Annual Report 2025-26

A Message from the Chairman

As a parent, the one thing you always do is try and protect your children. Being Chairman of the Trust is in some ways quite similar! Hear me out; you are there to look after the organisation but are not involved in the day to day running of the Trust. In the same way as seeing your child go through tough times can be upsetting, it is similar being the Chair. I am lucky enough to get to spend lots of time out and about with staff across our organisation and hearing about and seeing the challenges they face can be really hard. I spent New Year’s Eve out on the frontline and it was a difficult shift, not just for the patients we came across, but also the challenges our staff face every day.

Our Trust Board has spent a lot of time listening to staff talk about the impact of hospital handover delays on their lives – work and home. Our People Committee, which reports directly to the Trust Board, held an in depth session looking at how the lost hours outside hospitals impacts staff. Occupational stress and organisational culture are both highlighted as significant issues on the Board Assurance Framework (BAF) which identifies significant risks to the Trust strategic objectives. Members also heard about initiatives having a positive impact, such as:

• Work around sexual safety including modules in the mandatory workbook.
• Improvements in Freedom to Speak Up (FTSU) processes and confidential reporting.
• Results that show the “Say Thank You” app is improving staff morale.

As a Trust, we continue to do all we can to address these issues and provide a positive work environment, as supporting staff remains a top priority for the Trust. The work we are doing is clearly having an impact as the latest data shows that we now have the lowest turnover in staff (5.2%) for the last two years. It is also worth noting that the comparable national average in the ambulance sector is 9.6% and 12.1% in the NHS as a whole. While this is clearly good news, we feel there is more that we can do to support staff and I am excited to see us continuing to move forwards over the coming months.

One of the things that I have always noted with our staff is how embarrassed they are when people say ‘thank you’ to them. If you ask any of them, they will tell you that they come to work to help people in their hour of need and that is all the thanks they need. However, getting thanked is something many will have to get used to as the latest figures show that the number of compliments received in 2025-26 hit a new record with over 3,000 received. What this demonstrates is the amazing work being undertaken by staff in every corner of the Trust and the impact it is having on our patients. If you consider people generally call us on the worst day of their lives, the fact that they take the time to email, write or post on social media to say thank you is really quite humbling.

One of the highlights of my year is the annual awards ceremonies for both staff and volunteers. If ever there was a time to have your faith in humanity renewed, this is it. Approximately 700 guests attended the events this year where we heard many tales of people going above and beyond what would normally be expected, as well as recognising long service. The ceremonies are an opportunity for us all to say a big ‘thank you’ for all that our staff and volunteers do every single day when treating patients, protecting the public and saving as many lives as possible.

While it is often easy to only think about our staff when it comes to the care we provide, it is important that we also remind ourselves about the small army of people who give freely of their time to support us. As part of Volunteers’ Week we were proud to shine a spotlight on the hundreds of incredible people who use their skills and compassion to support patients, communities and colleagues across the West Midlands.

From Community First Responders and BASICS doctors to Patient Transport Service volunteer drivers, each play a vital role. But volunteering doesn’t stop at the frontline. Many staff take on voluntary roles within the Trust like Staff Advice and Liaison Service (SALS) advisors, Mental Health First Aiders, staff champions and Freedom to Speak Up ambassadors, helping to create a healthier, more inclusive workplace. Our chaplains offer invaluable spiritual support and let’s not forget our public and staff governors who volunteer to help shape the direction and future of the Trust. I also want to acknowledge the many staff who undertake voluntary work outside of WMAS, whether that’s as special constables, St John Ambulance medics or other voluntary positions.

The last year has seen the Trust and its staff receive recognition from a number of external organisations, which I wanted to highlight. The first is sadly not something I would like to see repeated as it marks the ultimate sacrifice of staff whilst at work. Long serving paramedic Jack Daw and student paramedic Tammy Minshell were among 106 public servants who were recognised in the second ever Elizabeth Emblem List, which recognises public servants who lost their lives as a result of their duty. Both passed away after incidents on the roads over the last few years. While at very different points in their careers, both were people who loved their jobs and gave so much to others.

In more positive news, two members of staff have been recognised in the Birthday and New Year’s Honours. Our former Medical Director, Dr Alison Walker, has been honoured for her 30-year service to the ambulance sector, receiving the King’s Ambulance Medal. Meanwhile, a member of the Trust’s Ceremonial Unit has received his British Empire Medal (BEM) following a 40-year career of dedication to the ambulance service. Carl Ledbury is also a trustee of The Ambulance Service Charity TASC.

Brilliant – it’s a word often overused, but it was one that was used very regularly when the Trust welcomed OFSTED (Office for Standards in Education, Children’s Services and Skills) inspectors to our Education and Training Academy. The visit wasn’t a formal one as it was a chance for the inspection team to test their assessment toolkit on a Trust where they already had good baseline data. They highlighted the quality of the teaching and how staff valued that. They also noted the investment in specialist equipment, simulation and the quality of the support available for students and mentors. The Education and Training Team also picked up two national awards: ‘Employer Provider of the Year for Registrations’ and the ‘Supporting Apprenticeship Success’ award from FutureQuals. It is a real recognition of both the team and the Trust in how it manages its many apprenticeships.

In WMAS we are very fortunate to have many veterans and current members of the armed forces working with us. It is therefore particularly pleasing to see that we have been re-awarded the Gold Award from the Defence Employer Recognition Scheme. This award recognises our commitment to supporting veterans, reservists and Cadet Force Adult Volunteers within the workplace.

The Service has once again been awarded Disability Confident Leader status, the highest level within the national scheme. This re-accreditation is recognition of the work we do every day to champion and support colleagues with disabilities, right from the recruitment stage through to career progression. The British Dyslexia Association has also awarded the Trust a silver Workplace Quality Mark in recognition of the hard work and dedication demonstrated in developing working practices that support dyslexic employees and enable them to thrive.

Finally, on behalf of the Board, I want to thank all of the staff, wherever they work in the organisation, for all that they have done during this last year. Whether on the frontline; staff within our patient transport service; control room; the likes of our mechanics, vehicle preparation teams and stores; the managers at all levels; and the corporate staff – thank you for everything you have and continue to do. Equally, my thanks to the many students and volunteers who also work with us. Together, your dedication to saving lives and helping people in their hour of need is second to none and I thank each and every one of you for what you have done over the last 12 months.

Prof. Ian Cumming OBE
Chair, West Midlands Ambulance Service University NHS Foundation Trust

Chief Executive’s Review 2025-26

I had dearly hoped that I could start with something new this year. For the past few annual reports I have commented about the issues we as a Trust and our patients have faced in relation to hospital handover delays. Sadly, at the risk of sounding like a broken record, this remains the biggest single issue that we as a Trust face, again.

When an ambulance arrives at hospital, our crews are supposed to be able to hand over to clinicians in the emergency department within a maximum of 15 minutes. In 2024-25, WMAS lost a staggering 381,000 hours over and above those 15 minutes! We thought that it couldn’t possibly get worse than that, but that is exactly what has happened. In 2025-26, that rose to just under 384,000 as many as London, North East, North West, South Central, South East Coast and Yorkshire combined! It is clear that the West Midlands is a complete outlier nationally. Our lost hours make up around a third of the national total! While these figures are deeply troubling, it must be remembered that we are actually performing at a really high level. For Category 2 calls, such as heart attacks and strokes, we have the second best performance in the country. Last year our mean performance was 29 minutes five seconds; this year we have been able to improve that substantially to 24 minutes 40 seconds, a remarkable achievement given the level of delays we have faced.

As a result of the hospital handover delays, the Trust faced difficult discussions with our commissioners about the level of funding required to mitigate the situation. We went through the process of contract dispute with the independent mediator accepting that there needed to be additional monies paid to the Trust. Unfortunately, despite us putting forward a very strong argument, they did not rule in our favour to the extent that we believed was required to ensure patient safety and end the toll that the delays have on staff and patients. I have always been clear that I don’t want additional money; I just want hospitals to release crews quickly. If that happens, then there would be no need for any additional funding and the stress that it has on staff would be reduced dramatically.

Another area that the Trust continues to be best in the country at is our Call Taking. The data from BT shows that we had fewer calls that took over 2 minutes to answer than every other Trust and that we answered calls faster than every other ambulance service, something that we can be truly proud of. We know that if we don’t answer the calls quickly we can’t help patients as quickly as they need. Last year, 2024-25, just 303 calls waited more than two minutes to be answered. This year that dropped to 77. To put it into context, across the ambulance sector 46,867 calls waited over two minutes to be answered, so WMAS made up just 0.16% of the total when we take roughly 10% of the calls.

Due to the hospital handover delays, the Trust once again increased the number of frontline staff. The Trust works with seven universities in the region offering their paramedic students placements. Unlike other services, we committed to offering all of those students who completed their course and passed our entry requirements a job. As a result we offered fewer student paramedic places but continued to ensure that we had a paramedic on every ambulance, the only Trust in the country able to do so. Allied to this, the Trust has seen a reduction in the number of staff leaving the organisation, which is clearly a positive position. Latest data published by NHS England shows that WMAS continues to set the benchmark with the lowest leaver rate amongst ambulance trusts. This achievement reinforces our commitment to making WMAS a great place to work by promoting staff wellbeing, investing in personal development and fostering a culture of compassion and inclusivity.

Clearly, we want to do everything we can to assist our acute trust colleagues as this will reduce handover delays, allow us to get to patients in the community more quickly and result in more crews to finish on time. Two areas that we have focused on are ‘Call Before You Convey’ and the work of our clinical validation team. Call Before You Convey sees crews contacting a multi-disciplinary team of clinicians who can offer a wide range of alternatives to A&E such as urgent care referral visits, admission to virtual wards, urgent social care intervention or direct admission to assessment units. Thousands of patients are diverted every month using these services. Our Clinical Validation Team is made up of experienced paramedics and nurses working in our emergency operations centres who are able to assess some Category Two, Three and Four calls to see if the patient can receive care through an alternative pathway that is more suitable than sending an ambulance. The non-conveyance rate now regularly reaches 25%, one of the best in the country.

While the delays clearly impact patients and staff, that is not where the costs finish. A report to the Trust Board this year showed that the delays also saw us rack up additional fuel costs in the order of £600,000 last year. This was the result of keeping ambulances either warm or cool by keeping engines running, sometimes for hours on end. Having diesel engines idling for hours on end is not good for them because they don’t operate at the required temperature. As a result, our fleet mechanics have spent hours and hundreds of thousands of pounds stripping down and rebuilding engines; this is time and money that could have been spent so much better, and another example of the huge impact handover delays have on every part of our Trust. With the NHS also looking to improve its green impact, running engines unnecessarily for hours on end only increases the amount of CO2 expelled into the atmosphere.

Hopefully next year, I will be able to tell a very different story in my review. There are certainly signs that improvements are coming. The introduction of a scheme that should see no patient wait over 45 minutes for a handover is beginning to take hold. We have seen some significant improvements at some of the hospitals who have introduced it. We dearly hope that this is sustainable and we never again see the levels of delays we have endured over the past few years.

To other matters…

The Trust is committed to creating a safe, respectful and inclusive workplace by addressing sexual misconduct, providing clear guidance and supporting employees in recognising and reporting it. The newly launched Sexual Misconduct Support Framework aims to promote a safe and respectful culture across the Trust. Creating a workplace where every colleague feels safe, respected and able to speak up is essential. This framework reinforces our commitment to preventing sexual misconduct and supporting anyone affected by it. There is no place within WMAS for such actions and I am determined that we take decisive action to ensure staff can thrive in a workplace built on trust, compassion and integrity.

Sadly, new figures released last year showed that every single day, our staff are subjected to more than nine incidents of physical abuse, verbal abuse or aggression from members of the public. For many staff, this sort of abuse can have a profound impact on their lives with some staff never recovering and actually leaving the service altogether. While it is a minority of people who commit these offences, we need the public to support us to make such abuse something that is unacceptable. It also, once again, underlines the need for the judiciary to use all available legislation to ensure appropriate sentences are handed out consistently to those found guilty of committing these horrific crimes against our workforce.

Perhaps, as a result of these statistics, it should be no surprise that over half of operational staff now use body worn cameras (BWCs) every shift. The average utilisation has risen steadily over the last few years. While staff undertake conflict resolution training, using BWCs and the vehicle CCTV system, can make a real difference when it comes to deterrence. Too many cases are not being taken forward by the Crown Prosecution Service (CPS) because it comes down to our word against the perpetrators. The footage makes a huge difference with offenders often pleading guilty before trial because the footage is so damning. While it is positive that staff are using the technology, it is a damning indictment of the state of our society that they need such technology when all they are trying to do is help someone in their hour of need.

Once again, we ran our ever popular Health and Wellbeing roadshows this year. Staff can get a health check which includes key indicators such as blood pressure, BMI and more, helping them stay on top of their physical health. Other events included dog walks, financial wellbeing advice and wellbeing conversations.

Keeping our staff safe is key to us being able to provide the best possible service to patients. I was therefore particularly pleased to see that our flu vaccination campaign was the best in the Midlands and in the top five nationally. Flu can be a killer and cannot be underestimated. Ask anyone who has had it and they will tell you they wouldn’t wish it on their worst enemy! Like many of our staff, needles are not my favourite, but I am committed to getting my flu jab every year because it is the best protection I can get. I also firmly believe that it is the right thing to do for all our clinicians because of the protection it affords family, friends, colleagues and, as importantly, our patients.

For many years we have been at the forefront of developing our fleet so that it is better for our staff to work on and more comfortable for our patients. A decade ago, we introduced learning taken from the aerospace industry to reduce the weight of our ambulances. Five years ago, we introduced the first fully electric ambulance. With the NHS being pushed to be a Net Zero carbon producer by 2040, it is imperative that the ambulance service looks at how it can reduce its impact on the environment. As part of that process, we are expanding the number of fully electric cars which are used by Operations Managers. Where the Skoda Enyaq is not viable in more rural areas we have introduced hybrid type vehicles. We also received national money to install additional electric charge points at six sites. The Trust has also recently introduced eight Ford electric ambulances with four based at Erdington and four at Sandwell, again part of national funding. We have also increased the number of frontline ambulances from 478 to 509 to enable us to get to patients faster. We continue to be the only Trust in the country to have no frontline vehicle over five years old.

There can be no question that the World is less safe than it has been for many years with conflicts in a number of areas. While we dearly hope that we are never called on to respond to a major incident, it is imperative that we prepare for such circumstances, be that as a result of a natural disaster or a terrorist incident. We have been committed to exercising as many staff as possible in multi-agency ‘live’ incidents. This year we undertook a significant exercise within our control rooms with more than 40 staff, including call takers, dispatch teams, clinicians and managers. They took part in a large-scale business continuity exercise designed to test the organisation’s ability to maintain critical services during a simulated failure of the Computer Aided Dispatch system, digital telephony and radio systems. This type of exercise is a vital opportunity to test our resilience and I’m incredibly proud of how our teams performed under pressure.

As the ambulance service, we know better than most about the importance of defibrillators, so it was worrying to see data from the British Heart Foundation (BHF) showing that almost half of school defibs in our region were not registered on the national defibrillator database – The Circuit. Data from NHS England shows that there are around 4,100 out of hospital cardiac arrests (OHCA) per year in the West Midlands, but the survival rate is just 1 in 13, the worst in the country. It is particularly important because research by the University of Warwick found that 69.3% of OHCA in the West Midlands happen within 500m of a school! The more defibs on The Circuit, the better the chance we have of saving a life. I would urge anyone who has a defib whether in a school or business to ensure that it is registered on The Circuit so that our call handlers know where it is and can access it when necessary.

While I often concentrate on the work of our frontline staff, I would also like to take a moment to comment on the outstanding work of all those who support those services. Be that the team who maintain and clean our ambulances, the stores team who move literally millions of items every year and those who work in our corporate teams. We could not operate without them and as such I would pay tribute to the work they do to ensure our frontline staff have the tools necessary to help patients.

May I finish by saying how enormously proud I am of each of our staff, students and volunteers; please accept my enormous thanks and pass on my personal thanks to your family members that have loved and supported you to enable you to give your best every day, saving lives across the West Midlands. I firmly believe that the public of the West Midlands should be justifiably proud of the team that protects them.

Anthony C. Marsh
Chief Executive Officer

Performance Report

Overview of performance 2025-26

Chief Executive’s summary of Trust performance in 2025-26

The Annual Report is a chance to reflect on the last year and look back at what went well, and as importantly, what could be improved. As you will have read in my Review, it was a challenging year for many parts of our organisation. The serious deterioration in hospital handover delays has continued and in fact got worse, but again, the actions we took mean that we have been able to get to more patients more quickly than we did the previous year.

After 2024-25 there was an acceptance that it was unlikely that we would see a significant improvement in hospital handover delays, and in our view, there was a very real possibility that they would continue to deteriorate. Sadly, that fear turned out to be well founded. While the rate of increase has slowed, the number of hours lost outside hospitals by our crews rose from 381,000 hours in 2024-25 to just under 384,000 in 2025-26. For context it was 255,000 hours in 2023-24. The first quarter of the year saw a significant increase in lost hours after which it largely tracked the previous year. January saw the second worst month on record with the Trust losing just over 50,000 hours, the equivalent of us losing over 130 ambulance shifts every day! Sadly, we have continued to see incidents where harm has come to patients simply because we did not get there quickly enough. The maximum time a patient waited to be handed over during the last 12 months was over 15 hours, but down from the record of over 32 hours.

Despite this, we have continued the good work of last year and our Category 2 Mean has dropped from 29 minutes 5 seconds to 24 minutes 4seconds. Equally, our call handling has remained the best in the country with the lowest number of over two-minute calls. Whilst this is progress, the Category 2 performance is still well above the national target of 18 minutes, something we used to beat every year. Similarly, we would not want to see any 999 call waiting over two minutes to be answered. A year of positives and negatives.

I cannot understate the impact these delays have had on both patients and staff. Our ability to get to patients quickly continues to be severely impacted. The reality is that we don’t get to heart attack and stroke patients as quickly as we should and that will have a long-term impact on the quality of the patient’s life going forward. It also pains me to see cases of elderly patients who have had a fall waiting hours on the floor, sometimes outside in all kinds of weather. It is truly heartbreaking.

While these figures are deeply troubling, it is only fair to say that there has been some progress. Although the Planning Guidance from NHS England for 2025-26 contained reference to no ambulance waiting over 45 minutes to offload and a clear direction of travel to get that back to the national target of no patient waiting longer that 15 minutes for a clinical handover, no hospitals in the West Midlands have achieved this. Some, such as Warwick and Walsall Manor lead the way in getting close to that, but further work is required at many hospitals. I would also highlight the work at University Hospitals Birmingham, who introduced their 45-minute handovers at the beginning of February. While they aren’t meeting it entirely, their lost hours dropped from almost 13,000 hours in January to 5,800 in February, a 56% reduction. When compared to the previous February, lost hours dropped from 9,329, a 38% drop. Clearly, we dearly hope that the improvement there and at other hospitals continues as this will protect patient safety.

Our Trust is committed to doing everything we can to assist our acute Trust colleagues. This can be demonstrated through a variety of metrics. We continue to have the best call answering performance in the country. The data from BT shows that we have the smallest number of occasions when it has taken more than two minutes to answer a 999 call. Last year we had 303, this year it was down to just 77. Nationally there were over 46,867 such cases. What is remarkable is that so few calls waited over two minutes when the teams in our control rooms in Stafford and Brierley Hill took over 1.6 million calls during the year.

As a Trust we have an incredible team in our control rooms. As well as the call assessors, the dispatchers do an incredible job allotting the right ambulance resources to particular cases, calling in officers, doctors, air ambulances and specialist teams when required. We also have a team of experienced paramedics and nurses working in our clinical validation team. Together they look at the majority of lower acuity cases to again see if they can provide care over the phone or bring in other parts of the NHS to help patients without the need to send an ambulance or take a patient to A&E. Together, their work has led to the Trust having the highest ‘Hear and Treat’ rate in the country with about a quarter of patients now not being sent an ambulance.

Across the region, the Trust has been working with Integrated Care Boards and other NHS Providers to embed a process known as Call before You Convey. Essentially, in each case where a patient meets certain criteria, our crew will contact a multi-disciplinary team who will look to see whether there is a better place than A&E to take the patient. This is leading to thousands of patients being treated by the likes of urgent care teams, GPs and district nurses. We saw the numbers rise steadily through the year with record levels towards the end of the year. This has led to the Trust taking less than half of patients to an emergency department, reducing the pressure on our acute trust colleagues. Indeed, we now take far fewer patients to hospital than we did pre-COVID despite having many more calls. A key fact that helps us to do this is that we have a paramedic on every vehicle, the only ambulance service in the country in this position. We continue to monitor the clinical data to see if there are any patterns that mean we can do more to refine the process so that each patient gets what is best for them.

It is hard to imagine just how difficult and frustrating the last few years have been for staff. We have been able to triangulate the impact on them through the results in our staff survey, the answers we get from colleagues and through the work of our Health & Wellbeing team, Staff Advice and Liaison Service and the conversations our managers have with staff. We absolutely recognise the impact these delays have on the health and wellbeing of our staff as they do all they can to cope with these very difficult conditions. It is why we have invested heavily in ensuring there is 24-hour support for staff on all of our hubs as well as improvements in the wellbeing support available such as employing three mental wellbeing practitioners as well as dedicated peer to peer and online support. In addition, the Human Resources team continues to update its Health & Wellbeing website which brings together in one place all of the support that is available to staff.

Another group of staff who do an excellent job caring for patients are those who work on our non-emergency patient transport service. They complete about a million patient journeys a year taking people such as those getting chemotherapy or dialysis to hospital. Together with the volunteer car drivers who support the PTS service, our staff are widely recognised for their care and compassion as they transport some of the sickest patients we see.

I also want to highlight the small army of people who support our operational colleagues. These are the people who enable those staff to carry out their vital roles. I am thinking of our mechanics, those that prepare our ambulances, our education and training department, but also the key corporate functions who make sure the organisation works effectively, safely and efficiently such as those in finance, IT, workforce, OD, audit, recruitment, supplies and distribution, and press and communications etc. They may not be as high profile but they play a vital role nonetheless. It is particularly notable given many of the corporate staff continue to work from home or in a hybrid manner.

Despite the NHS having more money than it has ever had, finances remain extremely challenged. This results in difficult decisions, but as an organisation we are committed to ensuring we utilise our resources effectively and will continue to invest the maximum amount in our frontline services. During the year, we entered into a mediation process with commissioners to establish the cost of the hospital handover delays. While our Trust received substantial additional funding, we were disappointed that it did not cover the full cost of the additional services. We are hopeful that this will now enable us to reach agreement more quickly in the current year, though as I have said many times, if there are no handover delays, there will be no additional costs.

The latest data from NHS England shows that WMAS is the most efficient ambulance service in the country. We will face each challenge head on and make the necessary changes to provide the highest standard of clinical care to our patients. With these commitments we will continue to strive to perform at the highest levels possible whilst also achieving our required Financial Control Total, thereby meeting all of our required financial duties.

If I can conclude by thanking the staff, students and volunteers who support us. Not only the community first responders who give up their time to support their local communities but also those that support organisations such as the two air ambulance charities and emergency doctors who respond to some of our most seriously ill and injured patients. Their work cannot be underestimated.

Again, the dedication and commitment of our staff, students and volunteers shines through and makes us the organisation we are. Please accept my grateful thanks for all that you do. There is no question that your work, whichever part of the organisation you are in, helps to save lives and that is something we should all be immensely proud of.

Thank you to you all.

Anthony C. Marsh
Chief Executive Officer

A brief history of the Trust

The former West Midlands Ambulance Service NHS Trust was created on 1 July 2006 with the amalgamation of the original West Midlands Ambulance Service NHS Trust, Coventry and Warwickshire Ambulance NHS Trust and Hereford and Worcester Ambulance Service NHS Trust. Staffordshire Ambulance Service NHS Trust joined in October 2007. West Midlands Ambulance Service became an NHS Foundation Trust on 1st January 2013.

On 1st November 2018, we became the first University Ambulance Service in the country after a Memorandum of Understanding was signed with the University of Wolverhampton. Following a public consultation, the name of the Trust was changed to West Midlands Ambulance Service University NHS Foundation Trust.

Trust activities, business model and environment

Urgent and Emergency Services (999)

This is the best known part of the Trust and deals with emergency and urgent calls. This service is directed from the two Integrated Emergency & Urgent Care Centres (IEUCs) one of which is at Brierley Hill near Dudley, and the second is located in Stafford, which answer and assess 999 calls. Dispatch will then send the most appropriate ambulance response to the patient, or the call will be handled by the Clinical Validation Team (CVT) who will look to provide an alternative pathway to meet the needs of the patient without the need to respond or attend the Emergency Department.

Call taking and assessment

The Trust provides 24/7 emergency response services comprising 999 call handling, and response. When a 999 call is made the caller is put through to a BT operator who asks what service they need – if it’s an ambulance, they will be put through automatically to their local ambulance service, based on their own location. When your call is transferred, you will speak to one of our call assessors who will ask you a number of questions to help us give you important first aid advice while our staff establish the most appropriate response.

Our emergency call centres managed over 1.5m 999 calls during the year and delivered the best call answering performance of any service from across the Country.

Over the course of the year the Trust saw just 77 occasions where it took longer than 2 minutes to answer a 999 call. Nationally there were nearly 47 thousand calls that took over 2 minutes to be answered across England.

WMAS continues to deliver the best call answering performance and the lowest number of call answering delays of any ambulance service.

Clinical Validation

Clinical validation is a core function of WMAS ensuring patients receive the right care, at the right time, and through the most appropriate response. The aim of CVT is support patients with immediate life-threatening getting the quickest response possible; and supporting those with urgent care needs to obtain the most appropriate care.

Ambulance Response

The Trust dispatches ambulances from fifteen Hubs located across the West Midlands.

Other Services

Non-Emergency Patient Transport Services

The Trust operates Non-Emergency Patient Transport Service contracts across Birmingham, the Black Country, Coventry and Warwickshire and Cheshire. There are 12 dedicated operational Non-Emergency Patient Transport Service bases, including staff that are home-based and 4 control rooms. The Non-Emergency Patient Transport Service transports just under 1 million patient journeys per annum. They transport eligible patients to and from hospital appointments, transfer between hospital sites, deal with routine admissions, discharges, end of life and for continuing treatments such as renal dialysis and oncology. The Non-Emergency Patient Transport Service also provides a high-dependency tier across Birmingham, the Black Country and Coventry and Warwickshire.

Emergency Preparedness, Resilience and Response (EPRR)

EPPR is a small but vitally important part of the organisation, responsible for planning and responding to significant and major incidents within the region, as well as providing medical support for large gatherings such as football matches and festivals.

Other Commercial Services

The Healthcare Logistics service provides a wide range of services for mainly NHS customers in Staffordshire and Stoke-on-Trent including clinical waste and mail collection, medical forms and supplies deliveries and specimen collections. This service also provides the clinical waste service across the Trust.

The Trust’s Commercial Call Centre offers message handling for NHS, public sector and private sector clients, including GP in hours call answering, UK Health Security Agency, National Burns Bed Bureau.

The Trust’s Operating Environment

Geographical coverage

Services are provided over 5,000 square miles of Herefordshire, Worcestershire, Shropshire, Coventry, Warwickshire, Staffordshire, Birmingham, Solihull, and the Black Country.

Population served

The Trust serves 6 million people across the West Midlands.

Diversity of population

The West Midlands includes the second largest urban area in the country, covering Birmingham, Solihull and the Black Country where 43% of the population live. Birmingham is England’s second largest city and the main population centre in the West Midlands, second only to the capital in terms of its ethnic diversity, which makes it vital that we work closely with the many different communities we serve, listening and responding to their suggestions and comments to ensure that our service meets the needs of everyone in the region.

Trust Structure and Resources

Staffing

The Trust employs over 7,300 staff of which 4,577 are frontline paramedics and technicians and 1071 provide non-emergency patient transport services.

Volunteers

The Trust is supported by a volunteer network of over 450 Community First Responders (CFRs) providing early intervention in life critical emergency situations and training in their communities on the use of defibrillators and resuscitation techniques. This reached over 24,000 members of the public last year.

Facilities

Ambulance responses are provided from 15 operational ambulance bases across the region. 999 call handling and call-based responses are provided from two emergency operations centres.

Fleet Assets

The Trust operates over 1,000 vehicles including emergency ambulances, non-emergency patient transport service vehicles and specialist resources such as major incident vehicles.

Vision, Values and Objectives

Vision

Delivering the right patient care, in the right place, at the right time, through a skilled and committed workforce, in partnership with local health economies.

Our vision places the patient at the centre of everything we do and provides a focus through which we deliver safe, high quality patient care and treatment, underpinned by sound values and a commitment to collaborative working with staff, members, volunteers and stakeholders.

Values

Excellence

A high performing organisation with professional, engaged, empowered and valued staff who learn from each other to be the best we can together in order to deliver the best possible care and outcomes for our patients and service users. Cutting edge and innovative using the best evidence.

Integrity

We all do the right thing for our staff, volunteers and students, our patients and service users, the organisation and the system with candour.

Compassion

We believe that showing genuine concern about the needs of others through our actions fosters appreciation and tolerance, leading to a sense of safety in the workplace.

Inclusivity

We treat everyone with dignity, respect, fairness and integrity, valuing difference.

Accountability

We are committed to upholding our values and behaviours and holding others to account for them.

Strategic Objectives

Strategic Objective 1: Safety, Quality and Excellence. Our Commitment to provide the best care for all patients.

Strategic Objective 2: A great place to work for all. Creating the best environment for staff to flourish.

Strategic Objective 3: Effective planning and use of resources. Continued efficiency of operation and financial control.

Strategic Objective 4: Innovation and Transformation. Developing the best technology and services to support patient care.

Strategic Objective 5: Collaboration and Engagement. Working in partnership to deliver seamless patient care.

The delivery of these objectives is monitored through the implementation plans of a suite of enabling strategies including:

• Clinical Strategy
• Quality Strategy
• Communications and Engagement Strategy
• Risk Management Strategy
• Security Strategy
• Sustainability Strategy
• Freedom To Speak Up Strategy
• Equality, Diversity and Inclusion Strategy
• IT, Data and Digital Strategy
• Commercial Services Strategy
• Fleet Strategy
• Estates Strategy
• Operations Strategy
• Finance Strategy
• People Strategy

Principal risks, impacts, mitigation and management

Risks

The Board Assurance Framework (BAF) is a tool to support the Board in carrying out its duties. The Board Assurance Framework brings together in one place all the relevant risk information on the threats to the achievement of the Board’s strategic objectives. The most significant risk during the year was the impact of hospital handover delays. This is discussed in detail in the Chief Executive’s Overview of Performance.

Impact on objectives

Principal risks, impacts, mitigation and management

SO1 – Handover Delays

Risk

SO1 – Handover Delays

Organisational impact

• Patient harm/Risk of Patient death/ Risk of patient deterioration
• Increased waiting time/delay for patients in the community waiting for 999 response
• WMAS – Failure to adequately observe a patient, HALO unable to see full number of patients
• Staff Welfare and Morale – Staff Increased sickness/fatigue
• Emotional and mental wellbeing of patient and WMAS staff
• Skill decay of staff and lack of exposure
• Reduction in CQC Outstanding rating – hospital delays referenced as the main cause for the CQC Improvement Notice
• Exposure to violence and aggression from Patients and Patients’ relatives
• Staff in EOCs raised stress levels speaking to callers for protracted periods, or on numerous occasions
• Performance reduction
• Adverse media coverage and loss of public confidence

Actions undertaken

• Ambulance Handover Delays Board report
• Gold Commander “reactive protocol” to specific cases in the event of significant Patient delays and Ambulance Turnarounds
• HALO Cohorting SOP
• Hospital desk 24/7 hours of operation
• On Call teams, Gold and SOM’s engaged in reporting delays and supporting at sites with ++ delays
• SOC and EOC management of Hospital delays, escalation of each delay to NHSE, CCG and Hospital
• WMAS Escalation Process – HALO to OM/SOM
• Regular meetings between WMAS and Hospital
• Regular Liaison with Hospital Leads from WMAS
• Escalation Plan this is monitored by SOC during times of pressure at acute sites
• Divert processes
• Implementation and monitoring of the Conveyance Policy
• REAP and Surge Plan
• Operational Performance Plans

SO2 – Calls Waiting

Risk

SO2 – Calls Waiting

Organisational impact

• Continued stacking of calls.
• Failure of category 2 performance.
• Continued patient delay and harm.
• IEUC staff fatigue and deterioration to their health and wellbeing due to increased activity and inability to allocate ambulance to waiting patients
• Call takers also impacted because of numerous duplicate calls received, chasing estimated time of arrival for ambulance, marked increase in call volume – 18% of the total emergency call volume which is an increase from the 17% received during 2024/25. The high volumes of duplicate calls mainly relate to service users and patients chasing a response because of delays allocating to outstanding cases as a result of the hospital handover challenges.
• Sickness in IEUC and E&U ops has increased due to stress and anxiety being one of the main causes
• Organisational reputation risk and litigation due to delays responding to patients and public confidence in the service as seen in recent press articles

Actions undertaken

• UCR Lead appointed to post
• Robust IEUC Policies, Procedures and protocols
• Engagement with partner agencies
• Significant investment and increases in operational staffing levels
• Significant increase in Call Assessor numbers. Current establishment circa above 420 trained call assessors.
• Resource output producing above 350 frontline ambulances at peak per day
• Surge demand management plan (SDMP) now embedded within the EOC and utilised as required.
• Implementation of the SCC (excluding Staffordshire)

Risk management

For a full description of the Trust’s approach to risk identification and management mechanisms, see Risk and Control Framework within the Annual Governance Statement.

The importance of engaging all staff in risk management

Staff have an important role to play in identifying, assessing and managing risk and the Trust encourages a culture of openness. Staff are able to raise risks directly with managers, through electronic reporting, whistleblowing and freedom to speak up, team meetings, via Staff Side representatives, partnership forums, and with Executive and Non-Executive Directors during their visits to Trust premises.

Going Concern Disclosure

At the meeting of the Trust’s Audit Committee on the 10 March 2026 a detailed discussion took place on the application of the Going Concern Concept to the Trust.

Taking account of the recommendation of the Audit Committee, and after considering the current financial and operational position of the Trust, the Directors at the meeting of the Board of Directors held on 25 March 2026 approved a resolution that there are no material uncertainties that may cast significant doubt about the Trust’s ability to continue as a going concern and therefore there is a reasonable expectation that the Trust has adequate resources to continue in operational existence for the foreseeable future.

For this reason, the Board of Directors continue to adopt the Going Concern basis in preparing the accounts for 2025-26.

Performance Analysis

Summary of Performance

Operational performance

Urgent and Emergency Services (999)

The Trust is measured nationally against operational standards for Emergency and Urgent as below:

Category 1 – Calls from people with life threatening illnesses or injuries

7 minutes mean response time, 15 Minutes 90th centile response time.

Category 2 – Emergency Calls, serious condition that requires rapid assessment (Serious injury, stroke, sepsis, major burns etc)

30 minutes mean response time, 40 minutes 90th centile response time.

Category 3 – Urgent calls, but not life threatening (e.g. pain control, non-emergency pregnancy)

120 minutes 90th centile response time.

Category 4 – Less urgent calls, but require a face-to-face assessment

180 minutes 90th centile response time.

The National NHS Category 2 target was at 30 min for Category 2 Mean. The WMAS stretch target for Category 2 Mean was 25 min. The Category 2 Mean that was achieved was 24:40.

Performance 1 April 2025 to 31 March 2026 (Hours:Minutes)

Performance by Integrated Care System (ICS) 1 April 2025 to 31 March 2026 (Hours:Minutes)

Non-Emergency Patient Transport Services

The Trust currently operates Non-Emergency Patient Transport Services contracts across Birmingham, the Black Country, Coventry and Warwickshire and Cheshire. Each contract has its own set of operational performance/quality targets and thresholds for achievement.

Currently there are 36 contracted operational Key Performance Indicators (KPIs) that are reported on, these include a set of standard measures in relation to punctuality both on inward and outward journeys and transfers/discharges, ensuring patients arrive for appointments promptly and are also collected in a timely manner. There are 12 operational Non-Emergency Patient Transport Service bases, including staff that are home-based and 4 control rooms. The Non-Emergency Patient Transport Service transports just under 1 million patient journeys per annum. They transfer and transport eligible patients to and from hospital appointments, transfer between hospital sites, deal with routine admissions, discharges and for continuing treatments such as renal dialysis and oncology. The Non-Emergency Patient Transport Service also provides a high-dependency tier across Birmingham, the Black Country and Coventry and Warwickshire. In total the Trust achieved 31 out of 36 Non-Emergency Patient Transport Services Key Performance Indicators in 2025/26.

Data Quality Policy

The Trust recognises that data quality is crucial to the delivery of fast and effective service provision. Complete, accurate and timely data is important in supporting care delivery, clinical governance, management of information, clinical audit and achieving service targets. The effective use of performance information depends on data that is robust and accurate. Sufficient high-quality information must be available to allow confidence that performance is tracked and, in particular, that the quality of key data entered by all control rooms across the region is monitored to ensure compliance with national and local requirements. There are several specific reports available on the Trust’s report portal, ORBIT, which the Emergency Operations Centre and operational managers can use to improve data quality. Additionally, a suite of automated data quality reports is circulated routinely to managers to help monitor data quality. Examples of data quality checks include Routine/Referral categorisation and the triggers for clock starts.

The Trust has a formal Data Quality Policy. The Digital and Transformation Oversight Group has responsibility for reviewing and endorsing it, and both Internal and External Audit review internal controls and undertake testing of data produced.

Quality Performance

Ambulance Quality Indicators – National Audits

Ambulance Services are not included in the formal National Clinical Audit programme, however, during 2025-26 the Trust participated in the following National Ambulance Clinical Quality Indicators Audits:

• Care of ST Elevation Myocardial Infarction (STEMI) Percentage of patients with a pre-existing diagnosis of suspected ST elevation myocardial infarction (type of heart attack) who received an appropriate care bundle from the trust during the reporting period.
• Care of Patients in Cardiac Arrest In patients who suffer an out of hospital cardiac arrest the delivery of early access, early CPR, early defibrillation and early advanced cardiac life support is vital to reduce the proportion of patients who die from cardiac arrest.

STEMI (ST- elevation myocardial infarction)

This is a type of heart attack. It is important that these patients receive:

• Aspirin – this is important as it can help reduce blood clots forming.
• Glyceryl Trinitrate (GTN) – this is a drug that increases blood flow through the blood vessels within the heart. (Improving the oxygen supply to the heart muscle and also reducing pain).
• Pain scores – so that we can assess whether the pain killers given have reduced the pain.
• Morphine – a strong pain killer which would usually be the drug of choice for heart attack patients.
• Analgesia – Sometimes if morphine cannot be given Entonox, a type of gas often given in childbirth, is used.

The Care Bundle requires each patient to receive each of the above. In addition to the care bundle the Trust measures 999 Call to catheter insertion by the mean and 90th percentile.

Cardiac arrest

A cardiac arrest happens when your heart stops pumping blood around your body. If someone suddenly collapses, is not breathing normally and is unresponsive, they are in cardiac arrest. The AQI includes:

• Number of cardiac arrests
• ROSC (return of spontaneous circulation) on arrival at Hospital
• Survival to discharge from hospital
• Post Resuscitation care bundle

ROSC

ROSC and survival to discharge from hospital are reported within two different groups as follows:

Overall Group

• Resuscitation has commenced in cardiac arrest patients.

Comparator Group

• Resuscitation has commenced in cardiac arrest patients AND
• The initial rhythm that is recorded is Ventricular Fibrillation (VF) / Ventricular Tachycardia (VT) i.e., the rhythm is shockable AND
• The cardiac arrest has been witnessed by a bystander AND
• The reason for cardiac arrest is of cardiac origin i.e., it is not a drowning or trauma cause.

In this element, we would expect a higher performance than the first group.

Post resuscitation care bundle

• 12 lead ECG taken post-ROSC
• Blood glucose recorded?
• End-tidal CO2 recorded?
• Oxygen administered?
• Blood pressure recorded?
• Fluids administration commenced?

Older adult fallers discharged at scene

Patients aged 65 years and over who have a fall from below 2 metres should receive a thorough examination to exclude missed injuries before being discharged at scene.

• Detailed physical examination documented?
• History of falls recorded?
• Description of events preceding fall recorded?
• 12 lead ECG assessment documented?
• Postural Hypotension has been assessed?

Care bundles include a collection of interventions that when applied together can help to improve the outcome for the patient.

Year-to-date Clinical Performance AQIs

Financial Performance Overview

The Trust met all of its financial targets for 2025/26. This was a significant achievement, against a backdrop of increased service delivery pressures across the NHS including unprecedented levels of hospital handover delays.

The Trust delivered financial efficiencies of £22.3m against a target for the year of £19.7m.

The Trust’s total expenditure for the year was £483m of which £379m (78%) related to paramedic and other salary and employment costs. Non pay expenditure, including costs of operating the ambulance fleet, totalled £104m (22%).

Total capital expenditure for the year was £42.5m and the Trust met the requirement to manage capital costs within its funded limit.

Income and expenditure

The outturn for 2025/26 reported within the Trust’s accounts was a surplus of £345k. This position is adjusted for a number of technical items for reporting purposes within the Black Country Integrated Care System. The adjusted position was a surplus of £14k.

Note 1 – Trust position

The Trust reported an income & expenditure surplus of £345k for 2025/26 against a planned deficit of £63k. The Trust’s position was thus £408k better than plan.

Note 2 – System adjustments

The Trust is one of the constituent organisations within the Black Country Integrated Care system (ICS) and as such, the Trust’s financial position is reported within the ICS financial position for 2025/26.

Certain nationally prescribed technical adjustments are applied to the Trust’s position for the purposes of consolidation at ICS level. The value of technical adjustments for 2025/26 was £331k including grant funding for capital projects.

Note 3 – Adjusted position

After allowing for the technical adjustments, the Trust’s position as included within the Black Country ICS aggregated position for 2025/26 was a surplus of £14k.

Capital Expenditure

The Trust’s spent £42.5m replacing fleet and other assets during 2025/26. Of this total, £389k was grant funded and a further £991k was financed via net book value of disposals. This left a net charge against NHS capital allocation funding of £41.2m

Capital Funding

Capital Expenditure

Note 1

The Trust received approval for additional expenditure for non-emergency patient transfer vehicles funded via a transfer of capital resource to Black Country ICB near the end of the financial year.

The majority (c.70%) of the Trust’s capital expenditure was on the replacement programme for ambulances and other fleet assets.

NHS organisations are required to account for leased assets using the IFRS16 accounting standard. Under this standard, leases are capitalised as right-of-use assets, the cost of which creates a charge against capital funding allocations. These charges are included within the expenditure values provided above.

The table shows the value of expenditure charged against capital broken down into leased and purchased assets.

Cost Improvement and Efficiencies

The Trust set a cost efficiency plan for 2025/26 of £19.7m. The Trust delivered efficiencies of £22.3m (of which £16.6m were recurrent and £5.7m non-recurrent).

Within the target of £19.7m, the Trust was tasked by NHSE with Corporate Cost Reductions of £7.1m and this has therefore formed a large part of the efficiency programme in year. Other efficiencies related to productivity improvements within operational areas, and procurement savings against key contracts.

Further details of Trust’s risk profile

The Board Assurance Framework (BAF) is designed to assist the Trust in the control of risk. The Framework incorporates and provides a comprehensive evidence base of compliance against a raft of internal and external standards, targets and requirements.

It is impossible to eliminate all risks and every organisation has to accept a degree of risk. It is for the Board of Directors to decide the balance between mitigating, tolerating and accepting risk which is not mitigated. The Trust Risk Appetite Statement is continually reviewed to ensure a continued progression towards the Trust risk maturity, this includes dynamic updates as the ever-changing healthcare landscape impacts the appetite. The statement sets out the Board’s strategic approach to risk-taking by defining its overall risk appetite, its boundaries, risk tolerance, acceptance and threats to its Strategic Objectives and supports delivery of the Trust’s Risk Management Strategy and Policy.

The committee structure ensures that any new or emerging risks are identified and discussed at meetings and escalated where necessary. Where risks are discussed, the relevant assurance is provided by the subject matter expert in attendance and evidence is provided of any action in place. If required, there will be an action added to the minutes and shared with the committee to provide an update at the following meeting. Any new or emerging risks will be added to the Chair’s report to the Executive Management Board for further scrutiny and decision on whether evidence suggests that further work is required, this will be based on the risk appetite of the Trust.

Environmental Matters and the Green Agenda

Task force on climate-related financial disclosures (TFCD)

The Group Accounting Manual (GAM) has adopted a phased approach to implementing the recommendations of the Task Force on Climate-related Financial Disclosures as part of sustainability reporting requirements for NHS bodies. This reflects HM Treasury’s TCFD-aligned guidance for public sector annual reports.

This phased approach has been implemented over the period to 2025–26, with TCFD-aligned disclosures now embedded within the Trust’s sustainability reporting.

In line with the TCFD framework, disclosures are provided across the four core pillars of governance, strategy, risk management, and metrics and targets, as set out in the relevant sections of this report. These describe how climate-related risks and opportunities are identified, assessed, and managed, and how progress against the Trust’s Green Plan is monitored.

Governance

Board oversight of climate-related risks and opportunities

The Board of Directors retains overall accountability for the oversight of climate-related risks and opportunities. The Trust’s strategic approach is set out in its Green Plan, which was approved by the Board and is subject to ongoing review, with regular progress updates provided throughout the year.

Climate-related risks and opportunities are incorporated into the Trust’s Board Assurance Framework where considered material. These include risks associated with delivery of the Green Plan, availability of funding, and the implementation of low-carbon technologies to support operational services.

Executive responsibility for climate-related matters is delegated to the Director of Finance, who acts as the Trust’s lead for Net Zero Carbon and Climate. Oversight and independent assurance are provided by a nominated Non-Executive Director, who supports scrutiny of performance, risk management, and progress against strategic objectives.

The Board is supported by its committee structure, which provides additional oversight of sustainability, financial investment, and risk management. Climate-related considerations are integrated into decision-making processes, including capital investment decisions and long-term strategic planning.

Management’s role in assessing and managing climate-related risks and opportunities

While the Board retains overall accountability for climate-related risks and opportunities, it has delegated day-to-day assessment and management to operational management.

The Trust’s Sustainability Manager provides specialist expertise in identifying, assessing, and supporting responses to climate-related risks and opportunities. This includes supporting the implementation and monitoring of the Trust’s Green Plan and associated Net Zero Carbon objectives.

Governance structure supports a clear escalation and assurance process for climate-related risks. The Health, Safety, Risk & Environmental Group, comprising representatives from key operational areas, is responsible for monitoring delivery of the Green Plan and overseeing progress against sustainability objectives. This group also identifies and escalates climate-related risks through established governance routes, including the Executive Management Board and the Quality Governance Committee.

The Financial Investment Group integrates climate-related considerations into investment decision-making which oversees capital and revenue investments across Fleet, Estates, Sustainability, and IT. This ensures that investment decisions support the Trust’s strategic objectives, including carbon reduction and long-term sustainability.

The Quality Governance Committee receives assurance reports on climate-related risks and opportunities, while the Finance and Performance Committee monitors delivery of the Trust’s strategic priorities and associated performance. Both committees provide assurance to the Board on progress and emerging risks.

Risk Management

Processes for identifying, assessing and managing climate-related risks are integrated into the organisation’s overall risk management

Climate-related risks are managed through the Trust’s overarching Risk Management Policy and established organisational risk management framework.

The same processes used for all organisational risks are applied, ensuring consistent governance, oversight, and escalation.

Managers are responsible for identifying risks within their areas of responsibility, including those arising from climate change. Risks are recorded on the electronic risk management system and assessed using a standardised matrix based on likelihood and impact (scored 1–5, maximum score 25). Each risk includes current controls and mitigation actions, which are subject to regular review.

Risk registers are maintained across the organisation and reviewed through established governance structures. Executive Directors hold accountability for risks within their portfolios, with escalation to committee level where required. Risks scoring 12 or above receive enhanced scrutiny through formal reporting routes.

Climate-related risks are considered across:

• Physical risks, including flooding, heatwaves, extreme weather events, and longer-term impacts on infrastructure and service continuity
• Transition risks, including regulatory change, cost pressures, and requirements associated with decarbonisation and low-carbon technology adoption

Specialist risk and resilience arrangements support this framework, including the Emergency Preparedness, Resilience and Response (EPRR) Risk Register, which addresses climate adaptation risks through business continuity and emergency planning. Site-specific vulnerabilities, including flood risk exposure, are identified and mapped to support mitigation planning and organisational resilience.

Risk management is further strengthened through external horizon scanning. The Sustainability Manager participates in Integrated Care Board (ICB) and national NHS sustainability forums, providing access to emerging policy developments and sector intelligence. These insights inform organisational priorities and Green Plan delivery.

Climate-related risks are also integrated into wider decision-making processes. The Financial Investment Group reviews capital and revenue investments across Fleet, Estates, Sustainability, and IT to ensure alignment with strategic objectives, including carbon reduction and environmental performance.

Operational monitoring tools, including the sustainability application and carbon reporting dashboard, support tracking of emissions and inform prioritisation of carbon reduction initiatives.

Environmental incidents are reported through the Incident Reporting System (IRS) and reviewed by the Sustainability Manager and Health, Safety and Risk Team.

Where appropriate, incidents are subject to structured review processes, including After Action Reviews, to identify learning and strengthen controls.

The Trust continues to develop its approach to climate-related risk management in line with evolving national guidance and best practice, and to strengthen integration of climate considerations within wider risk and assurance frameworks.

Metrics and Targets used to assess climate related risks and opportunities in line with its strategy and risk management approach

The Trust monitors a set of key climate-related metrics through a dedicated sustainability dashboard, which supports the assessment of risks and opportunities in line with its Green Plan, sustainability strategy, and risk management framework.

The core indicators include:

• Energy consumption – monitored across the estate to track usage trends, identify inefficiencies, and support energy reduction initiatives.
• Waste generation (volume and type) – tracked to support waste minimisation, segregation improvements, and alignment with sustainability objectives.
• Carbon emissions (Scope 1, Scope 2, and developing Scope 3 coverage) – providing an assessment of direct and indirect emissions associated with Trust operations, in line with NHS reporting requirements.

These metrics align with the Trust’s Green Plan objectives and the wider NHS Net Zero ambition. They are reviewed on a regular basis to support performance monitoring, inform operational and investment decisions, and track progress against carbon reduction priorities.

Where relevant, trend analysis is used to assess performance over time and identify areas for improvement. The Trust continues to develop the completeness and quality of its Scope 3 emissions data in line with national guidance.

Scope 1, Scope 2, and Scope 3 greenhouse gas (GHG) emissions disclosures and related risks

The Trust measures and reports its Scope 1, Scope 2, and a subset of Scope 3 greenhouse gas (GHG) emissions as part of its annual sustainability reporting and Green Plan monitoring. This supports the assessment of climate-related risks and progress toward Net Zero targets.

• Scope 1 emissions include direct emissions from sources owned or controlled by the Trust, such as fleet vehicles and on-site combustion of fuels (e.g. gas).
• Scope 2 emissions include indirect emissions from the consumption of purchased electricity.
• Scope 3 emissions include selected indirect emissions, including waste disposal, with further categories (such as business travel and supply chain emissions) being progressively developed in line with national guidance.

These emissions are used to monitor progress against the Trust’s decarbonisation objectives and to inform both operational and strategic decision-making.

From a climate-related risk perspective, greenhouse gas emissions are linked primarily to transition risks, including increased energy and carbon costs, regulatory requirements, and the need to invest in low-carbon infrastructure and technologies. There are also associated operational risks, including service disruption during decarbonisation activities and dependencies on supply chain decarbonisation.

Understanding and reducing emissions is therefore integral to the Trust’s approach to managing climate-related risks and opportunities and aligning with the NHS Net Zero ambition.

Full emissions data, methodologies, and reporting assumptions are set out in the Trust’s Green Plan and associated sustainability reporting framework.

Targets used to manage climate-related risks and opportunities and performance against targets

The Trust has established carbon reduction targets aligned with national NHS Net Zero commitments to support the management of climate-related risks and opportunities. These are:

• Achieving Net Zero for direct emissions (Scope 1 and 2) by 2040
• Achieving Net Zero for indirect emissions (Scope 3) by 2045

These targets are used to guide strategic planning, investment decisions, and operational priorities, ensuring alignment with the Trust’s Green Plan and wider sustainability objectives.

Performance against these targets is monitored through the Trust’s sustainability and carbon reporting dashboard. Progress is reviewed regularly and reported through established governance routes, enabling oversight of the Trust’s emissions trajectory and identification of emerging risks or deviations from planned reductions.

Where performance deviates from the expected trajectory, mitigating actions are identified through operational and capital planning processes, supporting timely intervention and continuous improvement.

Planned Improvements in 2026/2027

Following Board approval of the updated Green Plan in 2025, the Trust will continue to embed sustainability and climate considerations into core operational and strategic governance arrangements during 2026/27. Reporting on sustainability and climate-related matters currently feeds into the Health, Safety, Risk and Environmental Group, which provides oversight of progress and supports escalation through the Trust’s governance structure.

The Trust also intends to further strengthen this arrangement through the introduction of a dedicated multidisciplinary sustainability forum, chaired by the accountable Executive Director, which will meet on a regular basis. This forum will build on existing reporting arrangements and provide a more focused mechanism for coordinating delivery of sustainability and climate-related priorities across the organisation. The forum will report into the Trust’s formal committee structure.

Carbon reduction

The Trust’s approach to carbon reduction is aligned with the NHS Net Zero commitments and informed by the “Delivering a Net Zero Health Service” report under the Greener NHS Programme.

Climate-related risks and opportunities are considered as part of the Trust’s sustainability and risk management processes, with carbon reduction actions embedded within the Green Plan and wider operational and capital planning activities. This includes consideration of both emissions’ reduction and resilience to climate-related impacts.

The Trust has undertaken relevant risk assessments to support planning and prioritisation of carbon reduction initiatives across estates, fleet, procurement, and service delivery. These assessments inform investment decisions and operational changes aimed at reducing carbon emissions over time.

The Trust continues to ensure compliance with relevant climate change legislation, including the Climate Change Act and associated reporting requirements, and is developing its approach in line with evolving national NHS guidance on adaptation and mitigation.

Progress on delivery of the Green Plan

The Trust’s Green Plan (2025–2028), approved by the Board, sets out the organisation’s approach to reducing carbon emissions and improving environmental sustainability in line with the NHS Net Zero ambition. The plan provides a structured framework for delivering carbon reduction initiatives across estates, fleet, procurement, and operational activity.

Since approval, the Trust has continued to implement a range of initiatives to reduce its carbon footprint and improve environmental performance. These build on existing improvements and form part of an ongoing programme of sustainability development across the organisation.

Key areas of progress include:

• Estate optimisation and decarbonisation: Continued process to improve the operation of the Make Ready model, supporting rationalisation of the estate footprint and development of new operational sites designed in line with sustainability principles, including compliance with BREEAM environmental standards where applicable. Work has now started on a new site in Shrewsbury.
• Energy efficiency improvements: Ongoing upgrades to estate infrastructure, including the rollout of energy-efficient LED lighting across Trust sites, contributing to reduced electricity consumption. The Trust is also expanding the installation of electric vehicle (EV) charging infrastructure across operational sites to support fleet decarbonisation. In addition, a programme of estate improvements is underway to enhance energy performance in older buildings, including the installation of low-carbon technologies such as solar photovoltaic panels and battery energy storage systems at multiple sites.
• Fleet modernisation: Continued delivery of the fleet replacement programme, maintaining a modern ambulance fleet with alignment to the latest Euro emissions standards and supporting reductions in vehicle-related emissions. The Trust continues to operate no operational vehicles over 5 years old. During 25/26 we have introduced a further 5 fully electric rapid response cars, and 8 frontline fully electric ambulances.
• Operational sustainability improvements: Embedding sustainability considerations into day-to-day operations, including procurement, waste management, and service delivery planning.

The Green Plan continues to provide the framework for governance and delivery of the Trust’s sustainability objectives, ensuring alignment with statutory requirements and the NHS Net Zero target of achieving a significant reduction in carbon emissions (compared to 1990 levels) by:

• 2040 (direct emissions) with an 80% reduction by 2028-2032
• 2045 (indirect emissions) with an 80% reduction by 2036-2039.

Progress against Green Plan objectives is monitored through the Trust’s sustainability governance arrangements and reported through established committee structures, supporting oversight of delivery and identification of emerging risks and opportunities.

The Trust continues to develop and strengthen its sustainability approach to ensure ongoing alignment with national NHS guidance and evolving best practice in environmental sustainability and climate resilience.

Tackling Health Inequalities

The Trust recognises the requirements set out in NHS England’s Statement on Information on Health Inequalities (published under section 13SA of the National Health Service Act 2006). The Trust continues to consider how information and data can support a broader understanding of health inequalities across the populations it serves. The principles within this statement have been considered in the development of the Trust’s Public Health priorities for 2026/27. This includes a focus on community response and population health, alongside ongoing consideration of opportunities to strengthen the single point of access and the development of alternative care pathways.

Public Sector Equality Duty Compliance Annual Equality Report

The Trust publishes its Equality Report annually which encompasses the progress made in relation to Equality and Diversity and how the Trust has complied with the Public Sector Equality Duty under the Equality Act 2010.

Incorporated within the report is the annual Data Analysis report to ensure that the Specific Duties had been adhered to. The Trust reported on the Equality Objectives that had been established in the Equality Strategy as required under the duty.

The Annual Equality Report provides information on progress to enable the Trust to make informed decisions and incorporate the data into future plans and ensure equality across all Protected Characteristics.

The Diversity and Inclusion Annual Report 2025 can be found on the Trust website.

Equality Delivery System 3

‘Everyone counts’ is a key principle that applies to everyone served by the NHS and is at the heart of the NHS Constitution.

The main purpose of the Equality Delivery System is to help local NHS organisations, in discussion with local partners including local people, review and improve their performance for people with characteristics protected by the Equality Act 2010. By using the Equality Delivery System 3 (EDS3), NHS organisations can also be helped to deliver on the Public Sector Equality Duty (PSED).

The Equality Delivery System provides a way for the organisation to show how it is doing against the three domains (they are called goals in the EDS2 framework). The EDS Technical Guidance document is available at: https://future.nhs.uk/EHIME/view?objectID=119804773

All NHS organisations are expected to use the system to help them improve their equality performance for patients, communities and staff, as well as help them to meet the requirements of the Public Sector Equality Duty.

The Trust adopted the EDS3 2022 framework which comprised of 11 specific outcomes that are grouped across the following three domains:

Domain 1. Commissioned or Provided Services

Focus – Patient access and experience, reducing inequalities and enabling better health outcomes.

Domain 2. Workforce Health and Wellbeing

Focus – Ensuring that all workforce members are fully supported in relation to health and wellbeing.

Domain 3. Inclusive Leadership

Focus – How leadership demonstrates a commitment to equality and how it works in a way that identifies equality issues and manages them.

Each domain has outcomes that are evaluated and scored against set criteria, and experiences of stakeholders. These ratings provide assurance and/or direction for further improvement. For 2025, WMAS has completed the EDS framework and created an action plan, which can be accessed on the Trust website.

Social, community, anti-bribery and human rights issues

The geographical and demographic spread of the region served by the West Midlands Ambulance Service means that issues of diversity and inclusion are fundamental, yet also challenging, to the successful achievement of the Trust’s strategic objectives as well as addressing health inequalities. There are clear health inequalities between areas, with indicators showing lower levels of health tending to be clustered in the metropolitan and urban areas and the Trust continues to work with UK Health Security Agency (formerly Public Health England), Integrated Care Systems and the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) to identify and address them. Through regular engagement and education, the Trust will work to improve accessibility and, where necessary, the quality of services for population groups to assist in reducing these inequalities. The Trust has action plans in place which are working towards creating a workforce which is representative of the population that WMAS serves.

Any important events since the end of the financial year

Non-Emergency Services

The Trust continues to work closely with Commissioners and key stakeholders on the provision of the NEPT service. A 2 year extension to the Cheshire ICB Contract has been agreed with an end date of 31 March 2028. A replacement fleet for Cheshire funded as part of the extension period will arrive during Spring/Summer 2026. Contract values have also been agreed for the Birmingham and Solihull PTS contract and the Coventry and Warwickshire PTS Contract from 01 April 2026 to 31 March 2027.

Details of any overseas operations

None.

Chief Executive

22nd June 2026

Accountability Report

Directors’ Report

Board members during the financial year

The Board of Directors serving during 2025-26 (1 April 2025 to 31 March 2026). Please also see:- Board members – West Midlands Ambulance Service University NHS Foundation Trust

Voting Members of the Board of Directors

• Professor Ian Cumming, Chairman
• Anthony Marsh, Chief Executive Officer
• Alexandra Hopkins, Non-Executive Director
• Mohammed Fessal, Non-Executive Director
• Mushtaq Ahmed-Khan, Non-Executive Director
• Sukhjeeven Nat, Non-Executive Director
• Julie Jasper, Non-Executive Director
• Suzanne Banks, Non-Executive Director
• Karen Rutter, Director of Finance
• Dr Richard Steyn, Medical Director
• Caron Eyre, Director of Nursing
• Nathan Hudson, Chief Operating Officer
• Carla Beechey, Director of People

Non-Voting Members of the Board of Directors

• Murray MacGregor, Communications Director
• Vivek Khashu, Strategy and Engagement Director
• Nick Henry, Paramedic Practice and Patient Safety Director (to 30 September 2025)
• Aidan Brown, Service Transformation and Patient Safety Director (from 1 November 2025)

Register of Interests

The Trust maintains a Register of Interests for the Board of Directors and the Council of Governors that is open to the public. The register is reviewed by the Audit Committee.

The register is available for inspection on the Trust’s website – Declarations – West Midlands Ambulance Service University NHS Foundation Trust

Better Payment Practice Code

The Trust is committed to applying the Better Payment Practice Code (BPPC) to the payment of creditors. In line with most NHS bodies the Trust seeks to pay 95% of all NHS and non-NHS trade payables within 30 days of receipt of the goods or a valid invoice. The Trust measures achievement in terms of both the number and value of invoices. Commitment to this standard is embedded in the Trust’s terms and conditions of contracting for the provision of goods and services. The Trust fully achieved the public sector payments targets in 2025-26.

The Trust’s performance is summarised in the table below:

Invoices

Invoices

Care Quality Commission (CQC) and NHS England, Well-led Framework Disclosures

As detailed in the Annual Governance Statement, arrangements are in place within the Trust to assure the Board of Directors and stakeholders that quality governance arrangements suitably scrutinise the quality of the organisation and present a balanced view of the organisation.

For the purpose of providing high-quality, person-centred care for all the Trust is committed to be a high performing organisation working in partnership with, and for, local people and communities.

The Trust has a robust governance framework for quality. This provides assurance that the essential standards of quality and safety are being delivered and the processes for the governance of quality are embedded throughout the organisation.

The Trust’s Medical Director and Director of Nursing advise the Board on clinical issues and

and during the period covered by this Annual Report the post of Service Transformation and Patient Safety Director, was created following a restructure that deleted the former post of Paramedic Practice and Patient Safety Director. The post is a Board level position and has responsibility for Professional Paramedic practice, Patient Safety, Learning from deaths, Clinical and serious incident investigations and Duty of Candour.

The Trust has a Non-Executive Director with extensive clinical experience who Chairs the Quality Governance Committee, works closely with the Executive leads and is also the FTSU NED Lead on the Board of Directors.

The Trust’s Quality Governance Committee (QGC) provides assurance to the Board on clinical standards and registration compliance requirements. The Committee’s primary responsibility is to monitor and review quality and clinical aspects of performance.

The Committee ensure required standards are achieved and action taken where required and that the organisations systems and processes in relation to quality are robust and well-embedded so that priority is given within the organisation, to identifying and managing risks to the quality of care.

There is a schedule of business that includes appropriate review of nationally and regionally agreed quality performance measurements such as Ambulance Quality Indicators (AQIs) relating to aspects of clinical care, workforce data, patient and staff feedback and timeliness of operational response targets.

Fees and charges (income generation)

Income disclosures

Section 43(2A) of the NHS Act 2006 (as amended by the Health and Social Care Act 2012) requires that the income from the provision of goods and services for the purposes of the health service in England must be greater than its income from the provision of goods and services for any other purposes.

The Trust confirms that it is compliant with this restriction.

The Trust furthermore discloses, as required by S43(3A) of the NHS Act 2006, that the Trust received a total of £646,085 for the provision of crew hire to commercial events for which a commercial rate was charged. This included shows and sporting events and the net contribution from these services was used to support the provision of health services.

Chief Executive

22nd June 2026

Remuneration Report

The remuneration report provides information on those persons in senior positions having authority or responsibility for directing or controlling the major activities of the Trust.

Annual statement on remuneration incorporating the Senior managers’ remuneration policy

The Trust’s Remuneration and Nominations Committee (the Committee) manages the appointment of Executive Directors and considers and determines their remuneration, benefits, allowances and terms of service. Salary level reviews are undertaken regularly by considering the overall financial pressures, pay and employment conditions elsewhere in the Trust, other NHS Foundation Trusts and comparable organisations both regionally and nationally through benchmarking data to ensure they remain competitive. Since the inception of the Trust as an NHS Foundation Trust on 1 January 2013, Executive Directors have been remunerated under a contract that mirrors the Very Senior Managers Pay Framework with a single point personal salary. The Trust has adopted and complies with the NHSE Guidance and Very Senior Managers pay framework.

Pay uplifts are based on the recommendations of the Senior Salaries Review Body (SSRB) published each year. The only exception to this approach is in the remuneration of the Chief Executive Officer, where there is a performance related pay scheme in place.

There is no Performance Related Pay (PRP) process utilised by the Trust for Senior Managers or Executive Directors, with the exception of the Chief Executive Officer. Each year the Chief Executive Officer’s performance is considered against criteria on which up to a 10% PRP payment can be awarded. Any award is non-pensionable. In determining whether to pay an annual bonus to the CEO the Committee takes account of the Chief Executive’s performance against personal, corporate and strategic objectives to ensure performance conditions are met.

When determining remuneration, the Committee is sensitive to overall financial pressures, pay and employment conditions elsewhere in the Trust, other NHS Foundation Trusts and comparable organisations both regionally and nationally.

The Committee does not determine the terms and conditions of office of the Chair and Non-Executive Directors. These are determined by the Council of Governors.

The Committee Chair conducts the Chief Executive’s appraisal and appraises the Non-Executive Directors within a framework agreed by the Council of Governors and NHSE. The Chief Executive appraises the other Executive Directors.

The Chief Executive Officer considers the performance of each Executive Director against the specific objectives set for them for the year, and the Chairman further considers under grandparent rights, the achievements of each Director.

During the year, and at the request of the Chair, advice was provided to the Committee by the Chief Executive and Director of People. Advice is also provided, where appropriate and required, from Mills and Reeve LLP, the Trust’s Legal Advisor and Head of Claims and Coroners. In its deliberations the Committee takes account of national advice to ensure all decisions are defensible and equitable and takes advice from external professional bodies if required.

During the year ended 31 March 2026 the members of the Committee were the Non-Executive Directors and the Chief Executive (who was not in attendance when discussing his remuneration). Professor Ian Cumming was Chairman.

The Chief Executive and Executive Directors are directly employed by the Trust on contracts with a notice period of six months with the exception of the Medical Director who is engaged on a secondment basis from his employing Hospital Trust.

All other employees of West Midlands Ambulance Service are employed under NHS Terms and Conditions, and remuneration is determined in line with the NHS Job Evaluation Scheme.

Annual report on remuneration

Remuneration and Nominations Committee

Committee membership and attendance below.

The only remuneration changes were the national cost of living increase agreed by the independent body which was awarded to both Executive and Non-Executive Directors. The Committee reviewed and made an award to the CEO under the approved bonus scheme. During the period of this Annual Report the Committee, and within its Terms of Reference the Committee reviewed and approved the remuneration of two other directors following an internal review of structures and the membership of the Board.

The Trust Renumeration and Nominations Committee adheres to the Trust Equal Opportunities Policy and Strategic Equality Objectives.

Disclosures relating to specific pay and remuneration matters

Directors’ Salaries and Allowances (subject to audit)

Single total figure table – April 2025 – March 2026

¹ The Chief Executive opted into pension entitlement at the beginning of the financial year and opted out again on 31 October 2025. Therefore, there is no prior year comparison figure available, as the Chief Executive was not a member of the pension scheme during the previous financial year.

Single total figure table – April 2024 – March 2025

Notes

1. Pension figures have been provided by the NHS Pensions Agency. Further clarification on their accuracy will be provided when available.
2. This table relates only to those senior managers with voting rights on the Trust’s Board of Directors.
3. The expense payments shown relate to lease cars.

Pension entitlements (subject to audit)

Notes

1. The Director of Nursing is not a member of the NHS Pension Scheme.

Cash equivalent transfer value (CETV) figures are calculated using the guidance on discount rates for calculating unfunded public service contribution rates that was extant on 31 March 2026. HM Treasury published updated guidance on 27 April 2023; this guidance will be used in the calculation of 2025/26 CETV figures.

Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme.

A CETV is a payment made by a pension scheme, or arrangement to secure pension benefits in another pension scheme, or arrangement when the member leaves a scheme and chooses to transfer the benefits in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

Real increase in CETV – This reflects the increase in CETV effectively funded by the employer. It does not include the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another pension scheme or arrangement) and uses common market valuation factors for the start and end of the period. CETVs are calculated by the Government Actuary Department (GAD) based on the assumption that benefits are indexed in line with CPI. The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2020.

NHS Pensions use pension and lump sum data from their systems without any adjustment for a potential future legal remedy required as a result of the McCloud judgment. (This is a legal case concerning age discrimination over the manner in which UK public service pension schemes introduced a Career Average Revalued Earnings (CARE) benefit design in 2015 for all but the oldest members who retained a Final Salary design). We believe this approach is appropriate given that there is still considerable uncertainty on how the affected benefits within the new NHS 2015 Scheme would be adjusted in future once legal proceedings are completed.

Pension Related Benefits of Single Total Remuneration

The Large and Medium-sized Companies and Groups Regulations require that the Trust includes the value of pension related benefits in the table of Salaries and Allowances. This figure includes those benefits accruing to a director from membership of the NHS Pensions Scheme. Accrued pension benefit balances represent the annual increase in pension entitlement at the end of the financial year and the rate payable at the start of the year.

Notes

1. The Director of Nursing is not a member of the NHS Pension Scheme.

Notes

1. The Director of Nursing is not a member of the NHS Pension Scheme.

Payments for loss of office

None.

Payments to past senior managers

None.

Expenses of the Governors and Directors

Reporting bodies are required to disclose the information relating to the expenses of the governors and the directors:

Fair Pay Disclosures (subject to audit)

NHS Foundation Trusts are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the lower quartile, median and upper quartile remuneration of the organisation’s workforce.

The banded remuneration of the highest-paid director in the organisation in the financial year 2025-26 was £280,000 to £285,000 (2024-25, £285,000 to £290,000). This is a change between years of -2%.

Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.

For employees of the Trust as a whole, the range of remuneration in 2025-26 was from £24,857 to £281,595 (2024-25 £22,368 to £287,660). Zero employees received remuneration in excess of the highest-paid director in 2025-26 (2024-25: zero employees).

The remuneration of the employee at the 25th percentile, median and 75th percentile is set out below. The pay ratio shows the relationship between the total pay and benefits of the highest paid director (excluding pension benefits) and each point in the remuneration range for the organisation’s workforce. The relationship to the remuneration of the organisation’s workforce is disclosed in the below table.

The percentage change in average employee remuneration (Note 1) between years is 4.9%. Total remuneration includes salary, non-consolidated performance-related pay, benefits-in kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.

Note

Note 1 – based on total for all employees on an annualised basis divided by full-time equivalent number of employees.

Chief Executive

22nd June 2026

Staff Report

Analysis of Staff Costs (Subject to audit)

Staff Costs

Average number of employees (WTE basis) (subject to audit)

Analysis of Staff Numbers

Contract type breakdown on 31^st March 2026

Analysis of Staff by Gender

The Trust has a good mix of male and female staff at all levels within the Trust. 

Gender breakdown on 31st March 2026

Sickness Absences – Sickness absence data

Average Absence Days Lost (Full-Time Equivalent) per Full-Time Equivalent January 2025 to December 2025*

*Note – Department of Health sickness absence figures are reported on a calendar year basis, rather than for the financial year.

Staff policies and actions applied during the financial year

The Trust has a full set of Workforce Policies which are regularly reviewed. These include the Recruitment and Selection Policy, the Sickness Absence Management Policy, the People Strategy, Flexible Working and the Freedom to Speak Up Policy.

The Trust’s Policy Group facilitates work between elected staff representatives and management to ensure the Trust is well-governed through its policies and procedures ensuring they are up to date and fit for purpose.

Management consult and negotiate with staff representatives on appropriate Trust policies and procedures and propose and formulate policies and procedures in partnership. All policies are appropriately reviewed, updated, and maintained, following legislative changes and good employment practice. An equality impact assessment is also mandatory for all policies.

The effectiveness and performance of all policies are reported through the relevant sub committees of the Board for oversight and assurance.

Disabled persons

The Workforce Disability Equality Standard covers measures that enable the Trust to compare the experiences of disabled and non-disabled staff. This informs an action plan to support positive change and a more inclusive environment for disabled staff.

Annual action plans are reported and monitored by the Diversity and Inclusion Steering and Advisory Group (DISAG) on a bi-monthly basis. The action plan is published on the Trust’s public-facing website.

The Workforce Race Equality Standard (WRES) was introduced in 2015 and is a set of specific measures (metrics) that enables NHS organisations to show progress ensuring employees from black and minority backgrounds have equal access to career opportunities and receive fair treatment in the workplace.

The WRES continues to prompt enquiry and assist the Trust to develop and implement evidence-based responses to the challenges revealed by its data.

Following data analysis, annual WRES action plans are developed and monitored by the Diversity and Inclusion Steering and Advisory Group (DISAG) on a bi-monthly basis.

The WRES metrics and associated action plans are published on the Trust’s public-facing website.

The Trust is committed on meeting and is delivering on the statutory and mandated requirements under the Equality Act 2010 and accompanying standards as required by NHS England and Improvement.

Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are complied with.

Staff turnover

Latest data published by NHS England shows that WMAS continues to set the benchmark for staff retention, proudly achieving the lowest leaver rate among all ambulance trusts in the country. This achievement reinforces our commitment to making WMAS a great place to work by promoting staff wellbeing, investing in personal development, and fostering a culture of compassion and inclusivity.

Retaining experienced staff ensures that patients receive expert care, in the right place at the right time. Staff retention is more than just a metric, it’s the foundation of continuity, experience, and quality in patient care which can only be achieved by listening to staff and taking action to improve their employee experience.

WMAS turnover at the end of March 2026 for the rolling 12-month period was 4.8%.

Expenditure on consultancy

£30k was spent on consultancy during 2025-26, compared to £126k in 2024-25.

Off payroll arrangements

An ‘Off Payroll’ arrangement is where contracted individuals are paid directly or through their own companies and so are responsible for their own tax and NIC arrangements. They are not classed as employees.

It is the Trust’s policy that all off-payroll engagements are subjected to a risk based assessment as to whether assurance is required that the individual is paying the correct amount of tax and, where necessary, that the assurance has been sought.

Prior to commencement, for each engagement the individual must have signed a contract stating that they are responsible for accounting for the relevant taxes, national insurance, liabilities, charges and duties.

Notwithstanding this, the Trust would not agree to such arrangements except in very exceptional circumstances, and there were no such arrangements in 2025/26 (2024/25 none).

Table 1: Highly paid off-payroll worker engagements as of 31 March 2026 earning £245 per day or greater

Table 2: All highly paid off-payroll workers engaged at any point during the year ended 31 March 2026 earning £245 per day or greater

*A worker that provides their services through their own limited company or another type of intermediary to the client will be subject to off-payroll legislation and the Trust must undertake an assessment to determine whether that worker is in-scope of Intermediaries legislation (IR35) or out-of-scope for tax purposes.

Table 3: For any off-payroll engagements of board members, and/or senior officials with significant financial responsibility, between 1 April 2025 and 31 March 2026

Staff Exit Packages (subject to audit)

Reporting of compensation schemes – exit packages 2025/26

Reporting of compensation schemes – exit packages 2024/25

Exit packages: other (non-compulsory) departure payments 2025-26

Exit packages: other (non-compulsory) departure payments 2024-25

Gender Pay Gap

All organisations with more than 250 employees are required to report annually on their gender pay gap. The gender pay gap shows the difference in average pay between all men and women in the workforce.

The gender pay gap is different to equal pay which deals with the pay differences between men and women who carry out the same jobs. A particularly high gender pay gap can indicate issues that need to be addressed, and the individual calculations may help to identify what those issues are.

The Trust’s approach to pay supports fair treatment and reward of all staff irrespective of gender.

A full Gender Pay Gap Report is published on the Trust’s public-facing website: Equality, diversity and inclusion – West Midlands Ambulance Service University NHS Foundation Trust

Gender Pay Gap Data

The following data has been extracted from the NHS Electronic Staff Record System for all employees in post on 31 March 2025. The calculations are in accordance with the technical guidance provided by Gov.UK and are provided for the following years:

Hourly Rate

Women’s hourly rate defined as:

• Mean – 2.62% lower
• Median – 2.70% lower

Bonus Pay

Women’s bonus pay defined as:

• Mean – 100% lower
• Median – 100% lower

Who received bonus pay:

• Men – 0.03%
• Women – 0.0%

Any payment of a bonus is determined by the Remuneration and Nominations Committee. In previous years the Trust determined only the Chief Executive Officer was eligible for a bonus of up to 10% based on meeting pre-determined performance criteria set by the Remuneration Committee annually. All other Executive Directors on VSM contracts and Staff covered by Agenda for Change are not included in the bonus pay scheme.

Pay Quartiles

• Top Quartile
  Men – 52.19%
  Women – 47.81%
• Upper Middle Quartile
  Men – 45.73%
  Women – 41.12%
• Lower Middle Quartile
  Men – 41.12%
  Women – 58.88%
• Lower Quartile
  Men – 50.78%
  Women – 49.22%

Staff Survey

Staff Experience and Engagement

West Midlands Ambulance Service University NHS Foundation Trust places staff engagement at the centre of its culture and improvement strategy, recognising the clear link between workforce experience, performance and quality of care. Engagement is supported by structured cultural insight work, leadership development and wellbeing interventions that have contributed to positive staff experiences. Our feedback arrangements include the NHS Staff Survey and local pulse surveys, team-based listening and engagement events, staff networks, and regular dialogue with trade union and staff side representatives to inform decision making and monitor impact. Insight from these routes is triangulated with workforce data such as turnover, sickness and equality metrics to shape priorities and track progress.

Key priorities and targets for 2026/27 are to:

• Continue to invest in compassionate, inclusive leadership capability as a key enabler of culture change and high-quality care.
• Continue to work on key areas such as reporting physical violence, sexual misconduct and bullying and harassment.
• Continue to be open and transparent about decisions that impact staff experience. Embed clear “You Said, We Did” feedback loops in all divisions so that actions arising from staff voice are visible and evaluated.
• Continue to support managers to deliver meaningful appraisals and supporting staff through career progression and professional development.

NHS Staff Survey

The NHS staff survey is conducted annually. From 2021/22 the survey questions align to the seven elements of the NHS ‘People Promise’, retaining two previous themes of engagement and morale. All indicators are based on a score out of 10 for specific questions with the indicator score being the average of those. The response rate to the 2025/26 survey among trust staff was 42% (2024/25: 68%). The full survey results may be accessed on the NHS Staff Survey Website: Working together to improve NHS staff experiences | NHS Staff Survey.

Scores for each indicator together with that of the survey benchmarking group (Ambulance Trusts) are presented below.

7116 staff were invited to take part in the 2025 staff survey, and 2989 staff returned a completed survey compared to 4697 in 2024. The response rate for WMAS is 42% compared to 68% in the 2024 survey. It is to be noted that in 2024 the Trust offered a £10 lifestyle voucher to all staff as a thank you token for taking part in the survey. Due to financial constraints this was not possible in 2025. The median response rate for all Ambulance Trusts (including Isle of Wight) is 55% compared to 49% in 2024. 195 BAME staff responded to the survey on this occasion compared to 357 in 2024.

Local Results of the 2024 Staff Survey

A total of 119 questions were asked in the 2024 survey, of these, 113 can be compared to 2023 and 101 can be positively scored. Responses to 10 questions are better than last year, and responses to 15 questions are worse than 2023. Overall, there is no significant improvement in the positive responses compared to last year’s results. However, when compared to other Ambulance Trusts that used Picker as their survey contractor, WMAS scored significantly worse in 62 questions.

Top 5 Scores

The table below shows the top 5 scores for WMAS compared to the 2025 results.

Four out of the top 5 areas are the same as last year (3h, 3i, 10c, 23a). Whilst they are among the top five positive scores for 2025, when compared with last year’s results, three of the scores are worse than 2024. In the 2025 survey, more staff said they felt encouraged to report errors /near misses/incidents than in the previous year.

Bottom 5 scores

The table below shows the bottom 5 scores for WMAS compared to the 2025 results.

Bottom 5 scores

The table below shows the bottom 5 scores for WMAS compared to the 2025 results.

All areas for the bottom five scores are the same as in 2024 and disappointingly they all relate to ‘Immediate Managers’. It is to be noted that ‘Leadership and Management’ was one of the three key priorities to be addressed on the Trust Action Plan in 2025 and one of the key priorities for the Trust in 2026 remain around doing more work in compassionate, inclusive leadership capability as a key enabler of culture change.

Most Improved Scores

The following are the areas where WMAS has shown the most improvement when compared to 2024.

It is pleasing to note that some of the work carried out around health and wellbeing and speaking up have shown an impact on the results. Although the figures are still in the low percentages, we are moving in the right direction and need to keep up the good work.

Most Declined Scores

The following are areas where WMAS scores have most deteriorated compared to 2024.

The most declined scores mostly relate to staff morale, career opportunities and diversity and inclusion support. These are on the 2026 Trust Action Plan as key priorities.

Advocacy Results

40% of respondents said they would recommend the Trust as a place to work compared to 45% in 2024. 52% said that if a friend or relative needed treatment, they would be happy with the standard of care provide by the Trust compared to 54% in 2024. 52% said that care of patients is the Trust’s top priority. This was the same in 2024.

Highlights

In the staff survey reports, staff show mixed but generally very similar experiences to previous years. Some strong areas around safety, respect and basic support are noticeable but there are persistent concerns about workload, involvement, development, staff feeling safe to speak up and confidence in the Trust’s response to concerns.

• Engagement is moderate – 38% often/always look forward to work and 53% feel enthusiastic.
• Retention risk is significant as only 35% of staff said they do not think about leaving and 50% are unlikely to look for another job in the next 12 months. This means a large proportion of respondents are either undecided or do think about leaving or finding another job.
• Safety and civility are relatively strong as the scores for absence of violence, harassment and discrimination from managers /colleagues are very high. 92% reported they have not experienced unwanted behaviours of a sexual nature from other colleagues. Although a high percentage of respondents (60%) said they get the respect they deserve from colleagues and 75% said they enjoy working with colleagues at work, these are still below the average scores compared to other Ambulance Trusts. The remaining staff who may have had negative experiences still need to be addressed.
• Immediate Managers – 52% of respondents do not feel pressured by their manager to come to work when feeling unwell and almost half of the respondents (49%) feel their immediate managers take a positive interest in their health and wellbeing. However, only 38% of respondents feel supported to develop their potential and 39% feel they are able to achieve a good balance between work and home life. 47% feel they can approach their immediate manager to talk openly about flexible working.
• Challenging work and basic resources – 58% of respondents say the organisation offers challenging work and 64% feel they have adequate materials and equipment to do their job. 60% report opportunities to improve their skills and knowledge and 50% say they can access the right learning and development when needed.
• Workload, Time Pressure and Staffing – Only 21% of respondents feel they have realistic time pressures and 37% feel able to meet conflicting demands. Possible negative responses are high across these questions.
• Voice, Involvement, and Improvement – Very low percentages of respondents feel they are involved in changes that affect their work (16%) or feel able to make improvements happen in their area (20%). Only 36% feel they are able to make suggestions to improve their team. These indicate low psychological ownership and hence low engagement.
• Appraisals – although a very high proportion of staff reported they have received an appraisal, only 15% feel the appraisal left them believing that their work is valued by the Trust and 28% are satisfied with recognition for good work.
• Confidence in the organisation and Speaking Up – Whilst there was an increase in staff who reported they felt encouraged to report errors/near misses/incidents, there was a decrease in the number of staff who feel safe to speak up about anything that concerned them (52% down to 48%) or confident that the organisation would address any concerns they raised(37%); leaving large proportions of staff unconvinced.

Workforce Race Equality Standard (WRES)

WRES results are based on a series of indicators, of which 5, 6, 7 and 8 are drawn from the NHS Staff Survey.

Indicator 5: Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months

A higher percentage of white staff than BAME staff at WMAS said that they have experienced bullying and harassment from the public. There is a slight increase in the percentage of white staff reporting this experience when compared to 2024, while there is no significant increase in the percentage of BAME staff reporting this experience when compared to 2024.

Indicator 6: Percentage of staff experiencing harassment, bullying or abuse from staff in the last 12 months

A higher percentage of BAME staff than white staff at WMAS have said that they have experienced bullying and harassment from other staff. When compared to 2024, there is a 3.48 percentage point increase for BAME staff experiencing bullying and harassment from other staff, while no significant difference was noted for white staff.

Indicator 7: Percentage of staff believing that the organisation provides equal opportunities for career progression or promotion.

A significantly higher percentage of white staff than BAME staff at WMAS believe that the Trust provides equal opportunities for career progression. The same is reflected in the average results for all Ambulance Trusts. Due to changes in the question wording in 2025, previous years’ results for WRES indicator 7 (Q15) are not reported.

Indicator 8: Percentage of staff experiencing discrimination at work from manager / team leader or other colleagues in the last 12 months.

A significantly higher percentage of BAME staff than white staff at WMAS have said they have experienced discrimination from managers and other staff. The same is reflected in the average results for all Ambulance Trusts. When compared to 2024 results, there is an increase in the percentage of staff from both groups reporting this experience. Whereas the average for the benchmark group shows a slight decrease in percentage for both groups in 2025.

Workforce Disability Equality Standard (WDES)

WDES results are based on a series of indicators drawn from the NHS Staff Survey. It includes results for q4b, q11e, q14a-d, and q15.

Percentage of staff experiencing harassment, bullying or abuse from patients/service users, their relatives or the public in the last 12 months

A significantly higher proportion of staff with a Long Term Condition (LTC) or illness than staff without an LTC, have said that they have experienced bullying and harassment from patients and their relatives in the last five years. This is the same on average across all Ambulance Trusts. A slight increase is noted in the response rate for both categories when compared to 2024. The same is noted across all ambulance Trusts in the benchmark group.

Percentage of staff experiencing harassment, bullying or abuse from managers in the last 12 months.

A higher percentage of staff with a LTC or illness than those without have said that they have experienced bullying and harassment from managers over the last five years. A slight increase is noted in the response rate from 2024 to 2025 for both groups. However, across all Ambulance Trusts there is a decrease in the number of staff from both groups reporting this experience.

Percentage of staff experiencing harassment, bullying or abuse from other colleagues in the last 12 months

WMAS staff with a LTC or illness are more likely to experience bullying and harassment from other colleagues than those without. This is also true on average for all Ambulance Trusts. There is a slight increase in the figures for both groups of staff when compared to 2024, whereas a slight decrease in the figures is noted on average for all Ambulance Trusts when compared to 2024.

Percentage of staff saying that the last time they experienced harassment, bullying or abuse at work, they or a colleague reported it.

WMAS staff with a LTC or illness are less likely to report experiences of bullying and harassment than those without, whereas these figures are almost identical across the average for all Ambulance Trusts. A slight decrease is also noted in the figures when compared to 2024.

Percentage of staff who believe that their organisation provides equal opportunities for career progression or promotion.

Due to changes in the question wording in 2025, previous years’ results for WDES metric 5 (Q15) are not reported. Overall, at WMAS and on average across all Ambulance Trusts, staff with a LTC or illness are less likely to believe that their Trust provides equal opportunity for career progression than staff without an LTC.

Percentage of staff who have felt pressure from their manager to come to work, despite not feeling well enough to perform their duties

A significantly higher proportion of staff with a LTC or illness at WMAS have said that they have felt pressured by their manager to come to work despite being unwell compared to staff without an LTC. The same is observed on average across all Ambulance Trusts. When compared to 2024, a higher proportion of staff with LTC have said they have felt pressure from their manager to come to work despite feeling unwell, while this proportion has decreased across the average for all Ambulance Trusts. A smaller proportion of staff without LTC have reported this experience at WMAS when compared to 2024 while an increase in the figures is noted across the average for all Ambulance Trusts.

Percentage of staff satisfied with the extent to which their organisation values their work.

Fewer staff with a LTC or illness are satisfied with the extent to which the organisation values their work compared to staff without an LTC. The same is observed on average across all Ambulance Trusts. The same is also noted in the figures for both groups of staff when compared to 2024.

Percentage of staff with a long-lasting health condition or illness saying their employer has made reasonable adjustment(s) to enable them to carry out their work.

Compared to the average figures for all Ambulance Trusts, fewer staff with a LTC or illness at WMAS have said that the employer has made reasonable adjustments to enable them to carry out their work. A significant decrease is noted for WMAS figures when comparing to 2024.

Staff Engagement Score

Overall, WMAS staff with a LTC or illness are less engaged than staff without an LTC. The same is also true on average for all other Ambulance Trusts. There is no significant difference in scores when compared to 2024.

Future priorities and targets

Statement of key priority areas

Priorities are decided locally with relevant staff in each locality through Listening into Action groups and staff meetings. The People Voice Action Group (PVAG) meets regularly to interrogate the results and make recommendations for organisation-wide actions. Three key priorities have been agreed by the PVAG and the Executive Membership Board to focus on following the 2025 Staff Survey Results.

PRIORITY 1 – Civility, Compassion, Communication

PRIORITY 2 – Managers and Teams

PRIORITY 3 – Staff Morale and Safety

The following actions and key deliverables have been agreed by EMB for the 2026 Staff Survey Trust Action Plan.

Promoting a culture of compassion and inclusivity

Actions to be taken

Deeper analysis of staff survey demographic data and free text comments to identify any themes or patterns that can inform workstreams or local action plans.

Attend network meetings to review Staff Survey demographic data and consider any targeted workstreams for particular protected characteristics.

Key Deliverables

Clear visibility of inequalities in staff experience and wellbeing. Evidence based priority areas to inform on-going action plans and EDI workstreams.

Targeted interventions that are more effective. A culture where staff feel seen and valued as individuals.

Aligned to Trust Value

Compassion, Inclusivity

Increasing Staff Involvement and Communication

Actions to be taken

Develop a structured communication approach that provides regular updates to staff about system wide pressures and what decisions/discussions are being made to attempt to relieve these pressures.

Add an agenda item to all committee papers and meetings to agree what can be shared with staff. Encourage chairs to follow up with a WB article to share key highlights and messages.

Develop a standard out of office template that should be adopted across the Trust, giving clear information including how long the individual is not at work until and an alternative point of contact in their absence. Example to be hosted on corporate identity pages on website and promoted via manager/staff briefings.

Key Deliverables

Staff feel informed and better equipped to understand why pressures occur, how they may impact their work and what the Trust is doing in response.

Improved communication and involvement. More consistent leadership messaging. Staff feel more aligned to Trust priorities and changes impacting their area of work.

When staff receive an out of office reply, they get clear information and signposting regarding who can assist them in the meantime.

Aligned to Trust Value

Accountability, Integrity

Excellence, Accountability

Promoting a culture of compassionate leadership

Actions to be taken

• Providing welfare support and being accessible and available to staff at shift handover/finish times.

Key Deliverables

• Being accessible and available to staff who may be late finishing due to holding at hospital. Providing welfare support and debriefs where appropriate.

Aligned to Trust Value

• Integrity, Compassion, Accountability

Management and Leadership Development

Actions to be taken

• Introduce Management and Leadership framework self-assessments to identify leadership development areas. Introduce a process for supporting leadership development, providing guidance, roadmaps and opportunities to increase their skills and experience.

Key Deliverables

• Strengthen leadership capability, consistency and accountability. Leaders develop greater self awareness of how their behaviours shape team culture. Leaders have a structured development plan to enhance development areas.

Aligned to Trust Value

• Excellence, Integrity, Compassion, Inclusivity, Accountability

Development Opportunities

Actions to be taken

• Following the implementation of the Management and Leadership framework, review PDC paperwork to adopt a similar approach of self-assessments for staff to make conversations more meaningful. This could be optional for staff who are interested in further development.

Key Deliverables

• More meaningful PDCs where staff are able to assess their own performance and consider what development may need to be taken forward.

Aligned to Trust Value

• Excellence, Accountability

Worklife Balance

Actions to be taken

• Explore alternative shift patterns to improve work life balance (i.e., weekend relief working and team-based rostering) to improve staff wellbeing and improve relationships between teams and managers.

Key Deliverables

• Improved shift patterns and work life balance for staff, Increased engagement and morale. Increased flexible working options.

Aligned to Trust Value

• Excellence, Integrity, Compassion, Inclusivity, Accountability

Freedom to Speak Up (FTSU)

West Midlands Ambulance University NHS Foundation Trust is committed to ensuring that staff have the confidence to raise concerns and to know that they will be taken seriously and investigated. At work, it is reasonable that staff may have concerns from time to time, which normally can be resolved easily and informally. However, when staff have serious concerns about unlawful conduct, financial/professional malpractice, or risk to patients/others it can be daunting to speak up about this. Therefore, the Freedom to Speak Up Policy aims to give staff the assurance that concerns will be listened to. This is supported by a simple procedure which demonstrates a fair and easy process for staff to raise concerns at work.

To deliver high quality patient care and protect the interests of patients, staff and the organisation, the Trust aims to encourage a culture of openness and transparency, in which members of staff feel comfortable about raising legitimate concerns. It is hoped that by providing clear procedures and channels for staff to raise concerns, issues can be addressed at the earliest opportunity, in the most appropriate way, so that positive steps can be taken to resolve them and reduce future risk.

FTSU Guardians

The Trust employs a Lead Guardian and a Guardian who are responsible for implementation of FTSU arrangements, liaising with staff, students, volunteers and managers throughout the organisation. Pippa Wall and Lucy Butler are registered with the National Guardian’s Office and are members of the West Midlands Guardian Network, and the National Ambulance Network (NAN), ensuring that good practice is followed and shared.

FTSU Ambassadors

There are currently approximately 70 trained ambassadors around the region, an increase from 63 in the previous year. We have at least one Ambassador per site who are known and trusted members of both the FTSU team and local teams. This helps to ensure that staff feel more comfortable discussing their concerns informally. The Ambassadors play a key role in the provision of our service across the geography that we serve. They attend regular developmental sessions and are encouraged to provide their own expertise in service developments. Digital posters showing the local Ambassadors’ photographs and personal statements are displayed on all sites.

Governance

There are number of ways in which assurance is provided for FTSU:

• Quarterly returns to National FTSU Guardian’s Office.
• Regular discussions with the Chief Executive Officer, Chairman and the Executive and Non-Executive Leads for FTSU.
• Quarterly reports to Quality Governance Committee, and bi-annual reports to the Executive Management Board and Board of Directors.
• NHS England’s Reflection and Planning Tool was refreshed and approved by Board of Directors in November 2025.
• National Guardian’s Office training modules are in place as follows:
  • All staff completed Speak Up as part of Mandatory Training during 2023/24 with refresher modules completed in 2025/26.
  • Staff on Bands 7 – 8B are required to complete Listen Up Module.
  • Staff in Bands 8C and above, and Board of Directors have completed Listen Up and Follow Up modules.
  • Ambassadors are required to complete Speak Up and Listen Up training modules, in addition to their induction training.

Concerns Raised 2025/26

2025/26 saw the highest number of concerns in a single year (159 concerns) with an increase of 21.4% from 131 in the previous year. The increase from 2023/24 to 2024/25 was 59.8% from 82 concerns in 2023/24, as the data below shows. We believe the continuing increase in concerns relates, in part, to our regular promotional activities and team briefings to both staff and managers.

When reviewing the source of the concerns, the increasing trend can be seen in each of the service areas, as shown below. Only those from ‘other departments’ decreased slightly.

• Emergency and Urgent – 43 (increase from 39 in 2024/25)
• Patient Transport Services – 24 (increase from 16 in 2024/25)
• Integrated Emergency and Urgent Care – 46 (increase from 33 in 2024/25)
• Other Departments – 8 (decrease from 10 in 2024/25)
• Not stated – 38 (increase from 33 in 2024/25)

Among these concerns, the following were recorded (some concerns were recorded in multiple categories).

The most reported category remains Worker Safety. Concerns recorded within this group include matters such as health and wellbeing, psychological safety, health and safety. This is followed by those relating to inappropriate attitude and/or behaviour of either peers or managers. Many of these categories are interlinked with one concern fitting into several categories.

Freedom To Speak Up remains one of many routes available to staff, students and volunteers to raise concerns, start conversations or provide positive suggestions or praise.

Corporate Governance

Code of governance

The Code of governance for NHS provider trusts (‘Code of governance’) sets out a common overarching framework for the corporate governance of NHS providers (being NHS trusts and NHS foundation trusts), reflecting developments in UK corporate governance and the development of integrated care systems. Providers must comply with each of the provisions of the code or, where appropriate, explain in each case why the provider has departed from the code.

The purpose of the Code of Governance is to assist in improving governance practices by bringing together the best practice of public and private sector corporate governance. The code is issued as best practice advice but imposes some disclosure requirements.

The Trust has applied the principles of the NHS Code of Governance on a ‘comply or explain’ basis. The NHS Code of Governance most recently published in April 2023, is based on the principles of the UK Corporate Governance Code.

The Directors of the Trust are responsible for preparing the Annual Report and Accounts. The Board of Directors consider that the Annual Report and Accounts, taken as a whole, is fair, balanced and understandable and provides the information necessary for patients, regulators, and stakeholders to assess West Midlands Ambulance Service University NHS Foundation Trust’s performance, business model and strategy.

Each individual who is a director are required to make themselves aware of any relevant audit information and to establish that the Trust’s Auditor is aware of that information, and as far as each individual Director is aware, there is no relevant audit information of which the Trust’s Auditor is unaware. ‘Relevant audit information’ means information needed by the Trust’s Auditor in connection with preparing their report.

A statement of the accounting policies for pensions and other retirement benefits is set out in a note to the accounts and the details of senior employees’ remuneration can be found in the Remuneration Report above.

The Trust has not made any use of financial instruments during the period of this Annual Report.

Governance, Leadership and Regulation

The Governance framework of a Foundation Trust is set out in Schedule 7 to the NHS Act 2006 as amended. It sets out an obligation to have:

• A Membership
• A Council of Governors
• A Board of Directors
• Specific directors on the Board
• Committees required under regulation

There are two main regulators that hold NHS Foundation Trusts to account for the quality of care they deliver and how they are run:

• The Care Quality Commission (CQC) is the independent regulator of health and social care services.
• NHS England (NHSE) through its NHS provider licence, regulates providers of NHS services.

The Trust is a licenced provider and is compliant with the conditions of the licence.

The Licensee now has a legal duty to co-operate with other providers of NHS services; and other NHS bodies, including any Integrated Care Board of which it is a partner.

The National Health Service Act 2006 (the Act) designates the Chief Executive of an NHS Foundation Trust as the Accounting Officer. The Accounting Officer is responsible for:

• Keeping proper accounting records.
• Preparing the compliant financial statements.
• Ensuring the trust delivers efficient and economical conduct of its business.
• Safeguards financial propriety and regularity throughout the organisation.
• Ensuring financial considerations are fully taken into account in decisions taken by the Trust.
• Acting as the principal advisor to the Board on these matters.

The Council of Governors

Staff Governors 2025-26

Staff Governors 2025-26

Public elected Governors 2025-26

Appointed Governors 2025-26

‘Appointed’ Governors were nominated by organisations to serve on the Council of Governors (CoG) in 2025-26.

Council of Governors Activity

At the Council of Governors meeting on the 30 July 2025, the chairman referred to the publication of the NHS 10 Year Health Plan and HM Government’s intention to remove the requirement for FTs to have governors. The governors endorsed that until further information/guidance was released that the Trust would not be holding elections until there was clarity on timescales, so that public funds can be redirected to patient care. If any governors retired prior to the end of their term of office, this position would remain vacant for the time being.

Eileen Cox was elected unopposed as Lead Governor at the Council of Governors meeting on 30 July 2025, and Khalid Ali was elected unopposed as Deputy Lead Governor for the period of one year until the next Annual Meeting.

Governor Remuneration, Terms of Service and Nominations Panel

The Governor Remuneration, Terms of Service and Nominations Panel met once between April 2025 and March 2026 on 29 April 2025. This meeting was convened to hear reports back on the NED Appraisals and NED Succession Plan. The minutes of the meeting were reported back to the Council of Governors meeting on 8 May 2025 and the following items were approved:

1. The Council of Governors received and noted the NEDs appraisal process that was undertaken and that there were no material concerns or objections raised.
2. That Mrs Julie Jasper be reappointed for a further three years from 13 October 2025 (having served three years previously).
3. That Professor Alex Hopkins be reappointed for a further three years from 1 April 2026 (having served three years previously).
4. That for the reasons set out in the minutes of the meeting Mr Mushtaq Ahmed-Khan be reappointed for a period of one year from 1 October 2025 (having served six years previously).
5. That for the reasons set out in the minutes of the meeting, Professor Ian Cumming’s tenure as Chairman be extended for a further period of two years from 1 April 2027, ending on 31 March 2029, subject to satisfactory annual appraisal (having previously served for six years).

At the Council of Governors meeting on 12 February 2026, the Governors approved the following:

1. That Mohammed Fessal be reappointed for a further one-year term from 1 January 2027 until 31 December 2027 (having served for a period of one year previously).

Governor Development and Assurance

Over the year, the Council of Governor meetings received presentations from members of the Board of Directors and other senior members of staff providing Governors with the information to ensure that the Council fully understands the business of the Trust and enabling it to fulfil its statutory duties. In addition, the Chairman and Chief Executive Officer report at every meeting to update the Council of Governors on matters of operational, financial and governance at local, regional and national level.

For the purpose of providing the Council with the knowledge required to carry out its duties both statute and those contained within the NHSE Code of Governance (2023 edition), a Governor Development Day was held in September 2025, which covered a number of topics presented by various senior staff from the Trust, including Freedom to Speak Up, the Staff Survey and Action Plans, NHS 10 Year Plan, Recruitment and interviewing techniques covering diversity and inclusion and unconscious bias; and given that it is an emergency service the Governors present were offered CPR and Defibrillator demonstrations.

The Governors, as part of the Trust’s assurance framework, had the opportunity to undertake observational shifts with operational staff throughout the year.

Council of Governors Self-Assessment

In November 2025 the Governors completed a self-assessment questionnaire on their collective performance. The results of the questionnaire have been reported back to the Council of Governors and Trust Board through the Chairman update. The results of the self-assessment undertaken in November 2025 are set out below:

Returns

• 10 returned questionnaires.
• 5 non-returns.
• 1 seat is currently vacant, and 1 governor was new to the role and therefore unable to assess the year.

In summary

• The majority of governors agreed or strongly agreed to all elements of the CoGs understanding its role in holding to account in terms of; Trust Performance, Delivery of Strategic Plans and the Trust being Well Led. One disagreed for each area.
• The majority strongly agreed or agreed that the Council received sufficient information to carry out their duties.
• The majority agreed or strongly agreed that there is sufficient opportunity to question members of the board, two strongly disagreed.
• Majority agreed or strongly agreed with the council having the opportunity to influence strategy. Two strongly disagreed.
• Most agreed, with one strongly agreeing and two strongly disagreeing that there is opportunity for the council to bring forward its own ideas on strategy.
• The majority agreed that the Council of Governors ensures there is appropriate communication and consultation with Members, Stakeholders and the wider public. One strongly agreed, two disagreed, one strongly disagreed.
• Majority agreed or strongly agreed that the Council process for the re-appointment or appointment of NEDs is effective. One strongly disagreed.
• Majority strongly agreed or agreed that the Council has in place an appropriate process for enabling performance appraisals for the Chair and Non-Executive Directors. One strongly disagreed and one disagreed.
• The CoG influence the work of the Trust – Three agreed, two strongly agreed, two strongly disagreed and three disagreed.
• Majority agreed or strongly agreed that the Council of Governors understands its role in representing members of the Trust and takes positive action to provide opportunities for the members of the public to make contact.

Meetings of the Council of Governors and Attendance

The Council of Governors is required to meet at least four times a year to discharge its duties and has a schedule of business for the year which is considered at each meeting. During 2025-2026 there were four meetings of the Council of Governors. The attendance of each Governor is shown in the table below. Meetings were held both face to face and via Microsoft Teams.

The Foundation Trust constitution sets a minimum level of attendance required by Governors at meetings of the Council of Governors each year, unless the Chair is satisfied that:

• The absence was due to a reasonable cause; and
• The person will be able to start attending meetings of the Council of Governors again within such a period as the Chair considers reasonable.

Attendance at meetings of the Council of Governors from April 2025 to March 2026 is presented below.

Declarations of Interest

Similarly to the Board of Directors, all of the Governors of the Trust must declare details of any material interests which could conflict with their responsibilities as a Governor of the Trust. The Council of Governors has adopted the NHSE guidance (2024 publication) on declaring conflicts of interest. A Register of Interests is maintained by the Trust and is published on the Trust’s website and is also available by request to the Trust Secretary.

The Board and Governor Relationship

The Board of Directors recognises the importance of receiving and responding to the views of the Council of Governors. As a Foundation Trust, the Board of Directors is keen to understand the statutory powers of the Council of Governors and to support it in creating the forums where the Council can hold the Non-Executive Directors to account for the performance of the Trust. The Board of Directors’ papers are available to all members of the Council of Governors.

Members of the Board in addition to the Chairman, CEO and SID have attended meetings of the Council of Governors, and in addition the Trust has established a Governor/Non-Executive Director Buddy scheme. The publicly elected Governors are buddied with a respective Non-Executive Director. Meetings take place facilitated by the Non-Executive Director with any views or comments flowing back through the meetings of the Non-Executive Directors for action or, if urgent, through the relevant Director into the Trust. Feedback will be through the same route.

A Staff elected Governor is buddied with the Chairman and buddy meetings have taken place both face to face and via Microsoft Teams.

The Council of Governors receive any urgent briefings especially if the matter will be of public interest.

Membership

The membership is the means by which the Trust is accountable to its local community. The Trust maintains a database of members and this database is cleansed regularly by its providers. The constituencies of the membership are set out in the Constitution of the Foundation Trust.

The Trust has circa 15,922 members; this includes both public members and staff members. WMAS operates an opt-out membership for its staff. This means that staff who are eligible for membership are automatically members of the Foundation Trust unless they choose to opt out.

Declarations of Interest

Similarly to the Board of Directors, all of the Governors of the Trust must declare details of any material interests which could conflict with their responsibilities as a Governor of the Trust. The Council of Governors has adopted the NHS England guidance (2024 publication) on declaring conflicts of interest.

A Register of Interests is maintained by the Trust and is published on the Trust’s website. It is also available on request from the Trust Secretary.

The Board and Governor Relationship

The Board of Directors recognises the importance of receiving and responding to the views of the Council of Governors. As a Foundation Trust, the Board of Directors is keen to understand the statutory powers of the Council of Governors and to support it in creating the forums where the Council can hold the Non-Executive Directors to account for the performance of the Trust. The Board of Directors’ papers are available to all members of the Council of Governors.

Members of the Board, in addition to the Chairman, Chief Executive Officer and Senior Independent Director (SID), have attended meetings of the Council of Governors. In addition, the Trust has established a Governor/Non-Executive Director Buddy Scheme. The publicly elected Governors are paired with a respective Non-Executive Director. Meetings take place facilitated by the Non-Executive Director, with any views or comments flowing back through meetings of the Non-Executive Directors for action or, if urgent, through the relevant Director into the Trust. Feedback is provided through the same route.

A Staff Elected Governor is paired with the Chairman and buddy meetings have taken place both face to face and via Microsoft Teams.

The Council of Governors also receives any urgent briefings, particularly where matters are likely to be of public interest.

Membership

The membership is the means by which the Trust is accountable to its local community. The Trust maintains a database of members and this database is cleansed regularly by its providers. The constituencies of the membership are set out in the Constitution of the Foundation Trust.

The Trust has approximately 15,922 members, comprising both public members and staff members. WMAS operates an opt-out membership arrangement for eligible staff. This means staff automatically become members of the Foundation Trust unless they choose to opt out.

Public Membership by Constituency

Total Membership

The Trust recognises within its Membership Strategy that, as a Foundation Trust, it has a duty to involve the local community in decisions that affect their lives and wellbeing. Involving people encourages and empowers them as individuals and as communities. The Trust also embraces the principles of inclusion and the benefits of diversity so that it is truly representative of the community it serves.

Engagement is the process of getting the public involved in decisions about them in a sustained way. This includes planning, developing and managing services, as well as activities that aim to improve health or reduce health inequalities.

The Trust holds an Annual Meeting of the Membership in accordance with NHS England guidance.

Members are invited to complete a membership form, providing information including protected characteristics under the Equality Act 2010.

Further details on patient and public involvement are included within the Trust’s Quality Account, which is published separately.

The Trust produces a Members’ Newsletter to engage with members. Members of the Foundation Trust and members of the public may contact Governors via the Membership and Governor Engagement Manager by emailing [email protected].

Further details can be found on the Trust’s website.

The Board of Directors

The Board of Directors is responsible for formulating and driving strategy, ensuring accountability and shaping organisational culture. It is ultimately accountable for everything that takes place within the organisation.

Key activities of the Board include risk management, establishing organisational culture and values, and overseeing financial reporting and controls.

As a licensed provider, the Board of Directors must have regard to the NHS Triple Aim.

The NHS Triple Aim

• Improve health and wellbeing for people, including addressing health inequalities.
• Improve the experience and quality of care for individuals and families.
• Use NHS resources sustainably and improve value for the wider system.

The Board is the place where all aspects of governance, including clinical, financial, workforce, staffing, information and research governance, come together.

Policies Governing Decision-Making

The key governing documents of the organisation are its Standing Financial Instructions, which ensure financial transactions are conducted legally and efficiently, and its Scheme of Delegation, which provides clarity on where authority lies to make decisions.

The Schedule of Matters Reserved for the Board of Directors sets out those matters delegated to the Chief Executive, those retained by the Board and those referred to the Council of Governors.

Composition of the Board

The appointments required by regulation to the Trust’s Board of Directors are:

• Non-Executive Director Chair
• Chief Executive (and Accounting Officer)
• Director of Nursing
• Medical Director who must be a registered medical practitioner
• Director of Finance

Good practice guidance also advises appointing:

• A Non-Executive Director with clinical experience to provide appropriate challenge on quality.
• At least one member of the Audit Committee with recent and relevant financial experience.

The Trust is compliant with these statutory requirements and good practice guidance.

Duties and Codes of Conduct

All Foundation Trusts have the following individual statutory duties:

• A general duty to promote the success of the Trust.
• Duties to avoid conflicts of interest, not accept benefits from third parties and declare interests in transactions involving the Foundation Trust.

The following codes of conduct and duties are upheld by Trust Directors:

• Code of Conduct based on the Nolan Principles.
• Fit and Proper Persons Test.
• Duty of Candour.

All Directors on the Board of Directors and all Governors on the Council of Governors meet the Fit and Proper Persons Test described in the provider licence. Directors also meet the requirements of the Care Quality Commission Fundamental Standards guidance. Both Directors and Governors are subject to Disclosure and Barring Service (DBS) checks.

Declarations of Interest

The Board of Directors and the Council of Governors have adopted Managing Conflicts of Interest in the NHS: Guidance for Staff and Organisations, published by NHS England.

Upon appointment, members of the Board of Directors are required to declare any business interests, directorships, positions of authority in charities or voluntary bodies in the field of health, and any connections with organisations contracting for NHS services. They are also required to declare their independence in accordance with the NHS England Code of Governance.

All declarations of interest are entered into a register, updated at least twice each year and published on the Trust’s website.

Trust Board Skills Audit

The Skills Audit Matrix assesses the membership of the Board of Directors against a number of key themes and skill areas agreed by the Board as essential for the stewardship of the Trust. These are in addition to the statutory requirement to have suitably qualified Directors of Finance, Nursing and Medicine.

Essential Skills and Competencies

• Strategic leadership, impact and influence.
• Risk management.
• Financial acumen.
• Legal awareness.
• Public policy.
• Knowledge and application of diversity and inclusion.
• Ability to exercise informed judgement while maintaining ethical standards, integrity and accountability.
• At least one Non-Executive Director with an appropriate financial qualification.
• At least one Non-Executive Director with an appropriate clinical or healthcare qualification or experience.
• At least one Board member with a legal qualification.

Desirable Skills

• Corporate communications and media.
• Commercial focus.
• Human resource management.

The skills identified above also align with the six competency domains of the NHS Leadership Competency Framework for Board members.

The Skills Matrix of the Board of Directors for 2025/26 is set out below.

Non-Executive Directors Skills Matrix

Professional Qualifications and Memberships

Professor Ian Cumming

Clinical Registration / Professional Membership

• Chartered Scientist – The Science Council
• Fellow of the Institute of Biomedical Sciences
• HCPC Registered Biomedical Scientist (PIN: BS31759)

Professional / Business Qualifications and Experience

• MSc in Sports and Exercise Medicine
• Postgraduate Diploma in Sports and Exercise Medicine
• Doctor of Health (DH)
• Doctor of Science (DSc)
• Doctor of the University (D Univ)
• Chartered Scientist (CSci) Qualification

Mohammed Fessal

Clinical Registration / Professional Membership

• General Pharmaceutical Council – Pharmacist (PIN: 2061184)

Professional / Business Qualifications and Experience

• Master of Science in Pharmacy
• Independent Prescriber Course

Mushtaq Ahmed-Khan

Clinical Registration / Professional Membership

• The Law Society (England and Wales) – SRA ID: 26073

Professional / Business Qualifications and Experience

• Solicitor (England and Wales)
• BSc (Hons) Social Policy
• Postgraduate Diploma in Law
• Legal Practice Certificate
• Postgraduate Diploma in Management Studies
• Certificate in Advanced Corporate Governance

Julie Jasper

Clinical Registration / Professional Membership

• Chartered Institute of Public Finance and Accountancy (CIPFA)

Professional / Business Qualifications and Experience

• Qualified Accountant

Professor Alexandra Hopkins

Clinical Registration / Professional Membership

• Nursing and Midwifery Council Registration (PIN: 0573742)

Professional / Business Qualifications and Experience

• Master of Business Administration in Higher Education Management
• Doctor of Philosophy (PhD)

Suzanne Banks

Clinical Registration / Professional Membership

• Nursing and Midwifery Council Registration (PIN: 83C0111E)

Professional / Business Qualifications and Experience

• Quality Service Improvement and Redesign Practitioner
• Postgraduate Certificates in Strategic Workplace Planning and Higher & Professional Education
• BSc in Healthcare
• MBA in Health Executive

Sukhjeeven Nat

Clinical Registration / Professional Membership

None.

Professional / Business Qualifications and Experience

• BA (Hons) Accounting and Information Systems
• RBS Advanced Diploma
• Financial Planning Certificates

Executive Directors (Voting) – Skills Matrix

Clinical Registration / Professional Membership

Professional / Business Qualifications and Experience

Non-Voting Directors – Skills Matrix

Clinical Registration / Professional Membership

Professional / Business Qualifications and Experience

Performance Evaluation of the Board and Directors

Development for directors appointed to the Board commences at induction, the content of which is reviewed by the Chairman and the Chief Executive Officer. The Board of Directors reviews its performance as a Board at the end of each meeting.

As a Foundation Trust, it is the role of the Council of Governors to ensure that there is an effective and meaningful performance assessment and appraisal process in place for both the Chair and Non-Executive Directors.

The Trust Chairman appraises the performance of the Chief Executive Officer annually and also carries out a mid-year review against objectives set by the Remuneration and Nominations Committee. The Chairman has also carried out an appraisal of each of the Non-Executive Directors. The Senior Independent Director undertook the appraisal of the Chairman.

The Chief Executive Officer appraises the performance of each Executive Director annually and also carries out a mid-year review against previously agreed objectives.

Executive and Non-Executive Director Responsibilities

The Board comprises Non-Executive and Executive Directors whose principal responsibilities are summarised below.

Non-Executive Director Responsibilities

• Nominated Non-Executive Director for Security Management.
• Emergency Officer Non-Executive Director required under the NHS England Emergency Preparedness, Resilience and Response Framework.
• Senior Independent Director.
• Safeguarding Lead.
• Learning from Deaths Lead.
• Freedom to Speak Up Lead.
• Lead Non-Executive Director to support the Executive Lead Director for maternity services.
• Complaints and Freedom to Speak Up Auditor.
• NHS Workforce Wellbeing Guardian.
• Lead Non-Executive Director for Diversity and Inclusion.
• Sustainability Lead.
• Security Management Non-Executive Director Champion (including safety and risk) covering Counter Fraud, violence and aggression, and security management of assets and estates.

Executive Director Responsibilities

• Accounting Officer.
• Accountable Officer for Emergency Preparedness.
• Director of Infection Prevention and Control.
• Caldicott Guardian.
• Chief Information Officer (CIO).
• Board-level Champion for Maternity Services (Better Births Report).
• Senior Information Risk Owner (SIRO).
• Prevent and Safeguarding Executive Lead.
• Director for Health, Safety and Risk.
• Security Management Director (SMD).
• Controlled Drugs Accountable Officer.
• Responsible Officer (Medical Revalidation).
• Responsible Director for the Care Quality Commission (CQC).
• Registration Authority (Smart Cards).
• Equality, Diversity and Human Rights.
• Patient Group Directions (PGDs).
• Freedom to Speak Up.
• Executive Nurse.
• Sustainability.
• Learning from Deaths Responsible Executive.
• Learning Disabilities and Mental Health.
• NHS Workforce Wellbeing Guardian.

Current Leads for SIRO, CIO, Caldicott Guardian and Freedom to Speak Up

Senior Information Risk Owner (SIRO)

This role must be undertaken by an Executive Director or Senior Management Board Member. The Trust’s SIRO is Karen Rutter, Director of Finance.

Chief Information Officer (CIO)

The CIO leads the strategy, delivery and governance of digital and IT services to support safe, effective patient care and operational performance. This includes driving digital transformation initiatives, data governance, IT security and the application of new and emerging technologies to improve patient care and efficiency. This role is carried out by Karen Rutter, Director of Finance.

Caldicott Guardian

The Caldicott Guardian is responsible for protecting the confidentiality of patient and service user information while enabling appropriate information sharing. This role is undertaken by the Medical Director, Dr Richard Steyn.

Freedom to Speak Up (FTSU)

Suzanne Banks is the nominated Non-Executive Director and Vivek Khashu is the nominated Executive Director for Freedom to Speak Up during the period covered by this Annual Report. Pippa Wall and Lucy Butler are the Trust’s Freedom to Speak Up Guardians.

Non-Executive Directors

Non-Executive Directors contribute to the development of strategy and play an important role in scrutinising management’s achievement of agreed goals and objectives, while monitoring organisational performance.

Drawn from the local community and living or working within the area served by the Trust, Non-Executive Directors also work with the Chair through the Remuneration and Nominations Committee in the appointment and remuneration of the Chief Executive and other Executive Directors.

Non-Executive Directors are considered independent by the Trust in accordance with the NHS England Code of Governance.

All Non-Executive Director appointments to the Board of Directors are made by the Council of Governors for a period of three years, as required by the Trust’s Constitution.

Current Terms of Office

• Professor Ian Cumming – period of office expires on 31 March 2029.
• Professor Alexandra Hopkins – period of office expires on 31 March 2029.
• Mr Sukhjeeven Nat – period of office expires on 4 November 2027.
• Mr Mushtaq Ahmed-Khan – period of office expires on 30 September 2026.
• Mr Mohammed Fessal – period of office expires on 31 December 2026.
• Mrs Julie Jasper – period of office expires on 12 October 2028.
• Mrs Suzanne Banks – period of office expires on 31 March 2027.

The Chair held meetings with the Non-Executive Directors without the Executive Directors present, although the Chief Executive Officer takes the opportunity to provide a brief update on national and regional issues so that the Non-Executive Directors are briefed on current matters.

At least one meeting a year is chaired by the Senior Independent Director without the Chair present as part of leading the annual appraisal of the Chair.

The Council of Governors agreed to link the Non-Executive Director remuneration to the Executive Directors’ “cost of living increase”.

Profiles of Non-Executive Directors

Professor Ian Cumming OBE – Chair

Ian started his career in the NHS as a Healthcare Scientist. Since then, Ian has held a variety of NHS general management posts, including three years as Chief Executive of the NHS in the West Midlands.

From 2012 to 2020, Ian was Chief Executive of Health Education England (HEE), the largest education and training organisation in the world. Ian has a personal interest in pre-hospital care and sports medicine, an area in which he holds an MSc.

Suzanne Banks CBE – Non-Executive Director

Suzanne joined the Trust on 1 April 2024. She retired as Chief Nurse at Sherwood Forest Hospitals NHS Foundation Trust in 2019 following a successful career of 38 years.

She worked as a General Nurse, Children’s Nurse and Health Visitor and gained her MBA at Keele University. Suzanne currently works independently to support NHS organisations with Quality and Safety, alongside coaching and mentoring Chief Nurses and Senior Nurses.

She has been instrumental in driving forward menopause workplace support across the NHS, having worked nationally as the Clinical Programme Lead.

Professor Alexandra Hopkins – Non-Executive Director

A nurse for 46 years, Alex qualified in 1980 and worked in cancer nursing as a staff nurse and ward sister until the early 1990s.

Further study of nursing at Manchester University led her to qualify as a nurse teacher and she moved into nursing and health education full time.

She was recently appointed as a Visiting Professor in Nursing and Health at Birmingham Newman University. Alex has retained a passion for, and commitment to, promoting excellence in quality patient care.

Mushtaq Ahmed-Khan – Non-Executive Director

Mushtaq is a senior solicitor and experienced Non-Executive Director with over 25 years’ experience across local government, the NHS and commercial practice.

He currently holds senior positions in local government and brings more than 15 years of board-level experience.

A former President of the Birmingham Law Society and a recognised leading lawyer in Chambers & Partners and The Legal 500, he is driven to ensure the effective delivery of high-quality services and brings independent judgment, strong governance and financial oversight, and clear strategic insight at board level.

Mohammed Fessal – Non-Executive Director

Mohammed has been a Non-Executive Director at WMAS since 2021, during which time he has been Chair of the People Committee.

As a qualified pharmacist, Mohammed has over 20 years’ experience across the NHS, private and voluntary sectors.

Currently Director of Pharmacy at CGL, a voluntary sector organisation specialising in substance misuse, Mohammed is passionate about supporting the most vulnerable in society by empowering people and tackling discrimination.

Mohammed is also a member of the Advisory Council on the Misuse of Drugs.

Julie Jasper – Non-Executive Director

Julie joined the Board of WMAS in October 2022 as a Non-Executive Director and Chair of the Audit Committee.

She has held Non-Executive Directorships within the NHS since 2006. Julie qualified as an Accountant in 1985 and has enjoyed a successful career in senior and Executive Director roles in the public, private, voluntary and nationalised industry sectors.

Sukhjeeven (Sukh) Nat – Non-Executive Director

Sukh is currently an Executive Director with Cynergy Bank, joining them three years ago to aid the growth of the Commercial and Property Finance West Midlands division.

He has 23 years’ banking experience in commercial and residential real estate finance with organisations including Santander, NatWest and the RBS Group.

He has wider leadership roles in the Midlands and is also a Board Governor for Birmingham City University.

The West Midlands Ambulance Service Council of Governors appointed Sukh, who took his seat on the Board of Directors.

Chief Executive Officer and Executive Directors

The Chief Executive through the Executive Directors has the day-to-day responsibility for managing the Trust and ensuring the Board’s decisions are implemented. The Board is then responsible for the oversight of performance of the Trust in terms of outcomes.

The National Health Service Act 2006 (the Act) designates the Chief Executive of an NHS Foundation Trust as the Accounting Officer. The Accounting Officer is responsible for:

• Keeping proper accounting records
• Preparing the compliant financial statements
• Ensuring the trust delivers efficient and economical conduct of its business
• Safeguarding financial propriety and regularity throughout the organisation
• Ensuring financial considerations are fully taken into account in decisions taken by the Trust
• Acting as the principal advisor to the Board on these matters

Executive Directors share the same corporate responsibilities as Non-Executive Director colleagues but bring detailed knowledge of the organisation’s management systems and processes and of the health sector, as well as specialised clinical and managerial expertise.

Anthony Marsh – Chief Executive

Anthony started his Ambulance Service career in Essex in 1987. Anthony has held several senior posts with the Ambulance Service in Hampshire, Lancashire, Greater Manchester and West Midlands. Anthony holds three master’s Degrees: an MSc in Strategic Leadership, a master’s in business administration (MBA) and a Master of Arts. Anthony also holds the National Portfolio for Emergency Planning, Response and Resilience.

Karen Rutter – Director of Finance

Karen is a qualified accountant with over 30 years’ experience in NHS finance. Karen is also the Trust’s Senior Information Risk Owner (SIRO), Chief Information Officer (CIO) and Proud Network Executive Sponsor. Karen is a member of the Chartered Institute of Management Accounts (CIMA) with associated designation of Chartered Global Management Accountant.

Caron Eyre – Director of Nursing

Caron has more than 30 years of experience in nursing and is a Registered NMC Nurse. She has spent her entire career in the West Midlands starting in Birmingham, moving to Warwick and Worcestershire and then back to Birmingham. She is an adult and children’s nurse and a nurse tutor.

Dr Richard Steyn – Medical Director

Richard has worked within the NHS since 1984. He initially trained and worked as a rural General Practitioner on the West of Scotland before subsequently moving into surgical training and was appointed as a Consultant Thoracic Surgeon at Birmingham Heartlands Hospital in 1999 before taking on more senior managerial roles including tenures as Medical Director at University Hospitals Birmingham and as Co-Medical Director at Shrewsbury and Telford Hospitals. He has had a parallel career as a prehospital practitioner, strategic medical advisor and now medical director for West Midlands Ambulance Service.

Nathan Hudson – Chief Operating Officer

Nathan is one of the Trust’s executive directors and strategic commanders who has worked for West Midlands Ambulance Service since 1992. He started his career as part of the non-emergency patient transport service before moving to the emergency side of the Trust and qualified as a paramedic in 1997. Nathan is also a Multi-Agency Gold Incident Commander and Tactical Commander. He has an MBA in executive leadership and holds PGD management qualifications in health care.

Carla Beechey – Director of People

Carla has over 25 years’ experience of working in the Human Resources profession having previously worked in the further education sector. She joined WMAS in 2008 as an HR Advisor after completing her professional qualifications in Human Resources Management at the University of Wolverhampton. Carla is a Chartered Fellow Member of the Chartered Institute of Personnel Development (FMCIPD).

Directors – Non-Voting Members

Vivek Khashu – Strategy and Engagement Director

Vivek started his career straight from university, after gaining a degree in Medical Biochemistry, on the NHS Graduate Management Training scheme. Vivek has held a number of operational management posts in Acute Hospitals around the country and has also worked at a national level with NHS England. Vivek also holds an MSc in Health Service Management, from the University of Birmingham.

Murray MacGregor – Communications Director

Murray has been working in the media and public relations since 1995, with the last 20 years as Communications Director for WMAS. During that time, he has overseen a significant upgrade in the way the Trust’s internal communications are handled and has helped raise the profile of the organisation within the Region and nationally.

Nick Henry – Paramedic Practice and Patient Safety Director (to 30.9.25)

Nick started his career in 1990 with WMAS at the age of 16 years on their Cadet scheme in Birmingham whilst gaining experience in every department of the service including first contact with patients. He went on to qualify as a paramedic in 1995. Nick worked in almost every area of frontline operations across the whole region.

Aidan Brown – Service Transformation and Patient Safety Director (from 1.11.25)

Aidan joined WMAS in 2010 and qualified as a paramedic in 2012. Since then he has undertaken several roles including HART paramedic, Critical Care Paramedic and Tactical Incident Commander. Throughout his work in pre-hospital care, he has been passionate about the care delivered to our patients and developing our staff and our service. Aidan holds a PGCert in Pre-hospital Critical Care and an MSc in Emergency Planning, Resilience and Response.

Board Indemnity

The Trust under its Constitution is required to put in place an indemnity for Directors and Governors to cover the risk of legal action against its directors, governors and appropriate officers. This insurance cover is in place.

Board Assurance

This section of the report describes the key governance and assurance mechanisms the Trust relies upon.

A key job of the Board is to seek assurance that risks to its strategic objectives are known and that there are clear plans in place to mitigate, eliminate or manage those risks. This is done through submission of its Board Assurance Framework which is reviewed regularly.

Governance Framework

Governance is the system by which the Trust is directed and controlled. The Board of Directors is responsible for overseeing the governance of the Trust. This includes setting the Trust’s Strategic Objectives and providing the leadership to put those Objectives into effect.

The Governance Framework enables the Board of Directors to supervise the management of the Trust. It is to be distinguished from the day-to-day operational management of the Trust by full-time executives.

Governance is primarily conducted and orchestrated through the leadership and functions of the Board. It is however the business and concern of everyone in the organisation.

Annual Governance Statement

The Annual Governance Statement sets out the means by which the Trust manages risk and how it is entrenched in the governance of the Trust. The Annual Governance Statement sets out clear responsibilities for quality of patient care.

Board Assurance Framework

The Board Assurance Framework (BAF) is the key source of evidence that links the Trust’s “mission critical” strategic objectives to risks, controls and assurances. It is the main tool that the Board uses in discharging its overall responsibility for internal control.

The BAF sets out the significant risks identified by the Trust, current mitigating actions and internal and external assurances. It also identifies control systems and processes and further mitigating actions to be taken for each risk area.

Whilst quantitative data assurance is essential, the Board also uses soft or qualitative data that involves more personal interaction to source as a means of gaining assurance e.g., both Executive and Non-Executive Directors are invited to undertake several site visits in the year based on the principles of “Ward to Board”.

Board meetings include a regular patient and staff experience story item on the ordinary meeting agenda to highlight matters that have gone well and those that have not gone so well. This is considered a key element of organisation learning.

Board Committees

The Board of Directors, during the period of this Annual Report, has appointed the following assurance Committees:

• Audit Committee
• Finance and Performance Committee
• Quality Governance Committee
• Remuneration and Nominations Committee
• People Committee

Also, the Board has established the following:

• Executive Management Board (consisting of the CEO and his Senior Management Team)
• Trustee Committee (responsible for ensuring funds within the Trust’s registered charity are managed in accordance with relevant legislation and regulations.)

Committee Assurance

The Board gains its assurance through its committee structure. Committees are chaired by non-executive directors that report directly to the Board.

• Provide forums for detailed scrutiny of clinical, operational, and financial performance
• Provide assurance of compliance with Foundation Trust registration requirements
• Alert the Board to any significant risks and assurance on maintaining compliance
• Structures are reviewed annually
• Terms of Reference are available upon request from the Trust Secretary

Responsibilities of Board Committees

Audit Committee

Audit Committee* responsible for ensuring the integrity of financial reporting, risk management, and internal controls.

Remuneration and Nominations Committee

Remuneration and Nominations Committee* responsible for agreeing, on behalf of the Board, individual remuneration, allowances and terms of service arrangements for the Chief Executive and Executive Directors.

Finance and Performance Committee

Finance and Performance Committee responsible for the oversight and scrutiny of performance of the Trust on matters of financial and operational performance.

Quality Governance Committee

Quality Governance Committee responsible for ensuring that appropriate standards are set and compliance with them is monitored on a timely basis.

People Committee

People Committee responsible for providing assurance on the quality and impact of people, workforce and organisational development strategies and the effectiveness of people management.

*Committees which are required under the constitution.

External Audit

Bishop Fleming (External Auditors since 1 November 2023) comply with the National Audit Office’s Code of Audit Practice. The Trust does not commission non-audit services from its external auditor.

Integrated Care System

WMAS is part of the Black Country Integrated Care System (ICS), however WMAS is a key stakeholder across all six of the ICS areas we serve, with the Black Country ICB acting as lead commissioner to simplify working relationships when the Trust works across a regional footprint.

The Trust measures its performance at Trust and individual ICB level using an executive scorecard, it also shares this information with all six ICBs, NHS England and the Care Quality Commission on a monthly basis.

Directors are linked to ICBs and the Trust has a representative that is invited to attend the Trust’s lead ICB Board.

Integrated Care System Link Directors

Integrated Care System Working and Accountability

Whilst we have a lead commissioner ICB, alongside the partnership arrangements across the West Midlands ICBs, there are also professional networks, across finance, people, strategy and digital which take place. These all have senior representation from WMAS.

WMAS is a member of the Black Country ICB, with the Strategy and Engagement Director attending the ICB Board in a non-voting capacity.

In addition to the arrangements above, WMAS is also accountable to and regularly attends Health Overview and Scrutiny Committee meetings across the region and an active participant in regional working groups chaired by NHS England, such as the regional Urgent and Emergency Care Board.

The formal oversight of WMAS is undertaken by the lead ICB with participation of NHS England. This is undertaken through monthly System Review meetings and Clinical Quality Review Group.

Board Meetings

Board Member Attendance at Meetings

The attendance at meetings during 2025/26 of those who have served on the Board of Directors is as follows:

Board Member Attendance at Meetings

The attendance at meetings during 2025/26 of those who have served on the Board of Directors is shown below.

Board Member Attendance at Meetings (continued)

The Board meets formally, both in public and private sessions throughout the year to discharge its duties.

Papers for Board meetings are available on the Trust’s website.

Matters are considered by the Board in public and only by exception would an item be considered in private session. Items considered in private would include those matters not normally disclosed under a Freedom of Information request.

NHS England Segmentation Score (NHS Oversight Framework)

During 2025/26, NHS England replaced the Single Oversight Framework with a one-year updated Framework designed to monitor performance, financial sustainability and leadership across organisations.

Organisations are placed into one of four segments, determined by nationally applied performance metrics:

• Segment 1 indicates the highest levels of performance.
• Segment 4 represents the lowest level of performance.
• Below Segment 4 indicates a process of special measures and intensive support.

The approach is rules and numbers based, with no national, regional or local discretion or moderation applied. This ensures the framework is consistently and transparently applied.

An automatic financial override is applied for any Trust reporting a deficit or receiving Deficit Support Funding, leading to a rating of no higher than Segment 3.

The segmentation score is reviewed quarterly, with the final month’s financial performance used to assess the quarter in question.

WMAS was initially rated as Segment 3, due to an in-year reported deficit linked to the costs associated with hospital handover delays, where no agreement was initially in place.

Once this issue was resolved, the subsequent segmentation score moved back to Segment 1. However, this has since moved back to Segment 3 for Quarter 3, linked to a 0.1% variation from plan at Month 9.

WMAS fully expects Quarter 4 to return the Trust to Segment 1, having delivered the full-year plan to break even.

NHS England Provider Capability Assessment

Linked to segmentation scoring is a further regulatory process introduced by NHS England: the Provider Capability Assessment.

The NHS Provider Capability Assessment is an annual mandatory process within the 2025/26 Oversight Framework. It evaluates Trust leadership across six key domains, including strategy, quality of care and financial management.

Trusts assess their capability by rating themselves as:

• Confirmed
• Partially Confirmed
• Not Met

The assessment determines the level of operational freedom available to organisations, with lower capability ratings potentially resulting in intervention through the Provider Improvement Programme.

The scoring matrix uses the following ratings:

• Green
• Green-Amber
• Amber-Red
• Red

In the first Provider Capability Assessment, WMAS was rated Green-Amber.

Care Quality Commission Rating

Trust CQC rating: Good

WMAS remains fully compliant with the registration requirements of the Care Quality Commission (CQC). The Trust was inspected during 2023/24 and received an overall rating of Good.

CQC Inspection

WMAS was inspected in 2023. The inspection assessed leadership through the Well Led domain and reviewed core services, including the Trust’s Emergency Operations Centres and 999 frontline service.

The outcome of the inspection was an overall rating of Good, with several areas of outstanding practice identified, including the Trust’s Control Rooms, which were rated as Outstanding.

WMAS regularly engages with the CQC and ensures that information relating to the Trust’s services, which may support system-wide assessments or assist the CQC in its regulatory role, is available and discussed where appropriate.

Any actions identified through these discussions are completed promptly and kept under regular review.

The full inspection report can be found here:

West Midlands Ambulance Service University NHS Foundation Trust – Overview – Care Quality Commission

Accounting Officer’s Statement of Responsibilities

The NHS Act 2006 states that the chief executive is the accounting officer of West Midlands Ambulance Service University NHS foundation trust. The relevant responsibilities of the accounting officer, including their responsibility for the propriety and regularity of public finances for which they are answerable, and for the keeping of proper accounts, are set out in the NHS Foundation Trust Accounting Officer Memorandum issued by NHS England.

NHS England has given Accounts Directions which require West Midlands Ambulance Service University NHS Foundation Trust to prepare for each financial year a statement of accounts in the form and on the basis required by those Directions.

The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of West Midlands Ambulance Service University NHS Foundation Trust and of its income and expenditure, other items of comprehensive income and cash flows for the financial year.

In preparing the accounts and overseeing the use of public funds, the Accounting Officer is required to comply with the requirements of the Department of Health and Social Care Group Accounting Manual and in particular to:

• Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis
• Make judgements and estimates on a reasonable basis
• State whether applicable accounting standards as set out in the NHS Foundation Trust Annual Reporting Manual (and the Department of Health and Social Care Group Accounting Manual) have been followed, and disclose and explain any material departures in the financial statements
• Ensure that the use of public funds complies with the relevant legislation, delegated authorities and guidance
• Confirm that the annual report and accounts, taken as a whole, is fair, balanced and understandable and provides the information necessary for patients, regulators and stakeholders to assess the NHS foundation trust’s performance, business model and strategy and
• Prepare the financial statements on a going concern basis and disclose any material uncertainties over going concern.

The accounting officer is responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the NHS foundation trust and to enable them to ensure that the accounts comply with requirements outlined in the above mentioned Act. The Accounting Officer is also responsible for safeguarding the assets of the NHS foundation trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

As far as I am aware, there is no relevant audit information of which the Trust’s auditors are unaware, and I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the entity’s auditors are aware of that information.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in the NHS Foundation Trust Accounting Officer Memorandum.

Chief Executive

22nd June 2026

Annual Governance Statement

Scope of Responsibility

As Accounting Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the West Midlands Ambulance Service University NHS Foundation Trust’s (WMAS) policies, aims and objectives, whilst safeguarding the public funds and departmental assets for which I am personally responsible, in accordance with the responsibilities assigned to me.

I am also responsible for ensuring that WMAS is administered prudently and economically and that resources are applied efficiently and effectively. I acknowledge my responsibilities as set out in the NHS Foundation Trust Accounting Officer Memorandum.

The Purpose of the System of Internal Control

The system of internal control is designed to manage risk to a reasonable level rather than eliminate all risk of failure to achieve policies, aims and objectives. It can therefore only provide reasonable, and not absolute, assurance of effectiveness.

The system of internal control is based on an ongoing process designed to:

• Identify and prioritise the risks to achieving the policies, aims and objectives of West Midlands Ambulance Service University NHS Foundation Trust.
• Evaluate the likelihood of risks being realised and the impact should they occur.
• Manage risks efficiently, effectively and economically.

The system of internal control has been in place within West Midlands Ambulance Service University NHS Foundation Trust for the year ended 31 March 2026 and up to the date of approval of the Annual Report and Accounts.

Capacity to Handle Risk

An understanding of the risks facing the Trust is crucial to the delivery of emergency and non-emergency healthcare services moving forward.

Risk management is a key component of enhancing patient care and is a central part of the Trust’s strategic management.

The Trust has a Risk Management Strategy which supports the Trust’s Strategic and Operational Plans by:

• Ensuring safe and timely systems for identifying, reporting and managing risks.
• Facilitating timely feedback and learning from reported risks, incidents and near misses.
• Providing Board-level ownership and assurance that risks are fully reviewed and well managed.
• Promoting an open and transparent culture of risk management throughout the Trust.

The Trust Risk Appetite Statement is continually reviewed. The statement sets out the Board’s strategic approach to risk-taking by defining its overall risk appetite, boundaries, risk tolerance, acceptance and threats to its Strategic Objectives.

It supports delivery of the Trust’s Risk Management Strategy and Policy.

Effective management of risk relies on adequate controls being in place to provide assurance. This is achieved through the Board Assurance Framework (BAF), which provides a comprehensive evidence base of compliance against internal and external standards, targets and requirements.

Register of Interests

The Trust has published an up-to-date register of interests on its website for decision-making staff within the previous twelve months, as required by the Managing Conflicts of Interest in the NHS guidance.

Impact Assessments

The Trust has approved Frameworks for Quality, Equality and Values Impact Assessments. These ensure that transformational programmes designed to provide improved efficiencies do not adversely impact the quality of services provided to patients or the experience of staff at work.

Care Quality Commission Compliance

The Trust is fully compliant with the registration requirements of the Care Quality Commission.

NHS Pension Scheme

As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with.

This includes ensuring that:

• Deductions from salary are made correctly.
• Employer contributions and payments into the Scheme are made in accordance with Scheme rules.
• Member Pension Scheme records are accurately updated within the timescales detailed in the Regulations.

Equality, Diversity and Human Rights

Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are complied with.

Climate Change and Green Plan

The Trust undertakes climate-related risk assessments covering the impacts of climate change and severe weather events, including risks to infrastructure, service continuity and operational resilience.

These assessments are integrated within the Trust’s wider risk management framework and inform planning and mitigation activity.

The Trust’s Green Plan, developed in line with guidance from the Greener NHS Programme, sets out the organisation’s approach to reducing carbon emissions and improving environmental sustainability in line with the NHS Net Zero ambition.

The Green Plan is actively implemented through operational, capital and estate planning processes.

Climate change and adaptation considerations are embedded within organisational governance and risk processes, supporting compliance with the Climate Change Act and associated adaptation reporting requirements.

The Trust continues to strengthen its approach to managing climate-related risks and ensure alignment with evolving national requirements and NHS sustainability standards.

Identifying and Reporting Risk

Risk management involves the following main steps:

• Identifying the significant risks that would prevent achievement of objectives.
• Assigning ownership.
• Evaluating the significance of each risk.
• Identifying suitable responses to each risk.
• Ensuring the internal control system helps manage risks.
• Regular review.

The Trust’s Risk Register and incident reporting systems are available for staff to view electronically at any stage, encouraging a culture of openness and willingness to acknowledge when errors have been made.

The Board is kept aware of actual and potential risks through a system of robust, formal and devolved reporting structures. This system provides a strong focus on evaluating and managing risk.

The Risk and Control Framework

Management of Risk

The Trust’s Risk Management Strategy includes guidance on responsibility for the management of risks, with clear guidance on the authority for treatment of risks. All staff have an important role to play in identifying, assessing and managing risk.

A Health, Safety and Risk Framework sets out safe working processes and the hierarchy of control needed to ensure overall compliance with the Health and Safety at Work Act 1974 and relevant regulations, in support of Health and Safety Executive (HSE) guidance.

The Framework aims to empower all managers to understand and conduct risk assessments by defining:

• How risks threaten achievement of the Trust’s Strategic Objectives.
• Risk appetite, tolerance, levels of residual risk and acceptance.
• The Risk Strategy and associated policies and procedures.
• How risk is managed within the Trust, regardless of risk level (low, medium or high).
• The duty of care and responsibility of every staff member relating to risk management.
• Allocation of responsibility.
• Identification, monitoring and review of risks.

The Trust’s Risk Register identifies risks at four levels, from 1 (very low) to 4 (high risk).

Regulation

As a Foundation Trust, the organisation operates under a licence. The revised licence and conditions came into effect on 1 April 2023. The Board of Directors and the Council of Governors have been made aware of the revised conditions.

The existing control and reporting mechanisms described in this Annual Governance Statement are used to ensure that the Trust is compliant with the terms of its licence.

The Board each year reviews its Annual Skills Matrix to ensure it has sufficient capability at Board level to provide effective organisational leadership on the quality of care provided. The Skills Matrix is presented in the Governance Disclosures section of this Annual Report. All Directors on the Board meet the “fit and proper” persons test as described in the provider licence issued by the regulator and also the CQC fundamental standards requirements as set out in regulations. The Directors are asked each year to notify the Trust if circumstances have changed.

As required by regulation, the Trust has an Audit Committee consisting of Non-Executive Directors. The Chair of the Trust is not a member of the Audit Committee and attends at least once a year, with the Chief Executive Officer attending by invitation to present the Annual Governance Statement. The Audit Committee, at the conclusion of each meeting, meets with the internal and external auditors without the presence of Executive Directors or staff. In addition, the Local Counter Fraud Specialist presents a report to every meeting of the Audit Committee on measures to tackle fraud, bribery and corruption and the importance of reporting concerns as appropriate.

The Trust also has a Remuneration and Nominations Committee consisting of the Non-Executive Directors and, when appropriate, the Chief Executive Officer is also required to attend in line with regulation.

In addition, the following committees are not required by regulation but are considered good practice for NHS Boards. A Quality Governance Committee, a Finance and Performance Committee and a People Committee have been established and meet regularly.

Each Committee is chaired by a Non-Executive Director. The approved minutes of all Board Committees are submitted to the next appropriate Board meeting where they are received.

Each Committee also has an identified lead Executive Director. The responsibilities of the Board and its Directors are defined in the Trust’s Constitution, Standing Financial Instructions and Standing Orders.

The Audit Committee submits an Annual Report to the Board of Directors and the Council of Governors and, in addition, the Trust’s External Auditor presents an independent report to the Council of Governors and the Membership at its Annual Meeting.

Bishop Fleming is engaged as the Trust’s External Auditors and KPMG is the Trust’s Internal Audit provider. Assurance for the 2025/26 financial year is provided under these arrangements.

The Board has a detailed schedule of business, which is reviewed at each ordinary meeting of the Board. The schedule defines when reports will be submitted, ensuring the Board can carry out its duty of oversight.

Key performance reports covering corporate, clinical, quality, workforce, finance and operational performance indicators are received at each ordinary meeting of the Board and are made available on the Trust’s website as part of the Trust Information Pack.

The Trust has in place Directorate Portfolios, and these are reviewed following any changes at senior level. There is a clear organisational structure with staff and managers identified within each directorate, who are appropriately qualified.

The Trust governance structure is based on financial control, operational performance monitoring and assurance in relation to clinical quality governance.

The Trust is compliant with healthcare standards that are binding, which is demonstrated by the Trust being rated overall as “Good”.

As part of gaining assurance, Board members are encouraged to visit staff and sites, with each Director allocated to a particular Trust site. In addition, through the ‘Day in the Life’ programme, members of the Board and the Council of Governors can attend operational shifts and meet patients and operational staff.

The Quality Governance Committee receives regular reports from clinical and operational staff and through several documents such as patient safety reports, learning from deaths, claims and inquests and other area updates to enable oversight and to gain assurance of the Trust in relation to the quality of patient care.

The Trust’s Medical Director, the Executive Director of Nursing and the Transformation and Patient Safety Director advise the Committee.

The Board of Directors holds overall responsibility for the management of risks within the Trust, ensuring significant risks to the Trust’s ability to provide a quality service are identified and managed. The Board receives a Trust Information Pack at each meeting, which contains key performance indicators.

Non-Executive Directors seek assurance in relation to the performance of the Executive Management Board in meeting agreed goals and objectives.

The Chief Executive Officer is the Accounting Officer and is responsible for ensuring that a system is in place for reporting all incidents.

Executive Directors hold responsibility for the identification and management of their risks and ensure they are documented, registered and updated in a timely fashion for the relevant forums to review. They are responsible for the risk management process within the Trust.

The Governance Director and Trust Secretary was, during the period of this report, responsible for Corporate Governance for the Trust and compliance with the Foundation Trust Constitution.

The Director of Nursing, during the period of the report, was responsible for monitoring and reviewing the Risk Management Strategy and associated policies, providing expert advice into the incident reporting process, and maintaining appropriate quality and clinical governance. The Director of Nursing is also the Chief Clinical Information Officer (CCIO), Director of Infection Prevention and Control (DIPC), Director for Health and Safety and Executive Nurse.

From April 2025 to 30 September 2025, the Paramedic Practice and Patient Safety Director provided strategic leadership and clinical advice to the Board, including patient safety and learning from deaths.

From 1 November 2025 to date, the Service Transformation and Patient Safety Director is the Controlled Drugs Accountable Officer (CDAO), responsible for Learning from Deaths, is the Patient Safety Incident Response Framework (PSIRF) lead and Champion for maternity services, and is the Director lead for Transformation and Efficiencies.

The Director of Finance is the Chief Information Officer (CIO), Sustainability Director, Security Management Director and Senior Information Risk Owner (SIRO). The Director of Finance is responsible for the production of the Annual Report and Accounts (ARA), Internal and External Audit, Counter Fraud, Information Governance (FOI/DSPT/GDPR), and Charity funding.

The Chief Operating Officer is responsible for performance and the efficiency of A&E and Non-Emergency Patient Transport Services, including operational delivery and resource planning.

The Medical Director is the Caldicott Guardian and Responsible Officer for medical revalidation and is responsible for Patient Group Directions (PGDs).

The Director of People is responsible for ensuring all staff receive an adequate level of training in accordance with the Trust’s Training Needs Analysis. The Director is also responsible for Equality, Diversity, Inclusion and Human Rights programmes, NHS workforce health and wellbeing, learning disabilities and mental health of staff, and is the Domestic Abuse and Violence Lead.

The Strategy and Engagement Director is the Freedom to Speak Up Guardian, the Director for CQC, Fraud Champion and NHSE Relationship Manager.

The Communications Director is responsible for the Communications Strategy, public relations and media liaison.

Pillar Committees and Subgroups of the Trust provide a process for escalation of assurance and risk through the Trust.

The Executive Management Board provides a support and challenge function, which includes agreement of actions required, including escalation of major and high-risk transformational change to the Board of Directors.

The Audit Committee monitors financial risks and reviews the Board Assurance Framework. It critically reviews and reports on the relevance and robustness of the governance structures and assurance processes on which the Board places reliance.

The Finance and Performance Committee has responsibility for monitoring and reviewing the adequacy and utilisation of resources to assure the Board on risks relating to the efficient and effective delivery of strategic financial and operational plans and in-year reported performance.

The Quality Governance Committee reviews and monitors actions relating to patient safety, clinical quality, health and safety, equipment and other areas of assurance.

The Health, Safety, Risk and Environment Group reviews Risk Registers, escalating high risks to the Quality Governance Committee. The Group ensures risks are managed in accordance with policy.

The People Committee has specific responsibility for the management of risks relating to the employment and development of staff and reviews the workforce element of the Trust’s Risk Register at least four times each year.

The Learning Review Group has responsibility for identifying and monitoring trends in incident reports, ensuring identified risks are delegated for assessment and management, ensuring learning from incidents is shared appropriately with all stakeholders, and reporting identified trends and issues to the Health, Safety, Risk and Environmental Group.

The Professional Standards Group ensures that risks relating to the Clinical and Quality Strategies are reviewed, ensuring high quality clinical care continues to be delivered across the organisation. The Professional Standards Group ensures the organisation remains safe, effective and responsive and that opportunities for further improvement are reviewed and actioned accordingly.

The Operational Management Team manages service delivery risks. It ensures that risk assessments from the Trust’s Risk Register are maintained by the relevant manager.

The Financial Investment Group ensures that appropriate scrutiny is undertaken on revenue and capital requests for expenditure, ensuring the correct approval routes are followed. The Group oversees delivery of the capital expenditure plan, working within the CDEL and IFRS 16 requirements.

The Efficiency and Transformation Group identifies, reviews and supports the implementation of initiatives that deliver the Trust’s CIP and aims to improve operational, clinical and financial efficiency across the Trust on behalf of the Executive Management Board.

The Digital Transformation Oversight Group oversees the Trust’s Digital, Data and Technology workstreams.

WMAS engagement with local communities emphasises building relationships, trust and confidence in the organisation.

The Trust has several staff networks, where information is shared on local and national developments around equality and inclusion. The networks are kept up to date on consultations and engagement opportunities where appropriate and form part of the Diversity and Inclusion Steering and Advisory Group (DISAG), which meets regularly.

The networks are:

• Disability and Carers Network
• ONE (BAME) Network
• Proud Network
• Military Network
• Women’s Network
• Student Network

The Trust engages with local authority Health Overview and Scrutiny Committees and local Healthwatch organisations across the West Midlands.

The Trust’s Communications and Engagement Strategy describes the means of engagement with its key stakeholders. The draft annual Quality Account is shared with key stakeholders, including Commissioners, Healthwatch and Local Authority Scrutiny Committees, to provide an opportunity for input.

The Trust’s website provides ready access to information across all areas of Trust activity. The Trust uses its newsletter for members to inform the public of new developments and items of interest.

The Trust secures the economic, efficient and effective use of resources through a variety of means:

• A well-established policy framework, including Standing Financial Instructions.
• An organisational structure which ensures accountability and challenge through the committee structure.
• An established planning process.
• Effective corporate directorates responsible for workforce, revenue and capital planning and control.
• Detailed monthly financial reporting, including progress on achievement of Cost Improvement Programmes and year-end forecasting.
• A Financial Investment Group that reviews the merits and risks of investments.
• A Business Case “post implementation” review is undertaken and reported to the Board.

Day-to-day management of resources is delegated through the Executive Management Board (EMB). EMB takes lead responsibility for the annual planning cycle, including formulating the plan, implementing the plan, monitoring delivery against the plan, taking action to bring variances back under control and reporting as required.

The Board of Directors’ Schedule of Business includes comprehensive reviews of performance against clinical, operational, workforce, corporate and financial indicators through the Trust Information Pack at each meeting. Any emerging issues are identified and mitigating action implemented.

The Finance and Performance Committee, which is chaired by a Non-Executive Director, with other Non-Executive Directors also as members, provides assurance to the Board of Directors regarding the achievement of the Trust’s financial plan and priorities. In addition, it acts as the key forum for scrutiny of the robustness and effectiveness of all cost efficiency opportunities.

In response to an increasingly challenging operational and financial environment, the Efficiency and Transformation Team was established at the start of the financial year. The Efficiency and Transformation Group, led by the Service Transformation and Patient Safety Director, has been reintroduced and leads on identifying, reviewing and supporting the implementation of initiatives that improve efficiency across the Trust on behalf of the Executive Management Board, whilst ensuring high-quality clinical care continues to be delivered across the organisation.

The Trust’s commitment to value for money is strengthened by the effective and focused use of its Internal Audit service, which is provided by KPMG. The Internal Auditors provide independent and objective assurance to the Trust through the Audit Committee and provide assurance statements to the Board that the Trust’s risk management, governance and internal control processes are operating effectively.

West Midlands Ambulance Service is able to employ a range of skills to ensure that the Trust, in general, and the Audit Committee, in particular, secures assurance that resources are being appropriately utilised.

The Trust has Local Counter Fraud Specialists (LCFS) who ensure Counter Fraud services are delivered and promoted throughout the organisation. Any concerns can be directed to the team, with information treated in accordance with confidentiality requirements.

External Auditors, Internal Auditors and the Local Counter Fraud Specialist report to each meeting of the Audit Committee. Audit colleagues meet with members of the Audit Committee without management present.

The Trust undertakes workforce planning with input from senior members of the Operational, Finance and Workforce Directorates, who ensure robust scrutiny and development of the workforce plan. This is completed with regard to commissioners’ future intentions. In support of this work, the Trust has developed People and Organisational Development strategies, which have been endorsed by the Board of Directors.

Work continues within the Information Governance Team to review, amend and update procedures and processes. This is with a view to strengthening existing workflows while also introducing efficiencies across the Trust. This includes:

• Refreshing information governance and data sharing principles so that each team is aware of their duties and expectations.
• Reviewing policies, procedures and notices to ensure they are accurate, fully support regulatory requirements and are clear.
• Introducing reference documents, process flows and “guides” for teams.
• Trend management and reporting, including updating categorisation.
• Learning from incidents to mitigate and reduce risk, for example data breaches.

The Medical Director undertakes the role of Caldicott Guardian for the Trust. They are the senior person responsible for protecting the confidentiality of patient and service-user information and enabling appropriate information sharing.

The Director of Finance is the nominated Senior Information Risk Owner (SIRO) for the Trust. The Head of Information Governance is the Data Protection Officer.

All organisations that have access to NHS patient data and systems are required to undertake a Data Security and Protection Toolkit (DSPT) self-assessment to provide assurance that they are practising good data security and that personal information is handled correctly.

The Trust continues to work on the NHS Data Security and Protection Toolkit (DSPT) for 2025/26. The Trust completed its baseline assessment as required by 28 February 2025. The self-assessment and associated evidence are independently audited, with final submission of the completed DSPT due by 30 June 2026 for the 2025/26 toolkit.

Training is provided to all staff, as part of annual mandatory training, on good information governance practices.

The Directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended) to prepare Quality Accounts for each financial year. NHS England (in exercise of the powers conferred on Monitor) has issued guidance to NHS foundation trust boards on the form and content of annual Quality Reports, which incorporate the above legal requirements within the NHS Foundation Trust Annual Reporting Manual.

The following arrangements are in place within the Trust to assure the Board that the Quality Account presents a balanced view and that appropriate controls are in place to ensure the accuracy of data:

The Trust, during the period of this Annual Report, had a Medical Director and a Director of Nursing to advise the Board of Directors on all matters relating to the preparation of the Trust’s Annual Quality Account. The Strategy and Engagement Director has designated responsibility for the development of the quality agenda.

All staff involved in collecting and reporting quality metrics are suitably trained and experienced.

The Business Intelligence Unit and Clinical Audit teams ensure that data quality checks take place prior to any published data reports.

Clinical reporting is regularly audited both internally and externally by Internal and External Auditors. Audit work is also being undertaken to ensure this takes place with individual clinicians.

Quality Reports outline the Trust’s performance against key quality objectives, including benchmarking and comparative data. These reports are subject to discussion and challenge at Trust governance meetings, up to and including the Board of Directors, to inform the annual Quality Account.

Policies and procedures are in place in relation to the capture and recording of patient data. Regular monitoring and scrutiny take place throughout the governance structure, with assurance and risks managed and escalated as previously described.

Systems and processes are in place for the audit and validation of performance data.

As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review of the effectiveness of the system of internal control is informed by the work of Internal Audit, clinical audit, executive managers and clinical leads within the NHS Foundation Trust, who have responsibility for the development and maintenance of the internal control framework.

I have drawn on performance information available to me. My review is also informed by comments made by the External Auditors in their management letter and other reports. I have been advised on the implications of the results of my review of the effectiveness of the system of internal control by the Board, the Audit Committee and the Quality Governance Committee. A plan to address weaknesses and ensure continuous improvement of the system is in place.

The Board of Directors has put in place and annually reviews the Trust committee structure to ensure clear governance arrangements are established, supported by Trust documentation. Approved Board Committee minutes are submitted to the subsequent Board meeting.

Each Executive Director reports to each meeting of the Board on matters relevant to their portfolio, including financial control, patient experience, patient safety, serious incidents, duty of candour, safeguarding, medicines management, claims and coroners, infection prevention and control, Freedom of Information, policies and procedures, and non-patient safety incidents.

The Board also receives a biannual report from the Freedom to Speak Up Guardian on whistleblowing and concerns raised by staff and volunteers.

The Audit Committee reviews the Trust’s risk management and internal control systems. It monitors the Board Assurance Framework, Risk Register and internal control processes through its own activities and through receiving relevant reports from the External and Internal Auditors.

Risks are monitored through the Executive Management Board, Audit Committee, Finance and Performance Committee, People Committee and Quality Governance Committee, with high-scoring or escalated risks reported to the Board.

The Audit Committee regularly reviews Internal Audit plans and reports in order to form an opinion on the effectiveness of internal control systems and to recommend acceptance by the Accounting Officer.

In 2025/26, the Audit Committee approved an Internal Audit Plan that provided a balanced focus on financial, operational and clinical governance. The plan allocated Internal Audit resources across governance and risk issues, finance, performance and operations, information governance, quality and clinical reviews, and human resource reviews.

The Quality Governance Committee has primary responsibility for monitoring and reviewing quality and clinical aspects of performance and development plans, together with associated risks and controls, corporate governance, and quality and clinical outcomes. The Committee provides assurance to the Board on these matters.

The Committee ensures that appropriate standards are set and compliance with them is monitored in a timely manner. It also ensures that relevant Key Performance Indicators, strategic and operational milestones, and timescales are identified and monitored for achievement and effectiveness.

WMAS recognises the importance of ongoing evaluation of the quality of care provided against key indicators. As a member of the National Ambulance Service Clinical Quality Group, which develops National Ambulance Quality Indicators and National Clinical Audits, the Trust actively participates in both national and local audits to identify opportunities for improvement.

As a result, the Trust has a comprehensive Clinical Audit Programme, which is monitored by the Clinical Audit and Research Group.

Internal Audit undertakes a range of reviews of internal processes and controls. Management has fully accepted the findings and agreed action plans to address and strengthen controls where required. The Audit Committee has considered all Internal Audit reports and monitors progress against any outstanding management actions.

The Head of Internal Audit provides me with an opinion on the overall arrangements for gaining assurance through the Assurance Framework and on the controls reviewed as part of the Internal Audit work. The Assurance Framework and performance reports provide evidence that the effectiveness of the controls in place to manage the risks to the organisation achieving its strategic objectives have been reviewed.

The Trust’s Internal Auditors provide an annual conclusion across four components: governance, risk management and control, financial reporting and management, and data captured and used by the organisation. These are aligned with the requirements of the Global Internal Audit Standards (GIAS), as applied to the public sector through the application note for Global Internal Audit Standards in the UK Public Sector by relevant standard setters.

Based on the controls reviewed, the following conclusions have been drawn:

• Governance (Amber-green): Overall findings on design show some controls to be effectively designed, with some exceptions. Testing showed some controls to be operating effectively, while others could be applied more consistently.
• Risk management (Amber-green): Overall findings on design show some controls to be effectively designed, with some exceptions. Testing showed some controls to be operating effectively, while others could be applied more consistently.
• Financial reporting and management (Amber-green): Overall findings on design show some controls to be effectively designed, with some exceptions. Testing showed some controls to be operating effectively, while others could be applied more consistently.
• Data captured and used by the organisation (Amber-green): Overall findings on design show some controls to be effectively designed, with some exceptions. Testing showed some controls to be operating effectively, while others could be applied more consistently.

Date: June 2026

I can confirm that no significant internal control issues have been identified within this Annual Governance Statement.

Chief Executive

22nd June 2026

The Trust is committed to preventing modern slavery and human trafficking in its supply chains, in line with the requirements of the Modern Slavery Act 2015.

During the reporting year, the Trust continued its approach by embedding modern slavery considerations within procurement processes, including ethical compliance checks at tender stage and the continued application of NHS Terms and Conditions.

The Trust maintains a zero-tolerance approach and continues to review and enhance its risk assessment and due diligence processes across its supply chains.

The Trust’s full Modern Slavery Statement is published on our website.