West Midlands Ambulance Service University NHS Foundation Trust

Updated 23 February 2024

West Midlands Ambulance Service University NHS Foundation Trust serves a population of around 5.6 million people. It operates in an area covering 5,000m² in the counties of Shropshire, Staffordshire, Herefordshire, Worcestershire, and Warwickshire. This includes Coventry, Birmingham, and the Black Country conurbation.

The service provides a 999 emergency ambulance response from 15 operational hubs across the region with a fleet of around 460 ambulances. In partnership with 2 local mental health trusts, the ambulance service operates mental health triage cars to help patients in crisis. The trust has 2 emergency operations centres (EOCs) taking and managing around 4,000 999 calls each day. One EOC is at Brierley Hill, alongside trust headquarters, and the other at Tollgate in Staffordshire.

The trust also provides patient transport services (PTS) for non-medical emergencies and completes around a million trips each year for patients in Birmingham, the Black Country, Coventry and Warwickshire, Cheshire, and Wirral. The service operates around 350 PTS vehicles and coordinates activity from dedicated control rooms.

The trust contacts with and commissions with 5 air ambulances run by independent charitable trusts, operates a Hazardous Area Response Team (HART), works with voluntary organisations, such as BASICS doctors, and has a network of around 750 community first responders.

The service employs around 6,800 staff, which reduced from around 7,600 the previous year after changes in service delivery (including the 111-contract moving to a new provider).

We carried out this inspection, with the core services announced on the morning of that visit, as part of our continual checks on the safety and quality of healthcare services. At our last inspection we rated the trust overall as outstanding.

On this inspection we covered the well-led key question for the trust overall which was announced to coincide with our inspection of the core services.

We inspected 2 core services – EOC and Emergency and Urgent Care (or frontline emergency operations). We did not inspect Resilience (which includes the HART teams) or PTS on this occasion.

Updated 23 February 2024

Updated 25 January 2017

Overall, we rated resilience planning within WMAS as outstanding because:

• Resilience planning and services in the trust were based on National Guidance provided in the Civil Contingencies Act, Department of Health, NHS England, the National Ambulance Resilience Unit (NARU) and the Joint Emergency Services Interoperability Programme (JESIP).

• Performance showed an excellent track record and steady improvements in safety. When an adverse incident occurs, an appropriate thorough review or investigation involved all relevant staff and people who used services.

• Lessons were learned and communicated widely to support improvement in other areas as well as services that were directly affected. Opportunities to learn from external safety events were also identified. Improvements to safety were made and the resulting changes were monitored.

• Staff had received up-to-date training in all safety systems.

• Staffing levels and skill mix were well-planned, implemented and reviewed to keep people safe at all times.

• Risks to safety from service developments, anticipated changes in demand and disruption were assessed, planned for and managed effectively. Robust plans were in place to respond to emergencies and major situations. All relevant parties understood their role and the plans were rigorously tested and reviewed.

• All staff were actively engaged in activities to monitor and improve quality and outcomes. Opportunities to participate in benchmarking, peer review, accreditation and research were proactively pursued. Credible external bodies recognised high performance.

• The continuing development of staff skills, competence and knowledge was recognised as being integral to ensuring high-quality care. Staff were proactively supported to acquire new skills and share best practice.

• The systems to manage and share the information that was needed to deliver effective care were fully integrated and provide real-time information across teams and services. People’s individual needs and preferences were central to the planning and delivery of tailored services. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs. The services were flexible, provided choice and ensured continuity of care.

• The involvement of other organisations and the local community was integral to how services were planned and ensured that services met people’s needs. A systematic approach was taken to working with other organisations to improve care outcomes, tackle health inequalities and obtain best value for money.

• Governance and performance management arrangements were extremely well embedded proactively reviewed and reflected best practice.

• The leadership drives continuous improvement and staff were accountable for delivering change.

Updated 22 August 2019

Our rating of this service improved. We rated it as good because:

• During our last inspection we found that mandatory training compliance was in breach of the Health and Social Care Act regulations. During this inspection we found that the service provided mandatory training in key skills to all staff and made sure everyone completed it.
• During our last inspection we found the storage of medicines was in breach of the Health and Social Care Act regulations. Systems and processes to safely administer, record and store medicines were in place. During this inspection we found that the service used medical gases only.
• Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
• The service mostly controlled infection risk well. Staff used equipment to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. However not all vehicles we saw during inspection were visibly clean and this was not consistently monitored. This was rectified post inspection.
• The design and use of facilities, premises, vehicles and equipment kept people safe. Staff managed clinical waste well.
• Staff completed and updated risk assessments for each patient and removed or minimised risks.
• The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed staffing levels and skill mix.
• Staff kept records of patients’ care and treatment. Records were clear, up-to-date, stored securely and available to all staff providing care.
• The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team, the wider service and partner organisations. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
• The service mostly provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients subject to the Mental Health Act 1983.
• The service did not routinely carry or use any pain-relieving medication. However, some high dependency vehicles were equipped with medical gases used to relieve pain.
• The service monitored response times. They used the findings to make improvements and achieved good outcomes for patients.
• The service made sure staff were competent for their roles. Managers appraised staffs’ work performance. This was an improvement noted since our last inspection.
• All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.
• Staff supported patients to lead healthier lives. Staff encouraged patients to attend important medical appointments.
• Staff supported patients to make informed decisions about their transport. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• Staff provided emotional support to patients, families and carers to minimise their distress.
• Staff supported and involved patients, families and carers to decisions about their care during transport.
• The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
• The service was inclusive and took account of patients’ individual needs and preferences. The service made reasonable adjustments to help patients access services.
• People could access the service when they needed it, in line with key performance indicators.
• The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff, including those in partner organisations.
• Managers at all levels in the service had the right skills and abilities to run a service providing sustainable care.
• The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in care would flourish.
• The service had good systems to identify risks, plan to eliminate or reduce them.
• The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
• The service engaged well with patients, staff and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.
• The service was committed to improving services by learning from when things went well or wrong, promoting training and better ways of working.
• Following our inspection, we highlighted areas of improvement to the trust. The trust responded positively and developed action plans to rectify concerns.

However, we also found areas for improvement:

• We found that staff did not receive any feedback or confirmation following the report of a safeguarding concern.
• We found some equipment had incorrect servicing dates on it. This was rectified post inspection.
• Not all vehicles we saw during inspection were visibly clean and this was not consistently monitored. This was rectified post inspection.
• Staff told us risk assessments undertaken by booking staff did not always provide sufficient information to keep patients safe. We saw this was a concern raised in the previous inspection; particularly in relation to working with patients who had mental health diagnoses.
• New trust guidance issued to staff regarding patients with an active ‘do not attempt cardio pulmonary resuscitation’ was not fully compliant to national best practice guidelines.
• A small number of staff told us they had received some training on sepsis, but they would not know how to identify this in a patient.
• Following our inspection, we found that the trust had recorded five incidents involving taxi drivers. Only one of these had been directly reported by the taxi driver or firm involved. A protocol was in place for taxi firms to use to report incidents; however, we were concerned that not all drivers and firms were adhering to this. However, we did see some shared learning following one incident about ensuring all incidents are reported to WMAS. In addition, we noted an incident that occurred post our inspection was directly reported by the taxi driver; and was investigated thoroughly.
• A small number of staff within a specific team did not feel supported.
• We saw team meetings were recorded and information was disseminated inconsistently between teams.
• Not all identified risks were formally recorded on the risk register.

Updated 23 February 2024