LIVES Headquarters

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

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We reviewed processes for recording patient risk assessments and escalation scores, how patient safety was reviewed and improved, and safe and effective staffing and infection prevention and control. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

Patient safety incidents were managed well. Staff understood how to identify, report and record incidents and recognised the importance of using information to support learning and improvement.

There had been approximately 230 learning events reported between April 2024 and March 2025. Themes identified included those relating to dispatch and appropriate resources, clinical pathways and procedures, fleet issues, medicines and learning from excellence. We saw that action following events included a data gathering stage, followed by a full investigation. Staff undertaking investigations had received appropriate training and had the skills to do this. We saw evidence of individual reflection following an incident, shared learning and feedback to all staff.

Monthly learning from safety event bulletins were shared with staff. These included the identification of learning event themes, updates on clinical pathways, clinical guidelines and policies.

A bi-weekly learning event review group met to review all adverse and learning events, near misses as well as excellence. Leaders reviewed events to identify if they needed to follow an NHS Patient Safety Incident Framework (PSIRF) to develop effective systems and processes to respond, learn and improve from patient safety incidents.

The service worked with people and healthcare partners to establish and maintain safe systems of care. Staff made sure there was continuity of care, particularly when people moved between different services.

At the November 2023 inspection although there were clear processes for the escalation of deteriorating patients, in 7 out of the 10 patient record forms we reviewed, the patient did not have a National Early Warning Score (NEWS2) calculated. In addition, in 4 out of the 10 records there was no documented review of the patient’s allergies.

At this assessment we found improvements had been made. The service had developed a deteriorating patient policy which included the use of NEWS2, local NHS maternity parameters and a paediatric observation priority score (POPS). Staff had received training in relation to the deteriorating patient policy and the use of agreed parameters and scores.

We reviewed a January/February 2025 audit of 30 patient record forms, 15 for CEMS patients and 15 for falls response patients. We found that 68% of patients had an appropriate early warning score in place and 84% of patients had a record of an allergy review. We found that patients consistently had a record of an early warning score and allergy review. Appropriate assessments were completed, including the identification of relevant risks.

At the beginning of March 2025, leaders had implemented an electronic patient record system within the CEMS and falls response teams, with plans to roll this out to community first responders in the following weeks. The system enabled automatic early warning scores to be calculated based on the observations recorded. In addition, both warning scores and allergy reviews needed to be completed prior to the completion of the patient assessment. We saw the electronic record system had been through a risk assessment process prior to implementation and staff told us they had been involved in its development. Electronic records we reviewed were appropriately completed. The new system included a remote monitoring support element where support could be obtained from senior colleagues, this included video streaming by phone.

There were systems in place to ensure continuity of care and effective collaboration between services, including NHS and other ambulance services. Leaders recognised that good communication and understanding of roles and responsibilities was important to ensure safe care for patients. The medical director carried out routine and triggered case reviews, with a view to identifying learning and improvements. This included case reviews that were triggered by feedback from external colleagues or where joint reviews of cases were undertaken with a view to identifying improvements in relation to joint systems, pathways and transitions. In addition, the service was carrying out ‘roadshows’ for NHS ambulance colleagues to raise awareness and address issues with the potential to impact the pathway of care.

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

All staff members had undertaken the appropriate level of safeguarding training for their role. Staff told us they knew what a safeguarding concern looked like and how to report it. There was a clear process for responding to safeguarding concerns. The service had recently updated the safeguarding policies for both adults and children to ensure safeguarding was person-led and that reporting pathways were clear to all staff.

Volunteer responders reported safeguarding concerns internally and these were relayed to the commissioning provider – the local ambulance service. The CEMS and falls response teams could report any concerns directly to GPs, or the local authority. The local authority usually advised the service of any further actions taken from referrals.

We saw evidence of referrals from the service to the local authority in cases where there was a safeguarding risk. Staff gave clear information and referred the cases promptly. They also provided information to other agencies where appropriate. In one case, they had also informed the local police as there was concern about potential criminal activity.

The service held fortnightly safeguarding review meetings to assess the suitability of the referral and consider learning points. Feedback from the local authority designated officer (LADO) was also shared at these meetings in cases of safeguarding concerns about children.

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.

There were holistic patient assessment processes in place that included an assessment of social, emotional and psychological needs as well as physical. This enabled staff to include a comprehensive assessment of risk for each patient. There were specific risk assessment processes that included moving and handling, pain, frailty and whole system assessments such as circulation and breathing.

The service used nationally recognised assessment tools that helped clinical staff recognise deteriorating patients and we saw that these had been completed appropriately. These included NEWS2, local NHS maternity parameters and the paediatric observation priority score (POPS).

Staff took account of patients wishes and adapted treatment and care to suit their needs where possible. This included where patients were supported to be cared for at home rather than transported to hospital where this was in line with their wishes. For example, we saw where a patient was administered intravenous antibiotics by the crew and arrangements were made for continuing intravenous treatment at home by community services.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff showed us a recently installed system for monitoring the current fleet of 15 vehicles. This enabled effective monitoring of the safety of the vehicles, all legal requirements and their servicing schedules. The service had also recently replaced several ageing vehicles and had adopted a vehicle leasing approach. The overall weight of the vehicles was checked along with the internal positioning of the personnel and equipment to ensure optimum safety whilst in use.

There was an equipment asset register. The team’s kit on each vehicle was checked at the start and end of each shift, with any issues raised with managers. Consumable items were replenished and all equipment and grab bags sealed at the end of each shift. Medical items were appropriately packed in IPC compliant storage areas in the vehicles. We saw that the store cupboard was kept secure. Consumable items nearing their expiry date were tagged to ensure they were used promptly and to enable efficient re-ordering. There was a system for staff members to alert the logistics team about items getting low in stock.

Access to the controlled drugs cupboard and equipment areas was only available to senior staff members. Regular tests and calibrations were carried out on electrical items and moving and handling equipment. New staff were trained to use the service’s equipment and manufacturers provided training for any new kit. We saw evidence there was nearly 100% compliance in staff training on the equipment used by response teams.

The service made sure there were enough qualified, skilled and experienced staff, and provided effective support, supervision and development. Staff worked together well to give safe care that met people’s individual needs.

At the November 2023 inspection we found that staff records were not always easy to find or review because of the multiple systems that were in use. The service also had high staff turnover and sickness rates. However, at this assessment we found there were robust recruitment processes and a single human resources system in use. These included appropriate disclosure and barring service (DBS) checks, references, professional registration and qualification checks. There were comprehensive onboarding processes for new staff. This included induction and the completion of operational scope of practice competency assessments. These were tailored for both the community emergency response service (CEMS) and for the falls response service. There were clearly defined probationary review timescales and reviews, and we saw evidence these were followed.

Staff turnover rates had improved in the 6 months prior to our assessment. The turnover rate was 9.86% in June 2024 but had reduced to 1.46% in December 2024. Leaders told us there had been significant staffing changes in the last year. They said that more than 50% of staff working in the CEMS team had been recruited in the last 12 months. We saw that overall staffing numbers were stable.

Overall sickness rates for the service between April 2024 and December 2024 were 1.46%. The service previously had high sickness rates in the CEMS team, of up to 10.5% in May 2023. Sickness within the CEMS team between April 2024 and December 2024 was 0.84%. and in the falls response team it was 2.8%.

Managers monitored mandatory training and alerted staff when they needed to update their training. Staff were only permitted to work for LIVES if they had completed their mandatory training. Arrangements were made for staff to complete due mandatory training subjects on their next shift. Mandatory training completion rates were at 100% in most subjects across all departments. These included safeguarding children and vulnerable adults, information governance, resuscitation and infection control. Within the CEMS team training completion was between 93% and 100% across all subjects and within the falls team this was between 91% and 100%.

At the November 2023 inspection we found that the service did not ensure that staff completed training on recognising and responding to patients with mental health needs or restraint training. However, at this assessment we found that all staff had completed mental health awareness training and online training in restraint. Service leads had budgeted for face-to-face training in restraint and resourcing this in the current year.

The clinical educators supported the learning and development needs of staff. LIVES employed trainers and used accredited courses. Managers identified any staff training needs and gave them the time and opportunity to develop their skills and knowledge. The medical director had developed pathways and scope of practice documents for staff in both the CEMS and falls teams. These were focused on clear objectives, competencies and skills.

Staff had the opportunity to discuss training needs with their line manager and were supported to develop their skills and knowledge. This was discussed as part of their appraisals. We saw that 93% of eligible staff working in CEMS had received an appraisal in the last year, 91% of staff working in the falls response team had an up-to-date appraisal.

Additional relevant training was made available for staff, based on the needs of the service. These included difficult airway management, wound closure and catheterisation. At the time of our assessment four clinicians were attending external training on the use of ultrasound.

The service assessed and managed the risk of infection. Staff implemented appropriate control measures to protect themselves, patients and others from infection.

At the November 2023 inspection, we found there were no infection prevention and control (IPC) audits in place. At this assessment we found leaders had taken action to prioritise infection prevention and control, including the establishment of a dedicated infection control working group to review and implement best practice.

The head of service had also undertaken an infection control policy review and implemented an IPC auditing framework.

We viewed examples of environmental and staffing audits. These were shared within the service’s safety software system. We viewed 6 months of audits and saw evidence of oversight and action to improve control and manage risks of infection. These included an environment upgrade and the development of a sluice area where staff could clean equipment.

We saw that the environment was clean and tidy. Supplies and consumables were stored appropriately and were within their use by dates.

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.

We viewed patient records that included where LIVES staff had optimised people’s medicines and liaised with their GP about ongoing treatment. There were clear records of allergies and current medication.

The service had up-to-date medication and controlled drugs policies which provided guidance around medication handling and dispensing. It also had a Patients Group Direction (PGD) policy to cover the dispensing of certain medications without an individual prescription and a clear formulary indicating what medication staff members could dispense, depending on their role.

Medication was stored securely, with controlled drugs kept in a keypad safe in a locked room. We checked the system of signing controlled drugs in and out and found these to be accurate, with a clear audit of regularly used items to confirm stock levels. Controlled drugs were kept in a locked safety box bolted to the floor of the response vehicles.

Medical gases were locked in a fireproof cabinet outside of the building to minimise the risk of explosion. We observed that the staff smoking area was situated near to the cabinet and this had been identified through the service health and safety risk assessment. Leaders told us that historically they had limited space to provide an area for colleagues who smoked, as there was a large LPG gas cylinder elsewhere on the site. However, due to the risks they confirmed the site would be designated smoke free. They would also offer staff smoking cessation referrals and support as part of the wider staff wellbeing programme.