ERS Medical North

On this page

• 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

At our last assessment we rated this key question good. At this assessment the rating has remained good. 

People were protected from avoidable harm in most areas. Staff completed risk assessments and demonstrated awareness of how to manage deterioration and escalate concerns appropriately. Vehicles and equipment were maintained and checked daily.

However, there were continuing concerns about governance systems that support safety. Incident reporting and shared learning were not consistently effective, and recruitment checks were not always fully documented, including health declarations and risk assessments. These gaps limited assurance that risks were always identified and mitigated.

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 evidence showed some shortfalls in the standard of care. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. We saw examples of where lessons were learnt to identify and embed good practice. 

Staff understood what constituted an incident and described using the 24-hour reporting line and electronic reporting system to raise concerns. All incidents reported in the last 12 months had been investigated, and leaders identified learning through governance processes. Staff also demonstrated awareness of their responsibilities under Duty of Candour (DoC), including offering apologies when things went wrong, even though no incidents had met the threshold for a formal notification. 

However, inspectors found limited evidence that learning was routinely disseminated to frontline teams. Staff told us they often only received feedback if they actively requested it, and learning was not consistently shared through team meetings or other formal mechanisms. This meant opportunities to improve practice were frequently missed and learning was not always embedded at local level.

We saw isolated incidents where learning had been shared, including improvements relating to wheelchair safety, driving standards, and vehicle manoeuvering. However, organisational learning was not consistently embedded.

Leaders used national guidance, incident findings, safeguarding information and competency monitoring to identify gaps in learning and drive improvements.

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

Patient transfers between locations were carried out safely. Referrals and bookings were managed through electronic systems used by hospital partners and crews. Staff completed pre‑transfer risk assessments before accepting journeys and undertook dynamic risk assessments during transport. They could refuse or escalate transfers if and undertook them as unsafe. We observed effective escalation when patient information was incomplete or when patients deteriorated, including returning patients to hospital when required. However, inspectors identified occasions where key clinical information had not been communicated at booking, which caused delays and required journeys to be reorganised. Whilst staff managed these situations safely, inconsistent information at booking reduced assurance that systems supported safe and efficient transfers. 

Procedures were in place for requesting NHS ambulance assistance when a higher category of need was identified on attendance. 

Vehicle tracking systems were in place to monitor the location of vehicles in real time to ensure the safe allocation of resources. Managers used the system to assess driving performance review CCTV following accidents or incidents. Staff told us the system helped improve road safety and reduced risks.

We accompanied two patients transfers and found these were carried out safely with appropriate skills, experience and equipment. 

The service engaged regularly with healthcare partners to discuss and maintain safe pathways.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. They understood their responsibilities for the notification of safeguarding incidents to the contractor of services and local authorities. Safeguarding cases were passed onto the relevant teams at the contracted NHS ambulance trusts. This meant staff did not report to the local authority directly.

All staff had completed Level 2 adult and children’s safeguarding training, with compliance at 100%. This was in line with relevant national and intercollegiate safeguarding guidance for healthcare staff.

The training staff had received included how to identify adults and children at risk of significant harm and working in partnership with other agencies. Staff could describe examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Safeguarding policies reflected national guidance. Staff described safeguarding risks and escalation processes and provided examples of concerns raised including unsafe home environments. Safeguarding concerns were recorded through the incident reporting system.  Although staff understood safeguarding responsibilities and had completed the required training, limited direct contact with the remotely based corporate safeguarding lead, combined with inconsistent sharing of learning at team meetings, reduced opportunities to reinforce safeguarding practice locally.

The corporate designated safeguarding lead was trained to level 4; safeguarding children level 3 and safeguarding adults level 3.

Staff were encouraged to report all incidents via incident reporting system. Use of the system and incident reporting processes forms part of the mandatory induction training completed by all staff.

Safeguarding incidents, emerging themes, and key learning are reviewed and discussed at governance meetings to support continuous improvement and organisational learning. Three safeguarding incidents were reported in the last 12 months, none of which showed common themes. All were considered isolated incidents, with learning focused on reinforcing the ‘Make Every Contact Count’ approach to safeguarding practice.

Staff involved people and, where appropriate, carers and professionals in managing risk during transport. Inspectors observed staff explaining journeys, gaining consent, and reassuring people who were anxious or distressed. Staff described how they adapted their approach when people became reluctant to travel or when risks changed during journeys. Discharge and on-going return journeys were organised safely. Patients we spoke with told us they felt safe with staff and during transportation.

Translation tools and communication aids were available to support people with communication needs, although these were not consistently available on vehicles.

Staff followed the service’s health and safety policy which outlined the risk assessment process, including for manual handling. For hospital contracts, ward staff completed transfer bookings using an electronic system that required clinical and logistical information to be entered. Where crews identified discrepancies between the booking information and the patient’s actual needs, they contacted the dispatch team to clarify and update arrangements.

On arrival, crews carried out a further assessment of the patient, reviewing their condition and transport requirements in consultation with the patient and, where appropriate, their next of kin. Information obtained during the assessment was documented and used to inform decisions about treatment, equipment needs and transport arrangements. Crews recorded any concerns, undertook risk assessments, provided additional advice when required and followed the provider’s deteriorating patient procedures. Clinical support was sought where necessary to ensure patients received appropriate care and transport. 

Staff told us they could access advice and support from senior leaders promptly. Where unexpected risks were identified. The service did not transport high-risk patients.

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.  

Vehicles and premises were appropriate, clean, and secure. Daily vehicle checks were completed and recorded., Inspectors found vehicles clean, with equipment appropriately stored and in date. Inspectors identified one expired hand‑cleansing gel during a vehicle check, which staff removed immediately, demonstrating prompt action when issues were identified. 

We inspected 6 ambulance vehicles and found these to be satisfactory.

Vehicles were equipped appropriately including seatbelt straps and child seats.  Maintenance records were available. Vehicles were stored securely and were not accessible by unauthorised persons. Vehicles had been serviced regularly and had current MOT certificates. Keys to vehicles were securely stored. 

Staff carried out daily safety checks of specialist equipment. There was a system for staff to report faulty equipment and vehicles. A formal record was made of action taken to address faults.

Leaders maintained oversight of equipment to ensure it was safe and ready to use. Equipment audits were completed and outcomes shared with staff. Staff told us they had enough equipment to carry out their work safely and to support the treatment and care needs of patients.

Fire safety equipment was available on vehicles and had been serviced. Fire exits were clear and free from obstruction in office areas.  Oxygen cylinders were stored correctly, upright safely upright and chained in separate locked cages with hazard signs.

All fire extinguishers onboard vehicles were securely fastened, checked and well within expiry date.
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. 

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.  However, we found shortfalls regarding recruitment processes.

Staff worked together well to provide safe care which met patient’s individual needs. However, we found that the provider could not satisfy themselves about employees conduct in previous employment. We found that one of the seven staff files reviewed contained a positive disclosure and the provider could not demonstrate that a risk assessment had been completed to assure safe recruitment decisions. We were not assured safer recruitment processes were consistently effective. 

New staff and temporary bank workers had a full induction tailored to their role before they started work. 

Managers reviewed the number of staff needed for each shift based on planned activity and assessed risk. Managers responded flexibly to short‑notice absences and could adjust staffing levels daily according to the needs of patients and changes in activities. 

Patients spoken with felt their needs were met in a timely way. We saw patients were attended to in a kind, sensitive 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 employed 138 staff members who were approved to undertake patient transport work. In addition, they employed operations managers, team leaders, controllers and administrative staff.  Cover for sickness and leave was mostly provided by the existing staff and using bank staff. Where bank staff were used, managers made sure they had a full induction and understood the service. The average sickness rates of staff were low, from May 2025- April 2026 this was 4% across Leeds and Manchester. Staff told us the shift patterns allowed for adequate breaks.

Staff were appropriately qualified for their roles. This ensured the service had a workforce with the skills and competence required to deliver safe and effective care. All staff completed a driving assessment as part of their induction. Annual checks of driving licences were completed.

The service supported the learning and development needs of staff. Mandatory training included an understanding of the Mental Capacity Act, dementia awareness, autism awareness and learning disabilities.  Processes were in place to monitor and manage completion of training, and at the time of this assessment, training compliance was high, with 97% at Leeds and 95 % of staff at Manchester having completed mandatory training. Staff described regular access to training and supervision.

Managers supported staff to develop through a supervision system and undertook 6 monthly appraisals of staff performance. Staff engagement processes were in place as well as mechanisms for staff to raise suggestions or concerns. Managers identified poor performance promptly and supported staff to improve through additional training and observed practice.

The service had infection prevention and control arrangements in place and managed the risk of infection. Staff detected and controlled the risk of it spreading by following policies. Infection and prevention and control data was collected and reviewed. Where required, actions were taken to improve shortcomings.  

There was a local infection, prevention and control policy (IPC) and supporting guidance was available to staff. There was an IPC lead who ensured this policy was up to date. Staff received training in preventing the spread of infections as part of the mandatory training programme and had good knowledge of infection, prevention and control processes.

Staff kept equipment and premises visibly clean. The 6 ambulances we looked inside were clean, tidy and well maintained and well organised. Vehicles and equipment were visibly clean, cleaning records were up to date and confirmed that cleaning was carried out daily. Clinical waste was stored and disposed of through contracted arrangements. 

Cleaning records were up to date and deep cleans were completed every 13 weeks. IPC audits showed strong performance. 

Inspectors observed staff following IPC practices during patient transfers. Staff cleaned the interior of vehicles and equipment routinely. A record of cleaning was retained. Equipment and supplies were in date and appropriately stored, and expired items were removed promptly when identified. 

Staff were informed when patients presented an infection risk. Staff had access to personal protective equipment (PPE) to work safely. We observed staff using PPE correctly and compliant with hand hygiene practices. Staff told us they carried hand gel, and hand wipes and PPE were used when sinks were not available. No hand hygiene incidents had been reported.

Staff supported infection prevention and control measures by following the uniform policy.

Staff understood the process for managing spillage of body fluids. 

People who used the service did not raise any concerns about vehicle or equipment cleanliness.

The service made sure that medicines were safely stored and met patient’s needs, capacities and preferences. 

Staff did not administer medication during transport. Patients travelled with their own medication, which was kept securely and handed directly to the receiving staff on arrival. Staff were trained in how to store and transport medicines safely.

Staff were trained in safe storage and transport of medicines. 

Patients were transported with their own supply of oxygen, but this remained the responsibility of the prescribing staff who were caring for the patient. The staff were authorised and trained to administer oxygen if required. Oxygen cylinders were in date and stored securely in line with national guidance. Staff administered oxygen only when prescribed and demonstrated appropriate knowledge of oxygen management. Arrangements supported safe use of oxygen during patient transfers.

The provider had an administration of oxygen guidance document in place for additional support for staff; however, although it had been in use since 2017, it was unclear whether it had been reviewed.

The service had a standard operating procedure and a storage of medical gases policy, for the use of medications, such as oxygen. The policy explained the risks of using oxygen, including fire and explosion. It also set out how oxygen should be stored safely and which materials should not be used with it.