EMED Sussex

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• 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

This means we looked for evidence that people were protected from abuse and avoidable harm.

We assessed all quality statements.

This is the first assessment for this newly registered service.

This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe from bullying, harassment, avoidable harm, neglect, abuse and discrimination.

The service did not consistently manage capacity, planning, and scheduling. This sometimes resulted in avoidable delays, cancellations, aborted journeys, and increased risks to patient safety for people with time‑critical needs. Patients were assessed at booking to determine suitability to travel by car but there was no clear process to review this when needs changed. This created a gap in assurance and a risk that transport decisions did not reflect patients’ current clinical needs or safety.

Staff did not always identify, grade or report patient safety incidents appropriately. They did not consistently recognise time‑critical delays and incidents involving psychological harm.

Mandatory training compliance was below target, which leaders attributed to the staff transferred under the TUPE process and delays in validating training records.

However, staff followed infection prevention and control procedures, and vehicles and equipment were generally well maintained, clean and fit for use. The service had systems and policies to support safe practice, which were in-date and appropriately referenced.

Staff knew how to recognise safeguarding concerns and took appropriate action. They made timely referrals and accessed safeguarding support when needed to help keep people safe. Staff managed medicines and oxygen safely, supported by clear policies, defined competencies and secure storage. Staff stored hazardous materials safely. We found a breach in safe care and treatment.

We have not awarded this service a score for Safe.

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

The evidence showed some shortfalls. The service did not always have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The service did not always manage patient safety incidents effectively. Staff did not consistently report late pick‑ups and drop‑offs for time‑critical treatments, such as renal dialysis, as patient safety incidents. They did not consider the potential impact on people’s treatment times and wellbeing.

Staff did not always grade incidents correctly. For example, incidents that included psychological harm were sometimes recorded as no harm. This reduced opportunities for early intervention and meant the service did not always have an accurate overview of patient safety risks.

However, the service used incident review meetings to share learning. They focused on risk assessments, patient handling, and reporting. Learning emphasised the importance of pre‑journey and dynamic risk assessments, safer boarding supervision, and correct use of equipment. Leaders addressed recurring risks, reinforced timely reporting, and introduced targeted changes, which staff were able to describe and apply in practice. We saw evidence of learning from incidents. For example, staff were required to support patients who required wheelchair assistance to use the rear ramp. Crews were required to document any decision to use the side-step and report to the decision to the control team to support leaders to monitor compliance.

The service had an incident reporting policy. This outlined incident reporting and investigation timescales, and the use of a risk assessment matrix to assess severity. Staff explained how they raised concerns and reported incidents and near misses, in line with this policy.

Staff told us that most incidents were reported through the organisation’s national incident reporting telephone line. This included vehicle-related events and safeguarding concerns. Personnel receiving calls recorded the details within the organisation’s risk, quality and compliance system. Team leaders also had access to this system and were able to enter incident information directly.

The evidence showed significant shortfalls. The service did not always work well with patients and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

We found that weaknesses in capacity, planning and scheduling led to delays, cancellations, aborted journeys and gaps in data oversight. These issues affected timely transport for people with time‑critical needs which increased risks to patient safety.

The service did not meet its key performance indicators for timeliness for patients attending renal services. The KPI required patients to be dropped off within 45 minutes of their appointment time and collected within 30 minutes of the planned pick‑up time. Between July and October 2025, average performance was 76.5% for inbound journeys and 69.3% for outbound journeys

Transfers between services were not always seamless. Staff did not always communicate effectively with receiving providers in advance of transfers. Hospital staff told us they were not always informed when crews were delayed, which sometimes resulted in staff working beyond their shifts to ensure that patients were not left unattended. Equally, crews told us that patients were often not ready for transfer from hospital, for example, because medication was not ready.

The service could not always meet the needs of all patients because the booking and eligibility process was not always effective. Patients were assessed at booking to determine suitability to travel by car but there was no clear process to review this when needs changed. This created a gap in assurance and a risk that transport decisions did not reflect patients’ current clinical needs or safety.

However, leaders monitored timeliness of drop-offs and pick-ups, split by patients being transported to renal services and other patients, they monitored inbound and outbound performance for both patient groups. We noted that performance was steadily improving over this period.

The evidence showed a good standard of care. The service worked well with people and healthcare partners to understand what being safe meant to them, and how to achieve that. They concentrated on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

EMED did not routinely report late drop-offs as a safeguarding concern, but we saw evidence that crews raised safeguarding concerns when it created a clear safeguarding risk for the patient. Leaders reported an increase in safeguarding referrals, which they attributed to improved staff awareness, particularly in relation to self-neglect and unsafe home environments. We saw evidence of appropriate safeguarding referrals and effective practice. This included situations where staff identified welfare concerns, took immediate action to keep people safe and made appropriate safeguarding referrals.

Staff reported safeguarding concerns through the 24-hour control centre, where call handlers recorded concerns and forwarded referrals to the relevant local authority. The local quality lead reviewed safeguarding referrals daily, escalated missed referrals, and monitored emerging themes. The safeguarding lead and manager provided weekly safeguarding oversight.

Staff had access to advice and support from team leaders, control supervisors, mentors, and managers. We saw evidence of effective safeguarding arrangements and practice. The organisation had a clear safeguarding structure with designated safeguarding leadership at corporate level and Deputy Designated Safeguarding Leads aligned to each service area. There was a dedicated Level 4 safeguarding lead for Sussex, supported locally by team.

The provider completed suitable recruitment checks. This included Disclosure and Barring Service (DBS) for both adults and children barred lists and a process to review any risks identified recruitment checks.

Safeguarding training compliance was inconsistent. The provider’s training target for compliance was 85%. Learning disability and autism training was 77% and prevent training compliance was 75%. However, Level 2 safeguarding compliance was 87% for adults and 84% for children. Formal safeguarding supervision had not yet been introduced. Leaders recognised the lack of safeguarding supervision as an ongoing corporate risk.

The evidence showed significant shortfalls. The service did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service did not always plan or coordinate care and support with people, partner organisations, or local services in a way that ensured continuity for people who used the service frequently. This included patients who were transported to renal dialysis several times a week and people living with dementia who would benefit from consistent arrangements and familiarity. However, during the factual accuracy process the provider advised that the percentage of patients transported for renal dialysis by regular staff members had increased from 20% (at the time of our inspection) to 37%.

We spoke with 9 patients from the same renal unit during our assessment. All expressed concerns about how the bookings were managed and told us they did not know what to expect in relation to pick-up and drop-off times.

Crews had access to computers during transfers. However, we saw evidence where a crew did not have access to key information in the event the patient deteriorated during transfer which meant they were unable to respond appropriately

Leaders told us the service did not transport any high-risk patients and that dynamic risk assessments were used for any patients with specialist needs. People also told us that crews were caring and listened to them during their journeys and staff were able to describe correct actions to follow in an emergency.

The evidence showed a good standard. 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 design, maintenance and use of facilities, premises and equipment kept people safe. Premises were secure and staff and visitors signed in and out in a dedicated visitor book.

Managers told us they tracked vehicles using a telemetric system and road safety manager app, to monitor journeys in real time. The camera‑based system recorded and scored driving behaviour, which supported managers to review incidents, understand causes and improve road safety through real‑time and retrospective oversight.

The service stored vehicles in a safe area, which could not be accessed by unauthorised persons. Staff secured vehicle keys securely. We assessed 6 ambulance vehicles and found they were well maintained and appropriately equipped. Equipment was regularly checked, serviced in line with guidance, and safe to use.

Leaders maintained oversight of equipment to ensure it was safe and ready to use. Vehicles were equipped for the type of services provided, this included safety seatbelt straps and child seats (if needed). Records of equipment maintenance and schedules were available, up-to-date, and outcomes shared with staff.

Staff carried out daily safety checks of specialist equipment. There was a system for staff to report faulty equipment and vehicles. Drivers could photograph any vehicle defects. We saw evidence of a small tear in the headrest of 1 ambulance stretcher but saw it had been immediately reported.

Fire safety equipment was available on vehicles and had been serviced. Fire exits were clear and free from obstruction in office areas. Oxygen cylinders were stored correctly, upright and in cages with no flammable or electrical equipment nearby. All fire extinguishers onboard vehicles were securely fastened, checked and within expiry date.

Staff disposed of clinical waste safely inside vehicles and outside in the storage areas. They segregated and labelled waste in accordance with the local policy. The service stored hazardous substances safely and information about these products was readily available to staff.

However, we saw the key for the cupboard used to store substances subject to Control of Substances Hazardous to Health (COSHH) on top of the cupboard. This created the potential for unauthorised access to hazardous materials. We escalated this immediately to a team leader, who moved the key to the designated key safety unit which mitigated the immediate risk.

The evidence showed some shortfalls. The service did not always make sure there were enough qualified, they did not always work together well to provide safe care that met people’s individual needs.

The provider did not always have enough staff for the activity required. Leaders did not always make sure that staffing levels were sufficient to meet demand, and this contributed to delays, cancellation and abort rates. The service subcontracted staffing shortfalls to third-party providers that included a taxi service.

The service did not always 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 provided mandatory training in key skills, but not all staff had completed it. The provider’s mandatory training compliance target was 85% but this had only been met for Induction and Safeguarding Adults Level 2 modules. Compliance was low for annual core updates, health and safety welfare (22%), human factors (54%), completion of journey to performance workbook (51%) and skills development (64.5%). Leaders told us this was partly due to the administration workload associated with TUPE staff. They told us that colleagues were providing their training certification, and this was expected to be completed by 7 December 2025. However, we could not see how this had been planned for in advance of the TUPE process and we were not assured that mitigations were in place to manage low compliance.

We reviewed 6 staff files and only 1 had no gaps across all recruitment and compliance checks. This included missing Disclosure and Barring Service (DBS) checks, missing references and out-of-date driving certificates which the responsible team leader was unaware of. Leaders told us staff were double crewed until DBS clearance was completed and there was a clear policy for safer recruitment. However, the lack of team leader awareness indicated recruitment controls were not always effectively implemented at operational level.

However, new starters attended a 2-week induction and training period. This included first aid, manual handling, cardio-pulmonary resuscitation, fire safety, dementia and infection prevention and control. At the time of our inspection 92% of new starters had completed their induction. They also completed a ‘journey to performance’ booklet during their first few months with the company. This included evidence of completing manual handling training, site-specific induction, oxygen therapy, vehicle safety.

The service recruited a small number of staff in advance to support mobilisation and fill gaps created by Transfer of Undertakings (Protection of Employment) 2006 (TUPE) transfers. As the service had been operating for less than a year, no staff member had yet reached their 12‑month point and formal annual appraisals were not yet due. Managers told us they planned to stagger the appraisal process to ensure it would be manageable once staff became eligible. The provider shared examples of probation reviews although they did not provide the overall compliance rate for all new starters.

The evidence generally showed a good standard. The service generally managed infection risks well.

The service generally managed infection risks well. Staff had access to a local infection prevention and control (IPC) policy and supporting guidance. They used equipment and control measures to protect patients, themselves, and others from infection. Staff kept equipment and the premises visibly clean.

Staff followed IPC principles and were bare-below-the-elbow to support hand hygiene and infection control. Liquid soap was available in staff toilets and hand sanitisers were available on all ambulances that we reviewed. The service prominently displayed posters for the ‘5 moments of hand hygiene’ on notice boards and hand-washing stations. Staff had access to personal protective equipment in a variety of sizes.

We reviewed 6 vehicles which were clean and appropriately presented. Staff cleaned vehicles using environmentally friendly sanitising products. A daily dry mist cleaning process was undertaken, and during operational hours staff used disinfectant wipes to maintain cleanliness between patient journeys.

All vehicles were equipped with spill kits, secured within cupboards, for use in the event of spilled bodily fluids or hazardous substances. In addition, despatch teams enquired about the infectious status of all patients when transport was requested.

Leaders told us that all vehicles were scheduled to receive a deep clean every 13 weeks, by an external contractor. However, records showed that, of the 113 vehicles operating across 4 sites, 19 (17%) were not compliant with this schedule at the time of review, although most were only recently overdue. An infection prevention and control audit completed in October 2025 identified compliance concerns at 1 location, which leaders attributed to delays in uploading completed deep‑clean records to the fleet management system.

Staff received mandatory training on IPC, although compliance was 75%, which was below the provider’s target of 85%. Leaders told us this was because of the ongoing Transfer of Undertakings (Protection of Employment) (TUPE) process and said they were on track to exceed the target by December 2025. However, they had not assured themselves that current compliance was sufficient to minimise the risk of infection in the meantime. However, the service had not yet commenced key audits such as hand hygiene audits and uniform inspections of staff. This made it difficult to understand how leaders assured themselves about infection, prevention and control (IPC), risk and performance.

Score 3.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences.

The provider maintained a comprehensive and current policy governing the storage and management of medical gases and a standard operating procedure (SOP), which outlined the staff roles permitted to administer oxygen and the specific training competencies required to undertake this responsibility safely. Staff were trained to administer oxygen during their induction period and authorised to administer flow rates up to 15 litres per minute. The planning team allocated patients requiring higher levels of oxygen to suitably trained external crews.

The service equipped all vehicles with oxygen supplies and displayed appropriate hazard signage indicated the presence of oxygen and flammable gases. We reviewed 6 vehicles and found oxygen cylinders were securely fastened in accordance with safety requirements. In addition, staff stored oxygen cylinders safely and securely in a well-ventilated, clean storage facility at the ambulance stations.