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.

At our last assessment we rated this key question requires improvement. At this assessment the rating has improved 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.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service carried out callbacks, a system where a clinician calls a patient back to conduct a further assessment for calls that are not immediately life-threatening. This process is part of the NHS Ambulance Response Programme, which aims to ensure the sickest patients receive the fastest response. Clinicians could cancel dispatched ambulances if their assessment indicated patients did not need this type of help. This was classified as ‘hear and treat’, an NHS ambulance service model where trained clinicians provide expert advice and direct patients to the most appropriate care (like pharmacy, GP, or self-care) instead of dispatching an ambulance. From June 2025 to November 2025 the service’s ‘hear and treat’ rates were on average 15.4%, compared to the national average of 17.7%. Leaders told us they planned to improve this by increasing clinicians’ callbacks per hour.

Clinicians could also upgrade the category of a dispatch; for example, if they felt the patient needed more urgent help, clinicians could request a higher category dispatch.

Most clinical staff had previous experience working in urgent and emergency care prior to joining the service. All clinicians were registered with their relevant professional regulator, such as the Nursing and Midwifery Council or the Health and Care Professions Council.

The service used to conduct welfare calls to patients waiting for an ambulance to ensure patients were safe whilst waiting. However, in 2023 the service carried out a quality improvement project, looking at data relating to these welfare calls to understand the impact they had on patient safety. The review showed welfare calls required a lot of clinicians’ time and did not impact significantly on ambulance responses being changed. As a result, the service now sent welfare text messages to patients who experienced extended delays to category 2 responses (category 2 relates to a high level of urgency but it is not immediately life-threatening). This ensured they continually monitored potentially vulnerable patients and allowed them to advise patients what to do if their condition worsened.

The service managed repeat frequent callers, who often had complex unmet physical, mental health, or social care needs. Each Emergency Operations Centre (EOC) had a dedicated frequent caller practitioner who identified and managed these patients. Personalised care plans were developed in collaboration with mental health services, safeguarding, and the legal team where required. Patients were flagged on the electronic clinical pathway system so call handlers could respond in line with the agreed plan, ensuring consistency and appropriate use of emergency resources. Frequent caller practitioners also participated in a national ambulance frequent caller group to share learning and best practice.

Staff knew what to do if patients had communication difficulties or if English was not their first language. The service had access to an online interpreting service, which could be accessed immediately. Interpreters could be patched into a live call to help. If a suitable interpreter was not available, staff used carers or relatives to help. This is not usually recommended; however, in this type of emergency service, it would be more important to get the right help to a patient. Any time staff had difficulty getting a suitable interpreter, they reported it as an incident. All computers could link with hearing aids. Staff had regular training sessions and workshops in relation to people with a learning disability people living with dementia and people who may lack mental capacity. Staff compliance with learning disability training was 91%, people living with dementia training at 87%, and mental capacity training was 77.8%.

We scored the service as 3. The evidence showed a good standard. 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. Leaders had developed clinical guidelines and policies used in the service in line with national guidance. Staff accessed policies and protocols on the trust’s intranet. We reviewed a range of policies and found them to be in date, appropriately ratified and reviewed within the last 12 months, with clear future review dates noted. This demonstrated effective oversight and document control.

The service conducted regular call handling audits across all staff groups, using a combination of retrospective and live calls. Each staff role had a set number of audits per month; for example, emergency medical advisors (EMAs) completed 3 to 5 audits, depending on factors such as past performance and length of service. Audits assessed themes including call control, skilled questioning, active listening, and provision of information and advice. Staff were rated as fully achieving, partially achieving, or not achieving their target, with a pass mark of 86%. Feedback was provided by supervisors or auditors following each audit. The audit team also carried out live audits, observing calls whilst they were still in progress, to assess performance in real time and give immediate feedback.The quality improvement team reviewed audit outcomes, including pass rates, to ensure the process remained effective. We reviewed 17 audits and found them fully completed, with clear comments explaining ratings.

Clinical leads reviewed Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidance and ensured they discussed any new guidance in the trust’s professional practice group. Staff in the Emergency Operations Centre (EOC) received updates to guidance as and when required. For example, the National Institute for Health and Care Excellence (NICE) published updated head injury coagulation guidance. Clinical leads reviewed this, discussed it at the professional practice group and implemented updated key skills training to EOC staff in a timely manner.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people.

We observed good interactions between teams and staff. It was evident everybody’s focus was on ensuring patients received the best and most efficient care. We observed positive and effective working relationships between the different professionals. For example, dispatchers communicated with ambulance crews in a friendly and professional manner. Emergency Operations Centre (EOC) staff treated helicopter emergency medical services (HEMS) staff as part of the team even though they were employed by a different provider.

The provider had a clearly mapped meeting structure, outlining how information from each meeting fed into other meetings right up to the executive management board level. Staff at all levels attended meetings regularly, both clinical and non-clinical.

The service worked with many teams and professionals, both internally and externally. Internally, the provider had clear structures for how teams worked together to provide the most efficient and safe patient care. Staff knew who to contact if they needed support. For example, call handlers had immediate access to their team leaders who were always based in the same pod area. We saw this worked effectively and seamlessly. Staff felt they had good working relationships with their colleagues across the EOC.

Externally, staff had direct access to many other professional groups, for example, the police, fire and rescue service, coastguard, and air traffic control and operational management at Gatwick airport. Staff accessed via a one-click function within the system, supporting timely multi-agency coordination. The service also hosted staff from the HEMS. HEMS staff were not employed by SECAmb but based themselves in the EOC. Working alongside critical care paramedics who, in turn, supported dispatch decisions and provided specialist clinical advice to crews managing complex or high-acuity incidents. This arrangement strengthened real-time clinical oversight and multi-agency collaboration.

The trust had established effective working relationships with the clinical authors and technical digital staff from NHS England who provided NHS Pathways used within the EOC. NHS England issued 4 updates to the tool each year. Managers told us the trust was a lead contributor to its ongoing development, ensuring operational insight from the EOC informed system improvements.

Some members of staff worked remotely. The service ensured home-based workers received the appropriate equipment to work effectively and safely, including computers, screens, and telephones.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service continuously monitored their performance through audit and national benchmarking. This ensured services worked within their key performance indicators and had plans to review and improve performance where needed.

The audit team compiled trends from call audits. They reported on these on a regular basis, both to management and executive level and to Emergency Operations Centre (EOC) teams. The provider had a Clinical Audit and Quality subgroup (CAQSG) who met monthly to discuss audit activity across the trust, extending beyond the EOC.

The service followed the national Ambulance Quality Indicators (AQIs). These were introduced in April 2011 for all ambulance services in England andlook at the quality of care provided as well as the speed of response to patients.

The provider reported on their performance compared to other ambulance providers. For example, the national average of call response times for 999 calls in England stood at 3 to 4 seconds. SECAmb’s average from June to November 2025 was 3.4 seconds.

The service had a patient pathways project plan. This showed current performance and ambitions for the financial year ahead. For example, the service aimed to improve internal productivity: in the financial year 2024 to 2025, clinicians made 1 call per hour following initial triage. The aim for the financial year 2025 to 2026 was to increase this to 1.5 to 2 calls per hour.

Data we reviewed, and conversations held during the inspection showed the trust aimed to achieve the best results they could in a pressurised environment. We saw evidence of continuous monitoring of EOC performance and plans for improvement and, ultimately, better patient outcomes and experience.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood their role and responsibilities regarding the Mental Capacity Act (MCA) (2005). They understood the importance of consent when speaking with or delivering care to patients. Staff always assumed patients had capacity to speak with them or to make decisions unless they found evidence to suggest otherwise. If needed, staff spoke with people accompanying a patient to get the most important information and to arrange help where needed. If staff noted a patient did not have the mental capacity to consent, they acted in the person’s best interests at the time of the call. They documented this in the electronic patient record.

Non-clinical staff did not conduct mental capacity assessments whilst on a call with a patient. If non-clinical staff had reason to question a patient’s capacity, they either escalated this to a clinician within the EOC or they communicated this to the crew via dispatch, in order that the crew could assess whilst onsite.

Staff received MCA training as part of their annual key skills. During our inspection we joined part of a mental health training session, which was informative and well received by staff. At the time of inspection, the compliance with this training for EOC staff was 85%.