EMED Sussex

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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 found that the provider did not consistently work effectively with partner organisations to ensure coordinated care, particularly during discharge and transport. Poor communication and booking errors contributed to delays, aborted journeys and low performance against key timeliness targets, especially for people attending renal dialysis.

The provider did not always assess, plan or deliver transport effectively. Leaders had not established clear eligibility criteria for taxi journeys and reassessment of frequent users meant changes in people’s needs may not always have been identified. Monitoring and use of performance data were inconsistent, particularly for subcontracted activity, limiting leaders’ ability to drive improvement.

Leaders were aware of longstanding issues affecting patient flow but had not implemented effective mitigations, and improvements to liaison roles were still at an early stage and had not yet resulted in sustained improvement.

However, staff gathered relevant information at booking, used communication aids appropriately, supported people to live healthier lives, and followed effective consent and mental capacity practices.

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.

The evidence generally showed a good standard. The service generally made sure people’s care and treatment were effective because they checked and discussed people’s health, care, wellbeing and communication needs with them.

Leaders told us the service used information gathered during the booking process to determine how best to meet each patient’s needs. This included information about health and mobility needs, medication requirements, eligibility criteria, and whether an escort was required. The service stored patient details within the service’s electronic system, and staff reviewed this information at each new booking. Staff highlighted any information that planners or crews needed to be aware of within the system, which was accessible to crews through their personal hand-held devices. This included updates to patients’ mobility or communication needs.

Crews used an online translation tool to communicate with patients whose first language was not English and used picture card booklets to support patients who were non-verbal, or preferred visual communication.

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.

The service also did not consistently review eligibility information for patients who booked transport frequently. Staff did not reassess patients who had used the service within the previous 30 days of their next booking. Leaders told us this change had been introduced to improve capacity for call handlers. However, this meant that important information about changes in patients’ clinical or care needs may not always be identified. This limited assurance that transport was consistently provided with the appropriate staff skill mix or equipment.

However, the service had corporate policies and standard operating procedures to support staff in aspects of their role. Leaders ensured these policies and operating procedures were regularly reviewed, evidence based and appropriately referenced.

The evidence showed some shortfalls. The service did not work well across teams and services to support people. Leaders had made some improvements to support partnership working but more was needed.

The service did not work effectively with partner organisations to ensure coordinated care, particularly during discharge and transport arrangements. Staff did not consistently receive or share accurate information about people’s readiness for transfer, individual needs, or onward care arrangements, which affected continuity of care.

The service reported 9,033 aborted journeys over the previous 5 months. This meant the crews arrived but were unable to transport people predominantly due to poor communication and booking errors. Records showed multiple instances where crews were dispatched unnecessarily because patients had already made their own way to appointments (2013 journeys), were not ready for collection when crews arrived (1031 journeys), or could not be located on arrival (1014 journeys). Leaders did not demonstrate that effective action had been taken to address the underlying causes of these repeated issues. This led to wasted journeys, delayed care, and inefficiencies within the service.

The service did not mitigate a longstanding and predictable issue with ambulance parking at an outpatient site. Leaders knew that ongoing construction had reduced parking capacity and increased average parking times from a planned 9 minutes to an actual average of 36 minutes. These delays had a substantial negative impact on operational flow, timeliness, and people’s experience, yet meaningful mitigations were not evident. In addition, we did not see evidence of a clear escalation process to manage delays.

However, leaders acknowledged that engagement with some units had historically been challenging. They told us they had employed Hospital Ambulance Liaison Officers (HALOs) who were based in the discharge lounges of relevant NHS trusts, and Patient Safety Liaison Assistants (PSLAs), who worked within outpatient departments to improve communication between services and coordinate arrivals and discharges more effectively. When we visited these improvements were still being implemented and had not yet led to better outcomes.

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.

The provider promoted the Make Every Contact Count approach through its recruitment policy, setting clear expectations for staff about their role in supporting patient wellbeing. Make Every Contact Count is a public health approach used across the NHS and social care, including Patient Transport Services (PTS). The approach promotes everyday interactions with patients to support healthier choices, without giving clinical advice or adding significant time to the contact. Examples included offering reassurance or signposting, encouraging hydration where appropriate, supporting safe mobility and independence, reinforcing existing clinical advice, and recognising wider wellbeing concerns such as isolation, confusion or environmental risks.

Staff contributed positively to help people live healthier lives. They used time spent with patients to reinforce key health messages and encouraged engagement with treatment plans, screening programmes, and rehabilitation activities.

The service promoted independence by helping patients maintain regular routines and access community or clinical support. This helped to reduce the risk of social isolation and helped improve overall wellbeing. Crew members also identified emerging concerns, such as deterioration, safeguarding issues or unmet needs, and we saw they escalated these appropriately to ensure timely support.

The evidence showed significant shortfalls. The service did not routinely monitor the outcome of the service to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Patient experience indicators were negatively affected by avoidable delays and frustration. Leaders faced difficulties in assessing whether changes to planning processes had the intended effect, as inconsistent scheduling limited their ability to identify trends in performance. Operational pressures meant leaders focused more on reactive problem-solving rather than on proactive monitoring and outcome improvement.

The provider lacked clear oversight of quality and safety across the whole transport service. Leaders did not routinely separate data for services completed by subcontractors, which limited their ability to accurately monitor performance, identify where problems occurred and hold subcontractors to account.

Leaders were unable to clearly demonstrate how information about cancelled and aborted journeys was used to support service improvement and if patients had incurred any harm due to delayed or missed appointments and treatment.

However, the service monitored aborted journeys and cancellation levels. Leaders explained that cancelled journeys fell into 3 main groups: those cancelled by hospitals, those cancelled by patients or their representatives, and those cancelled by the provider due to capacity or operational reasons. Leaders told us that only 1% of journeys were cancelled by the service due to capacity issues, this equated to around 52 per month. The service understood the main reasons for cancellation, which included hospital‑initiated cancellations, inpatient and renal journeys cancelled because patients were not fit to travel, patients making their own way, incorrect bookings usually identified in advance, and patients becoming too unwell to travel.

Leaders also told us that Hospital Ambulance Liaison Officers (HALOs) completed welfare checks where journeys were cancelled, to reduce the risk of harm to patients.

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 demonstrated a clear understanding of when and how to obtain consent. Staff described the actions they would take if a patient lacked the capacity to consent, including ensuring information was provided in a way patients could understand.

Staff had access (electronically and within vehicle-based resources) to information and guidance relating to the Mental Capacity Act (MCA), best interest decision making, and assessing capacity. Staff described how they would support patients with fluctuating capacity, including giving additional time, using clear and simple language, and involving family members or carers where appropriate.

The provider included consent and MCA training as part of its mandatory induction programme. This helped to ensure new staff were familiar with their responsibilities from the outset. Training compliance was 72.5% at the time of our inspection, against a target of 85%.