ERS Medical Midlands

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

This means we looked for evidence that patients were protected from abuse and avoidable harm. 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.

The service had systems and processes to identify, assess and manage risks to patients using the service. Staff understood their responsibilities for safeguarding, incident reporting and escalating concerns. Leaders promoted a positive learning culture and used incidents, safeguarding concerns and governance processes to support learning and improvement.

The service worked with healthcare partners to support safe pathways and continuity of care. Staff received appropriate training and support to undertake their roles safely. Leaders monitored safety, performance and risks through established governance arrangements and acted when concerns were identified.

During the inspection we identified some issues relating to equipment maintenance, storage arrangements and vehicle cleanliness. Leaders acted promptly to address these concerns and provided assurance that corrective actions had been taken.

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.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. Leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. 

The service had systems and processes to support a positive learning culture and promote continuous improvement. Staff understood how to report incidents, near misses and safeguarding concerns and were able to describe the processes for escalating concerns. They did this through managers and the provider's incident reporting arrangements. Staff told us they felt able to raise patient safety concerns and knew how to do this. 

The provider had an incident reporting and investigation policy which set out clear expectations for management of incidents. The provider had adopted the Patient Safety Incident Response Framework (PSIRF). The framework focused on learning from patient safety events, identifying emerging risks and themes, and using incident analysis to support organisational improvement. 

The provider used an electronic incident management system to record, review and monitor incidents. Incident records showed a range of incidents and near misses had been reported. This included patient handling incidents, equipment concerns, clinical deterioration, aggressive behaviour, transport delays and access and egress concerns. Investigations routinely recorded outcomes, contributory factors and actions taken to reduce future risk.

We saw examples where staff had reported incidents and lessons had been learned. For example, following a near miss involving a wheelchair not being secured correctly during transport, leaders completed an investigation and spoke with staff involved. They identified lessons learned and considered additional refresher training to reinforce safe practice. 

Leaders looked at incidents, investigations and risks through governance arrangements. Where incidents involved other organisations, leaders shared this with them. For example, risks associated with demand and transport capacity had been escalated to commissioners and system partners due to concerns about the potential impact on people using the service. We also saw evidence of partnership working with commissioners, renal services and other stakeholders to review incidents, performance issues and emerging risks. 

Staff told us learning was shared through different ways. This included training sessions, policy updates, email communications, staff meetings, newsletters and the provider's internal communication system. Staff also described examples where information from previous incidents had informed future transport arrangements and patient risk assessments. 

Staff experiences of the incident reporting culture were mostly positive. Many staff described managers as approachable and supportive and gave examples of receiving support following incidents. 

However, some staff told us they would welcome greater feedback following incident investigations. They told us that they were not always aware of outcomes or actions taken after concerns had been raised. However, during the inspection leaders showed how they had introduced a range of communication forums and engagement mechanisms to support staff involvement and organisational learning. 

We scored the service as 3. The evidence showed a good standard. The service worked with people 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 patients moved between different services.

The service had established systems and processes. This supported the safe coordination of patient transport services and continuity of care when people moved between healthcare settings. They worked closely with stakeholders to deliver and monitor transport services safely. 

Staff looked at who was eligible to us the patient transport service using criteria based on NHS guidance and local commissioning requirements. For example, people may be eligible if they require oxygen or medical equipment during transport, are unable to travel safely because of mobility, cognitive or sensory needs, or require a stretcher or wheelchair-accessible vehicle. The staff also considered safeguarding concerns and other complex needs when determining eligibility. 

The service considered wider support requirements during eligibility assessments. Staff double checked eligibility when patients booked transport as this could change, for example if a medical condition improved. 

Booking staff kept electronic patient records to make sure information was available to other staff who needed this. Staff recorded mental capacity considerations and resuscitation status. Staff recorded other risks relevant to safe transport. This helped staff to allocate the most suitable vehicles, equipment, and transport staff for patients’ needs.

Staff could allocate a range of vehicles and equipment depending on each patient’s needs. Vehicles included wheelchair-accessible vehicles, ambulances and stretcher vehicles. Specialist bariatric equipments were also available when needed to meet patients' assessed needs. 

The service had arrangements for patient handover and continuity of care when staff collected and dropped off patients. Crews were required to obtain and share relevant patient information. This included patients’ mobility needs, ongoing treatments, and infection risks. It also included peoples’ cognitive needs, medicines, and discharge arrangements. Crews were responsible for ensuring safe transfers between services and destinations. Policies stated that patients should not provide their own handover. The provider had a dedicated policy for deteriorating patients during transport. This included requirements for escalation, communication, and handover.

The provider had arrangements to support safe and timely patient discharges from hospitals. Hospital liaison and relationship management staff worked with hospitals and healthcare teams. They coordinated patient discharges and resolved operational issues. They also responded to emerging demand pressures.

We scored the service as 4. The service worked well with patients and healthcare partners to understand how best to keep patients safe, what it meant for individuals and the best way to achieve this. Staff had a clear focus on protecting patients’ right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They shared concerns quickly and appropriately.

The service had systems and processes to safeguard people from abuse and neglect. These also protected people from discrimination, harassment, and avoidable harm. Staff understood their responsibilities for safeguarding adults and children. Staff had access to clear policies, guidance, and reporting pathways. These supported the identification and escalation of safeguarding concerns. They also supported the management of safeguarding concerns.

The service maintained separate safeguarding procedures for adults and children. These were aligned with relevant legislation and national guidance which included the Care Act 2014 and Children Acts 1989 and 2004. Procedures also reflected the Mental Capacity Act 2005 including requirements under the Modern Slavery Act 2015.

Staff received safeguarding training appropriate to their roles. Training compliance was high across the service. At the time of inspection, safeguarding adults level 2 compliance was 99.32%. Safeguarding children level 2 compliance was also 99.32%. Prevent training compliance was 97.79%. Prevent training gave staff the knowledge to identify and report concerns about radicalisation, helping to keep people safe.

The service had clear safeguarding leadership and oversight arrangements. The quality and patient safety director was the designated safeguarding lead. They were responsible for safeguarding governance and safeguarding referrals. They also oversaw investigations, organisational learning, and partner agency liaison. Operational managers were trained to safeguarding level 3. Quality and patient safety leads were trained to safeguarding level 4. The designated safeguarding lead was trained to safeguarding level 5.

Staff had access to safeguarding advice and support both during and outside normal working hours. Staff could seek advice from quality and governance teams, hospital safeguarding teams and emergency services where required. Operational managers provided out of hours support. Policies contained clear escalation processes for safeguarding concerns. These covered both urgent and non-urgent concerns. Policies also described actions for immediate risks of harm.

The service worked collaboratively with NHS trusts, local authorities, police, and safeguarding teams. This helped protect people from harm. Safeguarding policies described a multi-agency approach. Policies made clear that staff must share safeguarding concerns. They also required staff to inform appropriate professionals about potential risks. Safeguarding referrals were shared with local authority teams. These referrals were monitored through established governance processes.

The safeguarding lead described several ways to ensure concerns were recognised and escalated appropriately. Quality and patient safety teams routinely reviewed safeguarding incidents.  Staff reviewed concerns identified through incident reporting systems. They considered safeguarding implications and escalated concerns where necessary. The service also received feedback from local authorities. 

Staff recognised safeguarding concerns and took appropriate action to protect people from harm. During the inspection, staff described identifying significant welfare concerns. These involved a couple who appeared unable to manage safely at home. They contacted emergency services and submitted welfare referrals. Staff also completed safeguarding referrals where appropriate. This helped ensure the couple received support and protection.

The service demonstrated a person-centred approach to safeguarding. Its safeguarding procedures reflected the principles of Making Safeguarding Personal. These recognised the wishes, views, and desired outcomes of individuals. Safeguarding was led by the person's preferences wherever possible. Policies included guidance on consent and mental capacity. Staff were required to involve people in decisions about their care. This applied whenever it was appropriate to do so.

The service actively monitored safeguarding activity. Between July 2025 and July 2026, the service recorded 17 safeguarding referrals through incident reports. Most concerns related to welfare issues, self-neglect and unsuitable living conditions. No safeguarding concerns progressed to a formal Section 42 enquiry during this period. 

We heard how the service used safeguarding concerns to support learning and improvement. The safeguarding lead described learning arising from concerns relating to self-neglect, lack of support packages and unsuitable living conditions. In response, they developed guidance to support staff when they identified concerns that it may be unsafe for a person to remain at home. Learning was shared with staff through supervision, management processes and training. 

The service had recently introduced formal safeguarding supervision arrangements. Monthly safeguarding meetings reviewed incidents and safeguarding concerns. These meetings also reviewed emerging themes. Teams shared learning from incidents across the wider organisation. Staff received feedback through management discussions and incident reviews. They also received feedback through learning activities. This supported continuous improvement in safeguarding practice.

We scored the service as 3. The evidence showed a good standard. The service worked with patients to understand and manage risks by thinking holistically. Staff provided care to meet patients' needs that was safe, supportive and enabled patients to do the things that mattered to them.

The service worked with patients to understand and manage risks safely. Systems and processes considered patients’ individual needs and preferences. Staff considered mobility, health conditions, and personal circumstances when booking transport. Staff also recorded cognitive impairment including dementia, mental health needs and any ongoing medical treatment. Staff recorded escort arrangements and safeguarding considerations. They also identified risks that could affect the patient’s journey or care.

The service took a holistic approach to assessing risk. The service had a policy requiring staff to consider a person's mobility and cognitive needs. Staff also looked at support arrangements and home access. They considered carer availability, medications, and care plans. Staff assessed whether it was safe to leave people at destinations. Staff also completed dynamic risk assessments when circumstances changed or where information differed from the original booking. Staff could change from the transport plan where necessary to protect people and maintain safety.

Staff considered risks within patients’ home environments to make sure it was safe for people to be left at home. For example, when taking a patient home who had just been discharged from hospital. Policies required staff to establish whether people could access their homes. Staff checked whether family members or carers knew about the patient’s return. They also confirmed that care packages were in place. Staff assessed whether destinations were safe. Where concerns existed, staff were expected to escalate them. They sought further advice before completing the journey. This helped protect people's care and safety.

We scored the service as 3. 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 service had systems to identify and manage environmental and equipment-related risks. Staff followed policies and processes to make sure ambulances and other vehicles, and the equipment onboard, was safe.  Staff described completing vehicle safety checks before each shift. These checks included vehicle condition, equipment and infection prevention requirements. Staff recorded concerns through the service's online fleet check system. Critical defects resulted in vehicles being removed from service until mended.

Leaders maintained oversight of fleet maintenance. All vehicles were leased. The contracts included agreements for maintenance, tyre replacement and roadside assistance. 

Paperwork showed all vehicles were up to date with servicing, MOTs and any other required maintenance. Leaders oversaw arrangements for maintaining patient transport equipment such as stretchers and wheelchairs. Fleet assistants serviced and checked equipment was safe to use. These staff had specialist training to inspect and maintain equipment.  Records showed repairs were completed when defects were identified, with replacement parts fitted where required. Equipment was assessed as safe following servicing activities. 

Staff described clear escalation processes for faulty equipment. Staff used electronic systems to record inspections and report defects. These systems supported vehicle monitoring and operational oversight. Managers removed faulty equipment  from service immediately. Staff placed equipment in a designated quarantine area if required. Equipment was inspected before being repaired or replaced.

Technology supported the safe delivery of care. We observed vehicles equipped with CCTV systems and 360-degree cameras. Staff had access to communication equipment and navigation systems to help make journeys safer. Staff completed environmental monitoring within the buildings. An established audit programme supported environmental oversight. The programme included environmental and, health and safety audits. Monthly site compliance checks and legionella monitoring also formed part of the programme. We reviewed completed audit records. Monthly water risk audits completed from April to June 2026 achieved 100% compliance scores, demonstrating that water safety controls were implemented as required. Leaders had completed two internal audits during 2026 to assess environmental, security and information governance arrangements. Both audits demonstrated high levels of compliance, achieving scores of 100% and 96%.

However, we identified concerns with some equipment maintenance and storage arrangements during our inspection. One vehicle contained an unsecured oxygen cylinder. One wheelchair ramp servicing had expired in January 2026. One wheelchair restraint servicing was overdue. Supplies were not always stored securely within overhead compartments on ambulances. These issues had not been identified through routine checking processes. We informed the senior operations manager about these issues. The service took immediate action and addressed the issues on the day of inspection.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met patients' individual needs.

The service had systems to recruit, develop and support staff to undertake their roles safely. Managers made sure all recruitment processes were followed. This included completing Disclosure and Barring Service (DBS) checks, checking applicants had the right to work in the UK, reference checks and driving licence verification where required. Managers checked to make sure all staff had completed the required processes before starting work. We saw records showed high compliance with this. 

The service also used third-party taxi providers to support some patient transport journeys. Leaders told us they completed due diligence checks before providers were approved to work with the service. This included reviewing governance arrangements, insurance documentation and compliance information. Providers were required to comply with the organisation's supplier code of conduct and relevant safeguarding and recruitment requirements. Leaders monitored compliance through their governance systems and reviewed provider information annually.

The service operated a structured induction programme for new staff. Staff told us the induction helped them develop the knowledge and skills needed for their roles and enabled them to work safely and effectively. Staff described the induction process as supportive and said it prepared them well for their responsibilities within the service.

Staff received mandatory training relevant to their roles. Overall mandatory training compliance was 97.4%. Training topics included safeguarding, infection prevention and control, moving and handling, conflict resolution, fire safety and health and safety. Compliance exceeded the service’s target across these areas.

The service had clear expectations regarding driver competence and safe working practices. Staff received a driver's handbook describing key responsibilities. These included vehicle safety inspections and defect reporting. The handbook also covered incident reporting and vehicle telematics monitoring, which was used to support driver safety, vehicle management and service performance. The handbook also outlined safe driving standards for all drivers. Staff were required to follow road safety policies. They also complied with requirements on mobile phone use. Staff had access to information to support them to drive safely and legally including seat belt use, and policies around alcohol and substance use whilst at work.

Leaders monitored driving standards through telematics and vehicle monitoring systems. Telematics data supported driver development and performance monitoring. It also helped monitor driving behaviours. Leaders used telematics data to investigate incidents where required and identify where further training was needed. 

Leaders described arrangements to maintain staff competence in specialist equipment. Fleet assistants completed additional training to inspect and maintain wheelchairs, stretchers and carry chairs. 

Staff received annual appraisals and opportunities to discuss performance, development and support needs. Appraisal records showed staff reflected on their roles, identified development opportunities and discussed areas for improvement with managers. Managers recorded strengths, objectives and performance against organisational values and competencies. Staff described feeling confident in their roles and identified teamwork, communication and patient care as important aspects of their work. 

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The service had systems and processes to assess, manage, and monitor infection risks. Staff had access to an infection prevention and control (IPC)  policy which was in line with national guidance and legislation. Staff followed infection prevention and control procedures. Staff understood their responsibilities for cleaning vehicles and equipment and described the processes they followed to maintain cleanliness and reduce the risk of infection. Staff had access to personal protective equipment (PPE) whilst working with patients. Staff used personal protective equipment PPE in line with assessed risks. Leaders maintained arrangements for FFP3 face-fit testing. This ensures the mask fits correctly and provides the intended level of protection against airborne infections. This supported staff working in higher-risk situations. 

The service had detailed cleaning and decontamination procedures for vehicles and equipment. Staff completed pre-shift cleaning checks before using vehicles. They cleaned vehicles and reusable equipment after every patient. Staff also undertook end of shift cleaning. Vehicles were subject to a scheduled deep-clean programme. However, we identified some areas of visible dirt within vehicles indicating cleaning was not always adequate. We brought these findings to the attention of senior operational leaders during the inspection. Leaders took immediate action and provided assurance that the affected vehicles had been cleaned, and the concerns addressed on the same day.

During the inspection, we observed vehicles fitted with fogging systems. These were located within rear patient compartments. Fogging provided an additional method of decontamination. This supplemented routine and enhanced cleaning processes.

Equipment cleaning requirements were clearly defined. Wheelchairs, carry chairs, and stretchers were cleaned after each use. Patient handling equipment was also cleaned after each patient use. The same requirements applied to reusable medical devices. Leaders told us equipment was cleaned following use. Staff prepared equipment for future deployment. This was completed in accordance with provider procedures.

Leaders had established arrangements to identify and manage infectious patients before transport. Staff recorded information about a patient's infectious status during booking. This information was communicated to crews before collection. Staff were expected to confirm infection risks with referring healthcare providers. Staff escalated concerns if new information became available. Where required, infectious patients were transported separately to other patients. Staff planned journeys to reduce risks to other patients. When booking journeys, staff allowed enough time for vehicle and equipment decontamination.

Staff received mandatory IPC training during induction and completed annual refresher training. Leaders monitored compliance with IPC standards through inspections, audits and testing. Quality and governance staff used ATP swab testing to check how effectively surfaces had been cleaned. The results helped staff identify where additional cleaning was needed. 

IPC audits were completed across the service's transport bases during 2026. Audit results demonstrated good levels of compliance, and where shortfalls were identified leaders implemented action plans to address them. This provided ongoing oversight of IPC performance across the service.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met patients' needs, capacities and preferences. 

The service did not routinely stock, supply, or administer medicines. This reflected the nature of it being a non-emergency patient transport service. The service stored and carried oxygen where required. Staff also managed patients' own medicines during transport. 

The service had arrangements to maintain oxygen supplies and equipment. The provider held a contract with an external medical gas supplier for the supply, servicing and replacement of oxygen cylinders. Information provided showed oxygen cylinders were exchanged and replaced when required. Staff received training in oxygen management and administration. This covered oxygen safety, storage, cylinder checks and emergency oxygen use. The provider had a medicines standard operating procedure. This outlined circumstances where staff could administer emergency oxygen and actions required following patient deterioration.

During the inspection, we found oxygen cylinders stored at operational bases were kept in a secure designated storage area. We checked a sample of oxygen cylinders and found they had been serviced and were within their expiry dates. We identified one cylinder where the service label had become faded and brought this to the attention of the on-site operations manager, who replaced the oxygen cylinder.

Staff told us they would seek advice if concerns arose about medicines. They sought advice from clinical colleagues where required. Staff also contacted referring organisations or receiving healthcare providers. Staff understood the importance of patients travelling with required medicines. They escalated concerns when medicines appeared to be missing. They also escalated concerns about unavailable medicines. Staff raised concerns where medicines were inconsistent with booking information. Staff demonstrated a clear understanding of their role. They understood the need to work within established procedures.