F.A.S.T. Ambulance Services

On this page

• 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

We looked for evidence of an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable and to reduce inequalities.

At our last assessment we rated this key question requires improvement. At this assessment the rating is good.

The service was previously in breach of regulations relating to good governance. We found improvements and the service was no longer in breach of this regulation. Managers had developed improved processes to monitor how the service was performing. Leaders and staff had a shared vision and culture, which was based on listening, learning and trust. However, staff did not always receive feedback about their contributions. Leaders and managers were visible and supportive to staff. Staff felt supported to give feedback and treated equally. Managers worked closely with local health systems to deliver safe and reliable services when people needed them.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff and managers provided a patient centred service. Staff felt managers and staff were supportive to each other. Standard operating procedures gave staff guidance when conveying patients to their homes. This included ensuring they were safe, comfortable, had access to a drink and reporting any risks to managers immediately.

Leaders and managers had responded to requests to provide transport for patients with mental health needs. This was being closely monitored by managers. Staff gave feedback on any journey they undertook. If they had used any form of restraint this was reviewed by managers for appropriateness. Staff were clear they could raise concerns and refuse to convey a patient if they assessed the risk to be too great.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders and managers valued the workforce and understood challenges staff faced in undertaking their duties. Managers had worked in ambulance care roles previously and would cover a shift if there was an unexpected staff shortage. Managers gave examples of when staff experienced difficult or upsetting situations and had provided personal support at the time. Mangers made adjustments to working patterns where possible to support staff who were experiencing personal challenges. Staff were clear they could raise any concerns to managers. Managers implemented systems to provide a clear overview of journeys, time they took and where staff were during the day.

Feedback from staff and leaders

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Managers had acted to make communications with staff more personal. Staff often raised concerns when they were at the base station. However, they did not always receive feedback about issues raised. A manager was a main contact for staff and had recently attended additional training to enhance their skills when staff wanted to speak up. Leaders monitored and encouraged staff comment in their policies and by using individual conversation and messages on an encrypted system.

The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for people who work for them.

All staff were able to access opportunities to develop if they chose to. Appraisals were held annually by managers who had attended training in the process. Staff gave examples of opportunities they had taken which enhanced their skills and working life. However, these communication systems did not suit all staff when encouraging staff engagement. Managers recognised the difficulties in holding face to face staff meetings when staff were in a variety of locations. Managers planned to review alternative options to improve staff engagement.

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Staff and managers were knowledgeable about their responsibilities within the service. Managers had implemented improved systems to record and monitor a range of information. Staff and managers used electronic systems to plan and monitor patient journeys. Staff contributed to the monitoring by ensuring they logged their activities using hand-held electronic devices. Managers reviewed audit results to identify where improvements could be made. Senior leaders and managers met each month to review a range of agenda items including but not limited to performance, staff compliance with policies, training needs and vehicle maintenance. Actions needed were clearly identified on the recorded minutes for progress review at subsequent meetings.

Directors had recently reviewed services it provided. This had resulted in closing a location in another county which was not effective enough to be sustainable. Work undertaken from the Frome base was in demand, financially viable and fully staffed.

Recruitment processes had been improved to provide a more efficient system. An electronic system recorded that recruitment processes followed the Recruitment, Selection and Retention Policy consistently. DBS checks had been completed and staff references were available in personnel files. New applicants for the service had a telephone triage prior to interview. This was effective in ensuring applicants who attend for interview meet the minimum requirements before a formal interview.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. Staff share information and learning with partners and collaborate for improvement.

Managers and staff worked closely with commissioners of the service and had created an effective and positive relationship. Patient journeys and timings were reported each day to the NHS Trust who commissioned the service. The service provided a hospital liaison role who was effective in communicating with the NHS trust and making adjustments to provide a smooth transition to and from the patient transport service. Staff from the NHS Trust found the service to be responsive to providing additional journeys which were outside of the contracted journeys but necessary to allow patient discharges when they no longer needed hospital care.

There were regular contract meetings between F.A.S.T. Ambulance Services managers and the NHS Trust which provided an overview of journeys, how effective they were and to manage any issues from both partners.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Managers used methods to encourage staff input to creative ways of delivering equality of experience, outcome and quality of life for people. Staff were encouraged to contribute to safe, effective practice.

Managers updated systems which would support sustainable development. The closing of a location outside of the local area made the business more viable and able to continue providing patient journeys. Electronic systems replaced manual processes and had improved efficiency and oversight of performance and safety within the service. Managers monitored the service activity and effectiveness and worked with partners to improve patient outcomes. Journey times were recorded and reviewed to assess if they were within times stated in the contract. For example, within a 2 hour timeframe for picking patients up from a ward area. Incidents were investigated to identify improvement opportunities and actions taken.