Medisec Ambulance Service Limited

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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 Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

We looked for evidence that the service encouraged learning and improvement while meeting the needs of patients and the community. We checked whether leaders supported staff and worked with partners to provide care that was safe, collaborative, person-focused, and fair.

The service respected diversity in its workforce but did not measure it. It did not always promote innovation or improvement across the organisation and local system. The service also lacked clear systems for accountability and good governance, which showed in how they managed policies.

The service was in breach of regulation for governance at the service.

We have not awarded this service a score for Well-led.

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

Description: We have a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

We scored the service a 2. The evidence showed some shortfalls. The service did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. Staff did not always understand the challenges and the needs of patients and their communities

The service lacked a clear vision and strategy to drive improvement. There was a disconnect between leadership in practice and the values displayed at headquarters. Staff we spoke with told us they did not feel involved in wider team meetings, and said discussions about service direction were largely limited to senior leadership level. This meant staff were not consistently engaged in shaping improvements or translating stated ambitions into meaningful change.

A large poster on the wall outlined the organisation’s commitments to vision, teamwork, leadership, excellence, communication, responsibility, and staff development. It promised energy, drive, determination, and a caring, enthusiastic workforce. In practice, however, these values were not consistently demonstrated or championed at senior leadership level, which further limited the service’s ability to embed them in everyday practice.

Although some senior leaders told us they felt motivated about the future and were keen to introduce new initiatives, such as teaching sign language and developing expansion plans, this optimism was not reflected by other staff members. While senior leaders celebrated achievements and held “Team Talk” meetings to share ideas, most staff did not feel part of these discussions or involved in the service’s longer-term plans.

Description: We have inclusive leaders at all levels who understand the context in which we deliver care, treatment and support and embody the culture and values of their workforce and organisation. They have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

We scored the service a 3. The service had leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders usually had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty and understood the impact their behaviours and leadership had on patient outcomes and experience.

The registered manager and leadership team brought a wide range of skills and experience to the service. They understood the priorities and challenges and worked to manage them effectively. Staff described managers as approachable, supportive, and visible in the service. Managers encouraged staff to grow their skills and step into more senior roles.

The service followed a traditional organisational structure with clear responsibilities and a transparent chain of command. Two managing directors shared responsibility, though staff told us one was consistently more visible while the other was often away. Operations Managers carried much of the day to day responsibility. They oversaw the smooth running of the business, ensured crews were fully briefed each day, monitored leaders and mentors, carried out compliance checks, created rotas, and responded to tasks set by directors.

The Office Manager played a central role in ensuring governance and oversight. Their duties included managing dispatch and booking systems, coordinating training, handling payroll, overseeing financial matters, recording management meetings, and supporting HR processes such as absence management and disciplinary actions. They also supported staff wellbeing, helped with rotas and training, and led the “Team Talk” meetings, which cascaded information across the service.

Staff told us they felt well supported by HR and finance teams, who kept them informed about legal requirements and compliance. Operations Managers were praised for being accessible, handling incidents quickly, and promoting a positive culture. They often went out on patient-facing activities to see first hand how services were running. However, staff said this visibility was not matched by another senior leader.

While some managers themselves said they were approachable, staff told us this was harder to achieve with other managers. Information from senior leadership was usually filtered down through line managers or “Team Talk,” but staff felt some updates were not always shared clearly.

Staff also noted that the service did not run staff surveys, even though concerns had been raised through the staff suggestion box. On the day of assessment, the box was empty, and managers confirmed only two suggestions had been received in the past year, both relating to food for festive events. Staff felt this lack of formal feedback opportunities limited their voice in the organisation.

Whilst some senior leaders failed to provide clear guidance, other managers showed energy and determination, focusing on the service future development. Staff told us they felt supported by these managers, who encouraged innovation and provided forums to share ideas.

Description: We create a positive culture where people feel that they can speak up and that their voice will be heard.

We scored the service a 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us when they had raised valid concerns or felt they would be able to, were or would be supported, without fear. When concerns were raised, leaders investigated sensitively and confidentially.

Staff where are aware of the whistleblowing policy and the staff we spoke to had completed the whistleblowing training.

A risk register and management reports contained analysis of concerns over time and associated action plans.

The service says there has been no matters raised via the whistleblowing process in the past year. The external stakeholders also confirmed this,

Description: We value diversity in our workforce. We work towards an inclusive and fair culture by improving equality and equity for people who work for us.

We scored the service a 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff were compliant with a wide range of mandatory training modules and while these modules incorporated elements relevant to equality and inclusion, there was no dedicated Equality, Diversity and Inclusion (EDI) training and policy to ensure staff had a comprehensive understanding of their responsibilities under the Equality Act 2010. The only relevant documentation produced was the Workforce Race and Disability Equality Report which included definitions and examples of equity displayed in the service. For a service that we were told that contained 10 women and 5 male ambulance crew members this was not displayed on the report. Additionally, the report did not contain any data on Workforce Race Equality Standard (WRES) metrics.

The service also demonstrated strong commitment to diversity and inclusion. For example, Muslim staff were supported to take prayer breaks during shifts and to adjust working hours during Eid Mubarak so they could break their fast at the appropriate time. The service also supported staff participation in cultural events. One staff member attended a local Sikh festival in a working capacity, which allowed him to see his family and friends take part in the parade. He later shared his knowledge of the festival’s significance with his colleagues, who said they valued and appreciated learning from him.

Although the service was small in nature with 21 staff members, we were told that there were staff from minority backgrounds. The service did not collect or audit Workforce Race Equality Standard (WRES) data, which was proportionate given its scale, but it could strengthen its approach by developing formal policies to support equality and diversity in the practice.

Description: We have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. We act on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.

We scored the service a 1. The evidence showed significant shortfalls. The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

While governance processes existed and staff understood their roles, risk management and policy oversight were inconsistent. Risks were not systematically reviewed, responsibilities were unclear, and key policies lacked alignment with national standards such as NHS safeguarding guidance. Without stronger leadership oversight, the service risks policies becoming static documents rather than active tools that drive safe and effective practice.

The service held monthly management meetings in Southampton Head Quarters to discuss staffing, progression, feedback, business management, new and existing contracts, supervision, appraisals, and actions from directors. Records from these meetings were logged on the system, forming part of the governance record.

Although managers discussed incidents, audits, and complaints during these meetings, staff we spoke to were often unaware of outcomes or changes, suggesting that information did not consistently filter down. The service also held monthly external stakeholder meetings, and minutes confirmed that they addressed complaints, outstanding actions, and audit findings.

The service had a Business Continuity Policy (BCP), which required an annual risk assessment. However, we found no evidence of this being completed. The risk register formed part of the BCP, but no formal risk meetings were held to update it or ensure that identified risks reflected the concerns raised by staff. Risks recorded in the BCP included operational, environmental, cyber security, human resources, regulatory, legal, and financial risks. However, the electronic system presented risks differently, creating inconsistencies.

The electronic risk register contained entries for DBS processes, control room issues, complaints, and staff mental health. Despite this, there was no evidence of designated risk owners, review dates, or updated mitigation strategies. This lack of clarity limited accountability and oversight.

Staff at all levels understood their roles and responsibilities. Job descriptions clearly set out expectations, and senior staff were allocated monitoring and audit responsibilities. Staff reported that they could access information easily to understand performance, track quality, and support decision-making. External organisations received consistent data submissions, and information systems were integrated and secure. We also confirmed that the service had not experienced data breaches and handled patient information correctly.

We reviewed several key policies and found them accessible and up to date. However, there was little evidence of senior oversight to ensure accuracy, consistency, and alignment with national standards. Policies often lacked clarity, failed to reference professional guidance, and in some cases did not reflect operational practice. We saw multiple examples of this in policies, for example, the Vehicle Cleaning Policy: Lacked clarity about who was responsible for deep cleaning, oversight arrangements, cleaning materials, or links to infection prevention and control standards.

Description: We understand our duty to collaborate and work in partnership, so our services work seamlessly for people. We share information and learning with partners and collaborate for improvement.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The registered manager met with external stakeholders and regional networks to understand the needs of the community and the provider’s ambitions, particularly in relation to charity work.

The service sup local ported charities, including the Make a Wish Foundation, scouts, schools, religious parades, and provided free transport to patients who were not eligible under the NHS patient transport criteria.

Leaders and staff actively engaged with patients, staff, equality groups, the public, and local organisations to plan and manage services. The service developed relationships with the local NHS ambulance trust, as well as with NHS acute trusts in the local catchment area.

There were many positive comments from NHS trust staff, praising responders for their expertise, experience, and the assistance they had provided.

There was also feedback from individuals, including members of the community, who had received care and assistance from the service.

Description: We focus on continuous learning, innovation and improvement across our organisation and the local system. We encourage creative ways of delivering equality of experience, outcome and quality of life for people. We actively contribute to safe, effective practice and research.

We scored the service a 2. The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Senior staff demonstrated a strong understanding of quality improvement methods, having received training in this area. The office manager introduced “Team Talk” sessions to strengthen collaborative working and encourage open discussion across teams.

Staff told us they felt supported to develop their skills in improvement and innovation when time allowed. They were keen to pursue service development projects and areas of personal interest.

Staff and leaders consistently showed commitment to improving the patient experience. When needs arose, they worked collaboratively to find practical solutions. For example, staff described adapting care pathways for end of life patients to ensure dignity, comfort, and timely support for families, even when resources were limited.