South East Coast Ambulance Service NHS Foundation Trust

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

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

We assessed all 8 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 were safe and protected from harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had processes to collect data from various sources, including performance and outcome data, inquests and claims, and feedback from patients and staff. There were policies, procedures and meetings to interrogate and investigate data. The results were used to actively learn from findings and drive continuous improvement, and implement changes in practices to improve safety, care and outcomes for patients. For example, the managing seizures on scene review.

Staff were encouraged to raise concerns and report incidents and near misses in line with trust policies. Staff told us they knew how to raise concerns and could give examples when they had.

Between Sept 2024 and August 2025 March 2025 there had been 4089 incidents reported in the service. Most of these incidents (82%) were rated as no harm. A further 14% were rated as low harm, meaning minimal harm where the patient required extra observation or minor treatment. Moderate harm accounted for 1.4% of incidents, involving short-term harm where the patient required further treatment or a procedure. Severe harm was reported in 0.7% of cases and involved permanent or long-term harm to the patient, and deaths accounted for 0.1% of incidents.

The incidents were categorised to see if there were any themes or trends, the top 5 themes were, delayed ambulance responses, mental health-related incidents, medication-related incidents, equipment and liaising with system partners. Incidents were reviewed and investigated according to the trust’s policy and processes and action taken if required.

The trust had implemented NHS England’s Patient Safety Incident Response Framework (PSIRF) in April 2024, which introduced a new approach to incident investigation with a stronger focus on learning and improving patient safety. There was good awareness of PSIRF among operational staff, most of whom were able to describe the updated processes for reviewing, categorising, and investigating incidents, whether by the patient safety oversight group or the local incident review group. Senior operational staff reported that this shift toward a learning focused approach was benefiting both patients and staff and was contributing to ongoing improvements in patient safety. There was no mandatory training requirements for patients safety for staff, however, training was available for staff if required in their job role.

Learning and improvement actions arising from incidents were shared with staff in a variety of formats, including clinical bulletins, short videos, staff meetings, information screens in the operation hubs and face-to-face training sessions focused on key skills. In addition, each hub had an assigned member of the education team, ensuring that any further training prompted by incidents was easily accessible and readily available to staff.

The service used complaint data to drive service improvement. Between September 2024 and August 2025, a total of 839 formal complaints were received. The main themes related to patient care, staff conduct, and professional clinical concerns. Complaints identified as potential patient safety concerns were investigated by the patient safety team. Those not deemed safety-related were reviewed by the patient experience team or investigated locally by operational teams. The service used complaint data to drive service improvement. For example, a patient with haemophilia who was taken to their local emergency department before subsequently transferred to a specialist hospital. The crew received feedback on the importance of contacting the patient’s haemophilia centre or an advanced paramedic practitioner for telephone advice or shared decision-making regarding the most appropriate destination. The wider learning related to a 2024 Joint Royal Colleges Ambulance Liaison Committee (JRCALC) update on conditions requiring specific prehospital clinical management, which included advice on administering tranexamic acid for haemophilia. This guidance did not align with the trust’s patient group direction for administrating tranexamic acid, and the issue was therefore escalated to the medicines team for review.

Learning and improvement actions stemming from complaints varied depending on the investigation route. Complaints managed by the patient safety or patient experience teams had their learning shared in a similar manner to incident-related learning. Locally investigated complaints were typically overseen by team leaders, who were responsible for sharing relevant learning with their teams where appropriate. Most team leaders reported feeling adequately trained to facilitate these discussions and support staff learning.

Compliment data was captured on the incident reporting system, and this was also seen as a way to highlight good care, share good practice, and to acknowledge when staff had performed well. Between Sept 2024 and Sept 2025, the trust had received 1993 formal compliments. Managers review this information regularly and discuss it during weekly team meetings to highlight examples of excellence and recognise good practice. The communications team also used compliments and messages of thanks to produce internal and external media stories, helping to celebrate achievements and promote practices that could be shared more widely in the service to support continuous improvement and high-quality patient care.

Staff understood duty of candour and said they were open and transparent and gave patients and families a full explanation if and when things went wrong. The service used an ‘open and honesty’ tracker to log incidents which required duty of candour and to monitor required steps such as verbal and written apologies, to document communication, and generate reports for regulatory bodies and internal review. These tools helped the service manage compliance and promote transparency in patient safety.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Ambulance crews reported they were briefed by call handlers before reaching a patient, which included key details such as the patient’s age, presenting symptoms, and the urgency of the call. This information enabled crews to prepare appropriately and deliver efficient, targeted care on arrival.

Upon reaching the scene, crews followed established clinical guidelines and applied their professional expertise to assess the patient and determine the most suitable course of action. This structured approach, combining systematic assessment, clinical judgment, and informed decision-making, helped prioritise patients effectively and ensured they were directed to the most appropriate level of care, optimising health outcomes.

Staff had access to support and advice from a range of healthcare professionals to help manage patients safely. This included utilising the urgent and emergency care (UEC) hubs, which were staffed by advanced paramedic practitioners and clinicians from the local healthcare community, as well as accessing GPs and patients’ medical records. Crews spoke highly of the UEC hubs and the decision-making support they provided, noting that this input enhanced patient safety.

However, there had recently been a reduction in the number of clinicians available in the hubs, as partner organisations were withdrawing their funding. Crews expressed disappointment about this development, emphasising that the clinicians were a valuable resource in delivering safe, effective and timely support to patients.

Ambulance crews used clinical pathways for patients’ onward care and treatment. Clinical pathways were available for ambulance crews on their electronic mobile device. SECAmb and the local healthcare community were developing pathways to help alleviate pressures at hospital emergency departments and to make sure patients were receiving timely access to the appropriate care. These included same day emergency care (SDEC) units in hospitals and single point of access (SPOA) in the community, who could provide rapid coordination of community services to meet a person’s urgent need. However, the service did not provide data to show the effectiveness of these pathways in reducing transfers to emergency departments.

Ambulance crews continuously monitored patients during transfer to hospital, enabling early detection of any deterioration and supporting informed decisions about treatment en route. This on-going assessment also allowed crews to communicate effectively with the receiving hospital staff, providing a clear picture of the patient’s clinical trajectory and ensuring a smooth, well-informed handover on arrival. The level and intensity of monitoring were determined by the patient’s condition and the severity of their illness or injury.

The service also had a team of critical care paramedics who were able to provide advanced life-support interventions and enhanced monitoring for patients with life-threatening conditions during transfer.

Ambulance crews had systems in place to pre-alert the receiving emergency department about the patient’s arrival. This included sharing of systems that tracked the ambulances and their estimated arrival time. Crews could also call ahead to inform them about a critically ill or rapidly deteriorating patient who was en route. This allowed the emergency department to prepare for the patient's arrival by freeing up resources, getting specialist staff ready, and potentially initiating time-critical treatment.

On arrival to hospital, ambulance crews handed over patients and their care to hospital staff in a thorough and structured process that involved verbal feedback and an electronic report. This process ensured a smooth transition of care, accurate information transfer, and patient safety. We observed handovers and all were carried out to a high standard. Feedback from the receiving hospitals was positive.

National guideline and best practice state ambulance handovers should be within 15 minutes of arrival of the ambulance to the receiving hospital. However, it is recognised that handover delays across the country are significant due to system pressures across the health and social care landscape. Whilst not always hitting this target, SECAmb were performing well when benchmarked against other ambulance trusts. From Sept 2024 until August 2025 SECAmb, when handover data was averaged across the footprint, showed 46% of patients had a handover within 15 minutes, 87% of patients within 30 minutes and 99% within 1hour. Performance varied across the SECAmb footprint depending on the local system pressures. For example, Medway crews achieved a 71% handover rate within 15 minutes, whereas Banstead crews achieved 29%. Until handover occurred ambulance crews were responsible for monitoring the patient. SECAmb continued to work with healthcare partners to reduce delays, recognising that prolonged handovers delays could negatively impact patient safety by delaying and reducing ambulance availability within the community.

The service employed advanced paramedic practitioners (AAP) who were able to self-allocate jobs to themselves and monitored the list of outstanding category 3 (urgent) calls. They could call patients back, refer to different healthcare agencies or upgrade or downgrade the urgency category of patients. AAPs were able to use their clinical judgement to make clinical decisions rather than following care pathways.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The service had well-defined and easily accessible policies and procedures for safeguarding, ensuring staff knew how to identify, report and respond to potential concerns. Staff understood their role and responsibilities in protecting patients from abuse, could give examples of when they had made a safeguarding referral, and explained the process of doing so via their electronic patient record (EPR). There were back up procedures in place in case of technical failures with the EPR. There was mixed views from teams about the feedback they received after making a safeguarding referral from the centralised safeguarding team, with some saying they could get feedback and others saying they did not.

Safeguarding was part of the staff induction and mandatory training. All members of staff and volunteers working in the service were required to undertake level 1 and 2 Adults and Children safeguarding training. All registrants, for example paramedics and registered nurses, were required to undertake level 3 adult and children safeguarding. Training records showed that 93% and 92% of staff had completed their level 1 and 2 adult and children’s safeguarding training respectively, and 85% of the required staff had completed their level 3 safeguarding training. This met the trust’s 85% completion training rate.

The trust had a centralised safeguarding team available 24hrs a day whom the service could contact for support and advice. This team actively engaged with frontline staff by attending operational meetings, conducting training and delivering a programme of safeguarding webinars to improve safe and effective safeguarding practices in the team. In some ambulance hubs we saw information on how staff could contact and engage with the safeguarding team.

The centralised team who worked in collaboration with system partners, such as local authorities and the police, throughout the SECAmb footprint to ensure vulnerable adults and children were protected from harm by information sharing, coordinating interventions and strategic planning. If required, information would be disseminated to the operational teams for action.

The service provided training in soft restraint as part of face-to-face conflict resolution training delivered by a third-party provider. This training included awareness of different types of restraint and the principles of using the least restrictive intervention. At the time of inspection, 74% of eligible staff had completed this training, which meant a quarter of eligible staff were yet to receive essential instruction on managing challenging or high-risk situations safely.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

When people called 999, they were assigned an urgency category based on their condition, which determined the type and time of the response from ambulances. These are category 1- calls from people with life- threatening illness or injuries, category 2- emergency calls, category 3- urgent calls and category 4 less urgent calls. These categories helped determine the appropriate response time and resources needed.

Crews were dispatched to emergencies by the emergency operations centre. On arrival ambulance crews used established guidelines and their own clinical expertise to evaluate the patient and determine the necessary course of action, to ensure that each patient received the most suitable and timely care, leading to the best possible health outcomes

The trust used volunteer community first responders (CFR) to respond to emergencies in their own communities. The CFR was able to relay patient information back to the clinical support desk in the emergency operations centre.

Staff completed dynamic risk assessments for each patient. These included moving and handling, violence and aggression and safeguarding.

Staff had access to clinical support desks, staffed by clinicians from partner organisations and advanced paramedics practitioners, if they required additional clinical guidance. The support provided included shared decision making, help with alternative care pathways, support to crews on scene, clinical referrals and patient follow ups and discharge advice.

Staff used the National Early Warning Score (NEWS2) tool to record and monitor patients’ physiological observations, supporting the early identification of any deterioration in a patient’s condition. Observations were documented in the electronic patient record. We requested audit results to demonstrate compliance with the use of NEWS2. The service provided audit data from 2021, which indicated that the tool was not being used in line with practice expected in an acute clinical setting. The audit made several recommendations, including a review of which observations should be undertaken by crews and how frequently these should be completed. Audit findings, including those related to recognising the deteriorating patient, were discussed at governance meetings and informed staff training in 2023. However, gaps in guidance remained. Meeting records from January 2023 highlighted ongoing uncertainty among staff regarding what constituted a full set of observations, when repeat observations should be undertaken, and expectations when handing over patients in emergency departments. Although there were plans to develop a best practice statement and further guidance, the trust did not demonstrate that this had been completed or implemented. The trust reported a mean compliance rate of 87% for NEWS2 within a sepsis audit between March 2022 and February 2024. However, the trust did not provide sufficient detail regarding the scope or methodology of this audit, and no additional audit data was available to provide assurance on wider NEWS2 compliance. As a result, the trust could not demonstrate how it was assured that patient monitoring was consistently effective or that deterioration was reliably identified and acted upon in a timely way. This presented a risk that changes in patients’ conditions may not be recognised promptly.

Where a patient’s condition deteriorated suddenly and the attending crew required additional support, a request was made via the emergency control centre, and an additional resource was dispatched urgently. Crews gave examples when they had requested the support of critical care paramedics to assist in managing complex or high-acuity situations.

When seriously ill or very unstable patients were conveyed to hospital, the crews could pre alert the hospital’s emergency department prior to their arrival. This ensured the patient could be transferred to the hospital’s care with the minimum of delay.

Patients arriving at the department by ambulance remained under the care of ambulance staff until they were formally handed over to hospital staff. A member of the ambulance crew stayed with the patient at all times and continued to monitor their observations. However, as no patient observation audit data was provided, we were unable to determine whether there was a formal or consistent approach to this monitoring.

When a clinical decision was made not to convey a patient to hospital, staff told us they provided advice tailored to the individual patient’s circumstances. This included guidance on monitoring symptoms, when to seek further medical help if symptoms worsened or new symptoms developed, and how to access alternative care options where appropriate.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

We inspected 15 ambulance resources centres across the SECAmb footprint. These varied in size and age. Some stations were small, housing only a few vehicles and staff, while others were larger, acting as operational hubs with extensive facilities and a larger workforce. Operational hubs had been thoughtfully designed with layouts that enhance staff experience of working there. For example, leadership offices visible at the front door with large windows which made the team feel connected and encouraged an open communication and the positive culture. Some stations had garages in which vehicles were stored when not in use. Other stations kept vehicles on forecourts either at the front or back of the premises. We visited 3 ambulance community response posts (ACRPs), which provided rest and welfare spaces for staff between emergency calls. These posts were strategically located, often with partners like local fire stations, so crews could stay nearby and respond quickly to emergencies.

All stations were secure, with entry doors requiring a staff pass to be able to access. This meant only authorised people could enter the station. Stations had CCTV cameras which monitored certain areas for security purposes. Station bases had staff locker facilities, showers, toilets and kitchen/mess areas available for staff to use. Facilities were clutter-free and clean.

Annual health and safety checks as per national guidance were carried out at stations by the health safety team. In addition, operational managers and operation unit managers would carry out station walkarounds to ensure a safe, compliant and operationally ready environment for staff and vehicles. Issues or potential issues would be flagged to the appropriate team, for example the estates team.

We inspected 15 ambulances across the SECAmb footprint. Vehicles had a standard layout for equipment and consumables which meant it was easy for crews to locate and access items quickly especially in an emergency. Consumables checked were in date.

Vehicles were variable in age and mileage, which was resulting in mechanical issues and vehicles being taken off road to repair. The service was in the process of replacing vehicles, as new vehicles arrived, older ones were being decommissioned, and this was lessening the issues that had been seen with an aging fleet.

The service had introduced 12 hours per day fleet provision at the larger operational hubs, allowing servicing and the majority of vehicle repairs to be completed on site. This initiative helped ensure vehicles could return to service more quickly, improving operational efficiency and response capacity. Some bigger repairs such as engine changes and bodywork repairs were completed by a third part.

All stations had make ready teams. These teams were responsible for ensuring ambulances and other emergency vehicles were cleaned, restocked with essential supplies and equipment, and fully operational before each shift. These teams were employed by a service partner but worked closely with SECAmb personnel. SECAmb employed make ready managers whose responsibility was to liaise with the service partner to ensure the smooth running of this part of the service. This included weekly and monthly meetings, the auditing of the service provided and making sure key performance indicators were met. SECAmb staff reported good working relationships with the make ready teams, with minimum issues, but when issues did arise they would be sorted quickly and efficiently. However, we were told vacancy rates in some of the make ready teams could impact on the availability of vehicles.

Equipment and consumables were stored appropriately. Equipment was available to meet patient needs, for example defibrillator and suction machines, and the emergency vehicle trolleys could carry patients with a high body mass index. All ambulances we inspected had harnesses, chairs, and trollies available for the safe transportation of patients, this included equipment for the safe transportation of children. Safety checks were performed on emergency equipment according to policy. Equipment was serviced, maintained and records kept ensuring quality of the service, with a central team being responsible for this. This included the calibration of blood glucose monitors in line with manufacturers guidelines. If issues were identified with equipment, such as items missing or not working staff would log these on the incident reporting system and they would be investigated. Main issues in 2025 had been related to pulse oximeters and equipment that required batteries. In addition, if incidents started to peak at certain locations the make ready managers would complete investigate if there were reasons for this and put in appropriate measures if needed.

The service made sure there were enough qualified, skilled and experienced staff. There were effective links between operational and educational teams which supported staff to receive the clinical training and guidance needed to deliver safe care that met patients’ needs. However, reported mandatory training and staff appraisals fell short of trust targets.

All staff with professional qualifications were subject to pre-employment checks to ensure their registration was active and unrestricted. New staff underwent a comprehensive induction programme tailored to their role, including both corporate and local orientation. This involved e-learning and face-to-face training, which staff reported as effective and supportive in preparing them for their responsibilities.

The service was staffed by an appropriate number of qualified, skilled, and experienced personnel. Sickness absence and staff turnover rates were 7% and 6% respectively. While the sickness rate was higher than the NHS national average, it was comparable to other NHS ambulance trusts, which typically report higher sickness levels than other NHS providers. Overall, the service’s sickness rate was in line with that of its peer group. The staff turnover rate was below the national average, demonstrating that the trust had been more successful than most in retaining its workforce. The service had operated under sustained pressure for the previous three years, predominantly at Resource Escalation Action Plan (REAP) level 3, reflecting a prolonged period of significant operational strain. Contributing factors to this elevated pressure included high demand, delayed hospital handovers, and a reduced ambulance fleet. Staff talked about workload pressures and stress and at times how this could impact on their ability to deliver the service.

Ambulance crews were composed of various roles, including paramedics, associate ambulance practitioners (AAP), emergency support workers associate emergency care assistants (ECSW), and specialist/advanced practitioners, working collaboratively within their clinical scope. Ambulance crews were staffed at different skill/qualification levels depending on workload, call severity, and resource availability. SECAmb used critical-care paramedics to respond to more serious emergencies requiring advanced clinical skills, including pre-hospital critical care and complex interventions.

Between September 2024 and August 2025, 3.8% of category 1 incidents and 11% of category 2 incidents were attended without a qualified paramedic as part of the responding crew. Although there was no national requirement for paramedic attendance at all category 1 or 2 calls and the service operated a clinically governed skill‑mix model with remote clinical support, the absence of a paramedic might have delayed access to advanced assessment or treatment in some cases. The trust described a range of governance and review processes to support safe decision-making. However, this did not fully demonstrate how the service routinely monitored and had oversight of the frequency and impact of incidents attended without a paramedic present.

Mandatory training was provided to staff with protected time for completion. The trust operated a rolling programme delivered through scheduled e‑learning days, which meant staff completed training at planned intervals throughout the year rather than simultaneously, resulting in varying levels of recorded compliance during the training cycle. Data available from the trust’s electronic staff record (ESR) system indicated that overall mandatory training compliance among operational staff was 81%, which remained below the trust target of 85% at the time of inspection. Based on ESR data, 10 of the 17 modules for registered clinicians and 9 of the 16 modules for non‑registered operational staff did not meet the trust target. Compliance was lowest for sexual safety at work (55%), infection prevention and control level 2 (58%), and information governance and data security (60%). In addition, the following modules were below the trust target: equality, diversity and human rights (77%), induction to the Mental Capacity Act (68%), learning disability and autism training (77%), and preventing radicalisation – basic Prevent awareness (75%). Mental health and end of life training were not classified as mandatory modules by the trust. The trust advised that while ESR data reflected recorded completion rates, delays in manually uploading completed training records meant that actual compliance was likely higher at the time of inspection. The trust also reported that, due to the structure of training delivery, there was still a significant proportion of the training cycle remaining to complete mandatory training. However, ESR data represented the trust’s official record of mandatory training compliance.

Emergency drivers received specific driver training, with additional support provided following incidents or concerns.

Crews were assigned to teams led by a team leader and each operational unit was supported by dedicated clinical educational practitioners, who acted as a conduit between training and operations. They delivered clinical education and training, including relevant trust clinical updates to operation staff to ensure clinical oversight and high standards of patient-centred care.

The clinical education practitioners delivered the formal key-skills programme for operational staff. Attendance at the programme was mandatory, and compliance was routinely monitored and recorded. The programme agenda was developed annually through collaboration between the education and operational leadership teams. It incorporated both refresher training in essential skills and new learning arising from patient-safety incidents, clinical developments, or changes to national guidance. They also provided clinical supervision, mentorship, and professional development to newly qualified paramedics (NQPs). NQPs felt well-supported by both their operational team leaders and the clinical education practitioners. The NQPs acted as a third crew members until their competencies were signed off. Their clinical practice was monitored two years post sign off. SECAmb also supported student paramedics through an apprenticeship model, which was positively received.

Ambulance staff had recently been offered access to a newly launched clinical supervision programme, designed to provide structured, supportive opportunities for professional reflection and development. The programme enabled operational staff to discuss their clinical work, reflect on their practice in a safe and confidential environment, and further develop their skills and competence with the aim of improving patient care. The model incorporated protected time for reflection on both positive experiences and challenging aspects of the role, supporting staff to enhance their personal and professional capability. As the programme was newly implemented, it was too early to assess its impact on the quality of patient care or clinical outcomes.

At the time of inspection, data indicated that 74% of operational staff had completed annual appraisals, with variation across the service, with the highest-performing operational unit achieving 93%, and the lowest 57%. Further information from the trust reported a technical limitation with the ESR system. Appraisals not fully submitted remained recorded as in progress despite substantive completion. This may have resulted in an underreporting of appraisal compliance. Updated information provided by the trust indicated that, when combining completed and in-progress appraisals, overall compliance was approximately 83–84%, with 10 weeks remaining in the appraisal cycle. However, the service was unable to retrospectively confirm the precise position at the time of inspection due to changes in data capture methodology. Additional data submitted also showed higher compliance in some staff groups, including critical care paramedics (over 93%), which had not been included in the original dataset. While updated information suggested higher performance than initially reported, compliance had not yet consistently met the trust’s 85% target across all operational areas.

Appraisals included a review of performance and training needs with the operational team leader (OTL), and incorporated an observational ride-out, during which staff were observed carrying out their operational duties. OTLs told us they often undertook more than one ride-out with team members, as they viewed this as a valuable way to monitor standards, provide feedback, and check in on the individual’s wellbeing. Where performance concerns were identified, OTLs worked collaboratively with clinical education practitioners to develop targeted performance-improvement plans.

The service assessed and managed the risk of infection. However, lapses in vehicle cleanliness and the discontinuation of deep cleaning without risk assessment could impact infection prevention and control assurance.

SECAmb had a dedicated infection, prevention and control (IPC) team that worked to prevent and reduced healthcare-associated infections. Their work involved assessing risks, auditing practices and providing the service with infection prevention guidance.

All ambulance stations and operation hubs we inspected were visibly clean and had suitable furnishings which were clean and well-maintained. Cleaning equipment was mostly stored securely in locked cupboards according to UK regulations control of substance hazardous to health. Cleaning records were up-to-date and showed that all bases were cleaned regularly.

The make ready teams were responsible for the cleaning of vehicles and equipment, and the storage of equipment and consumables. We inspected 15 ambulances across the SECAmb footprint. Two thirds of the vehicles were visibly clean, and equipped with visibly clean equipment, clean and available linen, hand gel, personal protective equipment (PPE) such as aprons and gloves, and decontamination wipes. However, accumulated dirt was seen on 5 of the vehicles, including dirt on vehicle entry steps, on stretchers and inside cupboards. On one vehicle, the stretcher had visible traces of blood, indicating a lapse in cleaning standards.

Routine ambulance cleaning between patients remained the responsibility of frontline crews. We observed crews cleaning equipment, including stretchers, outside emergency departments before attending their next patient. Suitable clinical waste bags for infectious waste were available on all vehicles.

In December 2024, the service piloted a reduced cleaning process, referred to as a winter pressure clean, which later became standard practice and renamed essential cleans. Under this model, vehicles received a full make-ready clean every 24 hours rather than after every shift. Between full cleans, the make ready team carried out an interim stock check and wipe-down clean. At the same time, the service, suspended its programme of deep cleaning, which had previously taken place every 12 weeks. These revised cleaning arrangements had become business as usual and remained in operation at the time of the inspection.

The IPC team monitored the impact of the revised cleaning regime using specialised swab tests to measure surface cleanliness. The IPC team told us their data indicated a decline in cleanliness standards; however, results remained within acceptable tolerance levels.

Crews told us that if a vehicle became heavily contaminated, they would return to base so the vehicle could be taken out of service and cleaned. Data received following the inspection confirmed that no deep cleans had been undertaken since their removal in December 2024.

Ambulance crews attending emergency departments were bare below the elbow and wore the correct personal protective equipment (PPE), including masks and gloves, at appropriate times. Staff generally demonstrated good hand hygiene practice in line with national guidance. The infection prevention and control (IPC) team regularly audited hand hygiene compliance and were actively involved in staff training to promote the importance of good hand hygiene for patient safety and staff health and wellbeing.

Staff maintained the cleanliness of their own uniform as per trust policy and explained if their uniform became severely soiled or contaminated it would be disposed of in the appropriate waste bin and a replacement requested.

The service, alongside the IPC team, operated a vaccination programme, including the annual influenza vaccine, to protect staff and reduce the spread of infectious diseases within the workplace and the wider community. Data for 2024/2025 showed that 74% of frontline staff with direct patient contact had received the influenza vaccine. This was the highest uptake of all ambulance trusts in England for that period. In comparison, the average uptake across all NHS staff nationally was 38%.

Staff disposed of clinical waste safely, with clinical waste being stored and collected at the stations. Sharp bins were used on the vehicles to safely dispose of needles, syringes and other sharp medical instruments. These were found to be dated and used appropriately.

The service used audits to monitor and improve compliance with infection prevention and control (IPC) standards. This included audits of hand hygiene, use of personal protective equipment (PPE), and premises cleaning standards. Where issues were identified, actions were recommended with clear timeframes for completion, followed by re-audits to ensure that improvements had been achieved.

Data reviewed for July–Sept 2025 showed audits had been completed and action plans implemented. For example, poor compliance with eye protection when there was a risk of splashes from blood or body fluids was identified. Further investigation showed the available eye protection was not suitable for staff needs, and a more appropriate type of eye protection was subsequently procured. A re-audit was planned to assess whether compliance improved following this change.

The service made sure that medicines and treatments are safe and met people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

Medicines were stored securely. All medicines, including controlled drugs, were centrally purchased. Color-coded tamper evident medicine bags were prepacked centrally. These bags and other medicines were distributed via a top-up service. However, we found that a small number of medicine bags were not appropriately tagged. These bags had the minimum quantities of medicines; hence, this did not impact patient care. There was an effective process in place to collect used bags and replace them with replenished sealed bags. The replenished sealed medicine bags were kept in automated storage units. Entry was restricted to authorised staff members, and access to the automated storage systems themselves was managed through biometric fingerprint identification. Ambulance staff were responsible for ensuring the correct medicines were on the vehicle before they started their shift. Medicine storage areas were temperature monitored and were within the required temperature ranges.

Medicines and medical gases storage facilities on ambulances were secure. There were medical gas storage areas at each station. These were well maintained, ventilated and secure.

Blood glucose monitors were quality checked as per the manufacturer’s instructions to ensure they provided accurate readings.

Staff adhered to established protocols and procedures to ensure the safe prescribing and administration of medicines. The use of handheld mobile devices enabled staff to accurately document all medicines administered to patients.

Ambulance staff followed trust policies, national guidance, and used handheld devices to access patient group directions (PGDs). PGDs enabled paramedics to administer a wider range of medicines based on their role, training, and competency. PGDs are written instructions for named healthcare professionals (like paramedics or nurses) to supply or administer specific medicines to patients who fit defined criteria, without a doctor's prescription for each patient.

Medicines and equipment alerts were centrally received, reviewed, and acted on, and information was shared with staff via newsletters and clinical briefings. There was an electronic system to report and investigate medicines related errors. Incidents were investigated, and learning was shared across the trust. Medicines management audits were carried out regularly to identify gaps, and actions were derived to make improvements.