Harley Street Ambulance Service

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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

At our last assessment we rated this key question inadequate. The service was in breach of the legal regulation in relation to regulation 17 Good governance. The service had made some improvements. Not all requirements of the warning notice were met and therefore the service continues to be in breach of regulation 17. At this assessment the rating of inadequate remained as we did not assess all quality statements as part of this inspection.

We looked at the quality statements associated with the warning notice and therefore not the whole key question. We assessed 1 quality statement which was scored 2, requires improvement. This meant the governance of the service was inconsistent.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The service did not always have clear systems of accountability or good governance. They did not always share information about risk and outcomes with staff when appropriate.

The service did not have a structured system to share the outcomes of complaints and learning from incidents in a formal way. In the staff meeting minutes we reviewed information about risk, performance and outcomes was not recorded. Therefore, there was no evidence that risk and performance was monitored, and action taken to address any issues. Staff we spoke with told us about an incident where learning had been shared informally and resulted in additional training. We did not see evidence of what training had been provided following the incident and which staff members had attended. Leaders told us learning was shared with staff informally in the office and conversations were held with staff involved in the incident and a record placed in their staff file which we saw in staff files and recoded on the incident sheet. This meant we were not assured all staff received the same knowledge and learning to prevent further occurrence of similar incidents.

The service held staff meetings that all staff were expected to attend. These meetings were held before the first shift of the day, with some staff attending in person while others attended virtually via a video call. A list of attendees was recorded and a sign in sheet used. Meeting minutes were shared with all staff however the date the minutes were sent were not added to the sign in sheet where the information should have been recorded. Staff told us the meetings were held once a quarter, they received an agenda before the meeting and during the meeting they were able to feedback to the managers about items on the agenda. Staff feedback was recorded in the minutes. However, the minutes for the last 3 meetings demonstrated the dates were inconsistent with meetings held in December 2024, March 2025 and August 2025 and there was not a standard agenda reviewing actions from the previous meeting. This demonstrated that regular quarterly meetings did not take as planned and updates on actions were not shared. Leaders told us as the team was small, they had regular informal conversations with staff. As these were not recorded there was no evidence of what information had been shared. A communication application was used to set up a group channel; however, leaders told us not all staff wanted to communicate or engage in this way. We saw evidence of messages being sent with information for staff, such a reminder that vehicle audits were about to commence. These messages were dated February and May 2025 or undated and it was unclear the frequency messages were sent, the consistency of the information or whether the channel was still active. Staff told us there was an open-door policy and they felt comfortable talking with leaders and raising concerns if they needed.

The service kept up to date staff records as required about all persons employed to provide regulated activity. The 3 staff files reviewed all included a checklist at the front of the file detailing what information should be included and ticked when complete. We found all the files reviewed included the information required. The service no longer used agency staff and did not have a contract in place to do so.

The service worked with their commissioners to ensure they complied with the minimum standards of training required for staff in order to carry out their duties in line with the commissioners’ policies. The service worked with a main commissioner and had regular monthly calls with their account lead. These were informal and not minuted and leaders told us they were useful conversations to ensure they were performing in line with the commissioners expectations and service level agreement.

The service had an online bank of policies which staff could access with an individual log in which allowed the operation’s manager to see who had logged in and for how long. When policies were updated, staff were asked to review the policy, and the operation’s manager undertook an audit of the policy platform as evidence of staff compliance. At the time of our inspection the audit had not taken place and we did not see evidence that action was taken by leaders to review staff compliance. In the staff meeting minutes we reviewed, staff were reminded to read the polices online however there was no evidence staff had done so or if a particular policy had been updated.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.