Hearts First Ambulance Service Limited

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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.

At our last assessment this key question was rated requires improvement. The rated has improved to outstanding following our assessment. This meant people were protected by a strong and distinctive approach to safeguarding, including positive risk-taking to maximise their control over their lives. People were fully involved, and the provider was open and transparent when things went wrong.

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 service had a strong, proactive and positive culture of safety, based on openness and complete honesty. They actively listened to concerns about safety and thoroughly investigated and reported on safety events. Lessons were always learnt to continually identify and embed good practice.

Managers actively promoted learning from internal and external incidents. For example, managers had developed a training package following a safety incident that happened at another independent ambulance service. Key learning was shared with all staff which included a picture step-by-step guidance to demonstrate safe manual handling techniques. All safety communication for staff required a ‘read and receipt’ to be logged prior to shifts starting to ensure all were up to date with any guidance, safety alerts or policy changes.

Managers embodied a positive ‘no blame’ safety culture that was person centred. Each incident was treated as an opportunity to learn and improve the service they provided. The service had effective policies and guidance in place to support staff and managers during incident investigation processes. Staff received tailored support following incidents including occupational health assessments, face-to-face counselling sessions and managers could directly refer employees who may be reluctant to seek help independently. The service was also available to immediate family members, including partners and dependent children up to the age of 24.

Staff understood the importance of reporting incidents and were supported to raise and escalate concerns. They underwent yearly patient safety and quality training. The safety culture was proactive, and patient and staff safety was a priority throughout the service. Staff could give clear examples where learning from incidents had directly impacted on improving care standards.

Staff used Incident reporting processes which were clear and consistent. They were involved in investigations and received feedback. Leaders identified areas of learning and supported staff training and development. This included producing reflective learning statements that demonstrated individuals learning had been embedded. Leaders shared incident outcomes and learning with commissioners and system partners.

The service reported incidents and safety events externally when required. The services Incident Reporting Policy V5 incorporated the principles of the National Health Services (NHS) Patient Safety Incident Reporting Framework (PSIRF) with detailed, clear incident risk assessments, processes flows, and timescales for managers to follow.

Managers effectively shared information about patient safety and learning from incidents through accessible newsletters, emails and refresher training. This included any safety alerts from commissioners or system partners.

The service had reported 117 incidents between June 2025 to June 2026. All had been investigated in line with the service’s policies and evidence of how learning was shared was recorded. None of the incidents had triggered a duty of candor response. Duty of candour is a professional obligation for healthcare providers to be open and transparent with patients when something goes wrong in their care. This may be verbal or written. However, the service had policies and training to support staff if a duty of candour was required.

Managers had specific ‘route cause analysis’ training to enable a systematic and consistent approach to incident investigations. Staff and patients were actively involved in this process ensuring opportunities for reflection and feedback. Evidence showed key learning following incidents was always shared promptly with staff.

Patients received feedback and welfare checks following incidents. For example, after a manual handling incident, managers carried out routine welfare phone calls to check if the patient was feeling well and if they needed any support. It also allowed them to share outcomes from incident investigations and what learning had been implemented as a result.

Managers empathised on the importance of all staff, permanent or bank, having the right skills and training to carry out their roles safely. Time was allocated for refresher training to help reduce the risk of incidents and near misses. This further supported the proactive approach to risk and incident management across the service.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service carried out subcontracted journeys for NHS and private repatriation contracts. Subcontracted work was either entirely managed within the service or part managed by their commissioners. The services were able to accommodate adults, children and those living with obesity. Any ad hoc work requested by commissioners was planned and resourced in advance. Managers assured appropriately trained staff and vehicles were available. There was no direct booking with the service for NHS journeys.

Staff told us they had received training and had access to guidance to support patients during their journeys. Staff were focused on delivering safe effective transport and understood their role and responsibility to ensure patients were on time for appointments and admissions.

The service booked repatriation journeys within the services acceptance criteria and in collaboration with external partners. Booking forms for these journeys were comprehensive and ensured all discharge and transfer arrangements were in place. Staff would plan complex transfers with system partners to enable safe transition from multiple health services. Where patients were being admitted to an NHS hospital for continued treatment, operational staff would communicate with admission teams ahead of arrival to facilitate a seamless transfer of care.

The service provided regular transportation for dialysis patients. On average they completed around 2742 journeys a month. At the time of the assessment, contract key performance indicators (KPIs) were 99%. Booking processes and acceptance criteria were monitored by commissioners, but journey planning and transport delivery were carried out by the service. Staff planned journeys following receipt of patient details from their commissioner. The services systems used to schedule patients’ journeys were effective and took into consideration patients’ mobility and medical needs. Operations staff demonstrated how they planned journeys to make sure travel time was kept to a minimum and escorts or carers were accommodated where indicated.

Day control staff monitored ambulance crews’ journeys through a live digital tracking system. Staff told us this was used to ensure journey times were as expected, and they reacted to traffic or unforeseen transport delays. Patients and relatives could request an estimated time of arrival and were given updates by staff. Staff would also proactively call patients to inform them of any delays to relieve anxiety and give reassurance.

Hospital clinic journeys were planned so patients were not dropped off more than 30 minutes prior to their appointment to limit unnecessary waiting. Operational teams communicated directly with clinic staff to ensure smooth transition to discharge for return journeys home.

The service’s vehicles could be adapted to meet patients’ journey needs. For example, extendable ambulance trolleys and child harnesses were available. All vehicles were equipped with an automatic external defibrillator (AED) and all staff had received competency training. Managers also monitored staff driving through the vehicle’s closed circuit television. A monthly report was shared with staff, and any areas of poor driving compliance were managed in a supportive way in line with the services policies.

Managers monitored service performance targets for all hospital clinic journeys. At the time of assessment key performance indicators were 99%. Feedback from commissioners confirmed high standards of performance compliance throughout transport contracts.

The service worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. They had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They always shared concerns quickly and appropriately.

The service prioritised safeguarding people who used the service. Staff were supported to recognise, escalate and report safeguarding concerns. All staff had received adult and children safeguarding training appropriate to their role. This training was supported by training on autism awareness, equality, diversity and human rights, learning disability awareness, mental health capacity, deprivation of liberty safeguarding (DoLS) and preventing radicalisation. Staff also received safeguarding supervision with support from training managers and safeguarding leads.

The service provided a patient led referral process. On each vehicle was a direct referral phone number that patients could access themselves to raise concerns if they felt unable to disclose safeguarding concerns to staff during care. This innovative approach empowered patients to raise concerns and seek support.

Staff understood the importance of the Mental Capacity Act. They explained how consent to care and treatment was recorded and how best interest decisions were considered. For example, staff identified a self-harm risk of a suicidal patient which was escalated to appropriate agencies in line with their responsibilities. Staff worked with the commissioned partners to maintain patient safety. They were confident of the support provided by managers and would receive feedback from referrals made.

Staff we spoke to explained how to intervene effectively and escalate safeguarding concerns to the safeguarding lead, operations centre and police if necessary. In the 12 months prior to our assessment, the service had submitted 12 safeguarding referrals to the local authority. The service had rigorous systems in place with clear roles and responsibilities to promptly act on safeguarding concerns to address any risks.

The service had a designated safeguarding lead trained to level 5 in safeguarding. Staff could also access level 5 trained staff through their external Freedom to Speak Up provision. Leaders were passionate and driven to deliver an exceptional service, taking immediate action to keep people safe from abuse and neglect. The service’s safeguarding lead gave examples of liaising with local authorities to share outcomes. The service monitored safeguarding incidents by key performance indicators and internal digital systems. The safeguarding lead used the process to identify themes, reinforce good practice and shared learning across the service and in the monthly newsletters. This included a list of common myths for safeguarding and external examples of a recent financial abuse incident to raise staff awareness.

Managers had taken a proactive approach to safeguarding provision. Following an audit in January 2026, training levels for operational team leaders was increased to level 3 to support out of hours staff. This was in addition to a 24/7 escalation messaging system that enabled staff to immediately raise concerns with on call managers. The service had rigorous process for investigating any allegations against people employed in positions of trust. This was outlined in policies and supported by external human resources provision.

Managers collaborated with commissioners when responding to safeguarding concerns. Commissioners told us the service acted promptly to address concerns and had clear channels of communication to ensure patient safety. The commissioners were confident in the ability of staff and managers to recognise and escalate safeguarding concerns. The service had thorough processes and oversight supported by policies. This ensured the appropriate action was always taken following a referral. The service also informed the relevant regulatory bodies when a safeguarding was raised.

The service shared key safeguarding learning with staff and external partners. The service’s continued passionate and professional approach to safeguarding ensured all patients and staff were empowered to recognise risk, report and take action to prevent harm.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff told us how they managed and escalated risk. Ambulance staff had effective pathways to inform operational room staff of concerns and potential risks. For example, vehicle breakdown was effectively reported, ensuring replacements were sourced promptly to limit journey disruptions. Staff in the operations room could also respond and support transport journeys if necessary as they were all trained to the same clinical grade.

Each ambulance was equipped with a personal digital assistance device that enabled staff to contact managers directly to escalate risk. For example, if staff felt the patient’s home was unsafe to be left in, they could call and record digitally the actions they took. The service also had a call recording system on all landlines within the operations room.

Staff said they could access prompt advice and support from managers. The service had an on-call system which meant managers were available 24 hours a day. Any communication and guidance given to crews was recorded and logged on internal IT systems accessible to all managers.

Staff knew how to carry out a dynamic risk assessment. Managers gave examples where staff had escalated concerns that a patient’s mobility had not been booked correctly and that additional resources would be required to support safe transport. Staff were supported by managers to complete these risk assessments and outcomes were recorded on journey record logs.

Staff received mandatory training on fire safety as well as general health and safety within the workplace. Changes in risk management policies were communicated to staff promptly with a recorded ‘read and receipt’ that was monitored by managers.

All staff were trained in basic life support or advanced life support depending on their role. There was effective guidance in place for staff to access in the event of a medical emergency during transport. Staff were confident in how to manage medical emergencies and when to escalate to 999 emergency services where needed.

Managers took a proactive approach to risk management. They recently communicated precautions staff needed to take to ensure staff and patients were kept safe during periods of extreme heat.

Managers had implemented a ‘random’ drug and alcohol test procedure for all staff, to reduce patient risk or eliminate driving risks/ and ensure adherence to conduct policy. All staff were required to press a randomiser button at the beginning of their shift, which if turns red, indicates that they must be tested. This is for all staff and any site visitors.

The service had carried out comprehensive risk assessments for all elements of the service. This included moving and handling, vehicle breakdowns and lone working. The services risk assessments were comprehensive and included risk ratings and control measures to reduce risks and were regularly reviewed by managers.

The service was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care.

The service had a designated ‘make ready’ garage, equipment and drug stores as well as offices, operations control room and training spaces. The service operated from a rural setting and had use of multiple buildings. Each area was equipped with monitored closed circuit television (CCTV) to ensure staff and visitors’ safety. All areas had undergone an environmental risk assessment.

The service kept all vehicles’ keys locked away and required staff to sign them out by a digital system. Staff recorded additional equipment, including drug bags and child harnesses, against their assigned vehicles to support effective tracking and use. All vehicles had air conditioning, seat belts and fire extinguishers.

Staff wore high visibility jackets when walking around the site due to moving vehicles. At time of assessment, staff wore baseball hats to protect themselves from the hot weather. Managers had installed and provided fans or air conditioning units for staff working in hot offices. Staff told us they had been supported with additional water, cool packs and regular welfare checks during the extreme heat.

Staff were trained to use all equipment and disposed of clinical and domestic waste safely. Staff carried out mandatory daily vehicle checks which were recorded in the service’s digital system. Shift managers tracked and monitored this. Staff reported vehicle and equipment defects promptly. Managers ensured there was sufficient spare vehicles and equipment to ensure limited disruptions to the service.

During assessment we reviewed 3 vehicles, all were maintained to an exceptional standard. All vehicles seen were prepared to a uniform standard, all areas were visibly clean including around door rims and footwells. Each vehicle had been standardised to ensure they complied with European Committee of Standardisation (CEN). Electrical equipment had been portal appliance tested, serviced and calibrated. All equipment was asset tagged and monitored through the services digital system.

The service had an exceptional ‘make ready’ provision. Staff were dedicated in ensuring each vehicle used was thoroughly cleaned inside and out and fully equipped with what it needed in line with the service’s policies. Staff followed mandatory vehicle cleaning check lists. This was recorded on internal systems which monitored daily checks and cleans including 4 weekly deep cleans. Evidence provided showed 100% compliance with vehicle cleaning schedules. This included vehicle health checks to monitor oil levels, tyre pressures and bodywork. The service’s vehicle washing solutions were biologically friendly to reduce impact on the environment.

Managers carried out spot checks on vehicles and premises to ensure good compliance with policies and environmental risk assessments. Any low compliance identified was addressed promptly by staff. The service carried out regular fire safety checks and drills. Staff’s driving was also monitored through the service’s digital system, this flagged up any occasion of driver distractions and enabled managers to address any potential risk or required training.

All staff had access to an emergency alert application that provided a 24-hour alarm system. This supported lone workers to request emergency support where required. There was also a sensor built into the application that would detect sudden sharp movements such as a fall followed by impact, ensuring the alert was activated even if staff members could not activate the alarm themselves.

The service had codeveloped a new digital system that allowed real time oversight of all aspects of the service. This included staffing, vehicle compliance, audit and performance. The service’s system enabled staff to report in directly, escalate and log risks, as well as monitor mandatory training compliance and shift allocation. Managers could use this central ‘all in one place’ system to have real-time oversight of all elements of their services to monitor safety and ensure good regulatory compliance. Managers told us the system was designed to eventually enable remote access for external compliance visits and assessments from regulatory bodies.

Managers and staff took a proactive approach to safety across all areas of the service. Staff were empowered to take ownership and act on environmental risk. Managers had taken accredited occupational health and safety training and had exceptional oversight of their premises, vehicles and equipment through audits, spot checks and their digital compliance system.

The service made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

The service had a mixture of full-time employees and bank staff. At the time of assessment, the service had approximately 116 staff, including road and office staff. Recruitment processes were robust and followed the service’s recruitment policy. We reviewed 4 staff records of various grades. All had complete recruitment, training and assessment processes. All staff received yearly Disclosure and Barring services (DBS) checks and bi-annually driving license checks in line with the service’s policy.

All staff were required to complete a new starter induction program which included core subjects, driving assessments and clinical assessments. Staff had to complete a new starter check list prior to starting shifts. Managers held development conversations with new staff within their 6-month probationary period to agree objectives and set a personal development plan.

Staff were provided with an employee handbook which detailed key health and safety protocols, safeguarding guidance and employee code of conduct standards. All staff we spoke to understood their roles and responsibilities and knew which managers they reported to and their roles. Permanent patient transport staff were trained to a minimum of First Responder Emergency Care Level 3 (FREC 3). This included all office staff and managers. This enabled additional flexibility in the event of short notice sickness of road staff.

The service was an accredited location to deliver industry specific qualifications. This included first aid and clinical training as well as blue light driver training. Training managers were registered healthcare professionals who had robust oversight of all aspects of staff’s competencies and training requirements. Any identified gaps in learning or learning from incidents were addressed promptly.

Staff received yearly updates in basic and advanced life support training and competency reviews depending on their role. Staff were not allocated shifts until they were compliant with this training. Trainers also offered ‘Staff upskilling days’ for those who wanted to refresh or advance their skills. Trainers carried out periodic driver assessments for both blue light and non blue light drivers. These assessments were comprehensive and enabled early detection of poor practice to ensure training and support was put in place to minimise risk.

Managers carried out ongoing monitoring of all staff through supervision, competency testing and yearly appraisals. At time of assessment the services were 100% compliant with staff appraisals.

Registered staff had their revalidations check carried out automatically annually through their digital system. Any registration lapses were investigated, and staff were not allocated shifts until compliant.

The service supported work experience opportunities for local school children. Examples were given where work experience placements had developed into full-time work. This had then continued to career development pathways including support for passing driving tests.

At our previous assessment we had identified breaches relating to safe staffing and good governance, the service had made significant improvements and were no longer in breach. Compliance managers and training leads had exceptional oversight of all elements of staff recruitment, training and competencies. There was a proactive approach to staffing management to ensure the service provided a consistent level of competent, trained staff. The service also carried out its own mock desktop compliance assessments to ensure they had all the necessary evidence to provide assurances during any regulatory inspection.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff received mandatory training in relation to infection prevention and control (IPC). All staff understood the key principles and demonstrated adherence to policies and national guidance. For example, bare below the elbows and good hand hygiene. At time of assessment all staff were permanent and were 100% compliant with this training.

During the assessment we observed all facilities, garages and vehicles to be clean. Some office spaces were slightly cluttered but were cleaned regularly.

The service’s vehicles had hand gel, spill kits and personal protection (PPE) equipment for staff. Staff would clean surfaces and equipment after each journey in line with the services policy.

Staff cleaned all site facilities. We saw cleaning check lists for all kitchen and toilet areas were up to date. Staff had access to appropriate cleaning materials for facility cleaning which they stored appropriately.

The service carried out hand hygiene audits on all staff. Audits from June 2025 to July 2026 showed 100% compliance. All permanent staff had received a Hepatitis B vaccine and were offered on site flu vaccines each year.

The service and effective policies and guidance to support good IPC compliance. Managers supported staff to ensure good IPC practices. Staff were regularly reminded of the importance of good hygiene and IPC measures to minimise risks of infection to patients and staff.

The service had an onsite ‘make ready’ service. This provision made sure all vehicles were cleaned, fully equipped and ready for crews to use. Staff we spoke to followed robust cleaning and maintained schedules that enabled close monitoring and auditing. The make ready team also carried out fortnightly deep cleans for any high dependency vehicle and monthly deep cleans for all patient transport vehicles. If any vehicles came back dirty or soiled these would be deep cleaned immediately before use. Audits provided showed the service was 100% compliant with their vehicles’ deep clean schedule in line with policies.

The service’s vehicle cleaning products were stored correctly in line with the service’s policy and national regulations. The service had robust Control of Substances Hazardous to Health (COSHH) procedures in place, including eye irrigation and first aid station in case of exposure incident. All cleaning chemicals had the necessary risk assessments and control measures in place.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff had access to a current, medicines management policy which was service specific. Staff knew their roles and responsibilities in relation to good medicine management and which elements related to the scope of practice.

The service’s medicines were well organised and stored securely including CCTV monitoring with access only to authorised staff. Managers had effective oversight of medicine ordering, storage and disposal in line with the service’s policies. The service had altered the ‘use by date’ in accordance with the manufacture’s recommendations when medicines were stored outside of a fridge.

During our on-site assessment staff were increasing the temperature checks of medicine stores due to the hot weather. Staff had also installed fans and placed ice packs inside the medicine cabinet to keep temperatures at required levels. Thermometers installed generated remote alerts if temperatures were reaching out of safe ranges or running low on batteries. Audits from March 2026 and May 2026 showed all medicine storage was kept within temperature range in line with the service’s policy.

The service’s drug bags were stored in secure cabinets, this required staff to sign out to them individually. Bags were logged and tracked on the service’s internal system. Each bag was sealed and tagged to be tamper proof. The opening and administration of the medicines were recorded and documented within patients’ care records. Managers ensured all drug bags were restocked promptly on staffs’ return.

The service’s medical gases were stored correctly and in line with national guidance. The environment temperature was also monitored to ensure gases did not reach over 45°C. Audits showed 100% compliance with daily checks.

Staff carried out stock checks and audits monthly. Evidence reviewed showed there were through processes which ensured effective oversight of the procurement, administration and disposal of medicines.

The service did not store or use controlled medicines. The service had a medical director who held overall responsibility for medicine management. For day to day oversight the service employed 2 paramedics. Any medicines requiring a Patient Group Directive were signed and counter signed by a pharmacist in line with regulations.

Managers monitored medical field safety notices regarding medicine alerts and if action was required for their service.

At our previous assessment the service was in breach of Regulation 17 in relation to medicine management, we saw significant improvement and the service was no longer in breach. The service had effective systems, polices and guidance in place to support safe management of medicines.