Quality Account 2024-25

A Message from the Chairman

One of the great delights of being Chairman of WMAS is the opportunities I get to spend time with staff hearing about their work and seeing the difference they make to patients. While it is often quoted that staff are the most important part of any organisation, I can say that this is 100% true of our Trust. Whichever part of the Trust they work in, they all contribute in their own way to supporting patient care.

As someone who started their career in the NHS as a scientist, research and development has always been hugely important to me. The Trust enrolled around 1,000 participants into more than a dozen different research studies last year, all with the aim of improving patient care and staff wellbeing.  As well as helping to save more lives, some research studies have looked at identifying patients who will benefit from care at a major trauma centre, would receive more effective pain relief, improve end of life care and ensure faster specialist stroke care.  What is so encouraging is the way that our staff buy into the chance to assist in these research studies as they understand their importance. NHS organisations that have an expansive research programme have been shown to deliver a higher quality of care, which improves patient outcomes and creates a fulfilling work environment for clinicians.  

Innovation is a cornerstone of our Trust. Whether that is having a paramedic on every ambulance, the work that we have done in our control rooms, our student paramedic programme; all have helped us to help patients. One innovation that was introduced this year did grab my attention. Our Education & Training team have been working with a software company to develop a state-of-the-art virtual reality driving simulator.  We know that driving on blue lights is never easy so providing a way of being able to introduce scenarios that would be impossible to recreate for real brings a real benefit to our staff. It is very exciting that we can offer our students such an incredible learning opportunity within their blue light driver training with the Trust. We have already had interest from other emergency services who are keen to see how they might follow suit.

Another area that I am passionate about is patient safety.  Over the last year, the Trust has introduced a new way of looking at how we review incidents that happen and more importantly what we can do to stop them happening again. We introduced PSIRF, the Patient Safety Incident Response Framework, which promotes a proportionate approach by ensuring resources allocated to learning are balanced with those needed to deliver improvement. As a Trust we have invested in building the team that looks at this area of learning as this will undoubtedly lead to fewer incidents and less harm coming to patients.  The feedback that we have had from both staff and external bodies has been very positive and that can only be a sign of the success of the implementation and the hard work of the team who have done so.

Last year I highlighted the work we had been conducting into how to support our staff.  That has continued this year with the appointment of a ‘People Promise’ Manager who has been working with colleagues to look at how we can better support them. This supports workstreams such as our Health and Wellbeing Champions, the Staff Advice and Liaison Service, Freedom to Speak Up Ambassadors and the six Staff Networks we have. While we are rightly proud of the work that do to recruit new staff, we are working equally hard to retain staff. While there is always more to do, we have seen the number of staff leaving slow considerably and we now have the lowest turnover of staff in the ambulance sector which suggests that we are making good progress.   

As you will read in the Chief Executive’s Review of the year, hospital handover delays remain a very real issue for us. As a Board, we took the difficult decision to increase our risk rating back to 25, the highest available, to register our concern that patients are coming to harm due to the delays. However, it is not just the patients that we as a Board are concerned about; the impact it has on staff cannot be underestimated.  Missed mealbreaks, regular late finishes that impact family time cannot be underestimated. I know I speak for the whole Board when I say it is our biggest concern and one that we will do all we can to find solutions to.

As Board we have seen very few changes for some years, however, we have seen no fewer than three changes over the last 12 months. From a Non-Executive side we welcomed nurse Suzanne Banks at the beginning of April. In December we welcome Sukh Nat who comes from a finance background. They replaced Wendy Farrington-Chadd and Narinder Kaur Kooner who had come to the end of their terms. From an Executive position, we were very sad to see our Medical Director, Dr Alison Walker, step down to concentrate on her health after a serious illness. While leaving us in a formal role, Alison will continue to be part of our Trust through her national work. We were also delighted to welcome Dr Richard Steyn as Alison’s replacement. Richard has worked with the Trust for decades in his role as a BASICS emergency doctor responding to some of our most seriously ill patients. His reputation in the NHS is unparallelled and we are delighted that he has joined us in a more formal role. 

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.  We continue to see hundreds of members of the public contact us each month to say ‘thank you’. Reading these messages is deeply humbling and is quite remarkable when you consider how tough the last few years have been for the Trust.  

Finally, on behalf of the Board, I want to thank all 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 staff; the likes of our mechanics, vehicle preparation teams and stores; the managers at all levels; the corporate staff; the many volunteers who support us daily, thank you for everything you have done. 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 review 2024-25 

Last year I said that I was trying to find a different way to start my annual review, but sadly, it is the same old problems that largely marked out the year: hospital handover delays and a tough financial climate.

We lost a staggering 380,000 hours of crew time as ambulances waited to offload their patients outside A&E. That’s equivalent to taking 86 ambulances off the road and putting them in a car park every day!  We have once again taken difficult decisions to prioritise frontline operations, bring in a balanced budget and work with our staff to improve our response time performance compared to last year.  

We will be one of only a few services to achieve the target of getting to the stretch target of reaching Category 2 calls in under 30 minutes.  While this is good news it must be remembered that the full target is 18 minutes, so we still have some considerable distance to go and the only way we will be able to reach that target is through a reduction in hospital handover delays

In more positive news, we continue to have the best call taking in the country with the fewest number of calls waiting over two minutes to be answered, despite receiving 1.78 million emergency 999 calls last year.  Another area where we lead the country is our ability to deal with cases in our control rooms. Over 20% are now dealt with by our experienced team of paramedics and nurses. In addition, we refer over 400 calls a day to urgent care providers which allows patients to get the care that best meets their needs.

We have seen real progress is in the way that we deal with mental health patients. We have seen a significant rise in such cases since the COVID-19 pandemic and as a result we have invested in specialist vehicles and staff to tackle this hugely important issue. Figures from the Home Office shows that we are the leading ambulance trust in England and Wales when it comes to the patients detained under section 136 of the Mental Health Act.  Our Patient Transport Services have once again had an excellent year despite incredibly challenging times. We have significantly improved our performance despite rising numbers of cases. – the feedback we receive shows just how much the efforts of staff means to their patients.  It’s been a busy year for our Community First Responders (CFRs), who dealt with around 1,000 cases a month, and so we’ve increased the number of CFRs we have assisting us.

The latest data from NHS England shows that we continue to be the most efficient ambulance trust in the country, with a bigger percentage of staff working in frontline roles. As well as taking on more staff, fewer of our existing staff are choosing to leave us.  We have the lowest turnover in the ambulance sector and one of the lowest in the NHS. 

While far too many patients have waited much longer than we would want to get the help they need, I have been moved by the record number of patients who’ve taken the time to contact us to say, ‘thank you’. While none of our staff do the job for that reason, there is no question it makes a huge difference to the staff who helped you. It’s truly appreciated.

I was pleased to see a rise in the number of staff using the Freedom to Speak Up (FTSU) service during the year. While this might seem an odd statement to make, it means that colleagues have the confidence to raise issues which allows us to make improvements. Of course, this is only one of many different ways that staff can do so. The work of our Guardians and the team of staff ambassadors who work on each of our sites is having a real impact on the belief amongst staff that they can and should raise concerns which can only be a good thing.

Sadly, staff continue to be on the receiving end of violence and aggression on an all too regular basis. It’s one of the reasons why we support the Association of Ambulance Chief Executives (AACE) #WorkWithoutFear campaign.   

We have seen an almost 100% increase in violence in recent years.  This isn’t just physical violence to staff on the road; our call assessors have been threatened in the most horrendous ways. 

While I often concentrate on the work of our frontline staff, I would also like to take a moment to pay tribute to the outstanding work of our support services.  Be that the team who maintain and clean our ambulances, the stores team who move literally millions of items every year or those who work in corporate teams.  

May I finish by saying how enormously proud I am of each of our staff, students and volunteers; governors and non-executive directors, 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.

Thank you for all that you do.

Anthony C. Marsh

Chief Executive Officer

Statement from the clinical directors

Last year’s Quality Account informs of a Regulation 12 notice from the Care Quality Commission which required us to improve our response times, particularly category 2. This was our organisation’s primary focus, all staff understanding the importance this has upon patient safety and, plus patient and staff experience.  A huge amount of focus went into working towards this safety target from individual paramedics spending effective and efficient time on sites, the education team training more paramedics and the vehicle preparation officers working in new ways to increase vehicle readiness to mention a few. The executive team raising and escalating concerns regarding excessive hospital handover times in all external forums, working to mitigate increasing risks from the increasing delays and reduce harm to patients.  As a result, we have put more ambulances on the roads than ever before.

We achieved the target of under 30 minutes for Category 2 despite the monumental increase in hospital handovers, that reached over 380,000 hours. This is not just a performance standard, but is key to patient safety, including the unassessed patient risk in the community.

Our patient safety team worked hard to successfully launch the Patient Safety Incident Response Framework (PSIRF). This is now in place enhancing our approach to organisational learning when things go wrong with a compassionate approach to work with patients, patients families & carers, also staff involved, learning from their experiences, and avoiding further trauma in the investigation process. The transition to PSIRF has received positive feedback from staff. Hearing about and learning from patient & family experiences and stories has been refreshed. We launched our Patient Experience Group and asked service users from across the West Midlands to work with us over the long term to improve care. We have had more patients, and their relatives come to Board and tell their stories. We have participated in the first ever national ambulance sector patient experience survey, coordinated by AACE.

This year saw the implementation of further support to people with Mental Health needs with dedicated NHS funding to provide increased services for this group. This funding was built on MH practitioners working in the Emergency Control rooms to increase this staff group, provide a specialised MH response vehicle in 5 Integrated Care Systems and increase the training provision to improve all emergency response staff.  

During this year we have also supported the Health Services Safety Investigations Body (HSSIB) with investigations in the sector for healthcare provision in prisons and pre-hospital interpretation on ECG’s in the ambulance services. This giving further opportunities for learning from the report findings to improve patient experience and care provided.

Since the publication of NHS England’s 2025/26 Operational Planning Guidance, that gives clear guidance on a maximum of 45 minutes for a patient to be handed over at hospital, there has been continued focus to support systems to achieve this. There is further work to improve the use of appropriate community services through ‘call before convey’, the support the NHS priority of ‘hospital to community’. This key focus for the Trust has seen the development of a new post to support direct focus on the Trust meeting this priority in 2025/26.

Nick Henry – Paramedic Practice and Patient Safety Director

Caron Eyre – Director of Nursing

Richard Steyn – Medical Director

Part 1 – Statement of Quality

Introduction

At West Midlands Ambulance Service University NHS Foundation Trust, we place quality at the very centre of everything that we do. We work closely with partners in other emergency services, different sections of the NHS and community groups. These include working strategically with the Integrated Care Systems as they plan local health services, and on a day-to-day basis with hospitals, Primary Care Networks, mental health and other specialist health and social care providers. We recognise that each organisation plays a vital role in responding to the day-to-day health needs of our population. 

Our strategy, which has been reviewed over the course of the last twelve months remains focused on our vision, as this continues to reflect our overall purpose: 

“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”.

Put simply, patients are central to all that we do. This means a relentless focus on the safety and experience of patients during our care and ensuring the best clinical outcomes are achieved. Our strategic objectives provide an alignment of the Vision with carefully determined priority areas of work.

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

We understand that to continue to improve quality, it is essential that our patients and staff are fully engaged with our plans and aspirations. Our values, which were launched in March 2023, are kept at the core of our work, helping us to improve the organisation, improve the quality of services for our patients and strengthen the support that we provide to all our staff.

• Excellence
• Integrity
• Compassion
• Inclusivity
• Accountability

Care Quality Commission 

The Trust is registered with the Care Quality Commission (CQC) and has been rated as ‘Good’ following its inspections in August and October 2023. This follows the rating of

‘Outstanding’ from the previous two inspections. The resulting report was published on 23rd February 2024. The following provides an overview of the Trust’s ratings for each of the five domains, and confirms the overall rating of Good:

• Safe – Good
• Effective – Good
• Caring – Outstanding
• Responsive – Good
• Well led – Good

We regularly engage with the CQC and ensure that any information relating to our service which may be of use in system wide assessments is available and discussed where appropriate. Any actions identified through these discussions are completed promptly and kept under regular review.

Ambulance Cultural Review

This independent review, commissioned by NHS England, considers the prevailing culture within ambulance trusts in England. It considers the core factors impacting cultural norms and offers actionable recommendations for improvement.

Based on insights from key stakeholders, this review has identified six key recommendations to improve the culture in ambulance trusts: 

1.  Balance operational performance with people performance at all levels.

2.  Focus on leadership and management culture and develop the ambulance workforce.

3.  Improve the operational environment, line management and undergraduate training.

4.  Translate the NHS equality, diversity, and inclusion improvement plan into a bespoke plan for the sector.

5.  Target bullying and harassment, including sexual harassment and enable freedom to speak up.

6.  Prioritise, support and develop human resources and organisational development functions.

A national ambulance implementation board has been set up to drive forward change at a national level, which includes the recommendations put forward for NHS England and ICB’s. WMAS has developed an action plan to provide evidence and assurance in respect of the recommendations.  A position statement outlines why the ambulance sector is different to other parts of the wider NHS, considering the unique operating environment, the barriers and enablers to achieving the seven NHS England People Promise elements.  Finally, a self-assessment has been provided in respect of the position statement to indicate where these elements have already been captured in existing Trust workstreams / action plans as to not create duplication and confusion in a further action plan being created and progressed.

Our Services

With a budget of approximately £400 million, the Trust serves a population of 5.6 million who live in Shropshire, Herefordshire, Worcestershire, Coventry and Warwickshire, Staffordshire and the Birmingham and Black Country conurbation. The West Midlands sits in the heart of England, covering an area of over 5,000 square miles, over 80% of which is rural landscape. 

The service provides a 999-emergency ambulance response from 15 operational hubs across the region with a fleet of around 460 ambulances. In partnership with 2 local mental health trusts, the ambulance service operates mental health triage cars to help patients in crisis. The trust has 2 emergency operations centres (EOCs) taking and managing around 4,000 999 calls each day, amounting to approximately 1.7 million during the year with a mean answer time of 2 seconds. One EOC is at Brierley Hill, alongside trust headquarters, and the other at Tollgate in Staffordshire.

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

The Trust contracts with 5 air ambulances run by independent charitable Trusts, operates a Hazardous Area Response Team (HART), works with voluntary organisations, such as BASICS doctors, and has a network of around 750 Community First Responders.

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

The Trust does not sub-contract to private or voluntary ambulance services for provision of its E&U services. To ensure excellent business continuity in support of major incidents the Trust has agreements in place to request support from other NHS Ambulance Services.

The Trust has utilised the services of private providers during 2024/25 to support Non – Emergency Patient Transport Services. Sub-contractors are subjected to a robust governance review before they are utilised. 

The income generated by the relevant health services reviewed in 2024/25 represents 99.86% of the total income generated from the provision of health services by the Trust for 2024/25. More detail relating to the financial position of the Trust is available in the Trust’s 2024/25 Annual Report.

Performance – Emergency and Urgent service

The Trust is measured nationally against operational standards for Emergency and Urgent with each category of call having difference timeliness standards:

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

• 7 minutes mean response time
• 15 Minutes 90th centile response time

Category 2 – 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 but not life threatening (e.g. pain control, non-emergency pregnancy)

• 120 Minutes 90th centile response time

Category 4 – Non urgent but require a face to face assessment

• 180 Minutes 90th centile response time

Ambulance quality indicators

National Audits

Ambulance Services are not included in the formal National Clinical Audit programme, however, during 2024-2025 the Trust participated in the following National Ambulance Clinical Quality Indicators Audits:

Care of ST Elevation Myocardial Infarction (STEMI)

This is a type of heart attack that can be diagnosed in the pre-hospital environment. Patients diagnosed with this condition are often taken directly to specialist centres that can undertake Primary Percutaneous Coronary Intervention (PPCI).

Audit element

Percentage of patients with a pre-existing diagnosis of suspected ST elevation myocardial infarction who received an appropriate care bundle from the Trust during the reporting period. In patients diagnosed with STEMI it is important to get them to a Primary Percutaneous Coronary Intervention (PPCI) centre as quickly as possible – MINAP records the time that the PPCI balloon is inflated by the hospital.

The Trust measures 999 Call to catheter insertion by the mean and 90th percentile.

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 out of hospital cardiac arrest. The Trust provides data to the Out of Hospital Cardiac Arrest Outcomes Registry.

Audit element 

Percentage of patients with out of hospital cardiac arrest who have return of spontaneous circulation on arrival at hospital and patients that survive to hospital discharge and a care bundle for treatment given post return of spontaneous circulation.

Clinical Audit Title

• PGD Audit
• Administration of Morphine Audit
• Adrenaline Administration
• Naloxone Administration
• Activated Charcoal
• Co amoxiclav administration
• Management of Paediatric Pain
• Maternity Management
• Post partum haemorrhage (PPH) management 
• Falls >=65 discharged at scene
• Non traumatic chest pain >=18 years discharged at scene
• Head Injury discharged at scene discharged at scene
• Feverish Illness in children discharged at scene
• Blood Ketone Audit
• Management of Sepsis
• Management of Asthma In Children
• Mental Capacity Act
• Management of Overdose
• MERIT PHEA 
• MERIT Transfusion

Participation in research 

During 2024/25, the Trust has continued to expand the opportunities for staff and patients to be involved in pre-hospital research, furthering academic and research relationships in collaboration with local universities, as a University Ambulance Service.   During the year, the Trust has continued to develop strong partnerships with NHS Trusts and universities from across the UK.   

The number of participants that were recruited during the 2024/25 period to participate in research approved by the Health Research Authority and a Research Ethics Committee was 578, of which 465 were added into the National Institute of Health Research Portfolio.  During this period, the Trust participated in 15 research studies meeting these criteria, of which 7 studies were categorised as National Institute of Health Research Portfolio eligible.

The following research studies have continued during 2024/25

Epidemiology and Outcomes from Out of Hospital Cardiac Arrest Outcomes (OHCAO)  

Survival from cardiac arrest differs around the country. This project aims to establish the reasons behind these differences in outcome.   It takes a standardised approach to collecting information about Out of Hospital Cardiac Arrest and for finding out if a resuscitation attempt was successful. The project will use statistics to explain the reasons why survival rates vary between region. It is sponsored by Warwick University and funded by the Resuscitation Council (UK) and British Heart Foundation. 

Golden Hour (Brain Biomarkers after Trauma)  

Traumatic Brain Injury is a major cause of illness, disability and death and disproportionally affects otherwise young and healthy individuals. Biomarkers are

any characteristic which may be used to gain insight into the person either when normal or following injury or disease.  The study will look at biomarkers taken from blood, from fluid in the brain tissue and from new types of brain scans and investigate whether any

biomarkers can give us insight into new treatments. West Midlands Ambulance Service and Midlands Air Ambulance are working with the University of Birmingham to support this study.  This study further expanded to include stroke patients, looking at the injury biomarkers of their cerebrovascular incident. Assessing whether biomarkers are detectable in the prehospital care phase.

PIONEER 

PIONEER is the Health Data Research Hub for Acute Care, led by the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, in partnership with West Midlands Ambulance Service, the University of Warwick, and Insignia Medical Systems. Acute care is the provision of unplanned medical care; from out of hours primary care, ambulance assessment, emergency medicine, surgery and intensive care.

Demand for acute health services are currently unsustainable for our national healthcare resource.  Despite this, there has been less innovation in acute care than in many others health sectors, in part due to siloed information about patients with acute illnesses. The PIONEER Hub collects and curates acute care data from across the health economy, including primary, secondary, social care, and ambulance data. PIONEER uses this data to provide accurate, real-time data for capacity planning and service innovation support learning healthcare systems including better use of current/novel investigations, treatments and pathways map innovation needed. 

Paramedic Analgesia Comparing Ketamine and MorphiNe in trauma (PACKMaN)

The PACKMaN study aims to find out if ketamine is better than morphine at reducing pain in adults with severe pain due to traumatic injury. Pain from severe trauma has been reported as being poorly treated and NHS Paramedics have a limited formulary of medicines to treat severe pain.  Current practice might suggest that patients with severe pain following trauma may receive Morphine, which can be slow to reach peak effect and has a number of associated side effects.  Ketamine may be an ideal prehospital drug due to it being a safe option and quick to take effect.

Pre-hospitAl RAndomised trial of MEDICation route in out-of-hospital cardiac arrest

(PARAMEDIC3)

Each year over 30,000 people’s hearts suddenly stop beating in communities around the UK (a condition known as cardiac arrest). Unless the heart is restarted quickly, the brain will become permanently damaged, and the person will die. Injecting drugs such as adrenaline through a vein is very effective at restarting the heart. Current guidelines advise paramedics to inject drugs into a vein. However, a new, faster way of giving drugs is to put a small needle into an arm or leg bone. This allows drugs to be injected directly into the rich blood supply found in the bone marrow. Some research studies suggest this may be as good, if not better, than injecting drugs into the vein. Other studies suggest it may be less effective. None of the existing research is good enough to help paramedics decide how best to treat people with cardiac arrest. Both of these approaches are already currently used in NHS practice.  In this trial, we tested these two ways of giving drugs (into the vein or into the bone) to work out which is most effective at improving survival in people that have a cardiac arrest. Results were published in The New England Journal of Medicine in October 2024, ahead of the latest resuscitation council guideline updates the study informed.

Specialist Pre-hospital redirection for ischaemic stroke thrombectomy (SPEEDY)

Stroke is a common medical emergency and time critical treatments reduce the chance of disability or death. Approximately 1 in 10 patients are suitable for an emergency operation to remove blood clots blocking large arteries in the brain (known as ‘thrombectomy’) which greatly improves their chances of recovery. However, this operation is only available at specialist regional hospitals and unless patients live nearby, they are first admitted to their local hospital and must be transferred for the treatment.  This research project is testing the impact of this new pathway by conducting a multicentre cluster randomised controlled trial, that will transport patients directly to a specialist centre. WMAS were the pilot site, and the study is now live across the country in a further four ambulance services with further expansion planned.

Paramedic delivery of end-of-life care (ParAid Study): a mixed methods evaluation of service provision and professional practice 

To evaluate different models of paramedic delivered end-of-life service provision. To conduct a large-scale online survey throughout England to evaluate paramedics’ current practices, factors influencing their professional contribution and the potential for the paramedic workforce to improve end-of-life care (Phase 1). To characterise and evaluate models of service delivery (including innovative models) via mixed methods case studies of practice (Phases 1 + 2). To conceptualise decision-making and risk management by paramedics on scene using vignette methodology within interviews (Phase 2). To hold an expert consultation workshop to consider findings and generate paramedic service delivery recommendations to support end-of-life care (Phase 3).

The paraHEALTH study: Cardiovascular disease on the frontline

This research aims to estimate cardiovascular risk amongst ambulance personnel through screening, whilst exploring the associated occupational risk factors and identify high risk groups for targeting appropriate interventions. CV events amongst ambulance personnel will also be measured where relevant. This data could then lead to justifying further research into effective, realistic and cost-effective interventions for both treatment and prevention of CVD within UK ambulance service.

Occupational stress risk assessment: Association of Ambulance Chief Executives

(AACE) Ambulance Trust Control Rooms

The principal goal of the project is to explore the root causes influencing occupational stress and subsequent impacts on mental wellbeing amongst staff within the specific area of control rooms in ambulance services. The project aims to examine the range of occupational factors currently influencing work-induced strain, develop a bespoke survey tool including the identified factors, and develop recommendations based on the findings to help alleviating levels of work strain. Scientific literature has identified the most common source of stress risks across occupations.

An evaluation of the South Warwickshire Frailty Admission Avoidance in the Community Pathway: a mixed methods study (E-WRAP)

This study aims to conduct a formative evaluation of South Warwickshire’s Frailty Admission Avoidance pathway in order to establish the progress of the care model and suggest ways in which its development and implementation model can be improved.  

The following research studies have commenced during 2024/25

Ambulance Response to Older Adults who have Fallen 

Around 10% of emergency ambulance calls are to people aged 65 years and over who have fallen. This population is diverse in their age, from 65 through to 100+ years old, which has not previously been reviewed within the context of decision-making, during ambulance assessments. The over-arching aim of the study is to understand factors influencing emergency ambulance staff decision-making, confidence and responses when attending older adults who have fallen in the UK, in order to identify opportunities to support ambulance staff and optimise care when attending this population. It is mixed-methods collecting 12 months of retrospective anonymous data (WMAS and EMAS), alongside survey and interviews from frontline staff (UK wide). Through the College of Paramedics Small Research Grant award the recruitment has been eligible for NIHR Portfolio adoption.

Clinical Randomisation of Antifibrinolytic in Symptomatic mild Head injury in older adults (CRASH4)

This study is to assess the effectiveness and safety of early intramuscular tranexamic acid (TXA) administration in older adults with mild head injury. Outcomes include the proportion of patients discharged from the emergency department

within 24 hours of arrival, intracranial bleeding on CT scan, neurosurgery, death due to intracranial bleeding and the risk of dementia at 1 year. Key safety outcomes include vascular occlusive events, seizures, and pneumonia. Intracranial bleeding occurs soon after injury and early treatment is most effective. Previous studies by the CRASH series team have shown that TXA is rapidly absorbed after intramuscular injection in trauma patients without local side effects. This means that paramedics can give intramuscular TXA before transport to hospital, and for those who do not travel by ambulance, intramuscular TXA can be given immediately on hospital arrival. If early intramuscular TXA treatment reduces death and disability in older adults with mild TBI this would be a major medical advance that would improve the care of many millions of patients in the UK and world-wide.

Moral injury and post-traumatic embitterment disorder in ambulance staff study  

The primary objective is to estimate the prevalence of potentially morally injurious events, moral injury, and post-traumatic embitterment disorder (PTED) at work. The secondary objective is to identify key risk and resiliency factors, and it is predicted that low self-esteem, low social support, low belief in a personal just world, low consideration of the future consequences of one’s actions, low resilient coping style, high exposure to occupational stressors, and high consideration of the immediate consequences of one’s actions will predict higher levels of PMIEs, moral injury, and PTED.

Ambulance Research Capacity and Culture Study  Multicentre, explanatory sequential mixed methods study.  

This mixed methods study aims to explore prehospital research culture and capacity building across UK NHS ambulance services. The Royal Society stated that “Research culture encompasses the behaviours, values, expectations, attitudes and norms of our research communities”. Phase 1 consists of, using the validated Research Capacity and Culture (RCC) tool, prehospital research culture and capacity building in UK NHS ambulance services. Surveying ambulance staff, irrespective of role. Phase 2 is semi-structured interviews with key stakeholders from all UK NHS ambulance services. This aims to quantify and explore prehospital research culture and capacity building in UK NHS ambulance services. The principal goal of the project is to explore the root causes influencing occupational stress and subsequent impacts on mental wellbeing amongst staff within the specific area of control rooms in ambulance services. The project aims to examine the range of occupational factors currently influencing work-induced strain, develop a bespoke survey tool including the identified factors, and develop recommendations based on the findings to help alleviating levels of work strain. Scientific literature has identified the most common source of stress risks across occupations. 

HIPPO: Health Inequalities in the PrehosPital critical care response to Out-of-hospital cardiac arrest

The study involves secondary data analysis of anonymised data collected by prehospital critical care teams between 2018 and 2023, to examine the relationship between demographic and socio-economic factors on prehospital critical care for out-of-hospital cardiac arrest patients. Differences in the conditions in which we are born, grow, live, work and age can influence our opportunities for good health and are called health inequalities. Research has previously shown that health inequalities exist in how the public respond to cardiac arrest. People in deprived areas and areas with more non-white ethnicity residents are less likely to receive chest compressions from bystanders and are less likely to have a defibrillator located nearby. Efforts are being made to address this by the NHS and charities. There is an urgent need to look at the NHS response to cardiac arrest and whether there is a need to improve in deprived and ethnically diverse areas.

Time to administration of prehospital tranexamic acid in trauma: comparing incidents on the basis of enhanced care team involvement This study is an observational retrospective data study sponsored by WMAS, led by members of the MERIT/enhanced care team. It aims to address a research gap by investigating tranexamic acid (TXA) administration with particular reference to ambulance service resourcing with enhanced care assets (clinicians with an extended scope of practice). It will make use of routinely collected data (extracted from computer-aided dispatch and electronic patient record data warehouses) for patients attended by WMAS. This will provide both comprehensive, contemporary evidence of TXA administration within a UK prehospital setting alongside an opportunity to investigate the influence of enhanced care team dispatch on TXA administration timings.

Sustainability

The NHS continues to take notable steps to reduce its impact on climate change. As the largest employer in the country, the NHS has a significant opportunity to do more. Action must not only cut NHS emissions, currently equivalent to 4% of England’s total carbon footprint, but also build adaptive capacity and resilience into the way care is provided. West Midlands Ambulance Service (WMAS) has led the way in the ambulance service by implementing significant changes to our operations, leading to substantial reductions in both direct and indirect carbon footprints. These initiatives include:

Implementing the Make Ready Model, optimizing the estate portfolio by commissioning new sites that meet BREEAM environmental standards.

• Upgrading site lighting to LED, significantly reducing electricity consumption.
• Installing PV solar panels at our headquarters in Brierley Hill and at Tollgate Unit 2.
• Delivering a fleet replacement program, ensuring all front-line vehicles are under five years old.

WMAS now operates the most modern ambulance fleet in the country, fully compliant with the latest Euro emission standards.

West Midlands Ambulance Service University NHS Foundation Trust is committed to the ongoing protection of the environment through the development of a sustainable strategy. Sustainability is often defined as meeting the needs of today without compromising the needs of tomorrow. A sustainable health and care system is achieved by delivering high-quality care and improved public health without exhausting natural resources or causing severe ecological damage.

The Trust’s Green Plan sets out our commitment to ensuring governance and management arrangements are in place to deliver both our statutory responsibilities for sustainability and the NHS target of reducing its carbon footprint, as outlined in Delivering a Net Zero National Health Service (published October 2020). This Green Plan is currently being updated for 2025-2028 and will focus on eight key areas, each targeting major emission sources and opportunities for reduction. Every area of focus is guided by a vision that outlines our long-term approach to achieving Net Zero emissions.

Looking to the future, we aim to achieve the following targets:

• Reduce the Trust’s carbon emissions by 25% by 2028
• Achieve an 80% reduction in carbon emissions by 2032
• Reach Net Zero by 2040

To support these goals, we have developed a comprehensive delivery plan. Below is a summary of our key initiatives and achievements to date.

Estates 

Since 2011, the Trust has engaged in a significant programme of activity to manage and reduce our carbon footprint, mitigate our impact on air pollution which has allowed the Trust to achieve a reduction in C02 year on year as shown below:

2021-2022

Energy reduced by 6.37% from the previous year

Transport reduced by 5.29% from the previous year

2022-2023 

Energy reduced by 13.68% from the previous year

Transport reduced by 8.64% from the previous year

EV charger install

In 2021, we installed EV Chargers across multiple Hubs, with additional charges to be installed in 2025

Sandwell Hub – BREEAM excellent standards

In October 22, we opened our new facility in Sandwell Birmingham, this site is our most environmentally friendly to date, conforming to BREEAM Excellent standards, the building has a 96kw PV on the roof.  We have also installed 20 electric vehicle chargers which are available for staff/visitors to use. 

Decarbonisation

In 2023, we secured funding through a SALIC project to refurbish the Hereford Hub.  This

focuses on energy efficiency and decarbonisation by install a Solar PV System with battery storage, replacing the old boiler with a heat pump, and upgrading the buildings glazing.

In 2025, we have begun to install Solar PV systems at HQ and Tollgate 2, and is expected to generate 132,996 kWh annually which will reduce our carbon emissions by 27.838kg in Year 1 at Tollgate 2, and at HQ this is expected to generate 86,337 kWh annually which will reduce our carbon emissions by 18.223kg in Year 1.  Both projects are expected to be completed by the end of March 2025.

Fleet 

Our commitment to delivering the emission reduction targets set out by NHSE remains on track.  We have a total number of 1092 vehicles, and x61 one of those are electric vehicles, with 117 hybrid vehicles.  The Lease Car Policy has also been updated so only fully electric vehicles can be ordered for staff covering the necessary business related mileage to be eligible.  Year on year the emissions from transport related activities reduced from 5.29% for 21/22 to 8.64% for 2022/2023.  All WMAS internal combustion engine vehicles remain compliant with the latest Euro 6 emission standard.  Zero emission vehicles and electric charging points, reduced business miles and cycle to work schemes.  Continue to operate the most modern ambulance fleet in the country, no more than 5 years old, we have introduced a further 13 electric vehicles into our support fleet operation.

Waste management

Increasing recycling at all sites has been very successful over the last few across the Trust, which resulted in significant carbon savings for the Trust.  Additional cardboard recycling was introduced at all sites in March 2023, whereby cages were placed at each site, and are then returned to the Sandwell Hub to be placed into the cardboard compactor which generates an income for the Trust, which is £110.00 per tonne. 

In April 2025, new food waste disposal regulations will take effect, requiring businesses to manage their waste more sustainably. Under these regulations, businesses must separate recyclable materials—including glass, metal, plastic, paper, and card—as well as food waste from general waste streams. This initiative aims to reduce landfill use, lower methane emissions, and promote environmental sustainability. To ensure compliance, food waste bins have been ordered for external areas across the Trust’s portfolio, along with internal waste bins for use within sites.

Cleaning products – environmentally friendly

Working alongside our cleaning provider, that have been successfully using PVA products, which are environmentally friendly cleaning products which come in water soluble sachets.  Data from 2021 to date shows we have had plastic savings of 4,999,33kg by switching to these environmentally friendly products.

• 2021 – 460.03kg
• 2022 – 1,642.63kg
• 2023 – 1,865.11kg
• 2024 – 960.15kg
• 2025 – 71.42kg
• Total – 4,999.33kg

Data quality 

West Midlands Ambulance Service will be taking the following actions to assure and improve data quality for the clinical indicators while the Clinical Audit Department completes the data collection and reports. 

The patient group is identified using standard queries based on the Electronic Patient Record. These clinical records are then audited manually by the Clinical Audit Team using set guidance. The data is also clinically validated and then analysed following an office procedure that is available to the Clinical Audit Team and is held on the central Clinical Audit Team’s drive. The process is summarised as:

• For the clinical indicators, the Clinical Audit Team completes the data collection and reports.
• Patient Report Records are audited manually by the Clinical Audit Team. 
• A process for the completion of the indicators is held within the Clinical Audit Department on the central Teams site.
• A Clinician then reviews the data collected by the Clinical Audit Team.
• The data is analysed, and reports generated following a standard office procedure. A second person within the Clinical Audit Team checks for any anomalies in the data.
• The results are checked for trends and consistency against the previous month’s data.
• The Clinical Indicators are reported through the Trust Clinical Performance Scorecard.
• The reports are shared via the Trust governance structure to the Board of Directors, Commissioners and Service Delivery meetings.

NHS Number and General medical practice code 

The Trust was not required to and therefore did not submit records during 2024/25 to the Secondary Uses service for inclusion in the Hospital Episode Statistics to be included in the latest published data. 

Data Security and Protection Toolkit 

The Trust continues to work on the NHS Data Security and Protection Toolkit (DSPT) for 2024-25 (version 7). The Trust completed and published its baselines assessment as required by 31 December 2024.

The process for assurance of the DSPT will be undertaken by external audit (KPMG).  KPMG are due to report to the Trust’s Audit Committee on 3 June 2025.  Progress reports are provided to the Trust Digital Technology Oversight Group (DTOG).  The Head of IM&T leads on DSPT and reports progress to the Director of Finance (CIO/SIRO). 

NICE guidance

The Trust monitors NICE guidance to ensure relevance to the services we provide is identified. These are reported and reviewed at Professional Standards Group (PSG).

Learning from Deaths  

In March 2017, the National Quality Board (NQB) produced a framework for NHS Trusts and NHS Foundation Trusts on identifying; reporting; investigating and learning from deaths in care and from February 2018 this became a contractual obligation, to commence on April 1st 2018.

In July 2019, for implementation in January 2020, the National Guidance for Ambulance Trusts on Learning from Deaths was published, providing further clarity on how the Learning from Deaths Framework should be applied. WMAS have implemented all the requirements specified within The Learning from Deaths Framework and additionally have employed a full time Learning from Deaths Lead to ensure it is successfully embedded into the learning culture of WMAS.

From 1st April 2024 the Trust has implemented and is now working under the Patient Safety Incident Response Framework. This considers cases for review as Learning Responses and enables the Trust to implement a proportionate level of response, rather than investigating all incidents as a Serious Incident Investigations. 

For many individuals, death under the care of the NHS is a natural part of life and they frequently receive outstanding care in the months or years leading up to their passing. Sadly, some patients experience substandard care due to various contributing factors, often stemming from poor leadership and systemic failures.

NHS staff work tirelessly under growing pressures to provide safe, high-quality healthcare. When errors occur, healthcare providers and their partners must take decisive steps to investigate the underlying causes.

The purpose of reviews and incident responses into deaths potentially influenced by issues in care is to uncover insights and prevent future occurrences. However, these reviews and response only lead to meaningful improvement when their findings are effectively communicated and acted upon.

The Learning from Deaths Lead identifies cases where a death has occurred in WMAS care (from the point of 999 call, to the point we leave/discharge the patient). These cases are reviewed using the Structured Judgement Review (SJR) methodology to provide an overall judgement outcome. 

During the 2024/25 reporting year, the total number of deaths that occurred while in WMAS care, was 1323. This aggregate figure represents quarterly totals of:

• 371 in quarter one. 
• 304 in quarter two. 
• 420 in quarter three.
• 228 in quarter four.

During the 2024/25 reporting year, 1323 case record reviews were completed. Of these case record reviews, 36 investigations were completed under the Serious Incident Framework during Quarter One. From Quarter Two onwards, with the introduction of the Patient Safety Incident Response Framework, 63 cases were reviewed as learning responses.  WMAS, although not stipulated within the National Guidance for Ambulance Trusts, have adopted the approach that where deaths have occurred while in WMAS care, all will receive a case record review. Therefore, the number of case record reviews conducted will be identical to the number of deaths that have occurred while in WMAS care. This aggregate figure represents quarterly totals of:

• 371 case record reviews and 36 investigations in quarter one. 
• 304 case record reviews and 32 learning responses in quarter two. 
• 420 case record reviews and 22 learning responses in quarter three.
• 304 case record reviews and 09 learning responses in quarter four (figure correct at the point of submission).

During the 2024/25 reporting year, following initial case record review; investigation or learning response, 99 of the 1323 deaths or 7.5% were considered more likely than not, to have been due to problems in the care provided to the patient.  The number and percentage has been estimated from each case meeting the threshold for investigation under the Serious Incident Framework or requiring a learning response under the Patient Safety Incident Framework, which may ultimately determine there were no problems in the care that was provided. 

The aggregate figure and percentage represent quarterly totals of:

• 36 deaths or 2.7% in quarter one.
• 32 deaths or 2.4% in quarter two.
• 22 deaths or 1.7% in quarter three.
• 9 deaths or 0.7% in quarter four (figure correct at point of submission).

All deaths, where it was considered more likely than not to have been due to problems in the care WMAS provided to the patient, are now managed and reported under the Patient Safety Incident Response Framework. The purpose of the Patient Safety Incident Response process is to identify system wide learning and provide safety actions to prevent reoccurrence. To ensure learning occurs from the Patient Safety Incident Response, safety actions are formulated, these are instigated and monitored by the WMAS Learning Review Group. 

In the previous 2023-2024 quality account reporting period the following information was published “163 of the 1191 deaths or 13.68% were considered more likely than not to have been due to problems in the care provided to the patient”. This can now be confirmed as 167 of the 1259 deaths or 13.3% were considered more likely than not to have been due to problems in the care provided to the patient. This is as a result of Serious Incident Investigations being raised subsequently to the publication of the 2023-2024 Quality Account.

Performance against quality indicators

To ensure patients of the West Midlands receive quality care from their Ambulance Service a set of national Ambulance Quality Indicators have been set. This helps set our policies and guidelines and develop our organisational culture that places quality at the top of the Trust agenda. The following details the figures for each and highlights the national mean percentage and position of WMAS against other Trusts.

Operational performance

Ambulance Services nationally have again struggled to meet national performance targets throughout 2024/25, however West Midlands Ambulance Service works hard to prioritise the most clinically vulnerable patients to maintain patient safety and has continued to achieve faster responses than the national average for the most acutely unwell of our patient groups. The extensive delays experienced are directly attributable to the sustained extreme pressure within some of our major hospitals.

Performance by Integrated Care System April 2024 to March 2025 (Time displayed in Min:Sec)

Alongside our response standards, we are measured on the time in which emergency calls are answered. On this measure, WMAS remains the best in the country having taken more than 1.5 million emergency calls with a mean and 95^th centile answer time of 1 second.  Those calls that received a delayed answer accounted for only 0.3 per cent of the over 2 minute call delays across the country. Included in our calls were 13,391 from other services.

Clinical validation of Category 2,3 and 4 emergencies remains a key function to support the overall emergency demand and to ensure patients receive an appropriate response. When reviewing the outcome of patients triaged by the Clinical Validation Team Clinicians during January 2025, 49.8% received a Hear and Treat Outcome.  This contributed to the overall Trust ‘Hear and Treat’ rate of 21.9% of emergency activity managed through alternative services (including Urgent Care Referral) or self-care advice.

We continue to work with our commissioners and other providers such as acute hospital colleagues to ensure improvements in the provision of healthcare for the people of the West Midlands. This includes the ‘Call before you convey’ Programme. Launched in December 2023 to further support patients accessing appropriate healthcare. This initiative provides a collaboratively, and consistent regional approach for ambulance clinicians to access acute and community teams for a joint clinical discussion to support the right care for our patients. The programme is successfully supporting a continued reduction of conveyance to Emergency Departments and is also positively supporting our ambitions for our mental health patients.

WMAS continues to employ the highest paramedic skill mix in the country with a paramedic present in virtually all crews attending patients every day. WMAS considers that this data is as described for the following reasons: it has been cross checked with Trust database systems and is consistent with national benchmarking and has been audited by external auditors.

Ambulance quality indicators

• 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 90^th 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 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

Part 2 Priorities for improvement 2025/26

We have assessed our progress against the agreed priorities for 2024/25 and have confirmed those that need to continue to ensure a high-quality service is maintained and continues to improve. In deciding our quality priorities for 2025/26 for improving patient experience, patient safety and clinical quality, we have reviewed outputs from discussions with stakeholders throughout the year, engagement events, surveys, compliments, complaints and incident reporting. We regularly review all information available to us to identify trends and themes, this helps us to identify causes and priorities for improvement. We confirm the following have been identified.

Hospital handover delays reduction

Rationale

Following the release of the 2025/26 priorities and operational planning guidance from NHS England, there is a priority to Improve A&E waiting times and ambulance response times. There is a requirement to reduce handover delays by working towards delivering hospital handovers within 15 minutes, with joint working arrangements that the maximum handover period is 45 minutes. 

Measured by

A reduction in hospital handover delays to under 15 minutes and a maximum of 45 minutes, this calculated by a significant reduction in lost hours due to hospital handover delays.

Evidence of greater engagement with acute, ICB and NHSE regional teams

Clinical practice and supervision review

Rationale

Following a review of the Trusts Clinical Supervision Framework, develop workstreams to deliver this consistently across the Trust. There is a necessity to meet local and national requirements. In delivering this workstream there is the opportunity to directly link the Trust’s advancing clinical practice arrangements to understand how this meets the needs of patients and staff moving forward. This to include the review of clinical audits to evaluate the effectiveness of the reviewed clinical supervision model.

Measured by

Clinical supervision review / senior clinical advice

• Following signoff of the review of clinical supervision, deliver the action plan for clinical supervision modifications
• Use clinical audit outcomes as the measure of success when clinical supervision model has been delivered
• Complete a review of what ‘senior clinical advice’ should look like for the Trust as this term is used wider in the sector

Advancing clinical practice

• The clinical opportunities that could be planned and commissioned to support enhanced patient care and support further staff retention
• areas of work to support succession planning (paramedic career structure rather than enhanced care team and doctors) and career opportunity

Patient experience to include equality, diversity and inclusivity for communities

Rationale

Following the introduction of improved complaints standards from NHSE, there is a requirement to implement and operate these improvements. Whilst completing this work there is also an opportunity to review EDI access to services and identify any further gaps identified by service users

Measured by

• Complaints standard – reflecting a proposed new way of progressing concerns quickly, which once resolved may prevent some from becoming formal complaints for full investigation
• There may be an opportunity to incorporate equality and diversity monitoring as part of the new method of responding to complaints.
• Services which are not being accessed by certain community groups
• Planning, promoting and monitoring clinical services with equality, diversity and inclusion in mind

Use of alternative pathways for patients

Rationale:  

The Trust utilises a number of routes to signpost patients via hear & treat or see & treat to better navigate patients to appropriate services. There is a request from commissioners to ensure that continual learning is shared with ICB’s to ensure the alternative services are being used appropriately and also requesting feedback on further services that need to be commissioned or expanded to meet the populations served. There is also an opportunity to review EDI access to services and identify any further gaps identified by service users.

Clinical Validation Team, Measured by:

• Redirecting patients to appropriate service – engagement with system where patients rejected or recontact
• Sharing information with health system partners to improve acceptance rates to appropriately support patients and health systems

Call before you convey, Measured by:

• Improve the use of Call Before Convey with see & treat to support patients to receive the appropriate care following ambulance assessment
• Sharing information with health system partners to improve acceptance rates to appropriately support patients and health systems

Part 3 – Review of 2024-25

Our priorities for 2024-25 were based upon the following overarching priorities:

• Mental health
• Patient Safety Incident Response Framework (PSIRF)
• Handover delays
• Patient experience

Other Local Information

• Patient safety
• Safeguarding
• Patient experience
• Staff experience and engagement
• Equality and diversity
• Health and wellbeing
• Freedom to Speak Up
• Single Oversight Framework

Feedback from stakeholders

Board of Directors declarations

Mental health

Objectives:

• delivery of mental health nurses within the emergency operations centre  
• provision of mental health response vehicles (where commissioned by the ICB) 
• provision of clinical support to manage patients with complex needs presenting as high intensity service users to the Trust supporting educational opportunities for all WMAS staff in respect of mental health education to support and improve patient care delivery.   

Patient Safety Incident Response Framework (PSIRF)

Objectives:

• Compassionate engagement and involvement of those affected by patient safety incidents
• Application of a range of system-based approaches to learning from patient safety incidents
• Considered and proportionate responses to patient safety incidents NHS Providers   
• Supportive oversight focused on strengthening response system functioning and improvement

Handover delays

Objective:

• Follow a structured exit plan for the removal of ADA facilities across UHB as the temporary agreement comes to an end, requirement for UHB to maintain independence in managing ambulance handovers, returning Paramedics to substantive positions for frontline duties. 
• Review the region’s Hospital Ambulance Liaison Officer (HALO) cover. This will entail ensuring that all HALO positions are delivering optimal support, develop an enhanced HALO model to support Emergency Departments in streaming and supporting crews in accessing alternative pathways for patients where appropriate. 
• Undertake an independent capacity review with our partners
• Work with stakeholders to reduce handover delays, and where not possible, consider increasing the staffing establishment to mitigate delays

Patient experience

Objective:

Improve engagement to improve shared learning.  In addition to the existing arrangements, we will set up a Patient Advisory Committee, where patients, carers and Foundation Trust members will share experience to allow the Trust to learn and influence change.  These meetings will be undertaken once per quarter (online initially, with consideration to face to face annually.  

Service-based annual reports 2024-25

Whilst the above tables represent the overall progress in relation to the quality priorities that were established for 2024/25, the following reports are available on our website which contain further details of the work in each of these corporate and clinical departments.

• Controlled drugs and medicines management  
• Infection prevention & control  
• Maternity
• Patient experience  
• Safeguarding (including Prevent)  
• Making every contact count  
• Emergency preparedness  
• Security and safety  
• Health, safety and risk  
• Patient safety  
• Clinical audit
• Research  
• Learning from Deaths
• Freedom to Speak Up

The Annual Report in respect of the Data Security and Prevention Toolkit will be submitted and published by 30 June 2025. 

The Annual Report for equality, diversity & inclusion will be published by July 2025

Patient safety

At WMAS, we actively encourage all our staff to report patient safety incidents so that we can learn when things go wrong and make improvements.

The Trust went live with the Patient Safety Incident Response Framework (PSIRF) on 1^st April 2024 and has just celebrated its first PSIRF anniversary. PSIRF has been a significant learning curve for the organisation and has made us reflect on how we review patient safety cases, we have made changes in the way we review and respond to incidents as well as increasing our engagement with staff, patients, families and other organisations.

Whilst the numbers have stayed relatively high its important to remember we now review all patient safety incidents and not just those of severe harm, therefore its given us opportunity to focus on low level incidents and prevent become a more significant issues occurring.

The Trust has allocated a Learning Response Lead to all locations across the Trust to increase visibility of the Patient Safety Team, and has provided PSIRF awareness sessions to all staff, provided welfare sessions for those support staff going through the PSIRF process as well as having a wealth of knowledge on the Patient Safety intranet page for staff covering all areas of Patient Safety and PSIRF. The most recent addition is the release of the new safety spotlight newsletter which shares learning from incidents and is available bimonthly to all staff and welcomes feedback on what staff want to see.

Engagement has been key to the success of PSIRF so far and following a recent ICB learning visit the Trust has been praised for all the engagement work conducted with staff across the Trust.

The following demonstrate the 199 PSIRF investigations by Type during 2024-25

There have been:

• 77 Patient Safety Incident Investigations (PSII / Serious Incidents)
• 53 After Action Reviews (AAR)
• 0 SWARM (Huddle)
• 69 Multi-Disciplinary Team (MDT)

These investigations were categorised within the following priorities

• 30 National Priority
• 139 Trust Priority
• 0 High Risk (Litigation / Media)
• 30 Other

Each of these investigation types are described below

Themes (Patient safety)

Serious incidents

The trust moved away from serious incidents from 1^st April 2024 and align to the Patient Safety Incident Response Framework.  The Trust undertakes Learning Responses under PSIRF and the way we review and respond to patient safety incidents will change and there will be a number of response available to the Trust.

After Action Review (AAR)

After Action Review (AAR) is a structured approach for reflecting on the work of a group or an actions at an incident and identifying strengths, challenges and areas for improvement. AARs are not investigations, are non-judgemental and do not apportion blame. In simple terms it is a structured facilitated debrief, or similar to a case review.

Multidisciplinary Team (MDT) Review

The multidisciplinary team (MDT) review supports health and social care teams to: 

1. Identify learning from multiple patient safety incidents (including incidents where multiple patients were harmed or where there are similar types of incidents) 

2. Agree, through open discussion, the key contributory factors and system gaps in patient safety incidents for which it is more difficult to collect staff recollections of events either because of the passage of time or staff availability.  

3. To explore a safety theme, pathway, or process.

4. To gain insight into ‘work as done’ in a health and social care system. 

Multiple people from different areas of the Trust can be involved to look at changing processes, policies etc to make work safer. 

System Engineering Initiative for Patient Safety (SEIPS)

During the discussion, the Learning Lead will use a framework called the System Engineering Initiative for Patient Safety (SEIPS). SEIPS analyses the work system and assists to understand outcomes within this work system. It is a problem-solving tool that can be used to guide improvement in patient safety. More information on SEIPS can be found here.   

SWARM

A Swarm is a post-incident huddle where staff involved in a patient safety incident meet with the Patient Safety Team. Staff “swarm” to the site to gather information about what happened and why is happened as quickly as possible to decide what needs to be done to reduce the risk of the same thing happening in the future. 

It is a structured forum encouraging openness and honesty by reassuring participants they are in a blame free environment where everyone’s input is valued. 

Patient Safety Incident Investigation (PSII)

A PSII is undertaken when an incident or near-miss indicates significant patient safety risks and potential for new learning. 

Investigations explore decision or actions as they relate to the situation. The method is based on the understanding that actions or decisions are consequences, not causes, and is guided by the principle that people are well intentioned and strive to do the best they can. 

PSIIs do not apportion blame.  We understand that our staff come to work wanting to care for patients and patient safety incidents are unintended and the goal of a PSII is to understand why an action and/or decision occurred by those involved at the time.  

When we learn about why a patient safety incident happened, we can change or improve things to try and make sure it doesn’t happen again.  

Work As Done

By “work as done” we mean how care is delivered in the real world, not how is envisaged in policies and procedures (work as prescribed) or recounted in a walk through or a talk through (work as described). 

Exploring “work as done” allows Patient Safety Teams to identify everyday work hassles/frustrations and hazards in existing procedures or tasks.  By talking directly to the “boots on the ground” we can explore why policies are not followed, and if the design of work needs changing.

Duty of Candour

The Trust promotes a culture of openness to ensure it is open and honest when things go wrong, and a patient is harmed. NHS providers registered with the Care Quality Commission (CQC) are required to comply with a new statutory Duty of Candour, Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 20 Duty of Candour which relates to patient harm events considered to have caused moderate harm or above. This regulation requires a more formal process of ensuring that incidents are investigated at an appropriate level and that being open and honest with the patient and/or their families is completed.

Promoting a culture of openness is a prerequisite to improving patient safety and the quality of healthcare systems. It involves apologising and explaining what happened to patients who have been harmed as a result of their healthcare treatment. It ensures communication is open, honest and occurs as soon as possible following an incident. It encompasses communication between healthcare organisations, healthcare teams and patients and/or their carers.

Saying sorry when things go wrong is vital for the patient, their family and carers, as well as to support learning and improve safety. Of those that have suffered harm as a result of their healthcare, fifty percent wanted an apology and explanation.  Patients, their families and carers should receive a meaningful apology – one that is a sincere expression of sorrow or regret for the harm that has occurred.  Verbal apologies are essential because they allow face-to-face contact between the patient, their family and carers and the healthcare team.
A written apology, which clearly states the healthcare organisation is sorry for the suffering and distress resulting from the incident, must also be given.

Saying sorry is not an admission of legal liability; it is the right thing to do.

NHS to NHS Concerns

Incoming NHS Concerns

Once an incoming NHS concern has been received into the NHS to NHS mailbox, it is then logged and given a reference number.  An acknowledgement is then sent to the complainant stating, the concern is being reviewed, and a member of the Patient Safety Team will contact you with the findings.

We will aim to complete the investigation within 60 working days.

For the financial year 2024-2025 we received 1503 concerns

The top 5 themes for year 2024-2025 were

• Complaint/Conduct
• NEOC Response Delay
• IEUC System Processes
• Ambulance Response Delays
• Clinical Care/Treatment

Outgoing NHS Concerns

Since working with our lead ICB we have developed an Outgoing NHS concern process which allows WMAS staff to raise concerns that Patient Safety review and raise externally. This process started officially back in October 2023, we have reviewed 2880 concerns that have been raised to acute NHS trusts, GP’s Care homes, pharmacies, Police forces and Prisons. The top themes and trend picked up were:

• Delayed offload of a pre-alerted patient.
• Delayed handovers.
• Staff conduct/attitude.
• Failed discharges.

When we receive a concern, we triage each concern to determine if there is organisational learning or a serious concern. This will either be for information only or investigation. If investigation, the care provider must respond to the concern within 60 working days. We do send a chaser after 30 days just to ensure whatever investigation they are conducting is on track.

Safeguarding

In 2024/2025 West Midlands Ambulance Service has continued to ensure the safeguarding of vulnerable persons remains a priority within the organisation and the trust is committed to ensuring all persons are always protected through embedded policies, procedures, education and literature. All staff within WMAS are educated to report safeguarding concerns to the single point of access Safeguarding Referral Line. This Trust has experienced significant and sustained demand on the service, this combined with continuing delays in the ability to handover patients at hospital has led to on occasions patients waiting significant times for an ambulance response. These delays have led to concerns raised around the response to some of our more vulnerable patients from external stakeholders. WMAS continues to work at a local and national level to improve the situation and the safeguarding team reviews these cases and provides assurance to the local authority on the actions undertaken to mitigate the risk.

Adult Safeguarding Referrals

Child Safeguarding Referrals

Currently there are 27 Safeguarding Boards across the West Midlands and engagement continues to develop with WMAS, in addition to contribution to Child Death Overview Panels, Domestic Homicide Reviews, Safeguarding Adult Reviews,  Local Child Safeguarding Practice review’s, Offensive Weapon Homicide Reviews, Serious Incident Reviews, Social Care and Prevent panels and networks.

The Head of Safeguarding is the Prevent lead for the trust and ensures compliance with contractual obligations through reporting via Unify2 to NHS England. In addition, close links have been established with NHS England and Police to ensure Prevent is a key priority within our safeguarding agenda.  Despite the operational pressures on the Trust, we have delivered training to ensure all Paramedics are trained to level 3 in Safeguarding, which has refreshed and enhanced the knowledge of our staff in respect of best practice and current legislation.

Patient experience

The key themes for Patient Advice and Liaison Service (PALS) relate to:

Timeliness of 999 ambulance and Patient Transport Service Vehicles – there is a delay or perceived delay in the arrival of a 999 ambulance or response vehicle, or there is a delay in the arrival of a Non-Emergency Ambulance to take a patient to and from their routine appointment.

Eligibility for Non-Emergency Patient Transport – patients have to go through an eligibility criteria set by the Integrated Care Board and a patient may raise a concern based on the outcome of the eligibility criteria.

Professional conduct – that the patient or their representative feels that the attitude or conduct of the attending ambulance staff, or call taker was not to the standard that they would expect.

Complaints

Complaints are an important source of information about patients’ views regarding the quality of services and care provided by the Trust.  All staff are encouraged to respond to complaints and concerns raised by patients and relatives in an effective, timely, and compassionate way. 

The Trust has received 390 complaints raised so far compared to 410 2023/24. The main reason relates to timeliness (response) raised.

Breakdown of Complaints by Service Type (year to date)

Upheld complaints

The table below indicates that of the 390 complaints, 61 were upheld & 121 part upheld.  If a complaint is upheld or part-upheld, learning will be noted and actioned locally and will also be reported to the Learning Review Group for regional learning to be identified and taken forward as appropriate.

Patient Advice and Liaison Service (PALS) concerns  

This year has seen a decrease in concerns with 2303 concerns raised in 2024/25 compared to 2351 in 2023/24. The main reason for a concern being raised is ‘timeliness (response).

Learning from complaints / PALS

Ombudsman requests

The majority of complaints were resolved through local resolution and therefore did not proceed to an independent review with the Parliamentary and Health Service Ombudsman (PHSO). During 2024/25 –We have received 16 contacts from the Ombudsman. 10 cases the PHSO has requested information 9 closed with no investigation, 1 investigated and closed no further action. 5 have been investigated awaiting an outcome and 1 awaiting medication.

Patient feedback / surveys

The Trust received 306 completed surveys via our website, relating to the Patient Transport Service.   The table below outlines the response by survey type.

Friends and Family Test

The FFT question is available on the Trust website: ‘Thinking about the service provided by the patient transport service, overall, how was your experience of our service?’:

Discharge on scene survey:

58 responses were received relating to patients who have been discharged to the location the 999 call was made.

Emergency patient survey:

220 responses received in 2024/25

0 maternity survey responses.

Compliments

The Trust has received 2812 compliments in 2024/25 compared to 2402 in 2023/24.

Governance

Patient Experience reports monthly to the Learning Review Group (LRG) which focuses on ‘trend and theme’ reports.  The LRG reports to the Quality Governance Committee and reports any issues relating to assurance; any risks identified; and key points for escalation.  The Trust Board receive monthly data on formal complaints and concerns through the Trust Information Pack and the professional Standards Group.

Complex Patients

In areas where the activity is commissioned (all areas excluding BSOL) WMAS work with system partners to identify unmet and unrecognised need leading to high intensity service use of ambulance (and subsequently wider UEC) resources. Alongside this HART support work streams around complex bariatric patient transfers, the clinical team provide support to review and input to the care plans of patients who may have specific complex unique or non-standard needs where these are identified to us.

Implementation of the Incident Reporting System (IRS)

The Trust has developed and implemented a new system which includes:

• Replacement of the legacy ER54 incident reporting system
• New Trust Risk Register
• New Board Assurance Framework

The incident reporting process within the new system provides staff with the ability to receive feedback on incidents, real time sight of current progress, automated emails throughout.  The system prompts for Manager investigations, such as Violence and Aggression / RIDDOR and provides improved categorisations.  Staff can be assured that the managers will have the correct prompts to deal with their incidents effectively.  By using our Power BI platform, we have the ability to future proof the development path to ensure the system fully meets the changing requirements of the Trust and staff, and as such, reporting will continue to improve.  Safeguarding and Claims and Coroners modules will be incorporated into the system during a second phase of development.

ACPs now within CVT who have completed the Masters with prescribing

As of the end of the 2024/2025 financial year, the Trust has the following numbers of Advanced Practitioners (APs) in patient-facing roles within Integrated Urgent Care (IUC):

Practitioner Numbers by Advanced Practice Status:

• 16 Trainee Advanced Practitioners who are currently progressing through a three-year Level 7 university programme, which leads to a Master of Science (MSc) in Advanced Practice. As part of this programme, a non-medical prescribing module is undertaken in the second year.
• 5 Qualified Advanced Practitioners who have either completed the MSc in Advanced Practice or have been accredited at an equivalent level. All hold a non-medical prescribing qualification.

Staff experience and engagement

The National NHS Staff Survey is one of the largest workforce surveys in the world and has been conducted since 2003. It is a survey that asks NHS staff in England about their experiences of working for their NHS organisations. It provides essential information to employers and national stakeholders about improvements required in the NHS. The 2024 NHS Staff Survey fieldwork was open for 11 weeks at WMAS, from 16th September to 29th November 2024. It was administered by Picker Europe Ltd and was conducted as a census. For the last eight years WMAS has been running the survey electronically for ease of access to all staff. A unique link to the survey questionnaire is sent by email to each individual staff. The completed questionnaire is then submitted securely and anonymously to the contractor for processing.

6,922 staff were invited to take part in the 2024 staff survey and 4,697 staff returned a completed survey compared to 2261 in 2023. The response rate for WMAS is 68% compared to 40% in the 2023 survey. The average response rate for all Ambulance Trusts (including Isle of Wight) is 49% compared to 52% in 2023. There was a significant increase in the number of BAME staff responding to the survey on this occasion. 357 BAME staff returned the questionnaire in 2024, compared to 147 in the 2023 staff survey.

A number of actions were taken before and during the survey to encourage staff to take part and share their views:

1. Announcements through the Weekly Briefing prior to the survey launch.
2. Weekly publication of “You Said, Together We Did” poster and information about how the staff survey results is used in the Trust.
3. Staff were encouraged to complete the survey on their iPads whilst waiting for their flu jabs. We worked closely with the flu vaccinators to continuously promote the staff survey
4. Several People Promise Drop In sessions were arranged at different localities in early mornings between September and November, to capture as many staff as possible and encourage them to complete the staff survey. The sessions were supported by colleagues from Research Team, FTSU Guardians, Health and Wellbeing Champions, Staff Side colleagues, HR colleagues and SALS.
5. Staff survey pull-up banners displayed at different Trust events such as health and wellbeing, FTSU, Culture Day, People Promise Drop in to raise awareness about the staff survey.
6. Weekly results from Picker Europe were posted on the information screens at all locations, in the Weekly Briefing and on Engage platform to provide clarity and show progress.
7. Posters and video information about confidentiality were sent to all managers to be shared with staff at all sites.
8. Weekly emails were sent to managers to remind them to keep encouraging their staff to complete their survey questionnaire.
9. A banner was featured on the intranet home page as a constant reminder for staff to complete their survey.
10. All email signatures were assigned a staff survey tag.
11. Testimonials from staff who have positive stories to share about the staff survey and its impact on their personal experiences were shared in Weekly Briefing.
12. A live Questions and Answers session was organised on MS Teams in November for staff to ask any questions about the staff survey or to share their experience of completing the survey or any barriers that stopped them form completing the survey.
13. All staff were gifted a £10 Lifestyle voucher as a thank you token for giving 15 minutes of their time to participate in the survey.
14. Regular promotion and updates on the Engage Platform sent to all staff.

Additionally, the 2023 Trust-wide staff survey action plan was closed off and all actions completed. This was shared widely with staff at People Promise Drop-in sessions and in the Weekly Briefing for staff to provide feedback via a short survey about the impact seen or felt on their experiences. The feedback collected from this survey has been included in this year’s Trust action plan to ensure that we keep focusing on what is important for staff.

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 2023 results.

Four out of the top 5 areas are the same as 2023 and significant improvements are noted on three of them. This year access to clinical supervision opportunities is among the top 5 scores. It is also satisfying to note that less staff are working unpaid additional hours.

Most Improved Scores

The following are the areas where WMAS has shown the most improvement when compared to 2023.

Addressing bullying and harassment was one of the key priorities on the Trust action plan for 2023 survey. It is very satisfying to note the positive results in the 2024 as they reflect the outcomes of actions taken.

Bottom 5 scores

The table below shows the bottom 5 scores for WMAS when compared to other Ambulance Trusts that used Picker as their contractor. It is quite disappointing to note that despite the tremendous amount of work that goes into Management and Leadership development, the results still do not reflect the hard work. This will be one of the key priorities to focus on.

Most Declined Scores

The following are areas where WMAS scores have most deteriorated compared to 2023

Advocacy Results

45% of respondents said they would recommend the Trust as a place to work compared to 44% in 2023. 54% said that if a friend or relative needed treatment, they would be happy with the standard of care provide by the Trust compared to 55% in 2023. 52% said that care of patients is the Trust’s top priority. This was the same in 2023.

Experience of unwanted behaviour of sexual nature

For the first time in 2023 two additional questions were included in the staff survey questionnaire relating to unwanted behaviour of a sexual nature. The table below shows the positive responses for the questions for 2023 and 2024. Fewer staff have responded positively to both questions in 2024.

Experience of physical violence

1,815 respondents (39%) have said that they have experienced physical violence from members of the public compared to 762 (35%) in the 2023 survey. 66 respondents (1%) said that they have experienced physical violence from Managers compared to 37(1%) in the 2023 survey. 123 respondents (2%) said that they have experienced physical violence from colleagues compared to 49 (2%) in the 2023 survey. 1302 respondents (71%) said that themselves or a colleague reported the experiences of physical violence compared to 577(73%) in the 2023 survey.

In the last 5 years there has been a slight improvement in the number of staff reporting in the survey that they have experienced physical violence at least once from the public. 36% in 2020 and 34% in 2024. However the figures have increased for reports of physical violence from Managers (0.66% in 2020 to 1.59% in 2024) and colleagues (1.86% in 2020 to 2.84% in 2024) over the last five years.

Experience of bullying and harassment

2,291 respondents (49%) reported that they have experienced harassment, bullying or abuse from patients/service users, their relatives or members of the public compared to 1,422 (53%) in the 2023 survey. 567 respondents (12%) said that they have experienced harassment, bullying or abuse from managers compared to 477 (19%) in the 2023 survey. 795 (18%) staff reported that they experienced bullying and harassment from colleagues compared to 556 (22%) in the 2023 survey. 1,217 respondents (47%) reported their experience of bullying and harassment compared to 734 (45%) in 2023. Addressing bullying and harassment was one of the key priorities on the 2023 staff survey action plan. It is one of the most improved areas since the 2023 staff survey.

Raising Concerns

On the 2023 Staff Survey Trust action plan, raising staff confidence to speak up and raise concerns was one of the key priorities to address. A slight improvement is noted in the results from 2023 to 2024. However, it is to be noted that since 2020 there has been a significant decrease in the percentage of staff saying that they would feel secure in raising concerns about unsafe clinical practice and also about the organisation addressing their concern.

Leadership and Management

Leadership and Management is one of the areas where we have seen the most decline in the results since 2023. Although, there has been significant improvement in this area since 2020, the results seem to lack consistency year on year. The worse results are from Emergency Services and Non-Emergency Services.

People Promise Elements and Themes: Scores Overview

Since 2021 the staff survey questionnaire has been re-developed to align with the People Promise in the 2020/21 People Plan. In support of this, the results of the NHS Staff Survey are measured against the seven People Promise elements and against two of the themes reported in previous years (Staff Engagement and Morale). The reporting also includes sub-scores, which feed into the People Promise elements and themes. All of the People Promise elements, themes and sub-scores are scored on a 0-10 scale, where a higher score is more positive than a lower score. WMAS results are benchmarked against the Ambulance benchmarking group average.

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. The tables below show the results for all four indicators for WMAS compared with the average response rates for all Ambulance Trusts over the last five years.

• 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 said that they have experienced bullying and harassment from the public. The same is reflected in the average response rates for all Ambulance Trusts. However there is a slight decrease in the number of white staff reporting this experience in 2024, while there is a 5.6% percentage point increase in the number of BAME staff reporting this experience in 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 have said that they have experienced bullying and harassment from other staff. However, a significant decrease is noted for both white and BAME staff reporting the same experience compared to 2023.

• 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 believe that the Trust provides equal opportunities for career progression. The same is reflected in the average results for all Ambulance Trusts. There is no significant change in the figures when compared to 2023.

• 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 have said they have experienced discrimination from managers and other staff. The same is reflected in the average results for all Ambulance Trusts. However, when compared to 2023 results, there is a significant decrease in the number of staff form both groups reporting this experience.

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 a 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 significant decrease is noted in the response rate for staff without LTC when compared to 2023, while a significant increase is noted for staff with a LTC or illness. Across all ambulance Trusts there is an increase in the number of staff with LTC reporting this experience, while there is no significant change in the number of staff without LTC reporting this experience.

• 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. This is the same across all Ambulance Trusts. A significant decrease is however noted in the figures from 2023 to 2024 for both groups of staff. Across all Ambulance Trusts there is a significant decrease in the number of staff without LTC reporting this experience, while there are more staff with LTC reporting this experience compared to 2023.

• 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 no significant change noted in the figures when compared to 2023.

• 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. It is reassuring to note that more staff in both groups have said they have reported the negative experience compared to 2023.

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

Overall, at WMAS and on average across all Ambulance Trusts, staff with a LTC or illness are less likely to believe that the Trust provides equal opportunity for career progression than staff without a LTC. When compared to 2023, more staff with LTC than without believe that the organisation provides equal opportunities for career progression.

• 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 a LTC. The same is observed on average across all Ambulance Trusts. A considerable increase in the numbers for both groups of staff is also noted when compared to 2023.

• 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 a LTC. The same is observed on average across all Ambulance Trusts. However, a slight improvement in is noted in the figures for staff with LTC when compared to 2024 whereas fewer staff without LTC are satisfied in 2024 than in 2023.

• 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. Although a significant improvement is noted from 2023 to 2024.

Staff Engagement Score

Overall, WMAS staff with a LTC or illness are less engaged than staff without a LTC. The same is also true on average for all other Ambulance Trusts. There is no difference in scores when compared to 2023.

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 SSRAG and the Executive Membership Board to focus on following the 2023 Staff Survey Results.

PRIORITY 1 – Safe Environment

Key Deliverables

1. A healthier and safer environment will be created for staff to thrive and perform their duties to their best potential and deliver the best patient care.
2. Create a safe environment for staff to thrive and ensure our leaders lead with compassion and civility.
3. Staff will feel they are being listened to by their leaders and have reassurance that our leaders are committed to ensure the safety of staff at work.
4. Staff will be aware of the support available to them and be assured that the Trust will prosecute those who demonstrate physical violence towards our staff.
5. Improvement in the confidence level seen in the staff survey, through our people feeling more confident to speak up because all processes are enacted in the right way.

Actions

1. Implement Dignity and Respect development sessions for managers.
2. Promotion of resources and information for sexual safety e.g. personal safety.
3. Promotion during “Sexual Assault Awareness Month” (April).
4. Continue to promote Bystander training in order to give staff the tools to feel confident to challenge such behaviour.
5. Building on from the Values and Behaviours Guide, to compile a summary of all staff comments relating to bullying and harassment, including ways of behaving differently and share widely as part of a poster, in view of raising awareness.
6. Facilitate Dignity at Work sessions for managers, highlighting comments and stories from our staff about their experiences and what may be perceived as bullying/harassment.
7. Encourage first line managers and supervisors to undertake 360 feedback based around compassion, civility and respect.
8. Communicate the figures of assaults from managers on staff, informing staff through various channels, highlighting that these assaults have not been reported to the Trust.
9. Leadership statement to emphasise the Values and Behaviours Framework, with senior managers across all localities signing up to always focusing on ensuring that people are behaving in the right way, for example through a charter.
10. Remind staff of various ways to report incidents of bullying, harassment and physical violence and provide assurance that reports will be handled with confidentiality, compassion and taken seriously.
11. Increase uptake and usage of body worn cameras (BWC).
12. Understand and communicate the impact of physical violence on staff from patients. Share stories from staff who have been affected by physical violence and Trust prosecutions to encourage others to seek support and use BWC.
13. Continue to press for prosecution in all appropriate cases.
14. Keep encouraging staff to speak up and raise their concerns.
15. Improve communication with staff to demonstrate that we listen and act on their feedback. Ensuring consistency in responses from managers when staff raise concerns.
16. Endeavour to reduce the number of anonymous concerns raised by providing assurance to staff that their concerns remain confidential.
17. To raise with Network Leads (NL)and Diversity & Inclusion Steering and Advisory Group (DISAG) about NLs being promoted widely to take on reports of concerns from staff and be provided with the right development to deal with such reports.
18. To continue to mandate for managers to complete NGO training modules on listen up and follow up, dependent upon banding.

PRIORITY 2 – Leadership and Management

Key Deliverables

1. Leaders will be better equipped to lead with compassion and civility and understand how behaviours may be perceived differently than intended. Staff will feel more supported by line managers which will increase staff engagement.
2. Leaders will be more visible and approachable to staff and will be seen to demonstrate the behaviours that we want other staff to adopt.
3. Female leaders will be more visible and approachable to staff.
4. Staff will be more aware of senior leaders within the organisation and how their roles fit within the wider organisational structure.
5. Increased capacity to support staff wellbeing and hold important conversations. Staff will feel valued and supported.
6. Staff will be well informed of actions that are taken in response to their feedback. Staff will have an increased sense of engagement, involvement, advocacy and be more likely to make suggestions to improve their area of work.

Actions

1. Promotion of the Values and Behaviours Guide to reiterate the behaviours expected from all employees.
2. Civility and Respect by Chris Turner of Home | Civility Saves Lives included in OM and CTM development programmes.
3. Review of probationary procedures to make conversations more meaningful and including clarity around objectives and development.
4. Leaders to demonstrate that they value staff and the work they do.
5. Senior Leaders’ quiz to identify how many of our staff recognise their senior leaders.
6. Senior female leaders will be featured in our ‘Celebrating Female Leaders’ Booklet which will be displayed during International Women’s Day.
7. A document showing the organisational structure and key contacts is in development to share with staff and new starters.
8. Review the ratio of manager: staff in operational areas, including manager: admin tasks.
9. Reviewing Development OM shifts to increase capacity and support managers.
10. To look at how certain tasks/projects are resourced i.e. lengthy Trust investigations which increase stress related absences and reduce staff engagement due to the length of time to complete. could these be resourced better to relieve pressure from OMs or free up resources.
11. Appoint a Staff Survey Locality Lead(SSLL) for each locality to engage with staff locally and lead on the Local Action Plans(LAP).
12. Communicating actions taken as a result of staff feedback. Use various communication methods, Staff Survey Locality Leads, “You Said, We Listened” posters to promote positive action being taken.

PRIORITY 3 – Staff Welfare

Key Deliverables

1. A healthier and more engaged workforce feeling supported to deliver the best patient care.
2. Staff will feel more trusted and supported with their health and wellbeing.

Actions

1. Ensure consistency in communications around flexible working to manage staff expectations.
2. Ensuring managers understand how to support their staff e.g. pastoral care support from managers with regards to flexible working.
3. Taking action on data presented from staff on work: life balance in various surveys.
4. Adherence to the “Supporting Attendance at Work” policy with regards to daily contact with staff during absence.

Equality and diversity

Diversity and Inclusion

The Trust has its core Diversity and Inclusion running through all business streams of the Trust. Over the last year there have been a range of themes and workstreams where work has continued to advance the equality and inclusion agenda. These themes are:

• Equality Delivery System – covering all 3 Domains of the framework
• WRES Workforce Race Equality Standard
• Recruitment – implementation of the NHS 6 Point action plan
• Public Sector Equality Duty
• Specific Duties
• Equality Objectives
• Diversity & Inclusion Steering Group
• Staff networks including the launch of a new Student Network
• National Ambulance Diversity Group [NADG]
• National LGBT Group
• WDES Workforce Disability Equality Standard
• Gender Pay Gap
• Chaplaincy Service

Equality Delivery System – implementation of the new framework

The EDS is the foundation of equality improvement within the NHS. It is an accountable improvement tool for NHS organisations in England – in active conversations with patients, public, staff, staff networks and trade unions – to review and develop their services, workforces, and leadership. It is driven by evidence and insight.

The third version of the EDS was commissioned by NHS England and NHS Improvement with, and on behalf of, the NHS, supported by the NHS Equality and Diversity Council (EDC). It is a simplified and easier-to-use version of EDS2.

To take account of the significant impact of COVID-19 on Black, Asian, and Minority Ethnic community groups, and those with underlying and long-term conditions such as diabetes, the EDS now supports the outcomes of Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) by encouraging organisations to understand the connection between those outcomes and the health and wellbeing of staff members. The EDS provides a focus for organisations to assess the physical impact of discrimination, stress, and inequality, providing an opportunity for organisations to support a healthier and happier workforce, which will in turn increase the quality of care provided for patients and service users.

The EDS comprises 3 Domains:

1. Commissioned or provided services
2. Workforce health and well-being
3. Inclusive leadership.

Recruitment

The Trust aspires to recruit a workforce that is representative of the communities we serve. The Trust has a Positive Action statement on all job adverts encouraging applications from people with disabilities and BME backgrounds. Research tells us that a diverse workforce provides better patient care and to compliment the WRES & WDES action plans the Trust is keen to encourage both BME and disabled applicants for all roles within the Trust. To achieve this aim the Trust has enhanced its recruitment programme by the following:

• Literature is reflective of the diversity of the Trust
• Attendance at local community events
• Staff who are involved in the recruitment process must undergo training involving;
  • Value Based Recruitment
  • Equality & Diversity
  • Equality Act 2010 and the law
  • Unconscious Bias
  • Interview skills
• The Recruitment team offers support for BME & disabled applicants through the pre-assessment programme
• Encouraging applicants to disclose reasonable adjustments required at assessment stage
• Achievement of the Workplace Friendly accreditation
• Achievement of Disability Confident Leader status
• Close liaison with our Staff Networks to encourage and support applicants from all backgrounds and experiences allowing them to be their authentic selves in the workplace

Public Sector Equality Duties (PSED)

The Equality Duty is supported by specific duties (Public-Sector Equality Duty (section 149 of the Act), which came into force on 10 September 2011. The specific duties require public bodies to annually publish relevant, proportionate information demonstrating their compliance with the Equality Duty; and to set themselves specific, measurable equality objectives. Public bodies must in the exercise of its functions, have due regard in the need to;

• Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act.
• Advance equality of opportunity between people who share a protected characteristic and those who do not.
• Foster good relations between people who share a protected characteristic and those who do not.

These are sometimes referred to as the three aims or arms of the general equality duty. The Act explains that having due regard for advancing equality involves:

• Removing or minimising disadvantages suffered by people due to their protected characteristics.
• Taking steps to meet the needs of people from protected groups where these are different from the needs of other people.
• Encouraging people from protected groups to participate in public life or in other activities where their participation is disproportionately low.

Through the adoption of mandated standards such as the; Equality Delivery System (EDS); Workforce Race Equality Standard (WRES); Accessible Information Standard (AIS); and Workforce Disability Equality Standard (WDES), Gender Pay Gap, WMAS is able to demonstrate how it is meeting the three aims of the equality duty. 

The Specific Duties require public bodies to publish relevant, proportionate information demonstrating their compliance with the Equality Duty; and to set themselves specific, measurable equality objectives and to publish information about their performance on equality, so that the public can hold them to account. The Specific Duties require the Trust to:

• Publish information to show compliance with the Equality Duty at least annually
• Set and publish equality objectives at least every four years

A four year Equality Strategy and Equality Objectives will be established in 2025 (2025-2029). 

The Trust publishes this information annually on the website.

Equality Objectives

The Trust is required under the “Specific Duties” to prepare and publish equality objectives which help to further the aims of our Equality Duty. The objectives must be published every four years and this year WMAS has continued to deliver on the Equality Objectives.  A full report on progress on the Equality Objectives will be included in the annual PSED report in 2024. 

Equality Objectives 2020-2024

Objective 1 Equality Standards

Our commitment to meeting the Equality Standards set by NHS England will be demonstrated by the implementation and monitoring of the following standards:

• Workforce Race Equality Standard
• Accessible Information Standard
• Equality Delivery System 2
• Workforce Disability Equality Standard
• Gender Pay Gap Reporting

We will do this by:

• Implementing and strengthening our approach to the NHS Equality Delivery System 2 (EDS2)
• Continuing to develop our response to the Workforce Race and Disability
• Equality Standards (WRES) (WDES)
• Investigate the experiences/satisfaction of staff through further surveys and focus groups
• Keep invigorating and supporting the staff equality networks to ensure they are aligned with our strategic equality objectives

Objective 2 Reflective and diverse workforce

We will enhance our approach to recruitment, selection and promotion to positively attract, retain and support the progression of diverse staff across the Trust

We will do this by:

Target local and diverse communities in recruitment campaigns

• Review our people policies to ensure that there is appropriate fairness
• Support managers and teams to be inclusive
• Work closely with external partners and providers (e.g., university paramedic programmes) to ensure diversity among the student group, and appropriate course content
• Ensure the recruitment and selection training programme informs recruiting staff and managers of their legal duties under the Equality Act 2010

Objective 3 Civility Respect

Ensure all our Board leaders, senior managers, staff, contractors, visitors and the wider community are aware of the effects of their behaviour on others and are equipped to challenge and report inappropriate behaviour when they experience or witness it

We will do this by:

• Develop and deliver an internal communication campaign on civility and respect in the workplace Develop a system where all cases of bullying or harassment are clearly recorded as such, and monitored to identify any trends or patterns across the Trust
• Capture good practice from our partners and peers to improve our diversity and Inclusion performance, e.g., working collaboratively with the NHS Employers’ National Ambulance Diversity Forum and Regional Diversity Groups

Objective 4 Supportive Environment

Ensure our leadership is committed to creating an environment that promotes and values equality and diversity and this is embedded in all we do

We will do this by:

• Delivering diversity and inclusion training to all members of the Board of Directors and Council of Governor’s
• Ensuring all our leaders have specific diversity & inclusion objectives in their annual objectives with performance discussed during their appraisals
• Board and Committee reports include an equality impact analysis

Diversity and Inclusion Steering Group

The Trust supports a “Diversity & Inclusion Steering Group” with representation from a diverse range of staff from across the Trust who are representative of the various roles and departments within the organisation. This group is chaired by the CEO. The Diversity & Inclusion Steering Group meets every two months to consult and drive the Diversity & Inclusion agenda forward.

Staff Groups

• Proud @ WMAS Network:
• This network is for Lesbian, Gay, Bisexual & Transgendered staff and is supported by “Straight Ally’s” which is a concept developed by Stonewall. The Network is represented at Pride marches and the Trust is a member of the Ambulance Sector National LGBT group. The Network provides support for all LGBT staff and raises issues at national level were appropriate.
• The ONE (BME) Network
• The ONE Network meets a number of times during the year and is supported by a HR buddy, Equality and Inclusion Lead and Executive Sponsor to further the aims of the staff network. The network is consulted on the development of the WRES action plan.  Over the year the network has celebrated a number of events which are highlighted in the PSED annual report 2024.  National Ambulance Diversity Group (NADG The Trust is represented on the national group and attends the meetings regularly. It is a forum of shared knowledge and expertise which drives the Diversity & Inclusion agenda at a national level. 
• A Disability and Carers Network was launched in July 2020 and supported the recommendations for action in the WDES.
• A Women’s Network was launched in 2021 to support the Gender Pay Gap Action plan. The Trust runs a Springboard Women’s Development Programme each year, along with other development opportunities.  The Women’s Network also marks International Women’s Day by holding successful events, further events are planned in partnership with other networks.
• Military Network.  The Military network was formed to recognize staff who are serving reservists, veterans, cadet instructors and families of serving personnel.  The Trusts celebrates various military events and WMAS achieved the employer Gold Award in 2019 by the Defence Employer Recognition Scheme.
• Student Network.  In late 2023, a student staff network was established to provide support and development for this growing part of our workforce who are new to the organization.   Every operational site has a team of Student Support Officers to provide localized support and guidance.

Chaplaincy Service: Spiritual Care Team

Since the retirement of our Chaplain in early 2023, the Trust has been successful in replacing and recruiting five further chaplains from different faiths and are looking to add more to the team.  We now have five Chaplains in total which are accessible for staff throughout the Trust. 

Workforce Disability Equality Standard (WDES)

The NHS Equality and Diversity Council has recommended that a Workforce Disability Equality Standard (WDES) should be mandated via the NHS Standard Contract in England from April 2019. NHS England has launched this. This has now been implemented and published by the Trust.  An action plan has been developed which is being monitored by the Diversity and Inclusion steering group.

Gender Pay Gap

Since 2017 there has been a statutory requirement for all organisations with 250 or more employees to report annually on their gender pay gap.

West Midlands Ambulance Service NHS University Foundation Trust is covered by the Equality Act 2010 (Specific Duties and Public Authorities) Regulations 2017 that came into force on 31 March 2017.  These regulations underpin the Public-Sector Equality Duty and require the relevant organisations to publish their gender pay gap data annually, including:

• mean and median gender pay gaps;
• the mean and median gender bonus gaps;
• the proportion of men and women who received bonuses; and
• the proportions of male and female employees in each pay quartile.

The gender pay gap is the difference between the average earnings of men and women, expressed relative to men’s earnings, while equal pay is about men and women being paid the same for the same work.  There is a requirement to publish the data on the Trust’s public-facing website by 31 March 2025.

A full gender pay report and key data analysis, that highlights the key variations for different occupational groups, and the actions that will be taken to improve these findings has been published.  An action plan has been developed to address the gaps progress against those actions is being monitored by the Diversity and Inclusion Steering group.

Health and Wellbeing (HWB)

National Wellbeing Framework

In January 2022 a new NHS National Wellbeing Framework was launched. This is very different from the previous framework with a diverse range of sections. 

• Framework Dashboard
• Personal Health & Wellbeing
• Relationships
• Fulfilment at Work
• Environment
• Managers & Leaders
• Data Insights
• Professional Wellbeing Support

Other new frameworks have been developed which also need to link into the National HWB Framework the below all relate to Mental Health & Suicide

• AACE Employee Wellbeing and Suicide Prevention (EWSP) self-assessment matrix
• AACE self-audit tool
• Mental Health at Work Commitment [Trust signed up 2022]
• Preventing Suicide in Ambulance Sector Local Improvement Plans WMAS
• Mental Health Continuum AACE [released 10^th March]

Sexual safety

In October 2022 we launched our approach to raising awareness of sexual safety in the workplace, highlighting the support avenues for individuals who experience this unacceptable behaviour and confirming our commitment to addressing this robustly and appropriately.  We have continued to work with our University colleagues and our staff networks to promote sexual safety for all of our staff and students.

Health & Wellbeing champions 

Over the last 12 months the opportunities for training & development for Champions have continued, provided by NHS England.  The courses have been advertised to all of our 66 Champions currently.  In addition, further in house development opportunities HWB Champions have had are as follows: 

• To undertake Health Checks 
• Suicide Lite awareness training 
• Mental Health First Aider training
• Development meetings, face to face and via MS Teams, to provide updates and share ideas, working together. 
• To attend HWB roadshows and online events.

We regularly review the HWB champions with managers to ensure there is at least one HWB champion based at every Hub where possible.  Weekly communication via our HWB champion newsletter is sent out to the HWB champions and either face to face or online meetings take place with regards to updates, events, and development sessions.  The newsletter was launched last year and has been a huge success with our champions to enable us  to share updates, event details, religious festivals, training and general sharing of information / great ideas etc.

Health and Wellbeing Roadshows and Website

The Trust successfully launched a bespoke staff health and wellbeing website in July 2022. This provides our staff with a central single point of information that is easy to access and navigate based on their personal health needs and areas of interest. The website provides staff with access to a wide range of support services provided directly by the Trust, as well as signposting to appropriate specialist support services. To support and promote the HWB website, credit cards/stickers with the HWB logo have been developed with a QR code to enable staff to directly access the HWB website, this can be accessed on personal devices and provides new staff joining the Trust with access to support from day one. We continue to develop and promote merchandise to further advertise the website and HWB services to staff.  The corporate induction package, HWB mandatory training and Trust digital display screens have all been updated with the new HWB graphics and website information. 

To coincide with the website launch we have since ran a series of onsite health & wellbeing roadshows across the region to promote the website and further promote services available to staff on a yearly basis, which have been a great success, and we continue to do this each year. Again, this year the Trust have decided to undertake 12 roadshows and 11 health check visits to our sites in partnership with our internal and external partners, to promote the website, engage with staff, and encourage them to provide feedback via our health & wellbeing survey.  The events will be fun informative for staff, working in collaboration with our internal partners; SALS (The Trust’s peer support network), unions, HR Team, Mental Wellbeing Practitioner team, health and wellbeing champions, diversity and inclusion lead, staff networks, Freedom to Speak Up team, Organisational and Development and our management teams.   As well as our internal partners we have built great relationships with our external partners too, who will be supporting us this year at the events. In 2024, we also ran our first HWB online Festival, which again was a huge success, due to popular demand we have scheduled a 2-day online event in June 2025 and are also anticipating running a further one in the winter.

As well as the roadshows the Trust have produced a Cultural and HWB calendar, promoting events such as, Time to talk, internal wellbeing events along with National wellbeing offerings and cultural dates of interest.  Delivering the events is in alignment with our People strategy and the NHS People Plan, which is split into five key themes of delivery: the health and wellbeing of our people, recruitment and retraining our people, engaging with our people, inclusion and belonging and education and learning. 

Weight management 

Slimming World continues to be extremely popular with the Trust supporting staff for the first 12 weeks of their programme.  Staff have continued to engage with the programme though self-funding.

Physical activities

Physical activity programmes are frequently advertised in the Weekly Brief and on our HWB website from discounts to apps.

• “DoingOurbit” is an NHS platform that was designed in conjunction with the Royal Wolverhampton NHS. This programme covers cardiovascular workouts, Pilates, Yoga, Gentle exercise and salsa dance type programmes that children can join in with. Its totally free and has been nationally acclaimed.
• Be Military Fit a new NHS platform offering a mixture of not only exercise but nutrient, hydration and sleep.
• NHS Fitness Studio Exercise this offers different types of exercise for all levels of fitness. It also offers variety in terms of what’s available.
• Walsall MBC offer a 15% discount to all WMAS staff which is regularly advertised and covers all of their centres.
• Wyndley Leisure Centre in Birmingham offer staff 20% corporate discount on their one-year membership.
• Sandwell Leisure Centre offer monthly or yearly NHS discount.
• PureGym offer up to 10% off monthly membership and £0 joining fee.
• Evans cycle to work scheme which is open to staff all year round now, with an increased bike allowance of up to £3,000.   
• West Midlands Police Sports & Wellbeing Association, through joining the membership scheme a whole host of benefits from sports and wellbeing opportunities, days out with the family, money saving benefits, and more are available to WMAS staff. 

Mental health first aid courses

The Trust have 6 trained MHFA instructors, we were able to recruit 2 additional staff members to support us, which has been a great success as the new trainers are able to support us with online training courses, we ran our first online session in March 2024. 10 courses were delivered across the Trust during 24/25, 619 members of staff have completed the training up to 5^th March 2025

Suicide lite courses

WMAS is the first ambulance service in the country to use National Centre for Suicide Prevention, Education and Trainings (NCSPET). The Trust initially funded 13 instructors’ places; the Trust have 5 active instructors currently. 13 courses were delivered across the Trust during 24/25, 965 members of staff have completed the training up to 5^th March 2025.  In addition, we have also trained CFRs and students, since May 2024.

Sanitary products

The Trust has successfully rolled out free provision of sanitary products for all staff, across all sites. This was possible due to an initial successful funding bid to NHSE to provide free-vend units across all Trust sites. We have been able to provide an large initial stock level of products for all units and have encouraged individuals to “pay it forward” by topping up the units as and when they are able to do so.

Financial wellbeing

The Trust has an excellent partnership with Barclays Bank, Money Helper and Trussell Trust Foodbank to provide additional support to staff.

• Barclays Bank – Barclays offer staff financial health and wellbeing, including a broad range of products and services available to all UK based employees.  In addition, they provide a wide range of resources to support staff in their financial life.
• Money Helper, also provide free support for staff.
• The Trussell Trust Foodbank – The Trust recognises that some colleagues may need additional financial support from time to time, which is why the Trust have partnered with The Trussells Trust, a national charity who support a network of foodbanks, to make it easier for staff to access the support they need.  They provide a minimum of 3 days of nutritionally balanced emergency food to people who have been referred to them in a crisis.  As a partner organisation, the Trust can refer staff to their nearest foodbank and issue them with an e-vouchers for a 3-day food parcel.  

Physiotherapy

The Physiotherapy service is currently being provided by our Occupational Health Provider “Optima Health” which is working well. They are able to provide clinics across the Trust at a variety of locations, which are within staff vicinity. In additional, the Trust have continued to offer staff fast track physiotherapy support via Optima Health, which the Trust have received positive feedback for the support offered.

Flu Vaccination

The Trust achieved a 62.6% frontline healthcare worker flu vaccination rate.

Participation

The Trust is also involved with the following external groups:-

• National Ambulance Wellbeing Forum
• NHS England events
• Midlands Health and Wellbeing Network Meeting
• NHS Employers Health and Wellbeing Network Conversation
• H&WB strategy meeting

Freedom to Speak Up

West Midlands Ambulance University NHS Foundation Trust (The 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 63 trained ambassadors around the region, an increase from 50 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 WMAS Learning Review Group and Quality Governance Committee, and bi-annual reports to the People Committee, Executive Management Board and Board of Directors
• NHS England’s Reflection and Planning Tool, presented to Board of Directors in May and October 2023, and confirmed as complete by Board of Directors in January 2024.
• National Guardian’s Office training modules are in place as follows:
• All staff completed Speak Up as part of Mandatory Training during 2023/24
• Staff on Bands 7 – 8B are required to complete Listen Up Module
• Staff on 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 2024/25

2024/25 saw the highest number of concerns in a single year with a total of 131 concerns raised.  This compares to 82 in the previous year and 29 in 2022/23, 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.  

• 2023/24                82
• Quarter 1              14
• Quarter 2              19
• Quarter 3              29
• Quarter 4              20

• 2024/25              131
• Quarter 1              39
• Quarter 2              36
• Quarter 3              27
• Quarter 4              29

These were from the following service areas:

• Emergency and Urgent – 39 (increase from 26 in 2023/24)
• Patient Transport Services – 16 (decrease from 17 in 2023/24)
• Integrated Emergency and Urgent Care – 33 (increase from 20 in 2023/24)  
• Other Departments – 10 (increase from 9 in 2023/24)
• Not stated – 33 (increase from 9 in 2023/24)

Among these concerns, the following were recorded (some concerns were recorded in multiple categories).  The categories shaded grey are benchmarked nationally by the National Guardian’s Office

The most reported category is 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 / behaviour of either managers or colleagues.    

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.    During the last year, we have worked with other teams within the Trust to implement a guide to raising concerns, providing staff with examples of types of concerns and the routes that would be appropriate to each example. 

A data breach incident has been reported, which occurred in November 2024, relating to Ambassador conversations.  No individual cases which had been brought to the FTSU Guardians were breached.  A small amount of personal data was inaccurately made available to the Trust’s trained FTSU Ambassadors, on a restricted access site.  This was identified and reported by an ambassador, and access to the data was immediately removed.  An incident report was completed, and a full review was carried out jointly with the IT Department.  Actions to prevent such a breach from re-occurring were planned and implemented.   

Single Oversight Framework (SOF)

This Framework was introduced by NHS Improvement in 2016 as a model for overseeing and supporting healthcare providers in a consistent way.  The objective is to help providers to attain and maintain Care Quality Commission ratings of ‘Good’ or ‘Outstanding’, meet NHS constitution standards and manage their resources effectively, working alongside their local partners.  This is done by collating information relating to achievement of the following key themes:

Since maintaining its overall rating of Segmentation 1, since the SOF was introduced, WMAS has been rated within segmentation 2, in recognition of the pressures and support required to address ambulance handover delays and response times.   The Trust is working closely with our six integrated care systems and NHS England to jointly address the factors that are affecting patient care throughout the West Midlands.

Listening to feedback

Each year our commissioners and stakeholders provide feedback in relation to the content of the Quality Account.  We received many very positive comments in response to the 2023/24 report, along with some constructive feedback in relation to the challenges the Trust has faced and the chosen priorities.  These were responded to within the account published in June 2024. 

Comments Received Relating to 2024/25 Quality Account

• Comments from our Lead Commissioner, on behalf of all Associate Commissioners, received 20 May 2025

On behalf of all of the Integrated Care Boards of the West Midlands region, I would like to take the opportunity to thank West Midlands Ambulance Service leadership and staff for their tireless work to meet our patient’s needs.  Whilst ambulance handover delays at some hospitals within the region challenge operational performance, WMAS continues to deliver a highly effective response to patients with the most clinically urgent needs.  Building on previous years, in 2024-25 the service delivered one of the lowest conveyance rates to Emergency Departments in England and maintained the highest ‘hear and treat’ rate in the country; additional investment into clinical call-handling capacity also delivered the highest proportion of Category 2 cases triaged to alternative pathways of all Ambulance Trusts (50% more that next closest Ambulance Trust).  Within this challenging space West Midlands Integrated Care Board commissioners continue to work with WMAS and system partners to stabilise performance, reduce lost hours to handover delays and improve patient outcomes.  

• Comments from Health, Overview and Scrutiny Committees

The Solihull Health and Adult Social Care Scrutiny Board is grateful for the opportunity to comment on the West Midlands Ambulance Service (WMAS) Quality Account for 2024/5.  (Responses currently being agreed for inclusion here)

As set out in the message from the Chairman, Members welcomed how the Trust has introduced a new way of looking at how they review incidents that happen and more importantly what they can do to stop them happening again – through the Patient Safety Incident Response Framework. Members endorse how the Trust has invested in building the team that looks at this area of learning, on the basis this will lead to fewer incidents and less harm coming to patients.

Members note the work undertaken to better support staff, including the appointment of a ‘People Promise’ Manager.  Members welcome how the number of staff leaving has slowed considerably and WMAS now has the lowest turnover of staff in the ambulance sector.

Members also note, with particular concern, hospital handover delays continue to be a real issue, reflecting the extreme pressures experienced at different hospital sites. Member support WMAS, and all partner agencies, in the work they’re undertaking in finding solutions to this major challenge.

Members are also appreciative of the progress made in how WMAS support mental health patients, including investment in specialist staff and vehicles. Also, how figures from the Home Office show that WMAS are the leading ambulance trust in England and Wales when supporting the patients detained under section 136 of the Mental Health Act.

Members are extremely concerned that staff continued to be on the receiving end of violence and aggression, on a regular basis, with an almost 100% increase in violence in recent years. As a consequence, Members fully support the Association of Ambulance Chief Executives (AACE) #WorkWithoutFear campaign.

Strategic Objectives

The document’s Statement of Quality explains how patients are central to everything WMAS does, meaning a relentless focus on the safety and experience of patients during their care and ensuring the best clinical outcomes are achieved – clearly, this is an approach Members fully endorse. Members also support the following strategic objectives as set out in the report:

• Safety, Quality and Excellence
• A great place to work for all
• Effective planning and use of resource
• Innovation and Transformation
• Collaboration and Engagement

Care Quality Commission

Members recognise WMAS has been rated as Good in the latest Care Quality Commission (CQC) report published in February 2024, whilst taking into consideration it was rated as Outstanding at the previous two inspections.

Learning from Deaths

Members also take into account the work undertaken by WMAS on learning from deaths. This included how, during the 2024/25 reporting year, following initial case record review; investigation or learning response, 99 of the 1323 deaths that occurred, or 7.5%, were considered more likely than not, to have been due to problems in the care provided to the patient. Members recognise the role of the Patient Safety Incident Response process, in identifying system wide learning and providing safety actions to prevent reoccurrence. Members agree on the vital importance of ensuring sufficient resources are in place to respond to the findings of the PSIRF, enabling all safety actions to be fully implemented.

Staff Experience and Engagement

Members welcome that the response rate for the staff survey was a significant increase compared to 2023, whilst also higher than the average response rate for all Ambulance Trusts. This reflects the effectiveness of the actions taken before and during the survey to encourage staff participation.

Members take into consideration how a total of 119 questions were asked in the 2024 survey, where responses to 10 questions are better than last year, whilst responses to 15 questions are worse than 2023. Members express concern on the finding that, when compared to other Ambulance Trusts that used Picker as their survey contractor, WMAS scored significantly worse in 62 questions.

WMAS Response: There is a comprehensive action plan in place in relation to the staff survey. 

Members take into consideration that increasing staff confidence to speak up and raise concerns was a key priority arising from the 2023 Staff Survey and there has been a slight improvement in the results from 2023-24. However, Members note, with some apprehension, that since 2020 there has been a significant decrease in the percentage of staff saying that they would feel secure in raising concerns about unsafe clinical practice and also about the organisation addressing their concern. Members agree it is vital there is considerable focus upon this priority, so that staff can raise their concerns and are confident any issues identified will be addressed.

WMAS Reponse:   A comprehensive work plan has been in place since 2022 to promote and assure staff and students in the safety and integrity of Freedom To Speak Up and associated processes.

Members also note, with significant concern, trends identified in the Workforce Race Equality Standard (WRES) results, as well as the Workforce Disability Equality Standard (WDES) results, including the following:

WMAS Response:   The Trust has comprehensive work plans with regard to WRES and WDES, which are hoped to raise staff satisfaction scores in future surveys.

• A higher percentage of BAME staff than white staff have said that they have experienced bullying and harassment from other staff.
• A ignificantly higher percentage of BAME staff than white staff have said they have experienced discrimination from managers and other staff.
• A significantly higher proportion of staff with a Long Term Condition (LTC) or illness than staff without a LTC, have said that they have experienced bullying and harassment from patients and their relatives in the last five years.
• A higher percentage of staff with a LTC or illness than those without have said that they have experienced bullying and harassment from managers, as well as from colleagues.

Members agree these significant issues must continue to be a major area of focus for the Ambulance Trust going forward.

Priorities for Improvement 2025/26

Members also endorse the priorities for improvement identified for 2025/26 and welcome, in particular, the inclusion of Hospital Handover Delays Reduction as the first priority, reflecting the seriousness of this issue. Member also welcome how delivery of this priority will be measured by evidence of greater engagement with acute, ICB and NHSE regional teams, reflecting the joint work that is required across the whole health sector.

Freedom to Speak Up

Members take account of how, as part of Freedom to Speak Up, 2024/25 saw the highest number of concerns in a single year with a total of 131 concerns raised, compared to 82 in the previous year. Members recognise how WMAS believe the continuing increase in concerns relates, in part, to the regular promotional activities and team briefings to both staff and managers.

Member note, with some apprehension, that, taking into account service area, the biggest increases in FTSU concerns relate to Emergency and Urgent services and Integrated Emergency and Urgent Care services.

WMAS Response:  It is important to note the low numbers of concerns overall, also that with such low numbers, any increase when expressed as a percentage will appear to be a significant change.   These are still very small number when compared with the whole workforce.

Members agree it is vital the FTSU service has sufficient resource to respond to all concerns and welcome the increase in trained ambassadors.

Review of Performance against 2024-25 priorities

Members welcome that, as part of the Review of Performance against 2024-25 priorities, all objectives were achieved, apart from reducing over 15 minute Hospital Handovers across the Region. Members recognise this has been taken account of as part of priorities for improvement identified for 2025/26. Also, that delivery of this priority is dependent upon a system wide approach.

Members request for future reporting on West Midlands Ambulance Service delivery and performance to be presented to the Birmingham and Solihull Joint Health Overview and Scrutiny Committee.

WMAS Response: We would be happy to attend a future meeting of the committee.

Members wish to put on record their thanks to all staff at the West Midlands Ambulance Service for all their hard work and commitment, whilst facing significant pressures throughout the last 12 months.

Received from Birmingham Health and Adut Social Care Overview and Scrutiny Committee on 15 May 2025

During 2024/25 the Committee has continued to scrutinise the work of the WMAS through the Integrated Care Board Quality Report. This was considered at the Committee meeting on 16 October 2024 and members were informed that the Care Quality Commission had rated the Trust as outstanding for the ‘Care’ standard and ‘Good’ across all the other standards of Well-Led, Safe, Effective and Responsive. The report identified no concerns relating to the West Midlands Ambulance Service through the work of the System Quality Group.

Work of the Birmingham and Solihull Joint Health Overview and Scrutiny Committee (Joint HOSC)

The ICB provides Finance and Performance reports to the Birmingham and Solihull Joint Health Overview and Scrutiny Committee. At the meeting on 26 September 2024, it was reported that Category 2 Ambulance response times had improved to an average of 30 minutes across 2024/25 and that monthly benchmarking for ambulance handover times had reduced since April 2024, but some service pressures had been experienced during September 2024. It was discussed that Birmingham and Solihull remained an outlier with regard to ambulance hand overs times with long ambulance delays in the system due to high bed occupancy and flow constraints across the system. Members were informed that the WMAS was incurring lost ambulance hours and mitigating this in order to keep Category 2 response times down. Members were assured that there was daily clinical oversight of the pressures on the Emergency Department and the risk associated with ambulances waiting outside the Emergency Department.

At the Joint HOSC meeting on 30 January 2025 the ICB provided the performance update including Winter Pressure Status. Members were informed that bed occupancy remained near 100% impacting on flow and resulting in the continuation of poor handover and high numbers of delays on certain days, however average handovers improved in December 2024 from the November position. It was also reported that during November 2024 the average Category C response time exceeded 50 minutes, however there had been improvements during December 2024 where the average response time reduced to under 30 minutes.

The ICB Performance and Delivery report to the Joint HOSC meeting on 15 April 2025 reported that ambulance Category 2 response times had improved to an average of 30 minutes across 2024/25 and there had been a reduction in the number of ambulance hours lost as a result of handover at Emergency Departments since the peak in November 2024.

Received from Staffordshire County Council on 3 June 2025

“Staffordshire County Council held elections in May 2025 and due to the timescales were unable to comment on the quality accounts this year.”

Comments from Health Watch Groups

Received from Dudley Healthwatch 17/4/25

Thank you for reaching out to Healthwatch Dudley. Recent local cuts to services have resulted in reduced capacity for our team, as a result we have made the decision not to provide a response to Quality Accounts this year.

That said, we are as always, keen to work with you and collaborate on more targeted opportunities that help capture the voice of patients / those accessing services and their carers and families.

Please do continue to share updates and involve us in the vital work of helping to amplify local experiences of health and care.

Received from Healthwatch Walsall 22/4/25  

Comments

Healthwatch Walsall welcomes the opportunity to respond to WMAS Quality Account for 2024/2025. 

It should be noted that the last Care Quality Commission inspections were carried out in August and September 2023. The subsequent report published February 2024 rated the Trust as good overall and outstanding in the caring category.

Whilst the Trust reports as a whole for the West Midlands, it would be useful for the reader to see more comparators provided to determine how individual towns/Boroughs are performing. 

WMAS Response: The Quality Account is produced at Trust level, however we do provide a breakdown within the report at ICB level.  With the amount of other content included within the Quality Account, it would not be appropriate to provide performance data at a more granular level, however we can provide reports on request that might support the more detailed comparison suggested.

Ambulance services in England continue to face ongoing challenging conditions, which predominantly require Government policy intervention, designed to bring about sustained systemic change. 

This is especially applicable to the crisis currently faced within social care, which ultimately impacts on hospitals’ ability to discharge patients, thus freeing up space at Emergency Departments and therefore reducing waiting times.

Notwithstanding this, NHS data showed that WMAS was the most efficient Ambulance Trust in the country, despite having to take the unfortunate step of raising the risk rating to 25 to register concern that patients were coming to harm because of the delay in hospital handovers.

In spite of this commendable performance, the Trust declared a disturbing statistic of 380k lost crew time hours for the year.

Healthwatch Walsall notes the continued pressure on the Trust to balance financial obligations, whilst at the same time, minimising the impact on achieving targets but shares its concern for the impact on both patients and staff wellbeing.

Specifically, WMAS has achieved 8 minutes 15 seconds vs 7 minutes for getting to Category 1 calls and 29 minutes 6 seconds vs 30 minutes for getting to Category 2 calls.

It is encouraging to note, that the Trust accepts that in the case of Category 2 the target of 30 minutes is extended, (as of January 2023), against a real mean figure of 18 minutes.

The Trust’s call-taking response time recorded the fewest over 2 minutes in the country whilst receiving a total of circa 1.8m.

Within this, we note the ongoing commitment to staff specialist training, enabling cases to be dealt with more effectively and therefore helping patients to navigate to appropriate services accordingly. This is especially true for the ongoing work with mental health patients.

Staff are encouraged to speak up regarding their concerns and this is especially important given the unacceptable 100% increase in recent years of violence being directed at employees simply carrying out their duties on behalf of the public.

The Trust also promotes a climate which recognises diversity and equality. In addition, it engages with staff in general to tackle internal bullying and harassment. 

There are systems in place to manage public expectations and complaints, and robust procedures to investigate serious incidents.

Overall, public complaints are down slightly from 410 in 2023/2024 to 389 in 2024/2025.  Of these, some 52 were justified of which 31 were related to response. 

The Patient Safety Incident Response Framework, (PSIRF), introduced on 1 April 2024 has shown to be an effective tool for monitoring this aspect of service provision. This year there have been 199 investigations across all levels. 

We note the continued annual rises in trends for safeguarding referrals. Undoubtedly, this is not only due to the concerns of staff when providing care, but also the harmonisation of safeguarding services across the West Midlands network. 

As a whole, the Trust states that it has achieved all of its priorities for 2024/2025 other than the 15-minute hospital handover across the region.

Given the circumstances as described earlier in this response, Healthwatch Walsall acknowledges its progress.

Finally, we welcome WMAS work to reduce its carbon footprint.

Received from HealthWatch Staffordshire 23/4/2025

Comments Received

During the year Healthwatch Staffordshire worked closely with WMAS sharing the feedback we received from 359 members of the public on their experiences of calling the 999 service with the top three reasons being falls, shortness of breath and chest pain. We have visited the emergency control centre in Stafford and were impressed with the responsiveness of the call handling team and the increasing use of clinical validation. We also looked in some depth at the performance figures for Staffordshire.

We published a report on our findings in July 2004 and have since gone on to look at how admission avoidance schemes are developing and operating in Staffordshire.

It was clear from patient feedback that the ambulance service is greatly valued and is assisting many during their hours of need. Some shared their experience of life saving treatment from the service for which they will ever be thankful.

Genuine concern was, however, expressed about response times and the availability of ambulances across the County. The perception of the public is that all 999 calls are urgent. People were particularly shocked about the wait times for lower category calls. We picked up a degree of fear amongst older people living alone, particularly those who had fallen and injured themselves. 

The ambulance service is clearly aware of the issues that delays cause for patients and there are initiatives in place both to advise patients who are waiting and to divert to alternative support if appropriate and available. 

WMAS Response: We share the concerns about wait times, and have implemented several initiatives to address these, as described in this report.  We have, over the years, accelerated our recruitment and training programmes to maximise crews deployed for operational duty.  Wait times are, as widely reported, directly linked to handover delays at hospitals, which are escalated to the highest levels regionally and nationally for action.

It is reassuring to note that the percentage of patients being taken to hospital has reduced to 53% due to the efforts of both the ambulance service and community-based health and care interventions.

The introduction of specialist mental health ambulances has also been welcomed.

In spite of all this work, the handover delays at Royal Stoke Hospital and other hospitals continue to be of concern and have a knock-on effect on ambulance availability.

WMAS Response: We work every day to ensure that our patients access the most appropriate response and treatment, and work locally with the hospitals to maximise patient flow for those that are conveyed.  

Received from Healthwatch Worcestershire 

Approved at the HWW Closed Board Meeting on 22nd May 2025.

Progress against 2024/25 Improvement Priorities

Mental Health

We welcome the use of mental health nurses within the emergency operations centre. As stated last year we would support the use of mental health response vehicles where these have been commissioned by the ICB. It is again not stated whether Hereford & Worcestershire ICB has commissioned mental health response vehicles.

WMAS Response:  Herefordshire and Worcestershire ICB has commissioned mental health response vehicles, the report will be updated to reflect this point.

The report has indicated that WMAS has been successful in reducing High Intensity Service Users (HISU) demand and increased availability of appropriate care plan documents for HISU patients. We would be interested in seeing data to support this statement.

WMAS Response: We would be happy to provide information to reflect the progress made with regard to High Intensity Service User (HISU) patients.

Patient Experience

We welcome the implementation of a Patient Advisory Committee which meets quarterly, however, it is not clear how this committee will draw on individuals to gain representation from counties like Worcestershire and how this committee discussion informs WMAS policies and procedures. Evidence of changes made through this group would be helpful to understanding its impact on patient care and service delivery.

WMAS Response: As identified within the report, this groups is in its infancy. We would be happy to provide information on how we plan to gain representation from local counties across the Trust’s geography, and also to provide evidence as changes made through the work of the group as time progresses.

We note that complaints are less than last year and there has been an increase in the number of complements received by the Trust.

We commend the Trust on the achievement within the three measures of success of the 2024/25 patient experience (FFT, Patient Advisory Group and learning outcomes from service delivery).

Patient Safety Incident Response Framework (PSIRF)

It is not clear from the report what has been done to meet this priority. Surveys and focused groups of those who are involved in patient safety incidents have not occurred, due to the process being declined by the Working Group due to capacity. We would like the opportunity to see and comment upon the alternatives that are being considered.

There has been a transition from using Serious Incident Framework (SIF) to Patient Safety Incident Response Framework (PSIRF). As stated last year we would welcome a breakdown to see the impact in Worcestershire. It would also be of interest to see examples of how this process has improved patient safety and service delivery.

WMAS Response:  We would be happy to provide answers to your questions.  It will be more appropriate to do this in direct response to you, than provide an update within the Quality Account.

Ambulance Handover Delays

As previously stated in our response to the 2023/24 Quality Account, the main feedback we continue to receive from patients and carers is around response times. For this reason, we welcomed the inclusion of Ambulance Handover Delays as an improvement priority.

Although much work has gone on in greater engagement with Acute Hospitals, ICBs and NHS England, and the shared learning that has gone on, delays during handover remain consistently high. WMAS reported delays significantly deteriorated in Dec 24 and Jan 25.

It is good to see the timeliness standards comparison table across the 6 ICS systems, unfortunately the sea of red paints a sadly familiar picture, by adding a national comparator would help with the context of this information. Timeliness standards/response times is the highest complaint category – the metric most visible to the public. We note only 2 out of the six timeliness standards were achieved resulting in WMAS being rated with segmentation 2, what does this mean? Looking at the Operational Performance section of the report the size of the timeliness/response problem is clear across the West Midlands. It would be useful to have more commentary on explaining the key reasons for these performance targets e.g. what are the key areas that WMAS is working with the six ICS systems to improve response times?

WMAS Response:  We moved to segmentation 2 at the time due to 111 performance and category 2 performance.   Category 2 has been restored and we are no longer a 111 provider, so we are requesting approval to move back to segmentation 1.  Lost hours / reducing handover delays, we have worked over the last 2/3 years on alternative pathways uptake and use to reduce demand.  We have moved hear and treat to approximately 20%

The Call Before You Convey programme appears to be working, please tell us more about this. We understand that in  Worcestershire there are specific teams meeting ambulances, one of their aims is to have a more efficient handover. Are there any other programmes (specifically in Worcestershire) that are in place to  improve response times – as examples of reassurance that this remains a key objective for WMAS.

WMAS Response: We have appointed a specific senior role to further enhance Call Before You Convey, involving collaborative working between providers across each ICs. 

We note that WMAS has assessed their progress against the agreed priorities for 2024/25 and have confirmed those that it needs to continue to ensure a high-quality service is maintained and continues to improve. In deciding its quality priorities for 2025/26 for improving patient experience, patient safety and clinical quality, WMAS has stated that it has reviewed outputs from:

• Discussions with stakeholders
• Engagement events
• Compliments
• Complaints
• Incident reporting

We note that these outputs are regularly reviewed and have been used to identify causes and priorities for improvement. We would welcome more detail about how these events have improved patient experience, patient safety and clinical quality.

WMAS Response:

• Partnership in H&W include an audit in relation to opportunities missed
• Learning from incident management – PSIRF, Duty of Candour, Complaints and Compliments, Feedback loop CQRG, Feedback from CQC.  Learning Review Group and Quality Governance Committee considers all inputs from these sources to triangulate information.  Quality Governance Committee reports to Board of Directors for assurance and escalation.

Improvement Priorities for 2025/26

Hospital Handover Delays Reduction

Following the publication of NHS England’s priorities and operational planning guidance priority to improve A&E waiting times and ambulance response times. We support WMAS priority to reduce hospital handover delays by working towards delivering hospital handovers to under 15 minutes and a maximum of 45 minutes.

WMAS Response:

• We regularly escalate our concerns about delays regionally and nationally, we have continued to focus on ambulance conveyance through use of alternative pathways  and Call Before You Convey
• National initiative to ensure no patient waits more than 45 minutes, which is delivered through engagement across all 6 ICBs

Delays during hospital handovers remains consistently high and has deteriorated in Dec 24 and Jan 25. What steps are WMAS going to take this year that will improve on these figures?

Hospital Handover Delays Reduction – a priority for improvement in 2025/26: clearly a need for this as a metric. With the existing background of achievement in mind will WMAS hit the Cat 1 achievement objectives for H&W ICS? Can we have some commentary on what else needs to change for WMAS to be on the right trajectory to meet this objective?

WMAS Response:

• We have increased resources in the area, but handover delays prevent achievement of response times.   Our confidence will resume if nationally and regionally action is taken to effectively reduce handover delays
• If the Worcestershire system complies with the national requirement of handover delays, we will have confidence in restoring performance.

No mention is made of NHS England’s 2025/26 priorities and operational planning guidance stated aims of improving “hear and treat” rates, increasing the proportion of category 2 calls, and ensuring all 3 and 4 calls are clinically navigated, validated and where appropriate triaged in ambulance control centres or in single points of access in line with existing guidance.

WMAS Response:

WMAS is the national leader in performance terms with respect to Hear and Treat rates.  The progress we have made collaboratively across the region on alternative pathways supports our hear and treat performance.

Clinical Practice and Supervision Review

We support the aim of WMAS to directly link the Trust’s advancing clinical practice arrangements to understand how this meets the needs of patients and staff moving forward. We also welcome the Trust’s priority to review clinical audits to evaluate the effectiveness of the reviewed clinical supervision model. How will the stated aim of meeting the needs of patients be measured within this priority? The measurements

outlined within this priority seem to be action points to achieve the priority rather than methods of measurement.

WMAS Response: The actions are derived from the completed review, and the targeted clinical outcomes will be identified and used as measurement of success within this priority.   This detail will be identified during the year within our quarterly monitoring process and confirmed in the Quality Account for 2025/26.

Patient Experience to include Equality, Diversity and Inclusivity for Communities

We support all plans to improve patient experience whilst using the services provided by the NHS, however it is unclear what WMAS is intending to do to meet and measure success in this priority area. 

We would like more evidence of greater patient involvement. NHS England 2025/26 priorities and operational planning guidance stated aims of increasing its focus on listening to, learning from and working with patients, carers and communities to drive improvements in the experience of all people using the NHS.

WMAS Response:  We recognise this too, and this is the reason for developing the patient participation group.   The outcomes from this group will be reported throughout the year.

Use of Alternative Pathways for Patients

We support the use of a clinical validation team and use of call before you convey systems. However, this priority area outlines what WMAS is currently doing through signposting patients via “hear & treat” or “see & treat” to better navigate patients to appropriate services. As a priority area we would expect WMAS to outline how it is going to promote alternative pathways to patients. We would be interested to know how this is working within Worcestershire and how this compares with the other ICS areas?

WMAS Response: We would be happy to supply some information directly to you in response to this work.

Are there any important issues missed?

The report states that 54% of staff stated that if a friend or relative needed treatment, they would be happy with the standard of care provided by the Trust compared to 55% in 2023. 52% said that care of patients is the Trust priority. We would like to see greater detail regarding any further investigation by the Trust to establish why these responses are so low and what action is being taken to improve them?

WMAS Response: These figures reflect a very difficult time in Urgent and Emergency Care.  Since this time, Category 2 performance has been restored, which may result in an improvement in responses from staff.

Page 22 refers to 99 of 1323 deaths or 7.5% were considered more likely than not, to have been due to problems in the care provided to the patient. What was learned and how did the system wide learning and safety actions prevent recurrence?

WMAS Response: The 99 cases identified through LFD considered more likely than not, to have been due to problems in the care provided to the patient these are escalated according to LFD and PSIRF policies.  Each of these cases were reviewed as either a Serious Incident under the SI framework or PSIRF as Learning Responses dependant on the date they were escalated. As a result, either Recommendations for SI’s or Safety Actions for learning Responses would be submitted by the Investigation Officer (SI) or Patient Safety Learning Response Lead (PSIRF) for review at SIRG (SI) or PSIRG (PSIRF)  following submission of their report and then reviewed at Learning Review Group.

Page 23 Operational Performance – It is not clear to the reader what is meant by “Timeliness Standards” or “Achievement”, these titles should be clearly explained. We would also like to know what the Trust is doing to improve its Category 2 response times.  To help understanding the report needs an appendix that explains the acronyms used such as E&U, EOC and PTS.

WMAS Response: 

• A glossary will be provided that will clarify the meaning of some terms and acronyms.
• C2 response times – despite having the worst handover delays in the country, we initiated a number of actions which focussed on resourcing hours and alternative pathways.   This meant that we meat the standard for last year and so far this year are performing better than standard.

As stated in our response last year there has been a reduction in some CQC ratings that have not been commented on in either the 2023/24 or 2024/25 Quality Reports. In the CQC report on 22nd August 2019 the Trust achieved an overall rating of “Outstanding”  because of five domains achieving “Outstanding” grades. In the CQC report published 23rd February 2024 the Trust achieved an overall rating of “Good” with one domain rated as “Outstanding”. In one domain “Is the Service Effective” the rating was downgraded to “Requires Improvement”. This was not commented on in either the 2023/24 or 2024/25 Quality Account. We look forward to seeing a report on the impact of this improvement plan in the 2025/26 Quality Report.

WMAS Response: CQC ratings are publicly available.  The primary driver for the rating reducing was around response times and impact on handover delays, which resulted in regulatory action.   The response times have since improved and this has been extensively discussed in our Board.     We acknowledge your comments and will provide an update in the 25/26 report.

Has the provider demonstrated that they have involved patients and the public in the production of the Quality Account? There is no clear evidence that patients and the public have been involved in the production of the Quality Account beyond the normal feedback gained from compliments and complaints received by WMAS. We are not aware of the extent of patient engagement by WMAS in Worcestershire but would welcome any contact with the Public Governor representing the county. The Patient Advisory Committee may have had a role in producing this set of Quality Accounts, however, this is not stated, clarification regarding this would be welcomed.

WMAS Response: The Quality Account is presented to our Council of Governors and this is the purpose of sharing with our Healthwatch and HOSC colleagues.  The contact details of the Worcestershire Public Governor will be provided to assist with improved collaboration in future. 

The Patient Advisory Committee has only met for its first meetings, and the agenda is still being fully established.  The Quality Account will be available for review by this group in future.  With such a large, diverse population, this is not easy with the population served.

Is the Quality Account clearly presented for patients and the public?

The Summary Document that has been provided is a useful overview in an accessible format. It is expected that appropriate versions will be made available for those who need other forms of presentations. On page 56 of the report readers are directed to access “Service-based Annual Reports

2024/25” which can be found on the WMAS website. We have attempted to access these reports, however, they don’t seem to be available for 2024/25.  As WMAS covers a number of counties across the West Midlands a breakdown summary would be useful. The patients, carers and service users across Worcestershire would benefit from being able to compare WMAS performance across the different geographies that make up the West Midlands.

WMAS Response:  The Departmental Annual Reports are in the process of being approved by their respective committees.  The Board of Directors has approved those that were presented in May 2025, the remaining will be approved by the Board in July and will be published on the website accordingly

Statement from the Council of Governors

Once again, we have been presented with an extensive and detailed Quality Account. It is evident that a considerable amount of time and effort has been involved it its preparation.

This year, like no other, the Leadership of the Board and the work carried out by all Staff, Students and Volunteers within the whole Organisation has been nothing but extraordinary.

Hospital handover delays have been a significant risk for the Trust. Governors have received regular updates on performance, and the staggering number of hours that have been lost waiting outside hospitals. Governors have been well informed of the situation throughout the year, and of the continuous dialogue and various initiatives that have been put in place in a bid to relieve some of the pressures of these huge delays.

It is pleasing to see that the Trust continues to have the best call answering service in the country, and has made great strides with “Hear and Treat”, which has inevitably helped to ease some of the pressures on ambulance crews and hospital delays. These pressures really can take their toll on all staff throughout the Organisation, and therefore, we champion the many health and wellbeing initiatives that have been introduced into the Trust over the years to help those staff who may need some assistance.

This year the Trust welcomed two new Non-Executive Directors to the Board, Suzanne Banks and Sukh Nat, following competitive interview processes, led by the Governors. The Council of Governors have been pleased to see both new NEDS settle so well into their roles at the Trust.

There was also a welcome for Dr Richard Steyn as Medical Director, following Dr Alison Walker stepping down from her role. Dr Steyn brings a wealth of knowledge, and has worked with the Trust for decades in his role as a BASICS emergency doctor, and it is pleasing to see him join the Board.

It would be impossible within this relatively short statement, to highlight all of the excellent work that has been carried out, and fulfilled to such a high standard, throughout the whole Organisation. Once again, we welcome the future priorities and look forward to seeing how these develop over the coming year.

On behalf of the Council of Governors, I would once again like to thank all the staff within West Midlands Ambulance Service for everything they do to ensure our patients receive the best possible care!

Eileen Cox

Lead Governor, May 2025

Appendix 1 – Statement of Directors’ Responsibilities

The directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations to prepare Quality Accounts for each financial year.

NHS Improvement has issued guidance to NHS foundation Trust Boards on the form and content of annual quality reports (which incorporate the above legal requirements) and on the arrangements that NHS foundation Trust Boards should put in place to support the data quality for the preparation of the quality report.

In preparing the Quality Report, directors are required to take steps to satisfy themselves that:

• the content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2019/20 and supporting guidance Detailed requirements for quality reports 2019/20, as per guidance for the 2024/25 report
• the content of the Quality Report is not inconsistent with internal and external sources of information including:
• board minutes and papers for the period April 2024 to March 2025
• papers relating to quality reported to the Board over the period April 2024 to March 2025
• feedback from commissioners dated 20 May 2025
• feedback from governors dated 10 May 2025
• feedback from local Healthwatch organisations dated May 2025
• feedback from Overview and Scrutiny Committee dated from May 2025
• the Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated 28 May 2025.
• the [latest] national staff survey published March 2025
• the Head of Internal Audit’s annual opinion contained within the Annual Governance Statement.  This was discussed and agreed at the Trust’s Audit Committee on 3 June 2025, attended by External Auditors.
• CQC inspection reports dated 22/08/2019; 15/03/2023 and 24/2/2024
• the Quality Report presents a balanced picture of the NHS foundation trust’s performance over the period covered
• the performance information reported in the Quality Report is reliable and accurate
• there are proper internal controls over the collection and reporting of the measures of performance included in the Quality Report, and these controls are subject to review to confirm that they are working effectively in practice
• the data underpinning the measures of performance reported in the Quality Report is robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review; and
• the Quality Report has been prepared in accordance with NHS England’s annual reporting manual and supporting guidance (which incorporates the Quality Accounts regulations) as well as the standards to support data quality for the preparation of the Quality Report.

The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Report.

By order of the board

Professor Ian Cumming – Chairman

Anthony Marsh – Chief Executive

Appendix 2: The External Audit Limited Assurance Report  

There is no national requirement for NHS trusts or NHS foundation trusts to obtain external auditor assurance on the quality account or quality report, with the latter no longer prepared.  Any NHS trust or NHS foundation trust may choose to locally commission assurance over the quality account; this is a matter for local discussion between the Trust (or governors for an NHS foundation trust) and its auditor. For quality accounts approval from within the Trust’s own governance procedures is sufficient.

The Quality Account is presented to and approved by Quality Governance Committee each year, and progress updates are reported to this committee as each year progresses.

WMAS’ Audit Committee is an established sub-committee of the Board of Directors, which is attended by the Trust’s external auditors.   The Head of Internal Audit Opinion was presented at the meeting on 3/6/2025.  This meets the requirements of the Quality Account and is referenced in the Statement of Directors Responsibilities.

Further information

Further information and action plans on all projects can be obtained by contacting the lead clinician named on the project.

Further information on performance for local areas is available as an Information Request from our Freedom of Information Officer or from the leads for the individual projects.

Progress reports will be available within the Trust Board papers every three months with the end of year progress being given in the Quality Report to be published in June.

If you require a copy in another language, or in a format such as large print, Braille or audio tape, please call West Midlands Ambulance Service on 01384 215 555 or write to:

West Midlands Ambulance Service University NHS Foundation Trust

Ambulance Headquarters

Millennium Point

Waterfront Business Park

Brierley Hill

West Midlands

DY5 1LX

You can also find out more information by visiting our website

If you have any comments, feedback or complaints about the service you have received from the Trust, please contact the Patient Advice and Liaison Service (PALS) in the first instance; 01384 246370.