South Central 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. We checked whether staff felt able to speak up, and that leaders had the knowledge and experience to drive the service. We found communication was not always consistent or given in a timely way. Staff had not ‘bought into’ the transformation process. Senior leaders were aware of this and had plans to improve the culture that was impacted by the transformation. This was impacted by structural changes within the department, as well as future planning.

We assessed 7 out of 7 quality statements.

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

This service scored 57 (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 shared vision, strategy and culture. The managerial team and staff fully supported the vision and strategy of the service. However, staff advised us that specific details were not always effectively shared with teams.

The Fit for the Future programme had five programmes and seven pillars and this had developed into Fit for the Future five strategic themes, Enabling Services; Digital Transformation; Clinical Effectiveness;People and Culture; Partnerships and Sustainability. Each programme had a clear pathway and provided focus for managers as well as oversight. The Clinical Effectiveness programme's operations function split tasks into tiers, based on impact, Tier one projects included a Category 2 improvement programme, with the aim of reducing Category 2 response times by reducing task time, including hospital hand over times, improving vehicle availability, reviewing the response model and reducing demand via telephone clinical triage.

Staff advised us they understood the reasoning for the transformation, but were impacted by ‘change fatigue’. For example, the contracts for both sites where the EOCs were based were due to expire in the next few years. This meant it was likely the service was going to move to a different location. The senior leadership team were unable to share the specifics, in line with the Royal Institute of British Architects (RIBA) guidelines. Senior leaders arranged engagement events to ensure staff consultation. However, staff we spoke with advised us this had taken an enormous emotional toll on them, as well as impacting their ability to move and buy homes, as they were unsure where their job would be located.

A service, and its staff had recently moved from South Central Ambulance Service to another provider. Staff across the EOC stated they felt the strain of this move and were worried about their own jobs.

As part of the transformation process, the trust was completing a financial review that included potential redundancies. At the time of assessment, the corporate team review had completed, however the operational review was yet to proceed. Operational staff we spoke with were aware of the upcoming changes and were nervous about their potential impact. Staff within corporate services described the stress related to being categorised as an ‘at risk’ team, worrying about the risk of redundancy, and the preparations they made to re-interview for their jobs. However, many staff advised us that natural attrition meant staffing numbers had reduced, meaning their team was no longer at risk and “the stress was all for nothing”. Staff at both sites said the methods and communication for the review were poor and they were hoping lessons were learned prior to the operational review commencing.

The service held several staff engagement events to give staff the opportunity to discuss their thoughts and worries regarding the transformation programme. Although the trust, provided evidence they had consultations with the education team regarding leadership. Staff in the education team advised us they were told their team was not part of the transformation plans for the upcoming year. Therefore, they did not attend the engagement events. Two staff advised us they later found out their team was a part of upcoming plans; however, they had missed their opportunity to join the event.

Managers advised us they were introducing staff polls to determine whether the pace of change was appropriate. However, all the above had impacted staff morale and this was reflected in the most recent NHS Staff Survey results completed in October 2024.

Not all leaders embodied the culture and values of their workforce and organisation.

Non-clinical teams advised us they struggled to get managers onboard with new ideas and ways of working. Staff advised us that in pockets of the service there was a resistance to change from the leadership team, and this impacted on staffs’ ability to do their role. Staff in IT advised us they raised concerns regarding a lack of a document library at their weekly team meetings. This meant there was no official policy, process or procedure for responding to a wide range of service-related risks. However, managers did not provide the resources to complete this project. Therefore, staff were compiling documents themselves, ad hoc around their usual duties.

The education team was previously overseen by a head of department, a manager and a team leader. At the time of assessment, one member of staff was covering all three roles with support from an assistant, who did not have an educational background. Therefore, the team were not getting the support, challenge and oversight they would have from three separate managers.

At the time of assessment, the executive team were looking into ways of improving their visibility. The chief executive currently worked ad hoc shifts with crews; however, he was looking at widening his footprint to include the EOC service.

We observed there was a display showing photographs of managers, details of names and positions and lines of responsibility. This ensured staff knew who was leading each team that day and who to escalate concerns to.

Managers used notice boards and email bulletins to communicate changes with staff. The exec team also published a weekly ‘topical’ message on the service’s intranet.

Staff we spoke with were complimentary of their team leaders, control duty managers and shift managers. Staff were especially complimentary of the Head of EOC and the Head of Call Centres.

Most staff felt that they could speak up, however, there were mixed opinions as to whether action would be taken.

The service was previously in breach of the legal regulation in relation to good governance. This was regarding listening to staff concerns and demonstrating action against bullying, harassment and sexually inappropriate behaviour. Improvements were found at this assessment regarding the service’s approach to preventing harassment and sexually inappropriate behaviors. Senior managers had completed an annual review of trust oversight of Freedom to Speak Up that included an action plan for the upcoming year. This was focused on bringing staff onboard, improving trust in senior managers and developing a specific Freedom to Speak Up Policy, a Reflection and Planning Tool, and including Speak Up training as part of the mandatory training catalogue.

The service was focused on reviewing inappropriate behaviours and sexual safety, including a specific sexual safety training for managers. Senior managers met the Freedom to Speak Up Team monthly and reviewed and developed values around behaviours. Managers had also developed a performance and accountability framework, which was to be included as part of transformation work on people and culture.

Whilst the service had made many improvements, we found staff were not yet assured that they would be listened to, or that speaking up would lead to change. Therefore, there was still work to be done in supporting staff to ‘buy in’ to the culture change.

Staff we spoke with knew who the Freedom to Speak Up Officers were at their locations.

Staff in support roles at both sites stated they still found it difficult to speak up, and that suggestions for change were looked upon by their managers as complaints rather than recommendations for improvement.

The service valued diversity in their workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

The trust had an Equality, Diversity and Inclusion (EDI) Lead who produced an annual report of staff diversity and the work of the EDI networks. All staff support networks were active and each had a sponsor who was part of the executive team. Staff were supported to attend PRIDE events, and the Women’s Network was involved in the trust’s review of behaviours, especially around sexual safety.

All staff we spoke with were extremely proud to work for the trust. They were passionate about their work and wanted to provide a good service to the public.

We observed that the workforce at both sites were inclusive and people with protected characteristics were supported to work onsite. We noted an office desk located in an easy access area that had a bed nearby for a guide dog. Staff on both sites had access to disabled parking and lifts for employees with mobility issues.

All recruitment processes were anonymised, this ensured bias did not sway managers, supported staff with protected characteristics and ensured staff with the most appropriate qualifications and experience were recruited.

Staff completed a monthly survey, which enabled senior managers to understand and review issues from a staff point of view. Current staff also completed stay interviews with their team leaders. This gave staff the opportunity to state why they remained in their role, what they would change, whether they needed reasonable adjustments (employers must make reasonable adjustments to make sure workers with disabilities or health conditions are not substantially disadvantaged), and discussions regarding how they liked to be managed. Staff advised us they appreciated these opportunities as they felt very passionate about their jobs and the importance of the service.

Not all areas of the service had clear responsibilities, roles, systems of accountability or evidenced good governance.

The service was in breach of the legal regulation relating to governance as there was a lack of oversight of non-clinical services.

Reviews of IT tickets were undertaken on a daily, weekly and monthly basis by the Head of Service Desk. KPI’s are presented at the Digital Steering Group (bi-monthly) and reviewed with the stakeholders. However, none of the IT staff we spoke with were aware of this analysis and stated they did not known what themes were coming out of ticket analysis. Therefore, there was a disconnect between managers and staff.

Staff in the IT department advised us there was no formal system for managing IT issues out of hours. Staff stated they added their names to a contact list, and were unaware of a hierarchy or pathway for escalation of issues and concerns. The trust submitted evidence to us demonstrating the IT out of hours was part of the formal on call 24/7 rota, with escalations to the Silver, Gold and Duty Directors as needed.There was a formal incident management, group chat to alert and engage on issues and a daily report was presented to IT managers detailing themes from the last 24hrs. Again, all IT staff we spoke with were unaware of this system and was a further example of poor communication between managers and staff.

There was no decommissioning process for either IT systems or equipment. An official process would ensure the secure disposal of equipment, protect data and sensitive information, as well as ensuring compliance with regulatory requirements. Therefore, the service could not guarantee the safe disposal of IT equipment and its contents.

‘Support’ service reviews were reactive rather than proactive. For example, managers commissioned the development of a software approval process, when they determined the service did not have one. However, this did not trigger a full review of whether there were other gaps in their oversight of the service.

The audit department had a separate team who reviewed clinical audits with the education team, including the auditing of call compliance. We found whilst there were formal standardised processes for reviewing and marking calls. We were given examples where staff opinion differed as to whether the audit was a pass or fail, therefore the outcome of an audit depended on opinion rather than process, meant there was a risk of inconsistencies across the service, which could also impact call handler’s pathway license.

the Director of Clinical Coordination Centres had monthly meetings to review performance, as well as catch up calls with their Executive Director, 3 times a week.

The senior management team including the Head of EOC and Head of Call Centres had formal weekly meetings to review performance, as well as catch up calls with their director, 3 times a week.

A member of the board was the lead on quality governance. A monthly trust level performance report had service input. This was reviewed by the Trust Board. The service now used the findings from these committees to produce a monthly performance report that was reviewed by the board.

Managers received governance and risk assessment training to support them in ensuring consistency on how to report risks, complete a thorough investigation, and write reports for example coroners reports.

The trust developed a performance and accountability framework for managers to follow.Team leaders escalated risks in their monthly operational meetings with the head of EOC and head of call centres, who would then escalate to the divisional clinical governance meeting. Any risks that needed further escalation were reported to the governance lead who sat on the board.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. Staff shared information and learning with partners and collaborated for improvement.

The service had national contingency plans and systems with other trusts, including NHS trusts in case of external events, for example a national disaster or terror attack. There were also clear plans in place, including roles and responsibilities to support internal services in case of a targeted attack, power outage, phone outage etc. The service had an in date IT Major incident policy which was aligned to NHS Emergency Preparedness, Resilience and Response (EPRR). However, all staff we spoke with in the IT department were unaware of the document and advised us they had no process to follow in the event of an emergency.Therefore, staff awareness and understanding of the policies did not provide sufficient assurance that staff would act in accordance with them.

Managers advised us they had worked hard to improve relationships with partners, especially those who also worked onsite. For example, the Helicopter Emergency Medical Service. Managers arranged regular engagement meetings and worked with another air ambulance service to implement a common model of partnership working.

The service was focused on continuous learning and improvement. However, there were some areas where managers were not supporting innovative approaches to learning.

Staff told us they were involved in changes to practice, learning and improvement. For example, a crew was delayed in attending to a patient as they struggled to gain access to the building where the patient was injured. In response to this incident, the EOC team developed a tool to notify crews if there were concerns or issues with access to a particular address. This enabled staff to inform the crew of how-to best gain entry. The service audited that this initiative reduced delays in accessing addresses during future attendances.

The service’s education initiative programmes were not always followed through. Staff advised us projects were abruptly ended; however, they did not receive any reasoning behind the decision to stop.

Targets for the education department were based on statistics for training completion, rather than evidence of quality improvement. Staff in the education advised us that when they suggested introducing new methods, training and scenarios, they did not feel they had managerial support to implement this. However, the trust followed the NHS Pathways training programme.

We observed the service had ‘You said, We did’ boards where staff made suggestions for service improvement and managers stated what they had done in response. Staff we spoke with said they were encouraged to write on it.

Operational staff at both sites advised us they were encouraged to raise any issues or concerns with their managers.

Managers had also developed a Virtual Care Improvement Steering Group consists of seven work streams that detail the improvement work going across EOC and 111.