ERS Medical Midlands

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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. 

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

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted good quality, person-centred care. 

Leaders demonstrated effective oversight of quality, performance and risk. Established governance arrangements supported the monitoring of incidents, complaints and safeguarding concerns. Leaders used information from these systems to identify areas for improvement and support decision-making. 

The service maintained effective partnerships with commissioners, healthcare providers and other stakeholders. Leaders worked with system partners to respond to operational pressures, review performance and support service improvement. Risks relating to demand, capacity and service delivery were routinely discussed and managed through governance and contract management arrangements. 

Staff generally spoke positively about local leadership and described managers as approachable and supportive. Leaders promoted learning through incident reviews, audits, service improvement activity and staff communications. The service also demonstrated a commitment to continuous improvement and innovation through projects designed to improve efficiency, patient experience and resource utilisation. 

Although some staff described concerns relating to communication, feedback and organisational engagement, leaders recognised these issues and had introduced processes to strengthen staff involvement and communication across the service. 

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

We scored the service as 3. The evidence showed a good standard. The service had a shared vision and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of patients and their communities. 

Most staff spoke positively about support from their managers and colleagues and described strong working relationships across frontline teams. Staff demonstrated pride in their work and commitment to supporting patients. However, some staff did not feel recognised or valued by the organisation and reported challenges relating to communication and engagement. Leaders had introduced staff engagement events and team meetings to provide opportunities for staff to raise concerns, share feedback and contribute to service improvements. 

The service had clear organisational values of "collaborative", "agile", "reliable" and "empowered". These values outlined the behaviours expected of staff. Staff worked collaboratively with colleagues and partner organisations to support patients. Staff interactions with patients were respectful and professional, which reflected these behaviours in practice. 

Staff and leaders demonstrated a focus on meeting local needs. Leaders worked closely with commissioners, healthcare providers and other stakeholders. They sought to understand demand, capacity pressures and community needs.  Staff spoke positively about supporting patients. They took pride in helping people access appointments, treatment and discharge services.  

The service used several methods to communicate with staff. These include staff meetings, newsletters and engagement activities. We reviewed staff newsletters that shared organisational updates and service developments. These also recognised staff achievements and positive contributions.  

Many staff described strong working relationships with colleagues. Staff consistently demonstrated pride in their roles and responsibilities. Several staff spoke positively about their managers. Staff valued the support they received from colleagues and local leadership teams. 

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and 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. 

Leaders demonstrated a strong understanding of operational challenges affecting the service. They described pressures relating to demand, discharges, patient complexity and workforce capacity. Leaders worked with commissioners and healthcare providers to understand and address these challenges.  

Leaders had relevant operational and management experience. Several managers had progressed from frontline roles into leadership positions. Leaders described responsibilities for recruitment, training, complaints handling, incident investigations and staff support.  

The provider had invested in leadership development. Management training records showed leaders had completed a structured development programme. Training had covered equality, diversity and inclusion, investigations, disciplinary processes, appraisals and performance conversations. Compliance across the locations reviewed was 100%.   

Staff generally described local leaders as approachable and supportive. Staff told us they felt comfortable raising concerns and seeking advice.  

Senior leaders were visible within the organisation. Staff told us leaders attended operational sites and communicated through meetings and newsletters.  

However, staff views of leadership were not consistently positive. Some staff felt concerns raised were not always followed up and that there were limited opportunities to influence service decisions. Leaders had recognised these concerns and were taking steps to improve engagement and communication.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where staff felt they could speak up and their voice would be heard. 

The service had arrangements to support staff to raise concerns safely. Staff could raise concerns through internal and external routes. 

The provider had a whistleblowing policy. The policy promoted openness, transparency and early reporting of concerns. Staff raising concerns in good faith were protected from detriment. 

The service used an independent whistleblowing provider. Staff could report concerns openly, anonymously or partially anonymously. The service operated a 24-hour confidential reporting line. Whistleblowing information was available through several channels. These included policies, posters, noticeboards, site screens and staff communications. 

Staff could also raise concerns through alternative methods. They could approach their line managers, human resources staff or engagement champions. Staff could attend engagement forums and employee briefing sessions. Anonymous questions could be submitted during these sessions. Staff could also provide feedback through annual staff engagement surveys. Mental health first aiders were available to support staff wellbeing concerns. 

Staff we spoke with were aware of speaking up arrangements. Some staff specifically identified Freedom to Speak Up routes. Staff generally understood how concerns could be escalated. 

Leaders promoted a culture of speaking up and engagement. Regular opportunities for direct engagement with senior leaders was offered through forums and fortnightly sessions.  

Leaders monitored concerns raised through HR processes, including grievances. Information showed 11 grievances had been raised since the beginning of 2026. Leaders reviewed concerns raised by staff and acted in response.  Actions included improved annual leave monitoring and additional management training.  Leaders also reinforced organisational values through staff communications.  This demonstrated leaders used staff feedback to identify and address improvement areas. 

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them. 

The provider undertook equality monitoring of staff within the service to ensure it reflected the patient group. The service had an equality, diversity and inclusion (EDI) policy. The policy promoted equality, inclusion, dignity and respect for all staff. It also supported equality of opportunity and fair treatment.   

The provider had invested in EDI training and awareness. Training covered the equality Act 2010, protected characteristics, unconscious bias, menopause awareness and mental health. Training was mandatory and monitored through organisational systems. Refresher training was also provided.  

The service had established an EDI champions’ network. Champions represented different roles and levels across the organisation. The group met regularly to discuss initiatives, share ideas and support cultural development.  

The organisation used workforce data to understand equality and inclusion issues. Leaders encouraged staff to complete protected characteristic information and had developed systems to review anonymised data. This supported ongoing monitoring of workforce equality and diversity.  The service also encouraged applications from people from a range of backgrounds and monitored workforce equality data to support understanding of the diversity of its workforce. 

Staff had access to policies covering workplace transitions, flexible working, bullying and harassment. Leaders told us reasonable adjustments were considered in line with the Equality Act 2010 and flexible working requests were managed through a formal policy. Uniform policies had also been reviewed to support different religious and cultural needs. 

During our inspection, we observed EDI information displayed within staff areas. Leaders also described regular communications, awareness campaigns and information resources promoting inclusion and understanding across the workforce. 

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate. 

The service had established systems to monitor quality, performance and risk. Leaders reviewed operational, quality and performance information through governance processes.  

We reviewed monthly contract performance reports, which identified areas requiring improvement. These included activity, quality, complaints, incidents and safeguarding information. Trends were analysed and reviewed to support service oversight and decision-making.  

The service had a local risk register, and leaders demonstrated oversight of operational risks affecting the service. Risks were reviewed regularly and assigned to accountable leads. The main risks were transport delays, workforce shortages and control centre staffing pressures. Leaders identified mitigating actions and monitored progress against these.  

Risk reports regularly identified pressures relating to patient demand, mobility requirements and available capacity. Same-day demand, discharge activity and system pressures were monitored and discussed on meetings.  

Where pressures were identified, these were discussed with commissioners, acute trusts and system partners through contract meetings, transport working groups and escalation calls. This ensured there was a shared understanding of risks and coordinated action to mitigate impacts on patients.  

Leaders reviewed data on cancelled journeys, aborted journeys, complaints and patient timeliness concerns. This information was shared with operational teams and healthcare partners to support improvement plans and service delivery.  

Complaints, incidents, safeguarding concerns and stakeholder issues were reviewed regularly. Leaders analysed themes and trends to identify learning opportunities. Actions arising from concerns were monitored through established governance arrangements.  

The service had business continuity arrangements. A business continuity and emergency preparedness plan described escalation processes, operational responsibilities and recovery arrangements. It included arrangements for adverse weather, IT disruption and major incidents.  

Performance was monitored against contractual key performance indicators. Weekly monitoring was undertaken for performance measures and service recovery activity. Leaders used enhanced reporting, dashboards and trend analysis to strengthen oversight and assurance.  

However, some performance challenges remained. Call handling performance did not consistently achieve contractual standards. Workforce pressures, increasing demand and service complexity continued to affect some areas of performance. Leaders recognised these risks and implemented mitigation plans. Additional support was provided from other control centres in the wider organisation. 

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for patients. They share information and learning with partners and collaborate for improvement. 

The service worked collaboratively with commissioners, healthcare providers and system partners. Leaders maintained regular engagement with acute trusts, community services and renal units to support service delivery and patient outcomes. 

Performance, quality and operational issues were discussed through regular contract review meetings. Leaders shared performance information with commissioners and partners to support transparency, joint decision-making and service improvement. 

The service participated in transport working groups and other system forums. Leaders told us they attended monthly transport working group meetings and separate monthly meetings with acute trusts to discuss system improvements and strengthen partnership working. The service would increase communication with some partners when required. 

Leaders escalated risks relating to discharge activity, same-day demand and operational capacity to commissioners and healthcare providers. This supported a coordinated response to pressures affecting patient transport services. 

Leaders told us they attended system coordination calls twice daily during weekdays. Weekend system calls were attended by on-call leaders. These meetings included local trusts, urgent care providers and ambulance services. Leaders shared information about demand, operational pressures and service capacity. 

The provider worked closely with renal services to improve patient experiences and reduce avoidable journey disruption. Information relating to dialysis journey aborts was shared with renal units. Leaders told us there were monthly renal working group meetings with representatives from local renal units. Concerns and incidents were reviewed to support shared learning and make improvements. 

Leaders reviewed themes from complaints, incidents and operational performance and used this information to support improvements across pathways. Learning was communicated through meetings, discussions and improvement activities with system partners. 

Leaders participated in escalation calls and worked with healthcare partners during critical incidents, and business continuity events. Leaders also attended emergency preparedness, resilience and response planning meetings and winter planning meetings. 

Quality improvements were considered in commissioner and governance meetings. Leaders told us quality formed a standing agenda item within contract review meetings. Additional quality meetings were also held with commissioners when required. 

The provider demonstrated wider engagement with local communities and voluntary organisations. It supported charitable initiatives and workforce development programmes. It was involved in schemes designed to improve employment opportunities for people facing barriers to work. Leaders described initiatives supporting apprenticeships, volunteering opportunities and community participation. 

Feedback from partners was mixed. Stakeholders told us senior leaders engaged positively with system partners and were willing to discuss concerns and service pressures. They described good engagement and collaborative working at management level. Some stakeholders reported ongoing concerns regarding transport reliability and delays. They said there were sometimes challenges contacting the control centre, particularly during periods of high demand. However, several partners recognised that rising demand and limited commissioned capacity were significant contributory factors. They acknowledged this affected the provider's ability to consistently meet performance expectations. Despite these challenges, partners told us the provider remained engaged in system discussions and worked collaboratively to identify solutions and mitigate pressures. 

We scored the service as 3. The evidence showed a good standard. 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 patients. They actively contribute to safe, effective practice and research. 

Leaders promoted a culture of continuous learning and improvement. They routinely reviewed performance, quality and operational data to identify opportunities to improve services and patient outcomes. Information from incidents, complaints, operational performance and stakeholder feedback was also used to inform improvement activity.  

The service demonstrated a structured approach to improvement. Where areas requiring improvement were identified, leaders created action plans with ongoing monitoring to ensure progress was made.  

Leaders used operational data to identify ways to use staff and resources more effectively. They reviewed patient journeys that required more than one staff member and explored using portable ramps to support patients with different mobility needs. This enabled more patients with different accessibility requirements to travel together safely, helping reduce unnecessary journeys and make better use of staff and vehicles. 

The service introduced digital improvements to make booking easier for patients and healthcare partners. These included online and self-service booking, QR codes and improved reporting. Leaders monitored the changes to understand their impact on demand and service performance.  

Leaders used learning from operational performance to support service development. Reviews of cancelled journeys, aborted journeys and patient timeliness issues were undertaken to identify themes and opportunities for improvement.   

The service introduced additional monitoring processes to identify emerging concerns. This included patient timeliness monitoring and clinical risk dashboard reporting to strengthen oversight and support learning.  

Leaders worked with system partners to identify opportunities for learning and improvement. This supported the provider to reduce delays, minimise avoidable journey failures and provide the best outcome for patients.