South East Coast Ambulance Service NHS Foundation Trust

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

We assessed a total of 6 quality statements from this key question.

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

At this inspection the rating has changed to good.

This meant people’s needs were met through good organisation and delivery.

This service scored 67 (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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff always prioritised the individual patient’s needs, preferences and values throughout their care journey. They explained when entering a patient’s home, they had to be mindful of cultural sensitivities to ensure respectful and effective care. This included respecting religious or cultural practices regarding modesty or physical contact. For example, staff received training and had guidance to ensure culturally sensitive end-of-life care. This involved being aware of how different beliefs impacted the handling of the body and the grieving process.

Staff explained the importance of listening and giving patients their full attention to understand the reason for requesting an ambulance, and took their concerns, symptoms and preferences seriously. When appropriate, ambulance crews would acknowledge and respect the patient’s choice regarding their care, including the right to refuse treatment. Staff talked about a collaborative process between themselves and the patient regarding care, treatment and the best course of action.

Staff explained about adapting their communication style depending on the patient's condition, for example using simple or age-appropriate language. They knew to explain procedures and options in a way the patient could understand. They had access to interpretation services, and aids on their electronic hand devices to support effective communication, including pain assessments for adults, child and those with learning disabilities. Crews also received training on how to communicate with more complex patients, such as people with learning disabilities.

When appropriate, crews involved the patient's family and friends in the decision-making process, providing emotional support and information. Ambulance crews were given training on Lasting Powers of Attorney (for health and welfare) to understand who had legal authority to make decisions about treatment when the patient lacked capacity.

The service made sure people receive care and treatment from services that understand the diverse health and social care needs of their local communities.

The service knew it needed to work closely with other healthcare providers to be able to deliver safe, effective and timely care to the community it served. SECAmb covered a large area and had to work with many different healthcare providers and systems, meaning clinical pathways differed across their geography. Staff had access via their electronic mobile devices to make sure they conveyed the patient to the most appropriate care setting. The service worked continuously with their partners to develop effective pathways to help elevate pressures at hospital emergency departments and to make sure patients were taken to the most appropriate place to continue their care.

The service integrated with other health and emergency services to deliver collaborative, coordinated care. This included the integrated care hubs where paramedics worked alongside clinicians from other health services and community specialists to provide advice to ambulance crews to help prevent unnecessary emergency department admissions by directing patients to more appropriate service, and the joint response unit, where vehicles are by a police officer and a paramedic, allowing a coordinated response to incidents requiring both medical and law enforcement input, for example assaults, road collisions and alcohol-related incidents.

A range of systems supported continuity of care, helping ensure patients experienced a seamless transition between services. Call handlers passed essential information to responding crews before they arrived on scene, allowing them to prepare effectively. Paramedics could access GP records when needed to view medical histories, medication lists, and allergy information at the patient’s side. Crews were also able to alert receiving services in advance, enabling specialist teams to be ready and initiate time-critical treatment.

The service worked well with their local healthcare communities however, due to high demand and increasing pressures on the health and social care system, ambulance response times had fallen below optimal levels and were not always meeting agreed national targets. Prolonged delays in handing over patients at hospitals further compromised ambulance crews’ ability to respond to new emergencies in the community.

The service provided information about its urgent and emergency care through its website and a range of public-facing channels. The service had planned improvements to develop more accessible resources.

The service reported that its primary method of ongoing public engagement was through digital platforms, including social media channels. These platforms were used to share service updates, public health messages and guidance on accessing urgent and emergency care, and to respond directly to public queries.

The trust’s website contained information about the services it provides and how to access urgent and emergency care. The website included an accessibility statement explaining how people could request information in alternative formats, such as different languages or braille. However, during the inspection some accessibility features were not fully functional, including a non‑working language tab, and it was not always clear at point of use how people would be made aware that alternative formats were available.

The service used posters as a key communication tool to share important information with the public. These posters aimed to raise awareness about when it was appropriate to call 999, inform people about available healthcare services, and promote targeted health campaigns. Many of these messages were also displayed on the ambulances themselves, helping to extend their reach and visibility within the community.

The service had an active digital presence and used social media platforms to communicate with the public, respond to queries and share service updates. The service reported high levels of engagement through these platforms and described the use of accessibility features such as subtitles and image descriptions.

The service told us the patient experience questionnaire, which collected feedback on people’s experiences of using the service, was available in different formats on request, including braille and various languages. Although processes were in place, we did not see clear evidence of how these options were routinely promoted to people using the service.

The service described workshops, groups, and ongoing projects aimed at developing and co-producing a range of accessible resources to better support people with additional communication needs, and to meet accessibility standards. At the time of the inspection, these resources were not yet available.

Staff received information governance training and patient information was stored securely using electronic systems with individual logins. Although the trust had identified and responded to information governance risks, compliance with mandatory information governance and data security training was below the trust’s target at the time of inspection, with improvement actions in progress.

Staff had received training on the General Data Protection Regulation (GDPR). Patient records were stored on a secure electronic system that staff accessed using individual logins. During our visits, we saw GDPR reminder posters displayed at some ambulance bases. These had been introduced after issues were identified, such as staff not signing out at the end of their shifts. Information governance and data security were included in the trust’s mandatory training programme. Compliance with this training was 60%, which did not meet the trust target of 85%. However, the trust had improvement actions and a clear plan in place for meeting the target.

The service had taken positive steps to strengthen public and patient engagement, with clear plans to expand this further. However, the new initiatives were at an early stage and their impact had yet to be fully realised.

The service had taken positive steps to strengthen public and patient engagement, including developing a patient and public engagement strategy (2020–2025). During this period, it had introduced a patient experience questionnaire for urgent and emergency service users; established a community forum to gather feedback; and implemented patient experience stickers in ambulances to make it easier for patients and families to share their views. The questionnaire had been made available online through the trust's website. These engagement measures were monitored to demonstrate impact, for example increasing patient experience questionnaires from 13 to 115 per month, an increase of 784%.

Following consultation with stakeholders, an external research team, staff, and the public, the service had launched a new five-year patient and public engagement strategy in June 2025. This had built on previous work by identifying strengths and areas for improvement. The new strategy included plans to increase the service’s presence at community events, create additional avenues for patients and the public to share feedback about the urgent and emergency services and to work with diverse patient groups to adapt and evolve services. The service had developed a plan outlining what should be achieved each year.

The service demonstrated strong foundations and a clear strategic approach to improving equity of access. However, there was limited evidence provided to demonstrate the impact of these initiatives.

Equity in access to emergency care meant that all individuals, irrespective of their socioeconomic status, ethnicity, disability, location, or any other characteristic, had the same opportunity to access timely and appropriate emergency healthcare services. This involved addressing barriers to access and ensuring fair treatment for all patients.

The trust had introduced a local operating model across Kent, Surrey and Sussex to support better joined‑up working for patients and improve equity of access by aligning services more closely to local population needs. This approach aimed to ensure consistent specialist care across the region while allowing services to be adapted locally to reflect differences in geography, deprivation and population health needs. Also to support closer working with local integrated care systems and partners. The divisional model had been introduced in 2025 and was therefore still at an early stage of development at the time of inspection. While the intent of the model was clear and governance arrangements were being put in place, at the time of the inspection evidence of measurable improvements in impact, equity of access or outcomes were limited.

The service was available 24 hours a day all year round and saw people regardless of residency status.

The service measured equity in access by analysing data such as complaints, incidents, utilisation, wait times, and patient outcomes to identify and address disparities. The service worked to national operational targets and assessed its performance against those. However, due to high service demand, delayed hospital handovers and a reduced fleet, national targets had not been met.

The service recognised that some communities were less likely to access emergency services due to factors such as cultural beliefs, language barriers, or a lack of awareness. In response, the service had started planning ways to engage with the seldom heard groups within the local communities. This included running a health inequalities workshop to capture the good practice happening across the SECAmb region and the gaps that needed to be addressed. This information was to be used to form an action plan across emergency and urgent care services.

The service had developed new operating models to address identified gaps in access to care, including the introduction of an Adult Critical Care Transfer Service to support timely access to specialist care for critically ill patients requiring inter‑hospital transfer.

The service used a population health needs assessment–driven strategy to design services around different population needs, with differentiated models of care to move away from a one-size-fits-all approach. Service redesign and partnership working aimed to address regional access gaps and reduce inequalities. However, the service did not provide clear outcome data to show reduced inequalities, such as improved access for specific groups or areas, or evidence of how underserved groups (for example, deprived communities, ethnic minorities, or digitally excluded patients) had benefited. There was limited evidence that these changes had led to more equal access or outcomes, rather than improvements in structure or process alone.

Ambulance vehicles were equipped with ramps, powered stretchers and securement systems to accommodate patients in wheelchairs and on stretchers. The service used specialist equipment such as high weight-bearing stretchers to ensure that bariatric patients could be safely and comfortably accommodated. This commitment to inclusive care helped ensure that all individuals, regardless of their physical needs, could access the service with dignity and safety.

The patient and public engagement 5- year strategy mapped out how health inequalities and equity in access were to be addressed over the next 5 years which included making information available in accessible formats, widening outreach, and targeting underserved groups in the community. In addition, the service had plans to disaggregate patient experience and outcome data by socio-economic status, ethnicity, and geographic area, to highlight variation and drive targeted improvement.

The service was currently focusing on equity of access among two priorities groups, maternity and mental health and this was in line with the CORE20 Plus5 national approach, which was looking to reduce healthcare inequalities at both national and system level. The approach defined a target population (the 20% most deprived of the national population) and identified 5 key clinical areas where inequality is most pronounced thereby requiring accelerated improvement. The service had already looked at CORE20Plus5 children’s asthma priority. Two new workstreams had been set up to look at pain management and ethnicity coding in pregnancy and excluding physical health problems in perceived mental health presentations.

The service used data and analysis to identify inequities in patients' experience and outcomes to make sure people’s care, treatment and support promoted equality.

The service was working to understand the diversity of populations across its patch and how people accessed services.

Patient feedback was gathered through surveys, complaints, and incident reports to assess satisfaction levels and identify areas where patient experience and outcomes could be improved. This information was used to inform service improvements and enhance the quality of care delivered.

The service used performance data to monitor key areas such as response times, clinical care quality, patient experience, and the effectiveness of interventions to know how the service was performing and where improvements needed to be made.

The models of care work the service had undertaken in April 2025 corroborated information to understand where inequities existed. This enabled the service to move away from a ‘one size fits all’ approach and instead tailor service delivery and workforce planning to the needs of specific population groups. There was a focus on delivering timely interaction and equitable outcomes.

The service prioritised three key patient groups: patients experiencing falls, frailty and older people; patients receiving palliative and end of life care; and patients experiencing reversible cardiac arrest. The service used data from multiple sources to identify inequities in care. For example, analysis demonstrated that care home residents who had fallen experienced slower response times compared with older people living in the community.In response, the service implemented the Care Home Collaborative Programme. Post-implementation data demonstrated improved equity of response, with vulnerable older people in care home settings receiving a faster response.