LIVES Headquarters

On this page

• 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

We looked for evidence that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable. We also reviewed processes for staff raising concerns to ensure staff felt able to speak up without fear of bullying. We reviewed governance processes and looked for evidence of the management of risks, issues and performance. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant leaders improved the culture and ensure the delivery of high-quality care.

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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The service had a strategy which covered 2020-2025 and had been continuously reviewed to ensure it’s effectiveness. The aim of the strategy included understanding impact, growth, quality, stability and excellence. The service also had a strategy specific for each of the services it delivered. All projects that were undertaken were linked back to the vision and strategy for the organisation. These were monitored through the various governance committee and the charity board had overall oversight of the vision and strategy. The mission of the services was to empower the community, ensuring immediate care and fostering a culture of health resilience. They had a vision where people had timely access to emergency care and life saving skills, ensuring that no life was lost due to delayed response or lack of knowledge.

Leaders told us that a new strategy was in the process of being developed, for commencement in 2026. There were senior lead manager away days and board development days planned over the coming months. Leaders told us their goals centred around providing credible pre-hospital emergency medicine and providing enhanced training to communities. In addition, leaders told us they were focusing on reviewing the NHS 10-year plan ‘Fit for the Future’ and were working with system partners, including the local NHS ambulance trust to ensure collaboration and strategic alignment.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support. They embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

At the November 2023 inspection we found that the CEMS leadership team had undergone a period of instability over the previous year which had contributed to a high turnover of staff and staff being away from clinical duties. At this assessment we found there was greater stability in the leadership team. Key management roles had been established. As well as a chief executive officer and medical director there was now within the commissioned teams a head of education & commissioned services, commissioned services manager, education manager and clinical support manager. Within the voluntary team there was a head of quality, community and volunteers and there were also volunteer & community coordinators. There was a clear vision and a charity wide strategy, as well as specific service strategies for the CEMS, falls response and education. These plans provided leaders and staff with a clear direction and objectives to work towards.

Staff told us that leaders across the service were visible. There was an operational support on-call system and a clinical on-call system so that staff could access experienced clinicians and managers when they needed to. Staff we spoke with were very positive about the leadership of the service. They consistently told us that improvements had been implemented and that they felt appropriately supported by service leads.

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

At the November 2023 inspection we found that not all staff felt supported, respected and valued. Some staff told us they were not able to raise concerns as they did not feel listened to and feared the consequences if they spoke to leaders about bullying.

At this assessment we found that leaders had taken the concerns previously identified seriously. They had recruited an internal freedom to speak up guardian who was a member of the falls response team. In addition, they had identified both executive and non-executive guardians and had developed a speak up policy. There was a dedicated speak up email address so that staff could raise concerns directly. The speak up guardian had dedicated time allocated. They had also attended a national speak up conference as part of their role.

Staff we spoke with understood how to raise concerns and told us they believed their concerns would be listened to and addressed. The freedom to speak up guardian had identified themes around the concerns raised. These included communication and line management changes. The service identified priorities for the coming year, including the development of freedom to speak up champion roles, staff roadshows, leadership communication cafes and breaking down barriers to communication.

The service commissioned an external human resources provider to conduct a staff survey in February 2025. Results had been received by leaders just prior to our assessment. It showed staff felt clear about their roles and responsibilities and what was expected of them. They understood the values of the organisation and how those related to their role. They could get help and support they needed from colleagues. Staff reported less positive feedback on issues such as staff not always being treated fairly, receiving supportive feedback and choice in deciding how to do work. They also had concerns about, feeling able to share views about changes and reliance on managers to help with work problems. At the time of our assessment survey results were being shared with leaders who were working to address these issues.

The culture was centred on the needs and experience of people who used services. All staff we spoke with were positive about changes implemented in the last year. They described leaders as forward thinking and keen to change and develop the service. They also described a supportive, ‘family’ atmosphere and told us that a newly implemented daily briefing had helped to prioritise what was important and bring everyone together to engage in the changes.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff received training in equality, diversity and human rights. Training completion in this area was at 100% for staff across the service. The service had a promoting equality and valuing diversity policy which had been developed with input from staff who identified as having a protected characteristic.

Staff and leaders had an understanding of protected characteristics and working closely with relevant staff to ensure equity of opportunity. Staff we spoke with were positive about the support they received from leaders and colleagues. We were given examples where service leads made reasonable adjustments to meet the needs of staff. This included where health and changes in ability impacted individuals and adaptations were needed to enable them to fulfil their role.

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

There were effective structures, processes, and systems of accountability to support the delivery of the strategy and provide good quality, sustainable services. There were 4 governance committees: clinical governance, people and organisation, finance and performance, and risk management. Trustees were involved in the governance committees and staff groups were also represented. There were quarterly governance committee and board of trustee meetings held.

Staff were clear about their roles and accountabilities and reporting processes. There were clear arrangements with partner organisations to report on and review performance. There were key performance indicators (KPIs) defined for each service, and these were reviewed as part of monthly operational meetings with the local NHS ambulance trust. In addition, quarterly reports and reviews were undertaken with the Integrated Care Board (ICB).

We reviewed performance reports from April to December 2024 and saw that both the CEMS and falls response teams were on target with the majority of their KPIs. This included reducing the impact of ‘long lies’ for patients having fallen at home and reducing the proportion of patients requiring an ambulance response. However, we saw that the KPI for the CEMS team for reducing the number of patients requiring admittance to hospital had not been met in the most recent quarter reported, with performance at 28% against a target of 25%, meaning performance was 3% outside of target. Leaders were aware of drops in performance and regularly reviewed the cause and impact of these.

Key performance indicators within the community first responders’ team were also monitored. However, we were told there had been some restrictions on practice placed on the service because of the concerns raised from the last inspection in November 2023. This meant that some clinicians had left and moved to other services. Service leaders told us that following quality reviews, some aspects of the service had been reinstated. These included that critical care clinicians could now undertake sedation, basic surgical interventions and wider pain relief.

Overall activity of this service had reduced by 32% compared with the same period in the previous year, with a 47% reduction in the number of responders deployed. Leaders told us this was due to ongoing issues with dispatch, activity and volunteer numbers. They told us they were addressing these issues through regular operational meetings with the local NHS ambulance trust and integrated care board. There were also developing plans to increase the recruitment of volunteers.

There were arrangements for identifying, recording, and managing risks and issues, and putting in place mitigating actions. One example of an action to mitigate risks was that the service had set up regular meetings with the ambulance service to review operational activities. This had resulted in the reinstatement of some critical care services provided by LIVES because of assurances provided.

There were organisational and clinical risk registers and clear risk assessment and management processes. Potential risks were considered when planning changes and developments to services. For example, a comprehensive risk assessment of the implementation of the electronic patient record system had been carried out. There was alignment between recorded risks and those identified by staff. Risks were reviewed by the risk management committee and shared with the board of trustees.

At the time of the November 2023 inspection the service did not have a business continuity policy that reflected service provision. At this assessment we reviewed a revised business continuity plan. We saw that critical functions had been identified, along with analysis of the impact of disruptions in such functions. We saw the service had considered the impact of the loss of utilities, supplies, equipment and the workforce. They had put contingencies in place to try and ensure the service could continue to operate in these circumstances.

There were clear systems and processes in place. These included the management of learning events, complaints and staff and patient feedback. The service also monitored contracts, equipment management and safety processes. Policies and procedures were also regularly reviewed, along with the most recent clinical guidance, to ensure staff were following up to date evidence-based practice and guidelines.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborate for improvement.

The local ambulance service that commissions the work carried out by LIVES told us they had a good working relationship with the service. A recent service contract review had refined the scope of activity of Community First Responders (CFRs) to ensure they provided an effective and appropriate level of care. The two services held quarterly governance meetings to discuss strategies, while monthly operational meetings had been set up to ensure patient safety was maintained. The ambulance service told us that the CFR team were invaluable for their in-depth knowledge of the local area and services.

The service was working with the local community trust and other stakeholders to establish a single point of access (SPA) pathway for people to get help when they fall, to ensure people received the most effective care in the best place.

We saw evidence of partnership working when reviewing a record which described a patient who required blood tests to confirm the most appropriate treatment. On arrival, the CEMS team were able to examine the patient and take relevant blood tests. This meant they were able to provide immediate treatment so the patient could remain at home rather than have an ambulance transport them to hospital for treatment.

The service actively engaged with the local community, holding events in the area to encourage awareness of the service and provide basic bystander CPR training. Staff told us this was very popular with people, and we saw feedback from communities praising the outreach work the service had done. The community fundraising manager told us they had also set up First Response Emergency Care (FREC) training for local businesses. These arrangements helped to upskill workers in first response care and created potential sponsorship opportunities for the LIVES charity.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They 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 and leaders participated in appropriate research projects and clinical audits and quality improvement initiatives. There was a focus on how technology can be used to improve patient care. For example, a cohort of clinical staff had been trained in the use of ultrasound to enhance patient assessment processes.

There was evidence of learning and improvement from internal and external reviews. This included routine case reviews, plus triggered case reviews where issues had been highlighted and review undertaken to identify learning. The clinical development group included representatives from clinical, quality and education staff groups. The role of the group included the discussion of emerging clinical evidence and innovations. The clinical governance group with representatives from all departments held quarterly meetings which included a review of learning events.

The medical director conducted case reviews to identify learning and improvement. These were done through patient record audits. triggered by issues. Reviews carried out by external colleagues showed evidence of joint learning and discussion of cases.

Leaders told us the clinical development group drove innovation within the service. We were told of examples where front line staff were encouraged to contribute to the development of the service and sharing innovations. A commissioned services advisory group made up of representatives from across the organisation met every other month to share ideas. We were given an example of a volunteer who had observed the use of new technology online and was given the time to explore how this could be used within the service.

The service undertook and participated in research. For example, we viewed a poster presentation about the use of an inhaled anaesthetic for pain management within the falls team. The study looked at the safety and effectiveness of its use by non-registered staff. In addition, the service participated in research comparing agricultural and non- agricultural pre-hospital emergencies and university level research into training selection to maximise the effectiveness of community first responders.

Clinical audits were conducted to provide assurance and a basis for quality improvement and development.