Hearts First 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to outstanding.

This meant service leadership was exceptional and distinctive. Leaders and the service culture they created drove and improved high-quality, person-centred care.

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.

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

The service’s vision and values were clear, compelling and shared throughout the service. The service’s values focused on high quality, effective leadership, being attentive to all, being responsive, trusted and safe. Staff embodied the core values and principles when delivering care, interacting with system partners and commissioners.

Patient safety was a priority for all staff, with a focus on an open and transparent, no blame culture.

Staff were proud to work for the service and encouraged friends and family to use the service. A staff member commented they wished they had joined years ago. Staff’s achievements and successes were consistently recognised and celebrated. Staff reported high levels of manager engagement and trust in leadership. Staff had seen ongoing investment in vehicles and equipment to better support service delivery. Staff felt the service was inclusive and an empowering place to work.

Managers provided visible, valued‑driven leadership, actively shaping and testing the strategic direction through curiosity, constructive challenge and learning. The service had clear management and accountability structures with defined measurable goals and objectives. The service’s quality strategy outlined yearly targets of service improvement, including how they would achieve regulatory compliance and excellence. This strategy was supported by robust compliance and audit programmes.

The service recognised the direct correlation with staff training, competencies and wellbeing with delivering a good service. Managers had actively invested in staff development, training and wellbeing support to enable them to provide high quality care for patients.

Commissioners acknowledged the service’s high standards. They had seen the service develop and learn to support staff and patients.

The service was inclusive, culturally sensitive and non-discriminatory. The service’s person-centred approach was embedded in the values of the service and was evident in everyday interactions with staff, patients, families and system partners.

The service had exceptionally 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 always did so with integrity, openness and honesty.

Staff told us all managers were approachable and visible throughout the service. Managers supported staff wellbeing, learning and development as well as career development. We saw evidence of staff progression into senior roles and strategies for succession planning.

Staff were engaged, empowered and united by shared values, with a clear sense of belonging and a common focus on improving the quality of care and people’s experiences. Staff showed integrity, honesty and openness which was mirrored throughout the management teams.

Managers had the skills, knowledge and experience to perform their roles. The service had a clear and effective management structure with defined lines of responsibility which were shared with staff. The chief executive was supported by a medical director who had extensive experience in acute and emergency care. Many staff had transferred from other patient transport providers to work for the service. These staff provided a wealth of experience and industry knowledge which was recognised, acknowledged and celebrated by senior leaders.

All managers we spoke with had extensive understanding of the delivery service. They could explain all processes and procedures involved in their roles and were adaptable to supporting others in their team in case of staff absences. Managers were confident to address any challenges and took a proactive approach to problem solving. Managers would often carry out shifts on the road to lead by example and role model good practices.

The services outlined the requirements of staff and managers within their Fit and Proper Persons policy. This detailed the recruitment process, ongoing fitness to practice checks and compliance monitoring. At the time of assessment, we were provided with evidence that senior management had complied with these checks.

Managers had undertaken managerial training and development to support their staff. This included leadership mentoring and risk compliance training. Senior leaders took an active part in the Independent Ambulance Association (IAA) and Health Practices Associates Council (HPAC). Managers shared best practice, industry training and service development with staff. Managers’ involvement in independent associations proactively improved the standards of care and enabled the service to kept up to date with the sector’s future development.

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

Staff we spoke to were confident in raising concerns. The service had an open and transparent culture and staff were actively encouraged to speak freely without fear of reprisal. Managers were visible and staff would go directly to them and were assured information would be treated with confidence.

The service had a whistleblowing and raising concerns policy. This covered all elements of speaking up including making a protected disclosure. The service provided an external Freedom to Speak up provision that was accessible to all staff. Staff could directly contact the guardian by phone or email. This process was also highlighted within the employee handbook and newsletters. The services freedom to speak up processes were supported by the Staff Grievance Policy, Prevention of Bullying and Harassment at Work Policy and Equality and Diversity Policy.

The service had a complaints policy that was accessible to staff and patients. Managers carried out regular compliance audits to review learning and outcomes from complaints. The service had no complaints in 2026 at the time of the assessment. Commissioners also confirmed there had been no concerns raised by patients, staff or system partners.

Patients could also raise concerns immediately during transport if necessary. The service had quick response (QR) access codes and a direct phone number displayed on all vehicles next to the patient trolley and seats. Patients could raise concerns directly with management if they felt unable to raise concerns with their ambulance crew.

The service strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who work for them.

Staff felt safe and supported within the service. They were treated equitably and felt valued for their work. Many staff moved from other independent ambulance services to work at this service. All staff received the same recruitment, induction and 6 month probation period. New starters received a warm welcome and introduction to all staff through the services newsletters. All staff grades and roles had to complete the core mandatory training, which included equality, diversity and human rights training.

Staff groups represented the diverse community they served. The service’s recruitment processes supported candidates from all backgrounds, cultures and religions. The service’s communications with staff were inclusive. For example, they celebrated and shared staff employment anniversaries as well as religious holidays and national awareness events.

Staff were encouraged and supported to share health and well-being concerns. Staff were required to complete a yearly health declaration form which covered long-term medical conditions as well as responsible adjustments needed to support them in the workplace. The service’s absence policy was structured to offer support with regular check-ins and return to work adjustments if necessary.

Managers recognised the importance of talent spotting and several staff had progressed to permanent and team leader roles. Staff were supported with flexible working arrangements to accommodate the needs of carers and those with dependents. The service promoted a supportive, inclusive workplace. Neurodivergent staff were provided with one-to-one tailored support to enable them to thrive within their roles. This included breaking down processes into bite size chunks to assist understanding and task completion. The service’s digital systems used to record checks and audits were accessible, using pictures, process flow diagrams and quick check box lists.

Staff bonuses were structured to ensure all staff groups could benefit. The service recognised loyalty and punctuality as well as those who carried out additional shifts. Managers explained that not all staff could commit to extra shifts but wanted to recognise when staff represented the service well and embodied their core values.

The service had an open and inclusive culture that centred around the common goal to deliver ‘outstanding care’. Staff were respectful of all their colleagues and managers led by example demonstrating exceptional standards of inclusivity. Managers and team leaders consistently focused on the diversity of their workforce and had embedded measures to ensure all felt supported and valued.

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

Staff had clear understanding of their roles and responsibilities. Staff worked within their scope of practice and were supported to remain compliant with all core mandatory training. Managers shared learning from incidents, safeguarding and complaints promptly, this included learning for an external court case from another independent ambulance service. Managers were focused on risk avoidance and mitigation. Education and training played a key part in this. The service had made substantial investment in training provisions and the ambulance fleet to ensure they continued to meet strategy goals in the next 12 months.

The service had a permanent compliance manager who had exceptional oversight of all aspects of the service. The service had thorough audit programs that gave performance indicators for both patient services and repatriation work. Consistent compliance checks enabled managers to respond quickly to themes and trends before they affected patient care. For example, in response to vehicles with wheel issues being off road awaiting new tires, the service purchased a back stock of compatible tires to ensure replacements were timely.

Managers had regular meetings to review service delivery, planning and risk management. During our assessment we attended the service’s morning departmental meeting. There was a set agenda which covered all aspects of the service. This included what was happening that day, staffing levels and resource planning as well as future sustainability. Department staff also had documented regular meetings with their team leaders.

Commissioners met with service managers to discuss contract performance, safeguarding and incidents. They told us communication was effective and the service was consistently delivered against their performance targets.

The service had developed and invested in customised compliance and service management digital systems. This bespoke platform enabled staff to digitally record all aspects of the service. This included audits, staffing data, service delivery, incident investigations and performance data. The one-of-a-kind system was designed to allow future scope for stakeholders, regulators and commissioners to access it remotely to review compliance and performance.

The service kept policies, guidance and standing operational procedures up to date with the latest information. Managers kept staff informed of any changes to national guidance, regulations and legislation in relation to their service. The service had a comprehensive corporate risk register that was monitored and updated during governance meetings. All staff knew the risks related to service delivery and sustainability.

Service leaders ensured governance and compliance management was forward thinking and adaptable to service development. Managers had exceptional oversight of all areas of the service which ensured a high-quality service was delivered.

The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement.

The service had strong and sustainable relationships with system partners. They met regularly to discuss feedback, compliance and performance. Commissioners told us they had strong relationships with service leads, and a strong culture of trust and respect, enabling dialogue and collaborative problem solving.

Commissioners shared an example where the service supported a local NHS clinic by rearranging an entire cohort of patients to receive dialysis on a Sunday instead of a Saturday. This was to support staff at the dialysis clinic to attend a colleague’s funeral. Staff at the service changed shifts to work on their rest day to support system partners at a difficult and emotional time. This was recognised and commended by commissioners.

Repatriation clients met with the service twice per year at the International Travel Insurance Conference and support medical case worker teams to discuss service delivery, expectations and experiences. Patient, staff and commissioner feedback was welcomed by the service and seen as a vital way to hold the service to account.

The service worked closely with local schools and colleges. The service offered 2 work experience placements once a year as part of their local secondary schools’ work experience program for students. Staff attended several career days to discuss running a business and the sectors history. Staff attended local primary school education events and supported children to be aware of ‘what an ambulance does’ as well as letting the children explore the vehicle to reduce any fears they may have.

The service had donated 2 defibrillators to the local community to support first responders in the local area, including a first aid bag to a local food bank. The service offered basic life support training to local community groups and nurseries as a registered accredited training centre. The service also provided free first aid cover for community health and wellbeing events.

The service had donated equipment and vehicles to internal aid projects including consumables and medical equipment overseas to support humanitarian causes. The service financially supported several charity projects with sponsorship and donations.

The service embedded a sense of community, and managers understood the positive and wider impact the service could have on partners and communities. The service took a leading role in building and sharing learning to improve the broader health and knowledge of the local population.

The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff were given time and support to develop. Staff had progressed into managerial and team leader roles. Managers systematically shared learning and information internally and with other organisations to support measurable improvements within the service.

Managers and senior leaders were continuously focused on quality improvement and understood the direct link to investing in staff and delivering high standards of care. Managers actively listened and involved staff to enable collective problem-solving.

The service had strong external relationships with leading national ambulance associations. This supported the service to be current in its practice and adopt and share innovation with other services. Managers were focused on improving the overall standard of independent patient transport services across the sector. The managers played an active role in demonstrating high industry standards. For example, co-designing a one-stop digital system that enabled a helicopter view of all aspects of compliance, risk and safety across their service.

The service had been nominated for a number of external awards and were awarded the ambulance service winner in 2026 at the Healthcare and Pharmaceutical Awards.

The service had made substantial improvements since our last assessment. The service demonstrated a systemic approach to service development, embedding continuous learning and promoting a positive open culture throughout the service.