Archived: Head Office

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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

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. Leaders had systems for identifying and responding to safety risks. The service had safety processes for the preparation of vehicles, equipment and for the patient journey between locations. Oxygen was managed safely. Patients were safe from neglect, abuse and discrimination. Patient’s gave informed consent prior to any physical support required of staff. Where they were unable to consent, those close to them were involved in decisions made in their best interests. We found that IPC audits were not always completed and deep cleaning of vehicles was not always in line with policy. The service had not sent statutory notifications for notifiable incidents to care quality commission in line with their conditions of registration.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant patients were safe and protected from avoidable harm.

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 proactive and positive culture of safety, based on openness and honesty. Staff and leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Learning was shared with staff.

The service managed patient safety incidents well. The service had an incident reporting policy, which outlined incident reporting procedures, grading and timescales of investigation. There was a risk assessment matrix applied to each incident, according to severity. Staff told us how they raised concerns and reported incidents and near misses, which was in line with this policy. However, during our onsite assessment we were informed of an incident by staff that had not been reported in line with policy. Managers immediately followed up on this and we were provided with a copy of the subsequent incident report and action taken.

Staff reported incidents using the internal system, the digital form was accessed through an application on their mobile phone. Managers investigated incidents and shared lessons learned with the whole team and the service’s contracted NHS ambulance services at weekly and monthly meetings.

Incidents were investigated in line with policy. We looked at the system for managing incidents which was electronic. There had been 69 incidents reported in the preceding year. We saw evidence of incidents having been investigated, and sufficient action taken to reduce the risk of recurrence. Recent examples of incidents included medicines error(s) and vehicle damage and saw action had been taken in response to incidents raised.

Incidents were analysed to identify trends or themes and potential links to individual practitioners. Where additional training or support was required to ensure competence, this was arranged. For example, a staff member had a review of their blue light training following an incident and colour coded labels were introduced to aid easy identification of drugs.

Staff were able to identify and report risks, secure in the knowledge these would be addressed. For example, a staff member reported a problem with the windscreen wipers, and these were replaced by the next morning. Where there was an immediate risk of harm to patients or others, staff felt confident to intervene to prevent harms occurring. Staff also told us they were able to call the tactical operations contact (TOC) for advice or support when in doubt to ensure risk was reduced.

Staff we spoke to understood the duty of candour (DOC). They were open and transparent and gave patients and families a full explanation if and when things went wrong. Staff received feedback from investigation of incidents through the digital application. A staff member told us that managers debriefed and supported them after a recent serious incident. The service did not have any reported incidents where DOC needed to be applied in the last 12 months.

Managers used changes in national guidance, incidents, safeguarding and appraisals to identify gaps in learning. For example, all staff received major incident refresher training which was created in line with the NHS ambulance provider guidelines to ensure all Medicare staff were following the same guidelines in the event of there being a major safety incident.

The service had received 2 complaints. These were reviewed and responded to in line with policy with apologies offered and where appropriate action taken to prevent future occurrence.

As a registered provider, the service should notify Care Quality Commission (CQC) about certain changes, events or incidents that affect their service or the people using it. The service was not doing this therefore in breach of registration regulation for the notification of other incidents. Following the assessment, we met with the provider and they told us they would provide statutory notifications for incidents in accordance with their registration obligations.

The service worked with patients and healthcare partners to design, establish and maintain safe systems of care, in which safety was well managed and monitored. Staff made sure there was always continuity of care, including when responsibility for patient care moved between different areas of a service and between providers.

Safety and continuity of care was a priority throughout people’s care pathway. We observed staff receiving incoming information when a job was sent to them. They were able to contact control at the NHS ambulance provider should they need more information. During the onsite assessment we saw staff gather information from a patient and a health care professional when responding to a 999 call.

Staff had access to language line and abbey pain score chart through the electronic patient care record app (ePCR). This is a tool designed to assess pain in individuals with advanced dementia or those who are unable to clearly articulate their needs, such as non-verbal patients.

Staff had access to national guidelines, local policies and procedures to enhance patient outcomes by ensuring consistent, evidence-based treatment whilst caring for patients in prehospital environments. For example, clinicians were expected to follow the management of Sepsis guidelines which could be accessed through the Medicare Joint Royal Colleges Ambulance Liaison Committee (JRCALC) login which is linked with the NHS ambulance provider. This ensured that any updates made were followed by Medicare staff to ensure a uniformity in the delivery of high quality patient care.

Staff told us they were also able to call a clinical advice line through the NHS ambulance provider as well as the Tactical Operations Centre (TOC) where a member of the executive team were available 24 hours a day 7days a week. Staff we spoke to understood how to contact the TOC.

The transfer of patients between locations was done safely. Staff had appropriate driving skills and experience. Suitably skilled staff accompanied patients during the journey and safety equipment was used throughout. Where staff were transporting time critical patients there were processes in place to pre-alert the receiving hospital to ensure the hospital team were prepared.

When overall responsibility for the care and treatment of a patient moved to a different service provider, such as transfer to the NHS, there was effective communication, which allowed for seamless transfer. We observed the handover of a patient. Staff gave a clear summary of the patient needs and concerns including emotional needs.

Care and support was planned and organised with people, together with partners and communities in ways which ensured continuity after transfer to the destination. The Hospital Ambulance Liaison Officer from the NHS ambulance provider reported a good working relationship with the Medicare staff and crew took time to understand systems in place to ensure continuity of care moved between different areas of a service and between providers. For example, Medicare were working with their NHS ambulance provider to develop and deliver major incident training for their staff to ensure that they were training staff to follow the same protocols if supporting in a major incident.

Patient records were completed on the eCPR system digitally. This system was the same as that used by their NHS ambulance provider crew. This meant that care records accurately reflected the care and treatment received by Medicare clinicians. Managers told us monthly care records audits were completed looking at compliance with completeness. We reviewed the last 12 months audit data for patient care records. Overall patient records were mostly completed to reflect the care delivered. The last audit data in January 2026, showed that handover time and handover to were not always completed fully, scoring 89% against a target of 100%. Staff told us that they received feedback on the quality of their records if compliance was poor.

Where patients did not require or refused conveyance to hospital staff carried out and documented a full clinical assessment. Newly qualified paramedics (NQP) were not authorised to discharge care autonomously. Staff were required to follow the NHS trust mechanisms to safely discharge. Leaders told us they monitored compliance by reviewing patient care records. Poor compliance had been noted through recent audits. Leaders took action by sharing the policy and standard operating procedures via the app and measured the effectiveness of action taken through further auditing of NQP discharges. We were provided assurances that the action taken had been effective and there had been no reported incidents of NQP discharging patients without authorisation.

The service worked with patients and healthcare partners where required, to understand how best to keep people safe, what it meant for individuals and the best way to achieve that. Staff concentrated on protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Safeguarding referrals were made directly to the NHS ambulance service. The service had well established partner working and contacts around safeguarding with their NHS ambulance provider. All safeguarding cases were passed onto the relevant teams at their contracted NHS ambulance trust. This meant staff did not report to the local authority directly. Staff we spoke to knew how to make a referral or sought further advice when necessary.

The service met with their NHS ambulance provider safeguarding team as required and referrals made were discussed at the monthly received feedback from the contract provider about safeguarding concerns they had raised, to enable learning. The NHS ambulance provider told us that there were no concerns regarding the safeguarding referrals made by the Medicare staff. An average of 7.2 referrals per 1000 patients were made and this was considered to be appropriate by the NHS ambulance trust.

Senior leaders identified the need for an additional chaperone policy to keep both staff and patient safe. We saw evidence of this being shared and communicated with staff digitally.

They had a safeguarding lead trained to level 5 in safeguarding adults and children with another 2 managers trained at level 4.

Staff received adult and children's safeguarding training. Data showed 100% of staff had completed level 3 safeguarding adult and children’s training. There were current safeguarding policies, and these reflected the national guidance for adults and children.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. Expert safeguarding advice was available to support staff by both Medicare on call seniors or through their NHS ambulance provider. We reviewed 11 safeguarding referrals made by Medicare crew to safeguard patients from harm or abuse.

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

The service worked with patients to understand and manage risks. This included for example, actively listening to patients they were treating, considering not only what they needed but what they wanted making the whole care experience patient centred. We observed the crew being considerate of past emergency department experiences and needle phobia. They reassured them and gave all the relevant information to the receiving hospital staff so that care was tailored and supportive to the patient.

Staff recorded care and treatment delivered with clear documentation of decision making. During the assessment we observed crew responding to a call from a GP practice where the healthcare providers and patient were involved in the decision making process . For example the decision to transport to hospital or treat on scene and discharge.

We spoke to one patient during our assessment who told us they felt listened to, risks had been explained, and they were involved in decisions about their care and treatment. For example, the reason for transporting them to the hospital and measures they would take to reduce their anxiety around this.

We were assured that staff could manage risk with a patient that was deteriorating. The service had a deteriorating patient policy which contained guidance in the event of a life-threatening emergency. Staff also used Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines for the management of medical and emergency situations. Staff used patient observations and tools such as National Early Warning Score 2 (NEWS2) to aid them with this. NEWS2 is a standardised tool used across the NHS to assist and respond to acute illness in adult patients.
All staff were trained to provide Basic Life Support (BLS) Intermediate Life Support (ILS) or Advanced life Support (ALS) in both adults and children depending on their clinical grade and scope of clinical practice. Staff completed basic life support and resuscitation for adults, paediatric and newborn patient’s modules as part of their statutory and mandatory training (SMT). Compliance for training was 100% for all staff.

Where incidents related to vehicle damage during blue light transfers the service took appropriate action to review their driving competency in high risk situations. Patients we spoke to told us they felt safe with staff and during transportation.

Staff we spoke with said they could access advice and support from senior leaders in a prompt manner. Staff knew who to contact and could give examples of when they had or would contact the NHS ambulance trust support line or Medicare on-call team.

We were assured that staff could manage risk with a patient that was deteriorating. The service had a deteriorating patient policy which contained guidance in the event of a life-threatening emergency. Staff also used Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines for the management of medical and emergency situations. Staff used patient observations and tools such as National Early Warning Score 2 (NEWS2) to aid them with this. NEWS2 is a standardised tool used across the NHS to assist and respond to acute illness in adult patients.
Where incidents related to vehicle damage during blue light transfers the service took appropriate action to review their driving competency in high risk situations.

The service detected and controlled potential risks in the care environment. Leaders and staff took steps to make sure equipment, facilities and technology supported the delivery of safe care. Where they were unable to do so, they mitigated the risks.

The design, maintenance and use of facilities, premises and equipment kept people safe. The building had security cameras and swipe entry access for all areas.

Staff undertook daily vehicle inspections at the beginning of their shift which was documented electronically. We inspected 3 ambulance vehicles and found them to be visibly clean inside and out and free from damage. However, there was 1 vehicle where the fabric straps were visibly dirty and had a frayed passenger seatbelt. This was escalated to the crew immediately who completed the digital vehicle defect report on an app on their mobile device.

Vehicles were equipped for the type of services provided, this included scoop stretcher, children’s safety seatbelt straps, defibrillators and oxygen cylinders. Records of equipment maintenance and schedules were available. Vehicles were stored in a safe area with swipe access and could not be accessed by unauthorised persons. Keys to vehicles were securely stored. Non-operational vehicles were stored at a secure unit off site to eliminate the risk of them being used.

Staff carried out daily vehicle safety checks prior to leaving base. There was a system for staff to report faulty equipment and vehicles. A formal record was made of action taken to address the fault/s. The service had an onsite mechanic who had oversight of all reported issues. During the on site visit we observed a crew return due to a fault signal displayed. They carried out the safety checks on the replacement vehicle prior to leaving the base.

We saw evidence of vehicles taken out of commission due to staff reporting faults. We were assured there was a robust system to ensure the safety of vehicles. used. Prior to our onsite visit, the CQC had received information of concern in relation to the safety of vehicles and equipment. However, we did not find any evidence to support these concerns. We found vehicles to be safe with a make ready system to ensure vehicles were stocked appropriately with further checks carried out by crew prior to leaving the base. This was further supported by the evidence of vehicle daily inspection logs reviewed for the week prior to our onsite visit for each vehicle. The service was developing a digital loading list to ensure staff were consistent with loading vehicle depending on whether the vehicle was used for events or frontline contract work.

Leaders maintained oversight of equipment to ensure it was safe and ready to use. Equipment audits were completed. We were provided with the last equipment servicing and portable appliance testing (PAT) records. It showed that 1 out of 51 appliances checked was not suitable for use. The device was taken out of use.

Staff told us they had enough equipment to carry out their work safely and to support the treatment and care needs of patients. Managers told us that consumables for vehicles were locked in a store cupboard which was opened by senior management.

Fire safety equipment was available on vehicles and had been serviced. Fire exits were clear and free from obstruction in office areas. All fire extinguishers onboard vehicles were securely fastened, checked and well within expiry date.

We saw evidence of quarterly fire safety inspections and a bi-annual fire safety drill where staff practiced a full evacuation. These were in line with the Medicare standard operating procedure: Fire Safety document.

All full and used empty oxygen cylinders were stored safely upright and chained in separate locked cages with hazard signs. The service had a medical gas contract to support the delivery and collection of cylinders.

Staff disposed of clinical waste safely, both inside vehicles and outside the storage areas. Waste was segregated and labelled in accordance with the local policy. Vehicles had sharps bins, they had been signed and dated in line with regulation.

Hazardous substances were stored safely and information about the products was available to staff.

The service made sure there were adequate numbers of qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care, which met patient’s individual needs.

The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and support. Staff were made aware of their shifts in advance via the app on their mobile devices and could make requests.

Staff were employed on a mixture of permanent contract as well as self employed staff. The service had a total of 90 staff, of which 86 were blue light trained and 45 had completed the high speed driving assessment. This initiative was introduced in September 2025 to enhance safety for staff and patients.

The service had a recruitment policy and safe recruitment process. All staff employed by the service, were subject to an enhanced Disclosure and Barring Service check (DBS). All paramedics, were registered with the Health and Professional Council (HCPC). The service had subscribed to a credentialing system which ran background checks on compliance with DBS, HCPC and Driver and Vehicle Licensing Agency (DVLA). Nearing expiry or non-compliance flagged on the management system as well as alerting staff. Non-compliance would automatically prevent the staff member from booking shifts.

New staff and temporary bank workers had a full induction tailored to their role before they started work. Staff had to complete their induction and mandatory training before operational deployment. The digital shift booking system automatically prevented staff from booking shifts if they were not complaint with training.

The service provided mandatory training in key skills aligned to the Core Skills Training Framework which included but not limited to infection control, moving and handling and basic life support for both adults and children.

Additional training was also offered such as Oliver McGowan Mandatory Training on Learning Disability and Autism and major incident training. Managers monitored mandatory training compliance and alerted staff when they needed to complete updates. We reviewed the electronic dashboard for training compliance during our onsite assessment. The data showed a completion rate of 100% for all mandatory training. We saw evidence of staff not being able to book shifts if their training was not completed to ensure that all staff were complaint with required training.

The service offered safeguarding level 3 training to all grades of staff as extra CPD to equip all staff with a deeper, more proactive understanding of how to protect vulnerable individuals.

At our last inspection in July 2023 , we found that staff did not always have clinical supervision or constructive appraisals of their work. We were told that all staff had an annual appraisal and at least 1 clinical supervision annually. We saw evidence of 3 staff’s clinical supervision with evidence of feedback and additional training needs identified as a result of the supervision. This meant that practical and knowledge skills were assessed to ensure staff were working in line with current practice and guidance. If poor staff performance was identified, this was dealt with in a supportive way, with a view to improvement. For example, a development plan was in place for one member of staff around effective communication.

During our last assessment we found that staff did not always have an annual appraisal. We requested appraisal data for all staff and found that 81% of all staff had a completed annual appraisal in the last 12 months.
Managers reviewed the number of staff needed for each shift based on planned activity. Managers could adjust staffing levels daily according to the needs of patients and changes in activities.

The service had 5 staff resign in the last 12 months. The sickness rate reduced from 8% in February 2025 to 2.25% in January 2026. With 0% in November and December 2025. The service had sufficient self employed staff to provide adequate service provision.

Bank staff received the same induction and training as permanent staff to ensure the service was safe. They were able to take breaks during their shift.

Patients spoken with felt their needs were met in a timely way. We saw patients were attended to in a kind and supportive way. Patients appeared comfortable on vehicles and when transported on wheelchairs or trolleys, they were engaged in conversations because the staff were skilled and experienced in their duties.

The service supported the learning and development needs of staff and made sure staff received any specialist training for their role. Managers identified any training needs for staff by reviewing individual performance data, patient record forms and performance indicator data as well as riding out with staff and carrying out clinical supervision. Staff we spoke to felt they were supported with their learning and development.

Emergency medical technicians (EMT) training was overseen by the education director and chief quality officer. The clinical director had oversight of qualification training. There was an education and training policy in place.

The service did not hold formal team meetings, feedback on key performance indicators was emailed through the staff app. Managers held staff engagement meetings with members of the senior and executive team in order to share thoughts and feedback on how to enhance the work environment. We saw evidence of virtual teams meeting held to discuss performance indicators (KPI) with Medicare staff and share any challenges they faced which impacted on performance with the senior leadership. In addition, the service had recently introduced a quarterly newsletter. This included information such as incidents, upcoming training and other general information. Staff told us that communication was through the app on their mobile devices. However, they did not always have time or the opportunity to review or complete tasks in a timely manner due to work or working patterns.

The service assessed and managed the risk of infection. Staff detected and controlled the risk of it spreading by following policies. However, Infection and prevention and control data was not always collected and reviewed to address poor compliance.

The service managed infection risks well. Staff used equipment and controlled measures to protect patients, themselves, and others from infection. They kept equipment and the premises visibly clean.

The service had an infection, prevention and control (IPC) policy, that all staff had access to via their electronic devices. The Medicare IPC policy gave guidance to support staff to respond to infection prevention and control risks such as transmittable infections. Staff were 100% compliant in IPC mandatory training. We saw staff were following infection control principles including the use of personal protective equipment (PPE).

We saw handwashing guide and bare below the elbow posters within the communal staff areas. Monthly audits were carried out to review staff compliance against local policy. We found that these were not always consistently completed , for example, there was no audit data recorded for March and April 2025 and no hand hygiene audits carried out from March to December 2025. We were not assured that the service was completing regular reviews of clinical practices to ensure that infection control measures were consistently applied to maintain high safety standard.

Colour coding posters for cleaning materials and equipment in line with national standards of healthcare cleanliness 2025 guidance were displayed. A national colour-coding scheme for all cleaning materials and equipment is widely applied throughout healthcare organisations to reduce cross-contamination risk between different types of area: for example, bathrooms and kitchens.

There was a monthly IPC audit for the premises. We requested the last 12 months of IPC audits and were provided with audits for the last 8 months. The audit covered cleanliness of the kitchen area, segregation of waste and cleaning against the local policy. The service performed well in local IPC audits. In the most recent audits, the scores showed compliance with infection prevention and control measures in all clinical areas of the depot.
The service used an external company to deep clean vehicles. We observed some vehicle deep cleaning on the day of inspection. The service infection prevention and control (IPC) policy stated that vehicles used for urgent and emergency care should be deep cleaned every 6 weeks .

We reviewed deep clean logs for 26 frontline vehicles and found that three had not been cleaned within the required six-week interval, with cleaning overdue by two weeks on three occasions. Paper cleaning logs kept on one vehicle we reviewed during our onsite visit did not match the digital records; for example, one vehicle’s paper log showed a clean on 17 September 2025, whereas the digital log recorded 3 September 2025.

Managers provided disposable linen for vehicles. However, staff told us that they restocked their linen from NHS hospitals after handing over a patient. If the linen was soiled, they would dispose of it at the hospital or return it to the base in a dissolvable bag. This practice is against the Medicare IPC policy. Due to this there was no guidance for staff on how to manage soiled hospital linen. Therefore, we could not be assured that all staff followed safe linen disposal in line with national guidance.

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

During our last inspection in July 2023, we found the service did not have effective processes for the oversight and management of controlled drugs within the location and its satellite stations. During this assessment we found that medicines and medical gases were managed safely and securely. Access to the medicines room and controlled drugs (CDs) safe was role restricted and auditable. Staff issued and reconciled CDs and another staff member completed a second check. The service also completed weekly audits and authorised staff disposed of expired or unwanted medicines safely. We were assured that action has been taken in response to the previous findings.

During our last inspection in July 2023, we found staff did not complete medicines records accurately and keep them up to date in line with the medicine management policy. During this assessment we found medicines were procured and transported by named staff with documented checks and end to end traceability. Medicine packs were sealed, traceable and routinely checked and restocked. Staff recorded all batch numbers and expiry dates both digitally and in paper copies with the paramedic bags. A colour coded system alerted staff when a bag needed reviewing. This ensured rotation of stock and that every bag taken by a crew was complete and ready for use. Storage temperatures were digitally monitored. Staff acted promptly when temperatures went out of range. We were assured that action has been taken in response to the previous findings.

Medicines administration was documented comprehensively on the electronic patient care record (ePCR), including allergies, indication, batch/expiry and witnessed CD wastage, which supported effective handover. There were paper records which could be completed in the event the ePCR was not available. Patient group directions (PGDs) were current and accessible with electronic authorisation. PGDs are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment. We reviewed 5 PGDs whilst on sight which were inline with policy to support staff in the safe administration of these. These were also reviewed by the contracting NHS ambulance trust.

The team reported and learned from medicines incidents through a structured reporting system and regular operational briefings; staff received a supervised induction, on call clinical advice and welfare support.