South East Coast Ambulance Service NHS Foundation Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

We assessed all 6 quality statements from this key question.

At the last inspection we rated this key question as requires improvement.

At this inspection the rating has changed to good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Ambulance crews told us that when they were assigned an incident, key information was immediately available to them, including the location, nature of the emergency, and, where provided, additional details such as keypad entry codes. This supported crews to prepare appropriately for the circumstances they were attending.

On arrival, staff carried out dynamic risk assessments for every patient. These involved real-time evaluations of environmental and clinical risks to ensure the safety of both staff and patients. Crews implemented immediate control measures based on their assessment. These ranged from simple decisions such as determining whether it was safe to cross a busy road to managing complex situations, for example a patient with an altered level of consciousness in a potentially volatile environment, where support from other emergency services, such as the police, may be required.

Staff also assessed each patient’s communication needs to ensure effective communication, for example speaking directly to the patient if they had hearing difficulties.

Crews completed their initial clinical assessment using established protocols and applied their clinical judgement to provide appropriate care, such as administering pain relief or oxygen. Where needed, they could contact other teams in the service for specialist advice or request support from the critical care paramedic team, who had an extended scope of practice.

Where a patient required further medical care beyond what could be delivered on scene, crews would convey them to a hospital or other healthcare facility using established clinical pathways, which were accessible on staff mobile devices.

If a decision was made not to convey a patient, crews, where necessary, provided advice and guidance, such as recommending the patient contact their GP or speak with a pharmacist. With the patient’s consent, staff could also make referrals to other services, such as the urgent community response team.

Crews told us they consistently assessed for safeguarding concerns, including risks to patients, carers, and other household members such as children. Safeguarding referrals were made in line with the service’s policies and procedures where required.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Patient care and treatment followed evidence-based guidance. Clinical guidelines and policies used in the service were developed and reviewed in line with national guidance from the National Institute for Health and Care Excellence (NICE) and the Joint Royal Colleges Ambulance Liaison Committee (JRCALC).

Staff had access to the JRCALC guidelines, which were clinical guidelines used by paramedics to support practice. The JRCALC guidelines were regularly reviewed and updated to reflect the latest evidence and best practices in pre-hospital care. JRCALC updates were part of the key skilled training modules delivered to staff by the education team. The JRCALC app required staff to acknowledge receipt of updates, enabling the service to monitor who had read the information. These acknowledgements were stored centrally, providing assurance that staff had accessed the latest clinical guidance.

Policies and protocols were accessible on the trust’s intranet, with some being available on crew’s electronic handheld devices.

The process for the development, revision and withdrawal of policies and procedures was as per the trust Policies on policies and procedures. This ensured they contained current and best practice guidance. Governance meetings provided evidence of updates being made to procedures and policy documents.

There were a variety of up to date, evidence-based pathways used in the service which staff had access to on their electronic handheld devices.

Staff were updated on changes to clinical and operational practice through a range of communication methods, including team briefings, emails, newsletters, memos and operational bulletins. We observed examples of these displayed in rest facilities at ambulance bases. The service did not have the ability to track how many staff had read operational bulletins. However, there was an expectation that all staff would review and familiarise themselves with essential communications relevant to their role. Operation unit managers and operations managers told us they cascaded information to team leaders and crews to ensure they were aware of any clinical or operational changes. Crews spoke positively about how their managers kept them informed. However, operational staff raised concerns about the timeliness of some communications. They gave examples of bulletins being issued on a Friday afternoon with changes required to be implemented by the following Monday. Staff told us that, due to shift patterns, this made it difficult for leaders to ensure all team members had been briefed and adequately prepared ahead of the changes taking effect.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service worked with many teams both internally and externally to deliver their purpose of providing and coordinating emergency and urgent care to the public. Staff we spoke with told us open communications, mutual respect and keeping the patient at the centre of what they did helped the teams work together.

There was effective working between the teams at the emergency operations centre, where emergency calls were answered and resources dispatched. Crews told us it was important to understand each other’s role and they felt there was good working relationships between the teams.

Advanced paramedics practitioners and critical care paramedics staffed the urgent care and critical care desks and supported ambulance crews in complex clinical assessments and decision-making regarding patient disposition and safety. Crews had access to the critical care desk staffed by the critical team. Crews spoke highly of these and how they supported the teams to enhance patient safety.

Staff at ambulance bases worked closely with the make ready teams, a team responsible for ensuring ambulances and other emergency vehicles were cleaned, restocked with essential supplies and equipment fully operational before each shift. These teams were employed by a service partner rather than SECAmb but worked closely with SECAmb personnel. SECAmb staff reported good working relationships with the make ready teams, minimum issues and when issues did arise, they would usually be sorted quickly and efficiently.

During the inspection, we observed good interactions between emergency department staff and ambulance crews during handovers and when sharing information regarding patients.

The service operated a Joint Response Unit (JRU) in Kent, which was a collaboration between police and paramedics. Staff from both agencies worked together in a single vehicle to respond to emergencies requiring both medical and law enforcement support. By combining resources, the unit provided a faster, more efficient response, ensuring patient care and public safety needs were met simultaneously. These units responded to a wide variety of incidents, including traffic collisions, assaults, mental health crises, and cardiac arrests. Staff told us that the JRU had been particularly effective when managing mental health incidents or dealing with violent and aggressive patients, as it enhanced patient care, improved staff safety, and strengthened working relationships between police and ambulance teams. However, we were informed that the unit was due to stop operating due to funding issues. Staff expressed disappointment at the planned closure, describing the unit as a successful service that had clear benefits for patients and frontline staff.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The service supported patients who made multiple 999 calls for non-emergency situations, often due to complex needs, long-term conditions or limited access to other forms of support. The service used a national definition to identify these individuals and worked to ensure their needs were met more appropriately by coordinating care with other agencies such as GPs and community teams. The service had a dedicated team responsible for supporting these patients, and operational crews were able to refer individuals to this team for further assessment and intervention.

Clinicians working in the service had Ambulance crews had access to the NHS directory of services (DoS). This was a platform developed by the NHS to provide a comprehensive directory of health, social care, and voluntary sector services. Staff used this platform to find and direct patients and members of the public to a range of services that they might find helpful to their health and social care needs. For example, GPs, urgent care centres, community teams, and their availability. Staff found at times, this was a good tool to help facilitate safe and effective patient referrals.

The service routinely monitored people’s care and treatment to continuously improve it. They worked to make sure outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service had systems and processes in place to monitor, audit and benchmark the quality of services, and the outcomes for patients receiving care and treatment through continuous monitoring of responses to adverse events, routine monitoring and targeted areas of scrutiny. This information was reviewed, analysed and tracked over time to understand how the service was performing against key performance indicators, NHS standards, the Association of Ambulance Chief Executives (AACE) standards and locally derived standards. Quality and effectiveness are also monitored through clinical audit, supervision, and other governance activities.

Data was reviewed and discussed by the relevant groups and committees, for example the incident response group and divisional group meetings which would then feed into the board sub-committee meetings.

The service participated in the Ambulance Quality Indicators (AQIs) which are a set of measures used to assess and improve the quality of care provided by all ambulance services in England. System indicators focused on efficiency and timeliness of ambulances responses, and clinical outcomes which including measures like acute STEMI (ST-segment elevation myocardial infarction) care bundle outcome. STEMI care bundle is a set of immediate medical actions to treat severe heart attack, and survival rates for patients with specific conditions such as stroke and heart attack, were reported each month. This gave a monthly up to date picture on how ambulance services were performing individually, and when combined, an overall picture for England. Data presented show the service were reaching targets set and in some exceeding the targets. For example, the service had shown significant improvement in STEMI care bundle compliance since September 2024, with a compliance rate of 86.4% in May 2025, the latest figures available at the time of the inspection. This meant more patients with a confirmed STEMI were receiving the care bundle which although does not directly link to improved patient outcomes, does align with recognised post-resuscitation care priorities, and consistent delivery of the care bundle may support neurological recovery and survival.

Key performance indicators were used to track the service’s performance, for example, time to respond to category 1, 2, 3 and 4 calls, time on scene, see and treat, and conveyance rate. Where performance was not optimal, the service looked to see if there were reasons and what the service could do to improve performance. This included working with system partners to develop effective care pathways, ensuring that each patient was directed to the most appropriate place for the right treatment.

Data from July 2024 to June 2025 showed time to respond to category 1 calls (life-threatening) was the same or similar to England’s mean category 1 response time. Both England and SECAmb’s category 1 response time were slower than the national standard of 7 minutes but only by a small amount. In August 2025 the category 1 response time was 00:08:14hrs. This indicated that SECAmb were performing similarly to their peer services but still faced system pressures which was affecting response times.

Data from July 2024 to June 2025 showed time to respond to category 2 calls (emergency) was lower or similar to England’s national mean, which were both higher than the national standard of 30mins, the temporary target set by NHS England for 2024/2025. There was variation in SECAmb’s monthly means with 6 months over the target of 30mins and 6 months under. In August 2025 the category response time was 00:28:31hrs. Although SECAmb generally performed better than or similar to the England mean, the variation in response times reflected ongoing operational and system pressures.

Response to category 3 calls (urgent) had a target of 90% of these calls are responded to within 120 minutes (2 hours). Data from July 2024 to June 2025 showed SECAmb’s and England’s mean response times had been similar. SECAmb’s mean response has been under 2 hours for 3 out of the 12 months whereas England’s had been under 2 hours 7 times in total. SECAmb’s 90th centile response time varied from 4 hours to 6 hours 39 minutes, compared to England’s, which varied from 3 hours 25 minutes to 7 hours 20 minutes.

Response to category 4 calls (less urgent) had a target of 90% of these calls are responded to within 180 minutes (3 hours). Data from July 2024 to June 2025 showed SECAmb’s mean category 4 response times had been under 3 hours for 11 out of the 12 and it had been under 2 hours once. SECAmb’s 90th centile was higher than England’s in July and August 2024, but for the rest of the months, it was lower than England’s. England’s 90th centile of category 4 response time ranged from 4 hours 10 minutes to 8 hours 17 minutes. The service met the three-hour mean standard for the majority of the year and outperformed the England mean for most of that period, which demonstrated more consistent delivery for lower-acuity calls.

The service used post-discharge review (PDR) to ensure that appropriate decision-making had taken place when patients were assessed and treated at the scene and not conveyed to the emergency department. Advanced paramedic practitioners (APPs) reviewed the electronic patient care record (ePCR) within a few hours of the incident, focusing on key elements such as the accuracy of the clinical impression, appropriateness of the management plan, clarity of worsening-care advice, and the quality of safety netting.

Audit results showed that 95% of non-conveyance decisions were safe and appropriate. In 4% of cases, APPs requested additional information from crews, and 1% of cases raised concerns, requiring either a virtual consultation with the patient or the dispatch of another ambulance. When decisions were found to be unsafe or inappropriate, further analysis was undertaken and shared with crews to support learning and improvement.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service had up-to-date policies and procedures regarding consent and the Mental Capacity Act (2005), which covered areas such as assessing capacity, recording an assessment, best interests, restraint and the advance decisions to refuse treatment Staff received Mental Capacity Act (MCA) training as part of their mandatory training, operation staff were 68% complaint with this training.

Staff understood the importance of consent when delivering care to patients. We observed staff seeking consent from patients prior to examination and treatment. In most cases, this was implied consent and not documented. When patients did not have capacity to consent, for example if they were unconscious, staff followed legislation and guidance and made decisions in their best interests. The service had completed a mental capacity audit, with results published in November 2024, which looked at the group of patients where the ability to consent may be in doubt and if capacity assessments and documentation of capacity had been appropriately completed. Results showed that 96% of patient records were compliant. Audits of the electronic patient records were also completed in the operational teams, but we were not supplied with findings from these more localised audits.

Consent in children was included in the Safeguarding children level 3 training, which 85% of eligible staff had completed. This included understanding Gillick competency and children between the ages of 16-17 years of age. Gillick competency must be considered when offering treatment to children less than 16 years old to decide whether a child is mature enough to make decisions about their own care.

Staff we spoke with were aware of Mental Health Act (1983) holding power and section 136 requirements. Section 136 is an emergency power which allows patients to be taken to a place of safety from a public place, if the police considered the patient was suffering from mental illness and in need of immediate care. Police officers would ride with ambulance crews in these situations.

All operational frontline staff received training in end-of-life care which included do not attempt cardiopulmonary resuscitation (DNACPR) and recommended summary plan for emergency care and treatment (RESPECT) before starting their role. Training would be revisited if there was a local need or was highlighted as an area to be included in the annual key skills training.