South East Coast Ambulance Service NHS Foundation Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question requires improvement. At this assessment the rating has improved to good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people.

SECAmb had a clear organisational vision, which was underpinned by a 5-year strategy. The strategy was developed through engagement with staff, members of the public and stakeholders. It focused on delivering high quality care to people, ensuring a positive experience for patients, and being a sustainable partner within an integrated NHS. The trust’s core values prioritised kindness, courage and integrity.

Leaders ensured they shared the vision and strategy with staff in various ways. They ran forums for staff, carried out visits across the organisation, and communicated internally through bulletins, the intranet, and digital messaging.

Staff understood the trust’s vision to transform patient care by delivering a prompt, standardised service within the Emergency Operations Centre (EOC) and beyond. Staff demonstrated kindness and courage during the calls we listened to, in situations that were clearly stressful and emotive.

In the previous inspection in 2022, inspectors identified significant concerns around the culture within the EOC. In addition, several staff members raised concerns about cultural issues with the Freedom to Speak Up Guardian. As a result, the trust arranged for an external consultancy company to carry out an independent culture review. This led to a culture change project. The provider set up an EOC Culture Change Group, attended by unions, other directorates, and staff from both EOCs. The trust set clear actions, timelines, and responsibilities to improve the culture within the EOC. During 2025, sickness and turnover rates had levelled out and were in line with the service’s target. The number of cases where staff reported experiencing detriment because of speaking up reduced by 70% year on year.

We spoke with several members of staff, and the majority felt the culture had improved and “was going in the right way”. We heard staff felt safe and worked in an environment which was respectful, open and honest, and supportive. We heard leaders now listened more and staff felt safe to talk openly about work issues. The trust had established a culture forum, which staff from all levels of seniority attended. The service’s Freedom to Speak Up Guardian also attended this meeting.

However, some staff told us they continued to feel the culture in the organisation needed improvement. Some clinical and non-clinical staff raised concerns about a disconnect between leaders and frontline staff.

We reviewed the results of staff surveys from 2024 for both EOCs, which showed an improvement in most areas. There appeared to be a cultural difference between the 2 EOCs. The staff survey for the West EOC (Crawley) showed improvement across all areas, whereas the results for the East EOC showed an increase in staff reporting discrimination and feeling they were not listened to. For example, one of the staff survey questions asked whether staff felt they had a voice that counted. In the 2024 survey, this had decreased by one point in the East EOC. Compared to the trust as a whole, this was also one point below the overall average. Staff survey results showed an improvement around sexual safety and from 2023 to 2024. In 2023, 12.1% of staff stated they had been the target of unwanted behaviour of a sexual nature from colleagues. In 2024, this had reduced to 5.7%.

Although we still saw pockets of dissatisfaction, it was clear the provider had worked and continued to work hard to improve the culture of the EOC. For example, in March 2025, East EOC staff designed an East EOC staff charter, which outlined the standards of behaviour staff expected from each other. The service had established a staff forum where staff could meet to share thoughts, ideas, and concerns.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The trust had an organisational structure with clearly defined roles and responsibilities.

Leaders knew and understood the organisation well. We spoke with many leaders across the Emergency Operations Centres (EOCs) who clearly had the skills, knowledge and experience to lead effectively. The trust had undergone significant organisational change, including an executive leadership restructure, the development of a transformation programme, and the introduction of a new trust strategy for 2024 to 2029. Leaders understood the impact of change on their teams and the need to balance this with the organisational goals.

Leaders understood the pace of change could be difficult for staff. They had an open door policy and proactively sought and welcomed feedback from their teams. We spoke with staff who had left the organisation and then returned. They described how the organisation now had leaders who genuinely wanted to support their teams through the improvement journey.

Leaders were visible and approachable across the organisation. They attended many meetings, such as the culture forum. One staff member told us they could “email their leader anytime, day or night” and another leader was “very receptive and visible”. Another staff member named a particular leader who “knows everyone by name and attends every induction and always makes a point of saying hello to people they meet as they go around the EOC”. We heard many staff say organisational culture was “going in the right direction” compared to how it used to be.

We heard conflicting feedback around opportunities for progression. Some staff told us they did not have any opportunities for moving into more senior roles. Others told us routes for progression existed and staff received regular emails about job opportunities.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff knew how to raise concerns with team leaders, senior staff and with the Freedom to Speak Up (FTSU) team. The provider had an up-to-date Freedom to Speak Up policy, which aligned to the national policy. This clearly outlined how staff could speak up internally and externally. Internally, the trust had a Freedom To Speak Up team.

The Freedom To Speak Up Guardian co-chaired the National Ambulance Network for Freedom To Speak Up, which gave them insight into what was going on nationally and to share with and learn from other service’s experiences. We heard current leaders, including the CEO, helped to embed a culture of speaking up across the organisation. The CEO was described as “clearly not just paying lip service to Freedom To Speak Up, and they’ve made all the difference, not just for our organisation but for other organisations too”.

The Freedom To Speak Up team collected and analysed data from concerns raised by staff. They provided a bi-annual report to the trust board, which included themes from the data collected. We reviewed the most recent report, which showed SECAmb ranked second to top out of all ambulance trusts for year-on-year improvement in Freedom To Speak Up scores. The Freedom To Speak Up team told us they tried to triangulate data from human resources, such as reasons for people leaving, sickness data, and incident data. This was to ensure they did not just look at Freedom To Speak Up concerns in isolation but to get a more holistic picture of staff issues.

Staff at the trust attended a 2-yearly mandatory training session on speaking up. As of June 2025, 78.5% of staff across the trust had completed this training. In their report to the board the Freedom To Speak Up team highlighted the importance of training, especially for managers, to ensure they knew how to handle concerns and manage expectations.

Following the previous inspection, the trust invested more time and funds in speaking up. Staff gave mixed feedback about their experience of speaking up. Whilst some staff said they felt comfortable speaking up and leaders acted on this, others felt they were not listened to and leaders did not act.

In the year 2024 to 2025 the Freedom To Speak Up team received 297 concerns, 71 of which had been raised by EOC staff (23.9%). The 3 main themes identified from EOC concerns included relationships and behaviours, systems, and staff safety/wellbeing.

While there continued to be dissatisfaction amongst staff about speaking up, data analysed by the Freedom To Speak Up team showed a positive cultural shift overall. The staff survey results showed that in 2024 SECAmb ranked second to top out of all ambulance trusts for year-on-year improvement in Freedom To Speak Up scores, with a 4% overall increase. Furthermore, SECAmb remained above the benchmark for key measures such as feeling safe to speak up about anything (58% versus a 54% national average) and security in raising concerns about unsafe clinical practice (69%, equal to the benchmark best).

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The trust clearly focused on and valued equality, diversity and inclusion (EDI) in their workforce. The current focus was on 4 areas in particular: staff networks, inclusive recruitment, staff development, and data insights.

The trust had numerous initiatives to ensure EDI remained part of the workforce agenda. These included a working parent support café, a neurodiversity café, a menopause policy, men’s health hubs, the LGBTQI+ network, race network, and an impairment inclusivity meeting. SECAmb had adopted a wellbeing strategy spanning 5 years to support employees wellbeing and mental health.

The provider had EDI champions across the trust. Although the Emergency Operations Centres (EOCs) did not have their own named EDI champion, the trust EDI team ensured they had continued oversight of the EOCs. They did this through various routes, such as the staff culture forum.

The trust allowed flexible working arrangements to suit staff’s needs. For example, some EOC staff worked from home due to personal circumstances. They received the electronic equipment they needed to carry out their work and accessed the same internal or external support as their colleagues working in the EOC.

The trust put reasonable adjustments in place where needed. For example, they had adjusted shelves in accessible toilets for people using wheelchairs; replaced handrails with required colour contrast for people with visual impairment; added anti-slip stair nosing essential for reducing the risk of slips, trips, and falls. Within the automated staff break system, the provider also allowed for some flexibility, but staff had to check with their leaders before changing their allocated breaks.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate. However, the risk register did not always reflect current risk.

The trust understood the importance of having a clear and structured governance framework. It had a system of processes and procedures to ensure continuous improvement and development across the Emergency Operations Centres (EOCs), including clinical and non-clinical services. The provider had clear lines of accountability to ensure complete oversight of the service. There was a clear framework of what must be discussed at each level in team meetings; for example, learning from incidents and complaints, risk, audits, and patient feedback. At each level the trust had governance groups in place with regular meetings taking place. Minutes and outcomes of these meetings reached the executive management board through a governance mapping process.

The trust had produced a governance map, which showed a system of groups and subgroups and how they fed into each other to ensure information was shared and reached the executive management board. For example, the end-of-life oversight group shared information with the professional practice group, which reached the executive management board via the quality and clinical governance group. Leaders ensured they cascaded information back down to the EOC. All groups met regularly and produced minutes and action plans. We reviewed minutes from a variety of meetings. They contained actions or action trackers, discussion points, updates, data sets and attendees and their role. Minutes were well set out and identified areas for improvement.

The trust had a dedicated EOC practice development team responsible for all audit activity. Audits were a vital, continuous quality improvement process thatmeasures current healthcare practices against evidence-based standards to enhance patient outcomes. It identifies gaps in care, reduces risks, and ensures that services are effective, safe, and efficient.The team formed an integral part of the clinical governance framework. It consisted of 2 managers, one for each EOC, 4 clinical practice developers and 9 practice developers. The team also had support from a data analyst and a coordinator. The trust had an audit programme, and the practice development team produced regular reports for the board to keep them informed of developments or gaps. The trust’s clinical audit and quality subgroup meeting met monthly to discuss every live audit.

Staff attending the Clinical Audit and Quality Subgroup (CAQSG) meeting included senior figures, such as the Associate Director of Quality and Compliance, the Medical Director, and the EOC Practice Development Manager. We reviewed 3 sets of meeting minutes and presentations from the CAQSG, confirming in-depth discussions took place regarding clinical and non-clinical audit activity and any actions arising from these.

Audits formed part of the agenda for the monthly Quality and Clinical Governance Group. This assured discussions about audits took place in a variety of formats and across staff groups.

The trust had a dedicated head of risk responsible for oversight of the management of risk. The EOC business manager represented the directorate at the trust wide risk assurance group, coordinating the management and reporting of risk across the EOCs. We reviewed the service’s risk register, which clearly outlined and described risks, contained review dates, and had ratings associated with them. The trust had monthly governance group meetings in which staff discussed risks outstanding and actions needed. However, the risk register was not updated in real time. For example, we saw minutes from a quality and clinical governance group meeting, which indicated clinical supervision needed to be added to the risk register. This was not reflected in the risk register we reviewed as supervision did not form part of the register. We also heard from a member of staff about a concern of end-of-life flags not being uploaded to the care records in good time. They told us this was on the risk register; however, when we reviewed the risk register, this risk was not identified.

The trust had business continuity plans for both EOCs, which set out their approach to emergency preparedness, resilience and response (EPRR). Continuity plans had been aligned to national NHS England requirements, and the UK Resilience Framework. The plans provided a clear governance framework for managing, escalating and responding to business continuity incidents, for example, loss of power, or telephone failure. Leaders reviewed plans regularly to ensure they remained current, compliant, and reflective of emerging risks, learning and operational changes.

The trust engaged openly with external stakeholders, such as the CQC. They consistently submitted information as needed by the legal requirements, for example, certain changes, events and incidents that affected their service or the people who used it.

The provider had set up a monthly inquest forum, which was chaired by the legal department. This group met to discuss and learn from any deaths which had gone through an inquest with the coroner’s office.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborate for improvement.

The service understood the importance of working in partnership with external stakeholders and the public. They used patient, public, and system partner voices to help plan their service, their priorities, and their strategy. The service had positive and collaborative relationships with external partners, which supported effective care provision, service development and joined-up working.

The service engaged well with their commissioners. They attended meetings with commissioners to share insights from patient, public, and staff feedback, and ensured this was aligned with the service’s strategy and national requirements. We observed part of an online stakeholder meeting attended by leaders from the Emergency Operations Centre (EOC) and the commissioners. Interactions at the meeting demonstrated effective communication and working between services.

The service collaborated with care homes to provide education and training aimed at reducing unnecessary hospital conveyances. Following a small number of incidents involving prisons, the service worked with local prison staff to clarify and standardise the terminology used when calling 999 for assistance, supporting safer and more effective responses.

The service worked closely with other ambulance trusts across the country to share developments and best practice. Clinical leads visited other ambulance services as part of this relationship.

The service had a variety of initiatives to engage with the public. This included several patient forums and focus groups. Themes, trends, and direct quotes from these sessions directly guided strategic objectives. The provider also gathered feedback through face-to-face surveys during public events, or online surveys. It was clear the service valued feedback from the public to shape and improve the service and culture. SECAmb had a patient experience team whose responsibility included gathering and analysing data from patients and translating this into meaningful actions.

SECAmb was in the process of introducing patient safety partners during 2026 to 2027. Patient safety partners are a key NHS England initiative involving patients, carers, and laypeople in improving safety by collaborating with staff on governance, incident reviews, and service design.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery.

The service used quality improvement projects (QIPs) as a structured approach to identify areas for development, implement change, and measure the impact of interventions, supporting continuous learning, improvement and innovation. For example, the service was currently in the process of trialling a new bespoke healthcare AI tool, to help increase clinicians’ time with patients during calls. The tool had been designed to listen and create notes automatically.

The trust worked with another ambulance provider to look at vehicle tracking technology and how this could potentially be used to keep patients informed of how soon help would be with them, if being responded to by a neighbouring ambulance service.

Emergency Operations Centre (EOC) staff awaited the introduction of a video link option, which would enable real-time, face-to-face communication with patients. This technology would allow staff to visually assess conditions such as facial weakness or rashes, supporting more accurate triage and clinical decision-making. We heard this technology was ready to use soon.