemed roadworthy.

St John Ambulance North Region had multiple ambulance vehicles for events at each ambulance hub; we looked at 1 ambulance in Stockport and 1 ambulance in Warrington. The ambulances were front line ambulances for 999 calls or for event cover. Both vehicles complied with emergency ambulance specifications with all suitable equipment onboard. Staff maintained asset registers for each vehicle’s specialist equipment to monitor when it was next due for service. Bariatric stretchers were serviced, suitable and available for use. Both vehicles were well maintained and in a good state of repair. Vehicle trackers were in place, so the vehicle’s location was always known.

We reviewed information including MOT and service records that showed vehicles were regularly maintained.

For our detailed findings refer to the patient transport service (PTS) report for further information about how the service managed potential risks in the care environment.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s needs.

The service reported following our site visit that they had 44 operational ambulance crews employed. In addition, the service had volunteer health care professionals for events work including 21 doctors, 45 nurses and 29 paramedics and a volunteer ambulance crew of 133 staff in the North region.

Until June 2025 St John Ambulance North Region had a contract for emergency and urgent care (EUC) services across the North region dealing with all categories of calls for NHS ambulance and hospital trusts. This ensured EUC staff retained their emergency care clinical competencies. The service relied on volunteer Healthcare Professional staff (HCP) for events work, which included conveying a patient from an event to hospital in an emergency. Ambulance crew volunteers used by the service were qualified medical professionals.

The service gave all new staff a full induction tailored to their role before they started work. Two staff told us they felt the induction had prepared them well for their role. We saw that HCP staff had achieved mandatory training compliance of 97% at the time of our inspection. We checked records provided that showed a list of mandatory training topics that had been undertaken at the required intervals of between 1 and 3 years. The mandatory training modules for HCP staff included policies, procedures and role specific training.

Managers told us that both employed staff and volunteers received the same level of training, induction and development. Managers monitored mandatory training and alerted staff when they needed to update their training. Managers ensured staff completed any outstanding training. The service had a system to check that all staff had completed mandatory training before they could be deployed for ambulance activities. All staff completed the Essential Education Programme each year, in addition they completed a clinical and training portfolio. Managers we spoke with were aware of staff training needs and requirements.

Any volunteers utilised as ambulance crew worked only within defined roles for which they had received specific training.

Managers assessed the numbers and grades of staff needed for each event and considered their skill set and knowledge. We spoke with the events operations manager who confirmed staff could be deployed from other areas to support a large event.

The service had a process for appraising staff. Most managers supported staff to progress through development meetings and yearly appraisals. Records for staff based at the Warrington station showed staff had received a recent appraisal.

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 service had systems in place to monitor infection prevention and control. By July 2025, 94% of staff had completed IPC level 1 and 80% of staff had completed IPC level 2. Staff told us they could access the provider’s IPC policies and could contact the IPC manager if they required any support or guidance.

For our detailed findings refer to the patient transport service (PTS) report for further information about how the service managed infection prevention and control.

Staff followed systems and processes to administer medicines safely.

Staff followed the medicines management procedure (March 2025) for the safe and secure handling of medicines. Medicines including controlled drugs were stored securely and in line with national guidance and legislation.

The service had specialist input from a medicines and clinical team who had standard operating procedures to support the management of medicines for staff.

Medicines management mandatory training was provided and 94% of HCP staff had completed this training up to July 2025.

We looked at 3 patient report forms where medicines had been administered to patients during an event and the person had been transferred to hospital. The records we looked at were complete and up to date.

Any bespoke medicines packs considered necessary at an event would be identified during event planning, reviewed and approved by the regional clinical manager. Only ambulance crew staff who had undertaken specific training could administer designated medicines to patients under patient group directions (PGDs) in specific circumstances. PGD’s are written instructions to administer medicines to patients.

Staff stored and managed all medicines and related documents safely. Each ambulance station had a designated area to store medicines which could only be accessed by a secure passcode. Room temperatures where medicines were stored and medicine fridge temperatures were monitored electronically. Medicine grab bags had external tags with expiry dates and the individual pouches inside these were also tagged with expiry dates. Staff used smaller grab bags as they were easier to replenish when used. We checked 3 grab bags and found all medicines to be in date. An audit trail was in place to track the use of medicines and by whom.

Staff completed medicines records accurately and kept them up-to-date. Full and unopened medicines packs were colour tagged. If ambulance crew did open and use any medicines, a full count and record of contents was noted.

We checked a sample of emergency medicines; all were in date and consistent with national guidelines.

We spoke with the controlled drugs (CD’s) lead who talked us through the receipt, storage, recording, destruction and incident management of CDs. Controlled drugs cabinets were securely protected including CCTV security. Controlled drugs were stored securely and managed appropriately. Medicines bags and CD’s used by paramedics for events work were held on site and maintained by the service not by the individual paramedics.

Staff followed The Joint Royal Colleges Ambulance Liaison Committee guidelines (JRCALC) when administering emergency medicines and used electronic patient report forms as electronic patient / journey records. We looked at a 3 patient report forms and these showed administered medicines were recorded appropriately.

There had been 10 incidents reported by the service between June 2024 and June 2025 relating to medicines management. The service graded 4 of these as causing medium harm and 6 causing low harm.

The service had systems to ensure staff knew about safety alerts and incidents. We saw examples where information from the Medicines and Healthcare products Regulatory Agency (MHRA) had been cascaded to staff.

Medicines processes were audited to help ensure that the services policies were followed in practice. We looked at medicine’s audits for the North region from July 2024 to June 2025 which showed good compliance. An escalation process was in place for any locations that did not complete two audit submissions in two months.