South East Coast Ambulance Service NHS Foundation Trust

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that people were always treated with kindness, empathy and compassion. We checked that people’s privacy and dignity was respected, that they understood that they and their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them.

We assessed all 5 quality statements from this key question.

At the last inspection we rated this key question good.

At this inspection the rating has remained as good.

This meant people were supported and treated with dignity and respect and involved as partners in their 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 treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

Staff treated patients and their families with kindness, compassion and respect. They consistently demonstrated caring, calm and professional behaviours when interacting with patients.

We observed staff responding sensitively to people’s needs in a non-discriminatory way, including providing emotional reassurance and practical support when circumstances may have caused discomfort, such as walking via an external route in poor weather.

Staff maintained people’s dignity and privacy and were responsive to their needs, for example making sure they were covered with a blanket or talking to them so others could not overhear.

Feedback from the SECAmb patient experience questionnaires reflected these observations, with people consistently praising staff for their professionalism and compassion.

Staff understood about patient confidentiality. They used electronic patient records to log patient information. Ambulance crews made sure these were always in their possession to stop unauthorised people having access to patient information.

We observed positive and effective working relationships between the service and NHS staff in emergency departments. Interactions were consistently professional, calm and respectful, with communication focused on people’s needs and ensuring patients remained at the centre of all decision-making and discussions.

The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff told us they treated people as individuals and ensured care was person centred. They placed patients at the centre of their care and worked to build trust and rapport to support positive patient experiences.

They explained when caring and treating patients they needed to be mindful of individual circumstances, such as understanding potential language barriers, family dynamics and cultural sensitivities. Staff received mandatory training in equality, diversity and human rights which included understanding and respecting different cultural, religious and social backgrounds, recognising and addressing unconscious bias, promoting inclusive communication and behaviour and upholding the Public Sector Equality Duty as set out in the Equality Act 2010. Staff completion rate was 77% which was lower than the trust target of 85%. Staff also received training in dementia awareness, and training in learning disability and autism awareness, with completion rates of 94% and 77% respectively.

We observed excellent care provided to a person living with dementia. On arrival at the emergency department, the patient believed they were in a busy shopping centre. The ambulance crew entered the patient’s world by adapting their approach to align with the patient’s perceived reality, which helped to keep the patient calm, reduce anxiety, and demonstrated compassionate, person-centred good practice.

Staff had access to language translation services to support effective communication and help ensure patients understood their care and treatment.

We observed staff explaining care and treatment clearly to patients, using accessible language and checking understanding throughout.

The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Ambulance crews provided clear and open explanations to patients about their condition, available treatment options and decisions regarding conveyance to hospital. Staff ensured patients understood the reasons for recommended actions, including the choice of hospital or treatment, and explored alternative options when appropriate.

We saw ambulance staff frequently explain to patients what was happening at each stage of their journey. This helped people to understand their care and treatment and helped them maintain choice and control. Patients could have family members travel with them on their journeys if necessary and we saw one example of this where an unwell baby was accompanied by their mother. Ambulance staff told us people with a learning disability, people with dementia and children would usually have family members or loved ones travel with them in the ambulance if required.

Adults were presumed to have capacity to make decisions about their care and treatment, including the right to refuse treatment, unless there was evidence to suggest otherwise. Where there were concerns, staff assessed mental capacity on an individual basis, considering the person’s ability to understand relevant information, weigh up the options and communicate their decision.

Staff told us patients had the right to refuse treatment or conveyance. They said they encouraged patients to accept appropriate care and treatment, however, where a patient with capacity chose to refuse care, staff understood they were required to respect this decision. Where patients declined treatment or conveyance despite potential health benefits, ambulance crews respected the decision and clearly documented this on the electronic patient record for clinical and legal purposes.

The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Emergency calls were assessed by staff in the emergency contact centre, who determined the level of urgency using a triage system. Calls were categorised from category 1 to category 4, with category 1 representing the most urgent. The assigned category determined the response time, ensuring patients with the most serious or time-critical needs received the fastest response, while lower-priority calls were managed through clinical advice or longer response timeframes.

Staff told us that although they sometimes had limited information about patients before arrival, improved access to patient information through integrated care hubs helped them understand patients’ needs and deliver person-centred care from the outset.

Staff assessed patients’ conditions using established clinical protocols alongside their professional judgement. Where immediate intervention was required, such as cardiopulmonary resuscitation (CPR), this was initiated without delay. In some cases, staff also administered medicines, including pain relief, when clinically indicated.

We observed staff remaining with patients while their colleagues handed over care to hospital staff. This ensured patients were monitored while awaiting admission to the emergency department and that staff could respond promptly to any deterioration.

Staff identified and responded appropriately to changes in patients’ conditions. We observed staff providing advanced life support to a patient and noted effective multidisciplinary working with NHS emergency department staff during the handover of care.

The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

The trust had a well-being hub and used well-being practitioners, who supported staff through a well-being approach to promote staff wellbeing. Staff could self-refer to the team or be referred by their line manager.

The service had a variety of programmes and initiatives to help support staff, including advice on mental health and wellbeing; depression and low mood, counselling services, bereavement and how to manage stress. There were occupational health services that staff could be referred to. Additionally, they provided support for managing various health conditions such as osteopathy, with a physiotherapy team. Staff talked positively about the support the service gave to women going through the menopause, with a menopause policy and how with the support of occupational health adaptations could be made, it was no longer a taboo topic in the service. We saw 24/7 chaplaincy services were available to staff. These services, and the wellbeing hub, were advertised on notice boards in all of the ambulance bases we inspected, and information was also available on the staff intranet.

The service had conducted training on bullying and harassment in the workplace and launched the sexual safety charter to eliminate sexual misconduct, harassment, abuse or violence in healthcare settings.

The service had maternity and paternity policies to support staff. One operation unit had devised a local maternity pack for their team of the back of a staff member who had highlighted a poor experience. This had been shared in the local teams but not wider across the wider organisation. It was noted that many well-being initiatives were devised and implemented locally and that sharing of best practice and when not so good initiatives had taken place, learning opportunities could be better. Staff talked about inconsistent approaches and outcomes for staff across the service. Requests such as leave where not always managed in the same way. This led to staff feeling there was inconsistency, and they were being treated differently which impacted their wellbeing.

The service operated 24 hours a day, 7 days a week which meant operational staff were expected to work unsocial shifts and flexible working opportunities were limited. However, the service would try and accommodate a more flexible work pattern which worked both for the individual and the service. Flexible working did remain a concern amongst staff though, as only 43% of operational staff reported being satisfied with the opportunities for flexible working patterns in the 2024 staff survey.

Most staff reported that their workload was generally manageable. However, some staff expressed frustration that the locations they were scheduled to cover were often a long distance from their base. As a result, they sometimes finished after their usual working hours due to travel following their final emergency callouts. Staff estimated this occurred around 20–30% of the time.

The service used debriefs which were structured conversations that reviewed the actions, decisions, and outcomes of patient care incidents. These sessions aimed to support staff well-being and improve future practice by providing a safe space for emotional processing and fostering resilience. Staff reported they found debriefs particularly valuable following challenging or emotionally demanding situations.

The service also provided Trauma Risk Management (TRiM), a structured approach in which trained colleagues support staff exposed to traumatic or potentially traumatic events. TRiM is not a form of counselling or therapy, but it helps staff manage the potential mental health impacts of their experiences. Staff spoke positively about the support this service offered.

Staff were provided with body worn cameras to support their safety at work. The trust also held a monthly violence reduction working group which reviewed violence and abuse and identified any actions that could be implemented to seek to reduce incidents and improve support for staff. Staff also received 1 day training in conflict resolution as part of their key skills training, which 84% of staff had completed.

Staff talked of SECAmb being a good family friendly organisation. They spoke of family fun days and barbeques which aided staff wellbeing and boosted morale in their local teams.

Despite the range of initiatives offered by the trust and service, only 56% of staff in the 2024 staff survey felt the organisation took positive action on health and well-being. However, this represented an improvement on previous years, with 53% in 2023 and 43% in 2022. These results indicated that the trust’s initiatives were having a positive impact on staff well-being, but further work was needed to understand what additional measures could be implemented to enhance support. The service had an action plan in place to discuss and develop these initiatives with teams.