Hearts First Ambulance Service Limited

On this page

• 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.

At our last assessment we rated this key question requires improvement. This rating had improved to outstanding following our assessment.

This meant the effectiveness of people’s care, treatment and support achieved good outcomes and was consistent.

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 service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

All staff were trained to complete a dynamic risk assessment to review acute environmental risks for patients. Staff were patient focused and understood their role when delivering person-centred care. They told us they treated patients as if they were part of their family and ensured they were always safe and comfortable. Examples were shared of how staff had assessed patients’ homes as unsafe to meet their needs and had taken the necessary action to avoid potential harm.

The service had an effective booking process which was individually processed through their booking request forms, this included repatriation services. Managers and staff considered all patients’ and families’ needs traveling over long distances, planning regular comfort breaks and adequate nutrition and hydration.

The service’s journey planning reflected people’s physical, mental, emotional, sensory, communication, cultural and social needs.This included those related to protected equality characteristics. For example, dialysis patients who might be too unwell to travel were supported by contacting the clinical team at the hospital to discuss patients’ condition,re-arrange dialysis appointment where needed and to organise welfare checks.

Patients and their families and carers were actively involved in the assessment of their individual needs. Information collected and recorded included vehicle type required, medical history and adjustments needed to meet patient needs. For example, pressure-relieving seat cushions could be added to vehicles to reduce risk on longer journeys or specialised clamps could be used for patients traveling in their own wheelchairs.

The service delivered 2 patient transport contracts. For 1 contract they were responsible for providing the end-to-end process of booking and transport. They worked with the commissioner to ensure appropriate transport was provided to meet the patients’ needs; taking into consideration mobility, communication requirements and escorts if needed. If changes in patients’ needs were identified this would be communicated to operational team leaders and shared with commissioners.

The service transported a wide demographic of patients over short and long distances. Managers ensured staff were supported to provide person-centred care through effective initial assessment and booking processes. The service ensured the appropriately trained staff carried out the transport and provided agency specialist trained doctors and nurses where required.

Patient, relative and commissioner feedback also reflected an effective assessment process which ensured good outcomes for patients. Staff carried out all the necessary risk assessments for collection, transport and discharge of care. The service had several policies and training which supported staff to ensure patients’ needs were always met. For example, Patient Transport Services Meeting the Needs, Comfort and Safety of Patient policy V5, gave staff advise on how to assist patients with walking and those visually impaired.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff were experienced and qualified, they had the right skills and knowledge to meet the needs of all their patients. New staff were supported and provided with the appropriate supervision during their 6-month probation period. All staff were trained to a minimum standard of First Responder Emergency Care level 3 (FREC) including staff working in the operations offices.

Staff were provided with regular supervision and yearly appraisals to discuss learning, development and performance. Compliance managers also attended hospital clinics where patients were being transported to observe staff interactions and use of manual handling equipment. Any identified poor performance was addressed through supportive training. Staff were given regular opportunities to refresh and upskill.

The service used patient report forms (PRFs) for longer and complex patient journeys to record all assessments, clinical observations and interventions. This included pain assessments and management. Staff used recognised national tools to assess patients. For example, the National Early Warning Score 2 (NEWS) was used to monitor deterioration of patients. Staff were provided with guidance on how to complete PRFs, outlining the minimum required information and clinical observations to ensure safe transport.

The service also followed the Joint Royal Colleges Ambulance Liaison Committees (JRCALC) national guidance when supporting patients during journeys. This included any lifesaving procedures carried out in line with staffs’ scope of practice. This was further supported through emergency scenario training and the service’s Deteriorating Patient Policy V5.

Managers carried out monthly audits of all patient report forms. From March 2026 to May 2026, managers audited 216 PRFs which were of a good standard and followed the service’s policies and national guidance. Key performance indicators were also monitored for subcontracted patient transport journeys. Commissioners confirmed the service consistently achieved around 99% compliance with performance markers.

The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

All staff were patient, care and experience focused, and they worked together to achieve a high standard of care. Operational teams planned journeys to ensure all patients were supported. For example, if they knew certain patients preferred to travel with another particular patient, they would aim to accommodate this.

Staff had regular opportunities to meet with service leaders. The service had quarterly road staff meetings that could be attended in person or virtually, which were well attended. These meetings had a standing agenda which included raised and resolved staff questions from the previous meeting. An action log was kept and shared with staff. The May 2026 log showed actions had been taken in 21 out of the 26 concerns raised by staff.

Operation center staff were adaptable and could work on vehicles if required to support service delivery. Staff told us they were given direct support from office staff and knew escalated concerns or questions would be addressed promptly in a supportive way.

Staff worked with local National Health Service (NHS) teams to support safe continuity of care. For example, staff transporting regular dialysis patients had direct communication with dialysis nursing staff to ensure prompt discharge processes.

Operations management checked in regularly with all staff throughout their shift, this included those traveling long distances to make sure they had all received breaks and refreshments. During assessment we observed managers carrying out welfare checks on all staff due to the extremely hot weather.

Staff met regularly to discuss the delivery of services. During our assessment we joined the daily morning call which involved all departments at the service. Each manager gave a comprehensive update on the previous 24 hours, escalated any safeguarding, incidents or complaints and reviewed the planned service for the following few days. The meetings were structured to be ‘people’ focused and ensured all departments had the opportunity to contribute to the discussion.

Repatriation journeys were coordinated with multiple agencies which enable safe and consistent care during transfers. This included communication with international hospitals, airports, hotels and other health care professionals. Examples were given where team leaders had given live updates to specialty teams at hospitals waiting to receive a repatriated patient. These patients often had complex physical and medical needs which required highly trained staff to support safe transfers. The service had exceptional systems in place to cater for any eventuality during complex transfer. For example, relief crews were coordinated for exceptional long journeys to support staff fatigue and patient safety.

Commissioners told us there was effective, consistent communication between them and the service. This included day-to-day communication between operations center teams and more formal monthly contract meetings. Commissioners noted ‘the service might be more expensive’ compared to other patient transport services. However, commissioners said they knew they were getting a premium service for their patients.

During the assessment we saw how the service coordinated and accommodated a request from the dialysis unit. The service had organised their staff to carry out clinic journeys on their day off to support dialysis staff who had to attend a funeral. Commissioners had received outstanding feedback regarding the service who went above and beyond to support patients and system partners.

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, reduce their future needs for care and support.

Staff understood their roles and responsibilities in supporting patients to make healthy choices during service delivery. Staff had guidance on how best to support patients mobilise and supported patients to have confidence in their own physical ability to promote independence.

Staff and managers also ensured patients had access to extra water and cooling packs during hot weather. Staff were reminded of the effects of heat exposure and what signs and symptoms to look out for in patients. All staff were trained in recognising a deteriorating patient and knew how to escalate and seek appropriate medical support.

The evidence showed an exceptional standard. The service monitored all people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they fully met both clinical expectations and the expectations of people themselves.

The service monitored key performance indicators for commissioned patient transport services. Commissioners confirmed the service maintained an above target performance level consistently over the last 12 months prior to our assessment.

Staff were patient focused and ensured they were treated ‘like family’ during transportation. Operational teams planned regular journeys with the aim of keeping the same staff member with each patient. This enabled staff to notice and recognise any health or mobility deterioration. Staff told us they would escalate and document any concerns and request support where necessary.

Managers consistently carried out a full audit schedule throughout the year which enabled them to capture themes and trends. This included PRFs, incident and complaint audits. Managers shared areas of learning and improvement amongst teams and with commissioners. All staff were kept informed of performance and service benchmarking through monthly newsletters, emails and staff meetings. The service focused on patient experience, staff competencies and care standards. Staff had access to the service’s custom digital compliance system and played an active role in monitoring service delivery and patient outcomes.

The service’s repatriation service received continued positive feedback from patients and relatives which supported contracts with stakeholders. There was no formal performance indicator for this work. However, managers were confident the service was performing well due to repeated bookings from external companies.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood how and when to gain consent for care and treatment. All staff had completed Mental Capacity Act (MCA) and Deprivation of Liberty safeguards (DoLS) training modules as part of their mandatory training. At the time of the assessment staff were 99% compliant with this training.

Staff took steps to give people appropriate information and support to make informed decisions. Staff followed national guidance to gain patient consent. Staff described how to support patients who lacked capacity or were experiencing mental health issues to make their own decisions

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff followed the service’s policies related to consent, mental capacity, DoLS and restrictive practice. For example, staff to us they had made a best interest decision following a patient sharing intent to self-harm.

Operation teams accommodated escorts for NHS patients during the planning process if they had been authorised by the commissioner. Information about patients was only shared under the service data protection policy and in line with legislation.