Quality Account 2025/26

A message from the Chairman 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prof.  Ian Cumming OBE,  

Chair, West Midlands Ambulance Service University NHS Foundation Trust 

Chief Executive review 2025-26  

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

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

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

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

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

Clearly, we want to do everything we can to assist our acute trust colleagues as this will reduce handover delays, allow us to get to patients in the community more quickly and result in more crews to finish on time.  Two areas that we have focused on are ‘Call Before You Convey’ and the work of our clinical validation team.  Call Before You Convey sees crews contacting a multi-disciplinary team of clinicians who can offer a wide range of alternatives to A&E such as urgent care referral visits, admission to virtual wards, urgent social care intervention or direct admission to assessment units.  Thousands of patients are diverted every month using these services.    

Our Clinical Validation Team is made up of experienced paramedics and nurses working in our emergency operations centres who are able to assess some Category Two, Three and Four calls to see if the patient can receive care through an alternative pathway that is more suitable than sending an ambulance.  The non-conveyance rate now regularly reaches 25%, one of the best in the country.   

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

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

To other matters… 

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

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

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

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

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

For many years we have been at the forefront of developing our fleet so that it is better for our staff to work on and more comfortable for our patients.  A decade ago, we introduced learning taken from the aerospace industry to reduce the weight of our ambulances.  Five years ago, we introduced the first fully electric ambulance.  With the NHS being pushed to be a Net Zero carbon producer by 2040, it is imperative that the ambulance service looks at how it can reduce its impact on the environment.  As part of that process, we are expanding the number of fully electric cars which are used by Operations Managers.  Where the Skoda Enyaq is not viable in more rural areas, we have introduced hybrid type vehicles.   

We also received national money to install additional electric charge points at six sites.  The Trust has also recently introduced eight Ford electric ambulances with four based at Erdington and four at Sandwell, again part of national funding.  We have also increased the number of frontline ambulances from 478 to 509 to enable us to get to patients faster.  We continue to be the only Trust in the country to have no frontline vehicle over five years old.    

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

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

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

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

Anthony C. Marsh 

Chief Executive Officer 

Statement from the Clinical Directors 

Our quality purpose is to deliver outstanding levels of emergency clinical care to our patients, supported by the innovation of healthcare technologies, within the integrated care systems which result in safe, effective care and a positive patient experience. 

Our 2026/27 Quality Outcomes are to, 

• Better align PSIRF priorities with an evidence base audit programme, aligned with the clinical priorities of the ambulance sector, and designed to maximise organisational learning and promote the hospital to community shift.  
• Strengthening and evolving our Trust-wide model of clinical supervision and education, ensuring it is embedded across all clinical areas, to support excellence in care. Thus, maximising the ability of our staff to develop their clinical skills to deliver hear and treat, see and treat and see and convey pathways, further promoting the hospital to community shift.  
• Continue to seek and implement innovative technology solutions that support clinical practice, reduce administrative burden and improve the quality, safety and efficiency of care delivered across the organisation, in align with the analogy to digital intent. 
• Strengthening and evolving our Trust-wide model of clinical supervision and education, ensuring it is embedded across all clinical areas, to support excellence in care. Thus, maximising the ability of our staff to develop their clinical skills to deliver hear and treat, see and treat and see and convey pathways, further promoting the hospital to community shift.  
• We will work closely with our Education and Training Team, alongside our University Partners to produce paramedics who are appropriately trained to deliver excellent care and empowered to foster a learning culture moving from sickness to prevention when possible.  

Aidan Brown – Service Transformation 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, is currently being refreshed and 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

Our 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.   We understand that to continue to improve quality, it is essential that our patients, staff and stakeholders are fully engaged with our plans and aspirations and have recently been engaging on our proposed strategic objectives, which align with the three goals of the NHS Long Term Plan and our Vision: 

• Strategic Objective 1: From Analogue to Digital 
• Strategic Objective 2: From Sickness to Prevention 
• Strategic Objective 3: From Hospital to Community 
• Strategic Objective 4: Being a Great Place to Work 
• Strategic Objective 5: Developing our Organisation 

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.  

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 or indeed required to assist the CQC in their regulation of WMAS are available and discussed where appropriate. Any actions identified through these discussions are completed promptly and kept under regular review. 

Our Services 

With a budget of approximately £483 million, the Trust serves a population of approximately six 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.  

Employing around 7,000 staff, 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 two 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 utilises 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 500 Community First Responders. 

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 2025/26 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 2025/26 represents 99.71% of the total income generated from the provision of health services by the Trust for 2025/26. More detail relating to the financial position of the Trust is available in the Trust’s 2025/26 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 assesment

• 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 2025-2026 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). 

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. 

Older Adults Falls, discharged at scene 

A fall is defined as an unintentional or unexpected loss of balance resulting in coming to rest on the floor, the ground or an object below knee level’ (JRCALC 2024). Injury may or may not result from the fall, but an exhaustive assessment of any trauma sustained must be carried out. A ‘fall’ would therefore also include situations where the patient lowers themselves to the floor to avoid an uncontrolled fall. 

During 2025–2026, collaboration with senior clinical leads, the Business Intelligence function, and the Clinical Audit teams led to the development of an automated first clinical audit programme. 

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 

The Trust is refreshing and developing its clinical audit programme.  The new programme will offer a digital first approach for the future conduct of clinical audit.  The digital first approach will support primarily the automation of clinical audits, in contrast to the existing manual review and validation process. Launching in April 2026, this approach will allow the Trust to obtain real time patient reporting, across full clinical presentation cohorts or specific patient groups.  

The digital first reporting will allow responsive and continuous approach to quality improvement, which, when embedded within our PSIRF priorities, will promote timely and impactive change in the care we deliver.  To support digital clinical audits, and provide alternative assurance, manual review and/or validation of source data will be utilised to produce detailed snapshot audits, throughout the annual audit programme. 

The audit programme will be iterative by design but will be formally reviewed annually.  

Participation in Research  

WMAS has a strong record in the delivery of complex pre-hospital research studies across a wide range of clinical and workforce related subjects.  With strong links developed nationally with National Institute of Health and Care Research (NIHR) senior investigators, WMAS collaborates with academics throughout the UK and Europe to design, lead and delivery research within the pre-hospital environment. 

The Research Delivery Network (RDN), on behalf of the NIHR provide delivery oversight of research participation by NHS Trusts, measuring and reporting against strategic objectives, which form key performance metrics. In 2025, the most commonly report metric is participant recruitment.  For 2026/27, the NIHR have created a new funding model, linked to metric performance, which will lead to more detailed strategist oversight for the future.  These metrics will be reporter to QGC in future reports for oversight.  

Research Participation 

Within 2025/26, the Trust has participated with 17 Health Research Authority approved research studies, of which 12 met the criteria for NIHR portfolio.  The remaining 5 studies did not have competitively sourced funding, through a NIHR non-commercial partner and therefore were not eligible.  The trust has registered 12 new requests for service evaluation, which were made up of 4 WMAS staff Master’s projects and 8 WMAS initiated evaluations.  

The Trust has recruited 850 participants into research studies this year, of which WMAS have been awarded 655 recruitment accruals, against a target of 366.  

Participant Recruiting Studies 2025/26

Research Studies 2025/26 

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 regions. 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.

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.

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. 

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”. 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. 

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. 

Golden Hour for Stroke Study (GHoSt)

The GHoSt study aims to investigate biomarkers in blood, saliva, and urine to improve the rapid identification of stroke type – ischaemic, haemorrhagic, or non-stroke mimics – in patients presenting with suspected stroke at participating NHS ambulance services and hospitals. 

In-Situ Mobile Application for the Triage of Pedestrians (SENTINEL)

SENTINEL aims to revolutionise the triage of pedestrian patients by developing an AI based mobile app for the early identification of pedestrians’ brain injuries, enabling faster and more accurate medical interventions. This will not only improve patient outcomes and save lives but also advance the application of AI beyond traditional fields, generating new methodologies and insights applicable in various domains. SENTINEL is a feasibility study, a proof of applicability of such AI tools to support EMS in the future. SENTINEL will provide a Mobile app demonstrator, which will be implemented in future projects. 

Mapping Post-Falls Organisational Processes in Care Homes  

Falls are common among older people living in care homes and can cause serious injuries. After a fall, older people require post-falls management. This programme of research aims to develop principles for post-falls management for older people in care homes. Findings will help develop draft principles for post-falls management in later stages of the research. The research follows an implementation science approach, and the Behaviour Change Wheel will be used to structure the work. 

Ambulance Clinicians Experience of Attending OHCA in Children (POHCA) 

This research will explore ambulance clinicians’ experiences of attending out of hospital cardiac arrest (OHCA) incidents involving children. OHCA occurs when the heart stops beating. This is a time critical emergency that requires immediate treatment to maximise the chances of survival. OHCA affecting children is rare, but when it happens it is vital that paramedics and other ambulance clinicians can respond and deliver high quality care. Because OHCA in children is rare, ambulance clinicians attend these incidents infrequently. Some clinicians may only ever attend this type of incident once in their career. These incidents are technically challenging for ambulance clinicians, and highly stressful. Evidence from other setting suggests that clinicians may be ill-prepared to manage these events. Our research aims to understand how OHCA incidents involving children are currently managed, and to explore the views and experiences of ambulance clinicians with respect to attending OHCA incidents involving children. 

Exploring clinical Presentations and Paramedic Case-mix in AMBulance Services (EPPiC-AMBO)

Today more people are calling ambulance services than ever before, and we think that some of these people might have less serious injuries and illness. This might mean ambulance services are not used in the best way. This might also be bad for people with serious injury or illness, because ambulances might be busy with other people.   This research will understand who is calling ambulance services, why they are calling and try to describe what is wrong with them. We will use this information to help ambulance services understand more about the types of calls they might get in the future. 

Exploration of Clinical Advice Delivery 

Using a three phase, mixed-methods approach, the CLEAR study aims to evidence current national clinical support provision, improve understanding of national provision of clinical advice, the variation in national provision of clinical advice, and staff perceptions of the current clinical advice provision. 

Understanding the scale, impact and care trajectory for patients who have a long lie after a fall 

To understand the characteristics of patients who have a long lie, their care trajectory and the health, psychological and economic impact of the long lie, as well as understand potential interventions to mitigate the impact of a long lie.

What works to improve SafeTy, pAtient experience, outcomes and costs reLated to deLayed ambulance handovers at Emergency Departments? A whole system approach (STALLED)

There has been a problem in the UK and other countries for many years, that at busy times Emergency Departments (ED) become unable to manage the flow of patients. Patients remain in the ambulance, sometimes for several hours. In some areas this practice is rare, in others it is common. When ambulances are queuing, patients are not receiving full ED care and ambulances are unavailable, so there are ‘knock-on’ effects on patients and staff throughout the urgent and emergency care system. We aim to provide evidence about what works to reduce harms related to ambulance queuing.

United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers: InCreAsing Retention of healthcare staff from Ethnic minority groups (UK-REACH-I-CARE) 

We aim to understand why staff from minoritised groups stay or leave the NHS and produce policy interventions to help NHS organisations improve retention of these staff. Actions to improve retention will likely improve the working lives of staff and their productivity, resulting in improved patient experiences and advancing racial/ethnic equity. As such, we anticipate our study will have wider benefits to the NHS, patients and society.

emeRgEncy diSPatch decisiONs using viDeo consultation (999 R.E.S.P.O.N.D. 2) 

Ambulance Services are under pressure to optimise resources whilst managing increased demand and ineffective systems. This is relevant when considering specialist resources such as Enhanced and Critical Care Teams (ECCT), who deliver advanced care to seriously ill and injured patients at scene. When dispatched unnecessarily, they are unavailable to patients who need them which can lead to increased serious injury, death and costs. Our project aims to explore this by collaborating with decision makers within the ambulance service and members of the public, to develop effective interventions that will improve the use of live-stream video to benefit patients and staff.

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 SALIX 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 were completed in 2025. 

Fleet  

Our commitment to delivering the emission reduction targets set out by NHS England 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. 

WMAS considers that data within the report is as described for the following reasons:

• it has been cross checked with Trust database systems  
• it is consistent with national benchmarking  
• it has been audited by external auditors 

NHS Number and General Medical Practice Code  

The Trust was not required to and therefore did not submit records during 2025/26 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 DSPT for 2025/26 is currently entering its audit phase with external auditors KPMG to give the Trust assurance of the expected outcome.  This report will be returned to the audit committee once agreed. The deadline remains June 30^th. Once the audit work is complete reports will resume regarding evidence approval. Ther are no material concerns currently. 

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 and Learning Group (PSLG). 

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 2025/26 reporting year, the total number of deaths that occurred while in WMAS care, was 1183. This aggregate figure represents quarterly totals of: 

• 346 in quarter one 
• 283 in quarter two  
• 302 in quarter three 
• 252 in quarter four

During the 2026/26 reporting year, 1323 case record reviews were completed.  

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: 

• 346 case record reviews and 59 LFD investigations in quarter one 
• 283 case record reviews and 69 LFD investigations in quarter two  
• 302 case record reviews and 120 LFD investigations in quarter three 
• 252 case record reviews and 75 LFD investigations in quarter four (figure correct at the point of submission) 

During the 2025/26 reporting year, following initial case record review; investigation or learning response, 10 of the 1183 deaths or 0.8% were considered more likely than not, to have been due to problems in the care provided to the patient.   

The number and percentage have been estimated from each case meeting the threshold for investigation under the Patient Safety Incident Response Framework which may ultimately determine there were no problems in the care that was provided.  

The aggregate figure and percentage represent quarterly totals of: 

• 7 deaths in quarter one. 
• 3 deaths in quarter two. 
• 0 deaths in quarter three. 
• 0 deaths 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 Professional Standards and Learning Review Group.  

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 2025/26; 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.  Through the Call Before You Convey (CBYC) initiative, some hospitals have achieved demonstrable improvements in the last few months of the year, which have supported an improvement in response times across all categories of call with particular improvements in Category 2.  

The table below compares local ambulance response time performance against the national average across Categories 1–4.

The table below shows ambulance response times across each Integrated Care System (ICS), including mean response times for Categories 1 and 2 and 90th centile response times for Categories 1–4.

Performance by Integrated Care System April 2025 to March 2026 (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 answer time of 1 second and 95^th centile of 0.00 seconds.  A delay of 2 minutes occurred in 77 calls throughout the year, this accounted for only 0.2 per cent of the delays of the same length across the country. Included in our calls were 14,818 from other services. 

Clinical validation of Category 2,3 and 4 emergencies remain 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 2026, 56.3% received a Hear and Treat Outcome.  This contributed to the overall Trust ‘Hear and Treat’ rate of 23% 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.  With education and system updates, the number of ambulance crews using Call Before Convey increased from 800 in April 2025 to now approximately 5000 calls per month being made from our crews on scene with 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.  

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 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 collapses, is not breathing normally and is unresponsive, they are in cardiac arrest.  The AQI includes: 

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

ROSC 

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

Overall Group 

• Resuscitation has commenced in cardiac arrest patients 

Comparator Group 

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

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

Post resuscitation care bundle 

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

Older adult fallers discharged at scene 

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

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

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

Year-to-date Clinical Performance AQIs

The table below shows Ambulance Quality Indicators (AQIs) for WMAS from 2021–22 to 2025–26, compared with the latest national average. Figures are as at 13 April 2026.

Figures as at 13 April 2026.

Part 2 – Priorities for improvement 2026/27

We have assessed our progress against the agreed priorities for 2025/26. In deciding our quality priorities for 2026/27 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. 

Priority 1 – Hospital handover delays reduction 

Rationale 

Given the continued rise in lengthy delays at acute Trusts across the region during 202526, this was highlighted as a key priority in the Quality Account for monitoring through 2025/26.    Through regular dialogue and agreement to implement a maximum 45-minute wait (NHS Planning guidance), some progress has been witnessed in the latter part of the financial year.   However, there remains significant work to be completed to ensure continuation of improvements for the longer term.  NHS England’s Operational Planning Guidance continues to highlight ambulance response times as a national priority.  With WMAS experiencing the highest hospital handover delays in the country, this remains a key priority within our Quality Account throughout 2026/27. 

Priority 2 – Clinical Supervision Review 

Rationale 

The Trust’s Clinical Supervision Framework has been in place for a considerable time and now requires review to ensure it remains current and aligned with local, national and professional requirements. Refreshing the framework will help confirm that clinical supervision continues to support high‑quality care, staff wellbeing and professional development. 

The review will establish how supervision is currently delivered, identify any variation and ensure expectations are clear and consistent across all services. This will support a more standardised and equitable approach for all clinicians. 

Clinical audits and relevant activity data will be examined to understand the effectiveness of existing arrangements and whether changes in the workforce, learning preferences or clinical practice require adjustments to the model. This ensures the updated framework is evidence‑based, responsive to service needs and focused on improving clinical quality and patient outcomes. 

Priority 3 – Improving clinical care by use of Patient Safety Incident Response Framework PSIRF priorities and clinical audits 

Rationale 

Implement PSIRF priorities and an audit programme that are evidence based, aligned with the clinical priorities of the ambulance sector, and designed to maximise organisational learning. This alignment enables the Trust to direct quality improvement resources and strategic leadership to the areas where they will have the greatest impact.  

Priority 4 – Develop Clinical Models of Care

Rationale 

Develop clinical care models to further improve the quality of care provided to patients in the following areas: hear and treat, see and treat and see and convey. 

Part 3 – Review of 2025-26

Our priorities for 2025-26 were based upon the following overarching priorities.  The achievement status is included in respect of work which was planned during the year.  Several of these priority work streams will be continued into 2026/27: 

Hospital Handover Delay Reduction 

Measure of Success 

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 

Comments on Progress 

NHS England has convened an alternate weekly triumvirate meeting of executives from the most challenged systems and Acutes. While all have committed to implementing a maximum wait, compliance with the maximum 45-minute hospital handover has been challenged, however all sites have improved their hospital handover performance, particularly from January going into February.  The current set of Trusts involved in this programme is UHB, SATH, UHNM, DGH, RWT and WAHT.   WMAS lost hours equate to one third of the delays for the English NHS year to date and there were 40,000 lost operational ambulance hours for the month of December, 50,000 for January, but a reduction to 28,728 in February.   

Status – Not Achieved

Measure of Success 

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

Comments 

WMAS currently engaged with Trusts directly, ICBs through our link director system (which was recently reviewed and ratified by the Board of Directors) and with NHSE and Trusts through their max way triumvirate meetings taking place each week. During March 2026 WMAS also engaged all its external stakeholders, including NHSE and ICBs amongst many others regarding the development of its new organisational strategy 

Status – Achieved

Clinical Practice and Supervision Review 

Clinical supervision review / senior clinical advice 

Measure of Success 

Following signoff of the review of clinical supervision, deliver the action plan for clinical supervision modifications 

Comments on Progress 

Completion status for the Clinical Team Mentor Mandatory Update and Clinical Supervision (CS1) delivery for 2025/2026 has now been presented to the Senior Clinical Leads Group and the Professional Standards and Learning Group during Quarter 4. 

The quality account priority relating to clinical supervision, reflecting its importance for safe care delivery and staff support, will be continued and carried forward into the 2026/2027 quality account. 

Status – Achieved

Measure of Success 

Use clinical audit outcomes as the measure of success when clinical supervision model has been delivered 

Comments on Progress 

A clinical audit dashboard has been developed, and work has begun with Clinical Team Mentors to support the integration of the Trust’s audit programme and the PSIRF priorities into frontline clinical practice. This integration is being achieved through the clinical supervision programme, making full use of the CS1 shift and the involvement of Clinical Team Mentors (CTMs) and the Patient Safety Learning Leads (PSLL).  

CTMs and PSLL will continue to focus on the Trust’s priority audits, ensuring that audit activity remains aligned with organisational safety and learning objectives. As a result, audit outcomes can be used to demonstrate the effectiveness of quality improvement initiatives and measure improvements over time. 

Status: Achieved 

Measure of Success 

Complete a review of what ‘senior clinical advice’ should look like for the Trust as this term is used wider in the sector 

Comments on Progress 

Senior Clinical Advice for cardiac arrest and trauma is currently provided through the Trauma Desk. Senior Clinical Advice is also available via the Clinical Validation Team. This is detailed within the WMAS non‑transport and conveyance policy, and awareness has been promoted through a weekly briefing article issued by IUC in November, informing operational staff of the availability of Clinical Validation Team advice.  

The Call Before You Convey (CBYC) service also provides senior clinical advice to support on‑scene clinical decision making. A weekly briefing article and a clinical notice have been issued to highlight how CBYC supports clinicians in making evidence‑based decisions on scene 

Status: Achieved 

Advancing clinical practice 

Measure of Success 

The clinical opportunities that could be planned and commissioned to support enhanced patient care and support further staff retention 

Comments on Progress 

The Trust continues to support developments in clinical practice within the Clinical Validation Team (CVT) and MERIT by applying for and securing funding for Advanced Clinical Practice MSc programmes. In addition, funding for nonmedical prescribing courses is being provided to CVT clinicians to further enhance clinical capability and strengthen patient care within the urgent care environment.  

The quality account priority relating to advancing clinical practice remains fundamentally linked to the development of future clinical models of care. Reflecting its importance and ongoing relevance, this priority will be maintained and carried forward into the 2026/2027 quality account.  

Status: Achieved 

Measure of Success 

Areas of work to support succession planning (paramedic career structure rather than enhanced care team and doctors) and career opportunity 

Comments on Progress 

Opportunities for clinical development and career progression are now emerging because of the evolving role of the Clinical Validation Team and extensive recruitment in 2025. This specialised area of practice provides a pathway for clinicians to progress into advanced practice roles and nonmedical prescribing, creating meaningful opportunities for career advancement and enhanced clinical capability.   This Quality Account priority remains a focus as it is now absorbed into aspects of the 2026/2027 quality account priority relating to clinical supervision and the development of new clinical models of care. This alignment reflects its importance in supporting safe, effective, and continuously improving care delivery and is helping to shape the development of new paramedic career structures. 

Status: Achieved 

Patient experience to include equality, diversity and inclusivity for communities 

Measure of Success 

Complaints standard – reflecting a proposed new way of progressing concerns quickly, which once resolved may prevent some from becoming formal complaints for full investigation 

Comments on Progress 

We are unable to compare data from previous years to the new complaint standards; we are seeing more complaints being dealt with through Early Resolution the Closer look 

Status: Achieved

Equality Diversity and Inclusivity for community 

Measure of Success 

Are there any services which are not being accessed by certain community groups 

Comments on Progress 

Deep dive into maternity services and accessibility working in Partnership with the Executive Director of Nursing as part of the EDS3 project 2025-26.  Linking in with patient experience team 

Status: Achieved

Measure of Success 

What clinical services should be planned, promoted or monitored with EDI in mind 

Comments on Progress 

Maternity care will be monitored by considering safety incidents and complaints with a specific focus upon ensuring women and families for whom English is a second language understand the care being offered.    In Q4 2026, there will be communications to clinical staff to ensure Language Line is offered

Status: Achieved

Use of alternative pathways for patients 

Clinical Validation Team 

Measure of Success 

Redirecting patients to appropriate service – engagement with system where patients rejected or recontact 

Comments on Progress 

Growing referrals into pathways, with enhanced engagement.  Trials taking place on 24/7 access in black country and additional pathways being trialled – positive feedback received from several areas.  Extensions of operating hours from most single points of access.  New pathways such as direct access to Dudley SDEC.  Audits and feedback being undertaken by WMAS to regional SPoA to identify gaps and learning.  Introduction of new streaming portals for children and mental health in specific areas.  WMAS has also shared a region wide stocktake of the pathways and access available to us to all ICBs, Acute Trust COOs and the NHSE regional team to highlight the variation in offer with the ask that its closed, this has been well received by all.  WMAS has also facilitated external clinical engagement on the interface between crews and alternative pathways, with the Black Country clinical interface lead joining Dudley crews to see first-hand the issues they face.   

Status: Achieved

Measure of Success 

Sharing information with health system partners to improve acceptance rates to appropriately support patients and health systems 

Comments on Progress 

Joint audits undertaken and reports shared with partners evidence our sharing of information to support pathway uptake and reduce rejection rates.  New reports are being shared across the system for uptake of referrals from WMAS.  Weekly operational level meetings with each area.  Head of IUC now sits on most task and finish groups around the region 

Status: Achieved

Call before You Convey 

Measure of Success 

Improve the use of Call Before Convey with see & treat to support patients to receive the appropriate care following ambulance assessment 

Comments on Progress 

Crew engagement has improved over the past year with mandatory notices, good news stories, hub roadshows and a development in the CAD

Status: Achieved

Service-based annual reports 2025-26 

Whilst the above tables represent the overall progress in relation to the quality priorities that were established for 2025/26, the following reports will be published 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   
• Patient experience   
• Safeguarding (including Prevent)   
• Public Health 
• Emergency preparedness   
• Security and safety   
• Health, safety and risk   
• Patient safety   
• Clinical audit 
• Learning from Deaths 
• Freedom to Speak Up 
• Data Security and Prevention Toolkit (to be published after submission on 30 June 2026) 
• Equality, diversity & inclusion (to be published by July 2026) 

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 April 2026 will see the launch of the Trust’s second PSIRF Plan. 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. 

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 the recent staff results saw an improvement to how staff feel they will be treated if they report an incident. The Patient Safety Team also surveys staff who have been involved in a PSIRF Learning Response and the results are positive. 

The Trust’s new PSIRF priorities for 2026-2027 aim to improve care in the following areas: 

• End Of Life Care and Complex Decision Making in End-of-Life Patients 
• Paediatric Pain Management 
• Obstetric emergencies outside of the MNSI framework – with a focus on PPH and breech birth. 

The Trust will review the PSIRF Plan in January 2027 to identify if the priorities need to be extended into 2028. 

The following demonstrate the 43 PSIRF investigations by Type during 2025-26 

There have been: 

• 17 Patient Safety Incident Investigations (PSII) 
• 24 After Action Reviews (AAR) 
• 0 SWARM (Huddle) 
• 2 Multi-Disciplinary Team Reviews (MDT Reviews) 

These investigations were categorised within the following priorities 

• 3 National Priority 
• 36 Trust Priority 
• 0 High Risk (Litigation / Media) 
• 6 Other 

Each of these investigation types are described below.

After Action Review (AAR) 

After Action Review (AAR) is a structured approach for reflecting on the work of a group or an action 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 because 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 because 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 

The introduction of the digital MS Forms process in November 2025 has streamlined the management of NHS concerns. Once a concern form is completed online, it is automatically logged, assigned a reference number, and an acknowledgement is issued to the complainant confirming that the concern is under review and that a member of the Patient Safety Team will provide follow-up with the findings. 

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

This replaces the previous process, where providers submitted Word documents via email requiring manual logging, reference allocation, and acknowledgement. The revised approach reduces administrative burden, limits reliance on email communication, and improves efficiency and timeliness, enabling the Patient Safety Team to focus on review and learning. Engagement with our lead Integrated Care Board (ICB) supported implementation, with early discussions helping to build shared understanding and gather feedback. Dissemination was well received, supporting a smooth transition from the previous system. 

For the financial year 2025-2026 we received 1510 concerns. 

The top 5 themes for year 2025-2026 were: 

• NEOC response delays  
• Inappropriate Emergency Department destination 
• Conduct concerns 
• IUC systems and processes 
• EOC response delays 

Outgoing NHS Concerns 

Our established outgoing NHS concern process continues to work efficiently, with ongoing support from our lead Integrated Care Board (ICB). Developed in 2023, it enables WMAS staff to raise concerns for review by the Patient Safety Team and onward escalation externally.  

We reviewed 2110 concerns in the financial year 2025 – 2026 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 hospital handovers 
• Staff conduct/attitude 
• Clinical care concerns 

When a concern is received, it is triaged to determine whether it identifies organisational learning or represents a serious concern. All concerns are logged and reviewed to support the identification of themes and trends, informing wider organisational learning and improvement, before being shared with the relevant care provider.  

Following triage, concerns are categorised as either information only or requiring investigation. For concerns shared for information only, no formal response is required from the care provider. 

Where an investigation is required, the care provider is expected to provide a formal response within 60 working days. To support timely progression, a follow-up request is issued at 30 days to seek assurance that the investigation remains on track and is progressing as expected. 

For 2025 – 2026, 1321 concerns were shared as information only with the remaining 789 requiring an investigation and a formal response. 

Preventing Future Deaths

Unfortunately, the Trust received a Preventing Future Deaths (PFD) notification pertaining to maternity care for one of our patients. In response, the Trust completed a comprehensive action plan, has reviewed training provision and is providing more clinical updates to increase the exposure of paramedics to obstetric emergencies.   

Safeguarding 

In 2025/2026 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

The table below shows the number of referrals received each year and the percentage change compared with the previous year.

Child Safeguarding Referrals 

The table below shows the annual number of incidents and the percentage change compared with the previous year.

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 Abuse Related Death 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 NHS Safeguarding Integrated Data Dashboard (NHS SIDD) 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, this also includes upskilling PTS, CFR’s 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 Experience relate to Early Resolution concerns:

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. 

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. 

Eligibility for Non-Emergency Patient Transport – patients must 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. 

Closer Look 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 216 closer look complaints. The main reason relates to clinical care raised. 

Upheld complaints  

The table below indicates that of the 216 complaints, 39 were upheld & 73 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. 

The table below shows complaint outcomes by national reason category for the year to date.

Learning from Early Resolution and Closer Look Complaints

You Said 

Concern not eligible for patient transport 

We Did 

Continues to be a theme patients will be assessed at booking stage or face to face or periodic review 

You Said 

Concern that paramedics had a clear understanding of Addison’s disease 

We Did 

An article in the weekly brief for training/CPD in Addison’s disease   

Paramedic Training in Adrenal Crisis Management 

You Said 

Data breach of information available on a patient record (callers contact details when a 3^rd party) 

We Did 

Updated our system to stop 3^rd party information being shared 

You Said 

Patients that use the Non-Emergency Patient Transport who don’t have a timely pick up or require a specific vehicle 

We Did 

Notes added to the computer system and review by management to improve patient experience 

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 2025/26 we have received 15 contacts compared to 16 contacts in 2024/25.   

Patient feedback / surveys 

Friends and Family Test (Patient Transport Service) 

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?’: 

The table below shows patient survey responses received through the Friends and Family Test (FFT) survey and Patient Transport Service (PTS) survey year to date.

Discharge on scene survey: 

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

Emergency patient surveys: 

Emergency patient survey -197 responses received in 2025/26 

0 maternity survey responses. 

27 Mental Health survey  

19 Urgent Care Service (hear & treat) 

Compliments 

The Trust has received 3026 compliments in 2025/26 compared to 2812 compliments in 2024/25. 

Governance 

Since February 2026, Patient Experience reports monthly to the Professional Standards and Learning Group (PSLG) which focuses on ‘trend and theme’ reports.  The PSLG reports to the Quality Governance Committee and reports any issues relating to assurance; any risks identified; and key points for escalation.  The Board of Directors receives monthly data on formal complaints and concerns through the Trust Information Pack and PSLG 

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. 

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 can 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 2025/2026 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: 

• 19 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. 

• 8 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. 

Controlled Drug Licence 

In August 2025, there was an issue with the Trust’s Controlled Drugs (CD) Licence. Despite being applied for in good time, there was a period of around 24 hours where the Trust’s existing CD Licence lapsed. A ‘continuation’ agreement was provided by the Home Office within 24 hours, which allows the Trust to operate under previously granted conditions while a renewal is pending. The Trust continues to operate with the continuation whilst we await further update from the Home Office. This issue was escalated immediately to the CQC, ICB and Home Office once identified. 

At the time of writing (mid-May 2026), we are still working in a continuation agreement. The continuation agreement allows us to keep operating under existing licence conditions whilst the renewal is being processed. It is our understanding that there are delays in processing licencing with the Home Office and it is not unusual for Trusts to work in a continuation for prolonged periods.

Staff experience and engagement 

The National NHS Staff Survey is one of the largest workforce surveys in the world and has been running 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 2025 NHS Staff Survey fieldwork was open for 11 weeks at WMAS, from 15th September to 29th November 2024. It was administered by Picker Europe Ltd and was conducted as a census. For the last nine 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. 

7116 staff were invited to take part in the 2025 staff survey, and 2989 staff returned a completed survey compared to 4697 in 2024. The response rate for WMAS is 42% compared to 68% in the 2024 survey. The median response rate for all Ambulance Trusts (11 organisation in this benchmark group including Isle of Wight) is 55% compared to 49% in 2024. 195 BAME staff returned the questionnaire in 2025, compared to 357 in the 2024 staff survey. 

Several 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. A letter form the CEO was also sent to all staff by email to announce the start of the staff survey and to encourage staff to take part and share their views. 

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. Weekly results from Picker Europe were posted on the information screens at all locations, in the Weekly Briefing, on Engage platform and on the staff survey webpage on Treble 9, to provide clarity and show progress. 

5. Posters and video information about confidentiality were sent to all managers to be shared with staff at all sites. 

6. The People Promise Manager met with staff at various locations to engage with staff. 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. 

7. The Chairman shared some positive thoughts about why staff opinions matter in a video which was publicised in the Weekly Briefing.  

8. Regular communication about actions taken based on previous staff survey feedback were shared with staff through Weekly Briefing and other media platforms.  

9. Weekly emails were sent to managers to remind them to keep encouraging their staff to complete their survey questionnaire.  

10. A banner was featured on the intranet home page as a constant reminder for staff to complete their survey.  

11. All email signatures were assigned a staff survey tag. 

12. Regular promotion and updates on the Engage Platform sent to all staff. A strong communications plan was created to ensure constant and regular engagement with staff during the survey. 

13. Additionally, the 2025 Trust-wide staff survey action plan was closed off with all actions completed. This was shared widely with staff in the Weekly Briefing for staff to provide feedback via a short survey about the impact seen or felt on their experiences.  The purpose of the impact survey was to evaluate the effectiveness of the actions taken in response to the 2024 Staff Survey results, measure progress against key areas of concern, and gather feedback on the overall impact of the Trust action plan. A total of 115 colleagues responded to the survey. The results of the impact survey were shared with the Executive Management Board with recommendations to take forward.  

14. Staff Survey Locality Leads were appointed at each locality to engage with staff and develop Local Action Plans to address concerns at a local level. 

15. A weekly draw was carried out by the survey contractor for the duration of the survey and a randomly picked winner received one extra day of annual leave to be taken before the end of the financial year 2025-26. Eleven days of annual leave were offered in total. 

16. A weekly draw was carried out by the survey contractor for the duration of the survey and a randomly picked winner received a refurbished iPad worth £160. Eleven iPads were offered. 

Local results of the 2025 Staff Survey 

A total of 124 questions were asked in the 2025 survey, of these, 110 can be compared to 2024 and 101 can be positively scored. Responses to 3 questions are better than last year, and responses to 46 questions are worse than 2024. Overall, there is no significant improvement in the positive responses compared to last year’s results. Additionally, when compared to other Ambulance Trusts that used Picker as their survey contractor, WMAS scored significantly worse in 66 questions.

Top 5 Scores 

The table below compares selected staff survey scores for WMAS between 2024 and 2025.

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

Most Improved Scores 

The table below compares the most improved staff survey scores between WMAS 2024 and WMAS 2025.

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 continue to be one of the key priorities to focus on in the 2026 Trust Action Plan. 

Most Declined Scores

The table below compares the staff survey scores that showed the largest decline between WMAS 2024 and WMAS 2025.

Advocacy Results 

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

Experience of sexually inappropriate behaviour in the workplace from patients or the public 

798 (27%) respondents have said they have experienced unwanted behaviour of a sexual nature from patients/service users, their relatives, or members of the public. This may include offensive or inappropriate sexualised conversation (including jokes), touching or assault. There is no significant improvement in the scores compared to 2024. Students appear to be experiencing these behaviours the most. 

228 (8%) respondents have said they have experienced unwanted behaviour of a sexual nature from colleagues/Staff. This may include offensive or inappropriate sexualised conversation (including jokes), touching or assault. There is no significant improvement in the scores compared to 2024. 

The table below compares staff survey responses relating to unwanted behaviour of a sexual nature between WMAS 2024 and WMAS 2025.

Experience of physical violence 

• 1092 respondents (37%) have said that they have experienced physical violence from members of the public compared to 1815(35%) in the 2024 survey.  

• 42 respondents (1%) said that they have experienced physical violence from Managers compared to 66(1%) in the 2024 survey. 88% of the respondents for this question were Paramedics and Technicians.  

• 75 respondents (2%) said that they have experienced physical violence from colleagues compared to 123(2%) in the 2024 survey. 395 of the respondents for this question were Paramedics, 35% were Technicians and 15% were Students. 23% of the respondents in these three groups have said they have experienced physical violence from colleagues between 3 to more than 10 times.  

• 792 respondents (72%) said that themselves or a colleague reported the experiences of physical violence compared to 1302 (71%) in the 2024 survey. However, a noticeable proportion of staff having experienced physical violence at work, have not reported the incidents, indicating under‑reporting and the need for better support. 

Experience of bullying and harassment 

• 1489 respondents (50%) reported that they have experienced harassment, bullying or abuse from patients/service users, their relatives or members of the public compared to 2291(49%) in the 2024 survey.  

• 400 respondents (14%) said that they have experienced harassment, bullying or abuse from managers compared to 567(12%) in the 2024 survey. Of those, 53% are Allied Health Professionals (AHP). 40% of the AHP group have also said that they have experienced bullying and harassment from managers between 3 to more than 10 times.  

• 502 (17%) staff reported that they experienced bullying and harassment from colleagues compared to 795(18%) in the 2024 survey. 42% of the respondents are AHPs, 27% are Technicians and 11% are administrative and Clerical staff. 27% of all respondents said they have experienced bullying and harassment from colleagues between 3 to more than times.  

• 766 respondents (46%) reported their experience of bullying and harassment compared to 1217(47%) in 2024. 

Raising Concerns and Speaking Up 

A noticeable improvement is seen in the results from 2024 to 2025 for staff’s confidence to report errors/near misses/incidents. 88% of respondents said they feel encouraged to report these compared to 86% in 2024. 45% of respondents said that the organisation treats staff fairly when involved in errors/near misses/incidents compared to 43% in 2024. 65% of respondents in 2025 said they would feel secure to raise concerns about unsafe clinical practice. This was the same in 2024. However, there was a decline (51% in 2024 to 48% in 2025) noted in the percentage of staff who would feel confident that the organisation would address concerns about unsafe clinical practice.   

Leadership and Management 

Leadership and Management is one of the areas where we have seen the most decline in the results since 2024. Although, there has been significant improvement in this area since 2021, the results seem to lack consistency year on year. The worse results are from Emergency and Urgent operational 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 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.

The table below compares WMAS People Promise Indicator scores with benchmark group scores for 2023, 2024 and 2025.

Workforce Race Equality Standard (WRES) 

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

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

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

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

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

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

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

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

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

Workforce Disability Equality Standard (WDES) 

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

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

A significantly higher proportion of staff with a Long-Term Condition (LTC) or illness than staff without 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 slight increase is noted in the response rate for both categories when compared to 2024. The same is noted across all ambulance Trusts in the benchmark group. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Staff Engagement Score 

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

Future priorities and targets: 

Statement of key priority areas 

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

• PRIORITY 1 – Civility, Compassion, Communication 
• PRIORITY 2- Managers and Teams 
• PRIORITY 3- Staff Morale and Safety

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

Promoting a culture of compassion and inclusivity

Actions to be taken

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

Key Deliverables

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

Aligned to Trust Value

Compassion, Inclusivity

Actions to be taken

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

Key Deliverables

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

Aligned to Trust Value

Compassion, Inclusivity

Increasing Staff Involvement & Communication

Actions to be taken

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

Key Deliverables

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

Aligned to Trust Value

Accountability, Integrity

Actions to be taken

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

Key Deliverables

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

Aligned to Trust Value

Accountability, Integrity

Actions to be taken

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

Key Deliverables

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

Aligned to Trust Value

Excellence, Accountability

Civility and Respect

Actions to be taken

Continue promoting Civility and Respect at HWB roadshows and within the Weekly Briefing. Run civility sessions throughout the year both online and in person.

Key Deliverables

Improved working relationships with more respectful day to day interactions. Reduced conflict and increased team morale.

Aligned to Trust Value

Compassion, Inclusivity

Actions to be taken

Civility and respect module in development for April 2026 Mandatory Workbook.

Key Deliverables

Reaffirmed messaging on behavioural expectations in line with Trust values. Increased confidence in staff addressing incivility when it’s witnessed in the workplace.

Aligned to Trust Value

Compassion, Inclusivity

Meaningful Recognition

Actions to be taken

Continue promoting the Say Thank You App, sharing regular updates on number of Thank Yous sent and received, breakdowns by locality, value trends.

Key Deliverables

Staff feel more valued and appreciated for their contributions.

Aligned to Trust Value

Excellence, Compassion

Inclusion and social interactions

Actions to be taken

Encourage positive and social interactions, team building, attending local/Trust events, peer support.

Key Deliverables

Promotes a culture of kindness, compassion and inclusion so staff feel a sense of belonging. Engaged and empowered staff who learn from each other to be the best they can be.

Aligned to Trust Value
Excellence, Inclusivity, Accountability

Improve communication between staff and management

Actions to be taken

Hold ‘all staff briefings’ at directorate level (EOC, PTS, Ops) to increase communication, engagement and senior leadership visibility.

Key Deliverables
Increased communication from senior leaders where staff feel better connected to organisational realities and see their concerns acknowledged and acted upon. Topics will be specific to each directorate making staff feel more valued. Staff will have the opportunity to share feedback, ideas and hear updates from their own Director.

Aligned to Trust Value
Excellence, Integrity, Accountability

Actions to be taken

Ensure Local Action Plans are a standing agenda item on any local meetings and actions are communicated with staff.

Key Deliverables

Locality Managers to work with Staff Survey Leads to ensure Local Action Plans remain a priority and staff feel more confident that actions are being acted upon. Stronger engagement in local improvements and positive changes.

Aligned to Trust Value

Integrity, Accountability

Promoting a culture of compassionate leadership

Actions to be taken

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

Key Deliverables

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

Aligned to Trust Value

Integrity, Compassion, Accountability

Management and Leadership Development

Actions to be taken

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

Key Deliverables

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

Aligned to Trust Value

Excellence, Integrity, Compassion, Inclusivity, Accountability

Development Opportunities

Actions to be taken

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

Key Deliverables

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

Aligned to Trust Value

Excellence, Accountability

Worklife Balance

Actions to be taken

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

Key Deliverables

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

Aligned to Trust Value

Excellence, Integrity, Compassion, Inclusivity, Accountability

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. 

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. 

The EDS report will be included in the 2025-26 Public Sector Equality Duty Annual Report. 

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; 

1. Value Based Recruitment 
2. Equality & Diversity 
3. Equality Act 2010 and the law 
4. Unconscious Bias 
5. 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 was established in 2025 (2025-2029) and is available to access and download from our website.  

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 2025/26.  

Equality Objectives 2025-2029 

We have a legal obligation to publish our equality objectives under the Public Sector Equality Duty. These must be reviewed every four years and should be based on our consultation and involvement with stakeholders. 

The following high level Equality Objectives are based on findings from workforce data that has been collated from but not limited to Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) data.   

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  
• Workforce Disability Equality Standard 
• Gender Pay Gap Reporting 
• Ethnicity Pay Gap Reporting  
• Commitment to Disability Pay Gap reporting when the national reporting tool is available through ESR 
• Equality Delivery System 3  

We will do this by: 

Implementing and strengthening our approach to the NHS Equality Delivery System 2 (EDS3) (are you ok with how we will demonstrate this strengthening and improvement?) 

Continue to develop our response to the Workforce Race and Disability Equality Standards (WRES) (WDES) 

Collating Gender and Ethnicity Pay Gap data and identifying actions to address the gap. 

Keep invigorating and supporting the staff equality networks to ensure they are aligned with our strategic equality objectives. 

Working collaboratively with the local Integrated Care System/Board (subject to the new reconfiguration) 

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 
• Through the utilisation of the Workforce Race Equality Standard action plan which will detail specific actions that will be monitored at DISAG and People Committee 
• 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: 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 Governors 
• Ensuring all our leaders have specific diversity & inclusion objectives in their annual objectives with performance discussed during their appraisals 
• Board and Committee reports include due consideration to Diversity and Equality and have an equality impact analysis where appropriate or required. 

Objective 4: A healthy, fair and more resilient workforce   

To create a healthy, fair and more resilient workforce by systematically tackling the root causes of health inequalities within the Trust – ensuring all staff, regardless of role, background, or personal circumstances, have equal opportunities to thrive in work and wellbeing.  

We will do this by:  

• Prioritizing preventative approaches, including health screening, lifestyle support, and early intervention services 
• Equipping leaders and managers with knowledge and tools to identify and reduce health inequalities within their teams 
• Promoting an organizational culture that champions reducing health inequalities 
• Ensuring all patients receive accessible and culturally sensitive care – patient experience will need capture relevant data to achieve this outcome. 

These Equality Objectives will sit with the equality action plans and be monitored at the Diversity, and Inclusion Steering Action Group (DISAG) and People Committee. 

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 few 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 few events which are highlighted in the PSED annual report 2025-26 – when it will be published.  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.  We now have in place 3 Co-Chairs and 2 Vice-Chairs to help move the network forward. 

• 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.    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 was accomplished. 

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 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 our 67 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 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 11 roadshows and 13 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 run a further 2 online events, one in June 2025 and a further in January 2026. 

As well as the roadshows the Trust have produced a Cultural and HWB calendar, promoting events such as, Brew Monday, 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. 

• Promoting musculoskeletal health, with hints and tips provided by our Occupational Health provider and videos   
• “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. It’s 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 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 4 trained MHFA instructors. 8 courses were delivered across the Trust during 2025/26; 679 members of staff have completed the training up to 31^st  March 2026 

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 2 active instructors currently. 11 courses were delivered across the Trust during 2025/26; 1124 members of staff have completed the training up to 31st March 2026.  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 a 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 TASC Charity 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. 
• TASC – Provide financial support and wellbeing services to our staff. 
• 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.   
• The Physiotherapy service is currently being provided by our Occupational Health Provider “Optima Health” which is working well. They can 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 64.1 % 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 (FTSU) 

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

Governance 

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

• Quarterly returns to National FTSU Guardian’s Office 
• Regular discussions with the Chief Executive Officer, Chairman and the Executive and Non-Executive Leads for FTSU 
• Quarterly reports to Quality Governance Committee, and bi-annual reports to the Executive Management Board and Board of Directors 
• NHS England’s Reflection and Planning Tool was refreshed and approved by Board of Directors in November 2025. 
• National Guardian’s Office training modules are in place as follows: 
• All staff completed Speak Up as part of Mandatory Training during 2023/24 and is part of the Onboarding package for new starters   
• Staff on Bands 7 – 8B are required to complete Listen Up Module  
• Staff in Bands 8C and above, and Board of Directors have completed Listen Up and Follow Up modules 
• Ambassadors are required to complete Speak Up and Listen Up training modules, in addition to their induction training 
• FTSU has its own module in the Mandatory Workbook and has been updated for 2026/27.  

Concerns Raised 2025/26 

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

The number of cases increased year on year over the three reporting periods. In 2023/24, there were a total of 82 cases, with 14 recorded in Quarter 1, 19 in Quarter 2, 29 in Quarter 3, and 20 in Quarter 4. This rose to 131 cases in 2024/25, with quarterly figures of 39 in Quarter 1, 36 in Quarter 2, 27 in Quarter 3, and 29 in Quarter 4. In 2025/26, the total increased further to 159 cases. Quarter 1 and Quarter 2 each recorded 39 and 36 cases respectively, while activity rose in the second half of the year, with 42 cases recorded in both Quarter 3 and Quarter 4.

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

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

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

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

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

To raise awareness of FTSU and make speaking up business as usual, a Quarterly FTSU Newsletter is produced and shared with staff via the Weekly Briefing. Regular articles in the Weekly Briefing on anonymised cases and outcomes help demonstrate that staff are listened to, and that follow up action is taken. FTSU Guardians attend various Trust events during the year, including Health and Wellbeing Roadshows and Staff Network events to promote FTSU and increase visibility. 

NHS England Segmentation Score 

During 2025/26 NHS England replaced the Single Oversight Framework with a new process, which placed Trusts into one of four segments. Segment one representing the highest levels of performance, 4 the lowest and below 4 a process of special measures and intensive support.  The approach is rules and numbers based, no national or regional local discretion or moderation is used, this is to ensure the framework is consistently applied.    The process is very different, with one key override being financial performance, variation from a plan (even if in breakeven), being in deficit and or requiring deficit support limits a Trust’s rating to no better than 3.  The segmentation score is reviewed quarterly, with the final month’s financial performance used to assess the quarter in question.   

WMAS was initially rated segment 3, due to an in year reported deficit from not having a settlement in place linked to the cost of hospital handover delays.  Once resolved, the subsequent segmentation score moved back to 1.    However, this has since moved back to 3 for quarter 3, linked to a 0.1% variation to our financial plan for month 9.  We fully expect quarter 4 will return WMAS back to segment 1, having delivered on the full year plan to break even.   

Linked to segmentation scoring, is another new regulatory process from NHS England, which is the Provider Capability Assessment.   The NHS Provider Capability Assessment is an annual, mandatory process within the 2025/26 Oversight Framework that evaluates Trust leadership across six key domains, including strategy, quality of care, and financial management. By rating themselves as Confirmed, Partially Confirmed, or Not Met, Trusts determine their level of operational freedom, with lower capabilities potentially triggering intensive intervention under the Provider Improvement Programme. 

The scoring matrix is green, green-amber, amber-red and red, WMAS in the first such assessment was rated green-amber. 

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 2024/25 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 2025.

Comments Received Relating to 2025/26 Quality Account 

Comments from our Lead Commissioner, on behalf of all Associate Commissioners, received 07/05/2026 

Statement of Assurance from NHS Birmingham, Black Country and Solihull Integrated Care Board May 2026

1.1 Birmingham, Black Country and Solihull Integrated Care Board (ICB) as coordinating commissioner for West Midlands Ambulance NHS Foundation Trust, welcomes the opportunity to provide this statement for inclusion in the Trusts 2025/26 Quality Account.  

1.2 A draft copy of the Quality Account was received by the ICB on the 15th of April 2026, and the review has been undertaken in accordance with the Department of Health and Social Care Guidance. This statement of assurance has been developed from the information provided to date.  

1.3 The information provided within this account presents a balanced report of the healthcare services that the West Midlands Ambulance Service NHS Foundation Trust provides. The report demonstrates the progress made by the Trust against the 2025/26 priorities. It identifies what the organisation has done well, where further improvement is required and what actions are needed to achieve these goals and priorities set for 2026/27. It is a comprehensive, transparent and detailed Quality Account which demonstrates a strong commitment to quality, learning, and openness. and provides a detailed picture of performance, pressures, and improvement activity across the Trust.  

1.4 Throughout 2025/26, we have engaged in close collaboration with the Trust and Associate Commissioners across the West Midlands region to evaluate the organisations’ progress in implementing quality improvement initiatives. The contract with the MERIT Team has been renewed in recognition of their continued delivery of exceptional care for major trauma patients. Furthermore, we have worked jointly to address the considerable challenges associated with ambulance handover delays. The ICB commends the Trust’s performance in responding to Category 1 and 2 calls, noting its impressive response times despite substantial capacity and demand pressures during the year.  

1.5 Significant collaborative efforts have been made to enhance the relationship between the Trust and the region’s Urgent Community Response Teams, resulting in hospital avoidance and improved care pathways for patients. Additionally, the Trust has reinforced the “Call Before You Convey” process, enabling crews to promptly access expert guidance on alternative care options, thereby reducing unnecessary hospital admissions.  

1.6 The ICB is assured that the Trust is compliant with the Patient Safety Incident Review Framework (PSIRF) requirements and acknowledges the progress made throughout the 2025/26 year regarding the priorities outlined in the Patient Safety Incident Response Plan (PSIRP). We remain committed to supporting the Trust as it pursues measurable improvements aligned with its revised PSIRP priorities for the upcoming 2026/27 year.  

1.7 We will maintain ongoing engagement with the Trust in an inclusive and innovative manner through the Clinical Quality Review Group and additional forums and aim to further strengthen these relationships as we progress into 2026/27.  

Yours Sincerely,  

Sally Roberts

Birmingham, Black Country and Solihull (Cluster) Integrated Care Board Chief Nurse / Clinical & Quality Officer 

Comments from Health, Overview and Scrutiny Committees received April to May 2026

Received from Wolverhampton Council 22^nd April 2026

I recognise and appreciate the continued efforts WMAS is making to address hospital handover delays, which remain one of the most significant pressures on the wider urgent and emergency care system. I fully support ongoing initiatives and strengthened partnership working across the region to reduce delays and improve patient flow. I am encouraged by the improvements seen towards the end of the reporting year and hope that this positive trajectory can be sustained through continued system‑wide focus. 

I would also like to acknowledge the areas where WMAS continues to perform strongly. The Trust’s clinical outcomes – particularly in STEMI care, older adult falls, and call answering performance – are notable achievements and exceed national averages in several key indicators. The high level of research activity and the Trust’s leadership in sustainability are further strengths that deserve recognition. 

However, I am concerned by the decline in staff satisfaction results highlighted in the report. The feedback relating to morale, leadership, and experiences of bullying or harassment is worrying, and we hope that the actions outlined by the Trust will lead to meaningful improvements for staff at all levels. A supported, valued workforce is essential to delivering high‑quality patient care, and we would welcome continued updates on progress in this area. 

Overall, I appreciate the transparency and detail provided in the Quality Account and remains committed to working closely with WMAS and system partners to support the delivery of the priorities set out for 2026/27.

Comments from Dudley Council, 7^th May 2026

The Social Care and Wellbeing Scrutiny Committee welcomes the opportunity to review and comment on the West Midlands Ambulance Service (WMAS) Quality Accounts for 2025/26. We would like to thank the Service for the work involved in providing the Committee with draft Quality Accounts and presenting Committee with a detailed overview in April 2026. The Committee welcomes the organisation’s priorities as set out in the Quality Accounts and commends the progress made on last year’s priorities and the excellent service provided to the public. 

The Committee congratulates the Service for ambulance wait times across the Black Country, which are the best performing of all localities serviced by WMAS, especially considering heavy traffic and congestion in the area. The Committee recognises the ambulance wait times still fall below national targets but commends the significant reductions in wait times that have been achieved recently.  

The Committee recognises that the Service’s hospital handover delays are amongst the highest in the country and supports the organisation’s commitment to addressing this. The Committee congratulates the Service for the steep reduction in hospital handover delays achieved within the last four months at Russell’s Hall Hospital, which previously was both a national and local outlier in terms of length of delay. The Committee would welcome a further update on how these improvements are being sustained later in the year. 

The Committee asked about the Service’s approach to conveying Dudley residents to hospitals outside the borough. In response, the Service explained the closest available ambulance would normally convey a patient to their local hospital, as this supports discharge planning and social care coordination, unless another hospital has more appropriate specialist facilities for the patient’s immediate needs. They explained that due to the nature of emergency patient transport it is impractical to convey to a patient’s preferred hospital if different. Ambulance crews do have discretion to redirect to other hospitals where there is sound clinical reasoning.

Comments from Stoke City Council, 7^th May 2026

It would be helpful for data for 2025/26 to be included, as reliance on older data limits the ability to assess current performance effectively. More recent data appears to be available, given that seven deaths were reported in Quarter 1 of 2025/26. Further detail on the issues contributing to these deaths, associated factors and lessons learned would strengthen transparency.   

On page 21, it is noted that the national average would be provided at the end of April; clarification is requested as to whether this is now available.

On page 26, the wording around delays is unclear and would benefit from clarification, particularly regarding the scope of comparison. The feasibility of a 45-minute handover target could also be contextualised, given reports of significantly longer waiting times. 

The section on the Controlled Drugs Licence (page 46) would benefit from clearer explanation as to whether the issue was limited to a 24-hour lapse or whether the Trust continues to operate under a continuation arrangement. 

The commentary on the National NHS Staff Survey (page 49) could be more balanced, ensuring that staff feedback is clearly acknowledged. The decline in scores, alongside a reduced response rate, suggests that further consideration of staff engagement and leadership approaches may be required.

Similarly, the People Promise indicators (page 52) show a consistent decline and may warrant further analysis in relation to staff experience and organisational culture. 

On page 53, an increase in reported discrimination among BAME staff is noted; further detail on actions being taken to address this would be helpful. 

Comments from Staffordshire County Council, 23 June 2026

The Health and Care Overview and Scrutiny Committee were grateful to receive the WMAS quality account for 2025/26 alongside a briefing presentation.

This is a comprehensive and well-structured report that demonstrates a strong commitment to quality improvement, transparency, and patient safety across the Trust.

Comments from HealthWatch Organisations received April to May 2026 

Received from HealthWatch Shropshire, 28^th April 2026 

Healthwatch Shropshire welcomes the opportunity to comment on the draft Quality Account 2025/26 for West Midlands Ambulance Service (WMAS). Our role is to provide an independent, evidence‑based view on whether the account reflects patient experience, demonstrates learning, and sets out meaningful priorities that lead to real improvements in care. 

Overall, this is a detailed and transparent document that demonstrates strong organisational commitment to quality improvement. We recognise the scale and complexity of pressures facing ambulance services and welcome the Trust’s openness about ongoing challenges. 

Patient Experience and Engagement 

(Part 3: Patient Experience, pages 42–44; Listening to Feedback, page 74) 

The Quality Account draws on a wide range of patient experience data, including complaints, concerns, surveys and compliments. Healthwatch Shropshire particularly welcomes the use of early resolution approaches and “You Said, We Did” examples, which demonstrate responsiveness to feedback. 

To strengthen future accounts, we encourage WMAS to continue developing clearer narrative links between patient feedback themes and specific service changes, particularly where concerns relate to response times and handover delays. This would further reassure the public that lived experience actively informs improvement. 

Learning Culture and Patient Safety 

(Patient Safety and PSIRF, pages 35–38; Learning from Deaths, pages 19–21) 

Healthwatch Shropshire recognises strong evidence of an evolving learning culture, particularly through the implementation of the Patient Safety Incident Response Framework (PSIRF). The move towards proportionate learning responses, After Action Reviews and greater engagement with staff and families is welcome. 

The transparency shown in reporting deaths reviewed and learning identified is positive. We would encourage continued focus on demonstrating how learning from incidents translates into visible changes in frontline practice, especially in high‑risk and complex care situations. 

Priorities for Improvement 

(Part 2: Priorities for Improvement 2026/27, pages 26–28) 

The four priorities identified for 2026/27 are appropriate and well aligned with patient safety, staff wellbeing and system pressures. Healthwatch Shropshire particularly supports the continued focus on reducing hospital handover delays, given the impact on patient experience and ambulance availability across Shropshire. 

We welcome the inclusion of measures of success and encourage WMAS to ensure these remain clear, measurable and easily understood by the public. Where progress depends on wider system partners, clarity around shared accountability and escalation would strengthen confidence in delivery. 

Safe, Effective and Experience‑Based Care 

Across the three pillars of quality, the Quality Account presents a balanced and honest picture: 

• Safe care is supported by strong governance and safety frameworks. 
• Effective care is evidenced through audit activity, research participation and workforce development. 
• Experience‑based care is clearly valued, with continued efforts to improve how feedback is captured and acted upon. 

Healthwatch Shropshire also welcomes the Trust’s acknowledgement of inequality and variation in both patient and staff experience, and the continued emphasis on equality, diversity and inclusion.

Conclusion 

Healthwatch Shropshire considers this Quality Account to be a robust and constructive document that goes beyond regulatory reporting requirements. We welcome the Trust’s openness, learning culture and commitment to improvement. 

Continued focus on clearly demonstrating how patient feedback leads to tangible change will further strengthen future accounts. We look forward to ongoing collaborative engagement with WMAS to support improvements that reflect the real experiences of patients and communities across Shropshire. 

Received from HealthWatch Staffordshire, 20^th April 2026 

From a Staffordshire perspective ambulance drop offs and response times particularly at Royal Stoke Hospital are of concern, although some reduction towards the end of the financial year is encouraging. Feedback from patients and staff we received through recent visits we have done to Stafford and Burton Emergency Departments was positive and there was clear commitment to releasing ambulances as quickly as possible. 

It is noted that WMAS maintains the standard of having a fully trained paramedic on nearly all its ambulances, backed up by the Trust’s review and updating of clinical supervision along with research that advances clinical practice. 

It is good to see the consolidation of “Call Before You Convey”, “Hear and Treat” and the Clinical Validation Team. This highlights the increasing need for further development of reliable and responsive community services in line with the NHS 10-year plan. The significant increase in the discharge at scene of older adults falling is noted.  Patients tell us that this is better than a precautionary attendance at crowded Emergency Departments with inevitable long waits. 

It is noted where deaths have occurred while in WMAS care, a case record review is conducted with only 0.8% considered more likely than not to have been due to problems in the care provided to the patient. 

It is encouraging to see more patient complaints being successfully dealt with through early resolution. 

Thank you for all the work you do for our communities.

Received from Healthwatch Worcestershire, Healthwatch Herefordshire, Healthwatch Warwickshire, Healthwatch Coventry received 28/05/2026 

 Joint Healthwatch Response  

This is a joint response from Healthwatch Worcestershire, Healthwatch Herefordshire, Healthwatch Warwickshire and Healthwatch Coventry to the Quality Account of the West Midlands Ambulance University NHS Foundation Trust (WMAS) for the year 2025/26.  

This collaborative response reflects the evolving commissioning landscape, with these Healthwatch organisations covering the geographic footprint of both the Herefordshire and Worcestershire Integrated Care Board (ICB) and the Coventry and Warwickshire ICB.  

Healthwatch Worcestershire (HWW), alongside our partner Healthwatch organisations, has a statutory role as the champion for people who use publicly funded health and care services. We welcome the opportunity to comment on the WMAS Quality Account for 2025/26.  

We recognise that this has been another challenging year for NHS providers and acknowledge the continued effort and commitment of staff across the Trust. We note that WMAS is not commissioned to deliver Non-Emergency Patient Transport in Worcestershire.  

Our response has been informed by Healthwatch England’s national guidance.  

We would make the following comments:  

Section 1: Feedback from Healthwatch Worcestershire on progress against 2024/25 improvement priorities  

Focus: Do the priorities of WMAS reflect the priorities of the local population?  

• Hospital Handover Delays Reduction  

Hospital handover delays remain one of the most significant issues affecting patient care and operational performance. We agree that this should continue to be a priority and note the stated ambition to achieve average handovers of 15 minutes or less, with no handover exceeding 45 minutes. 

Although this metric has not been achieved the Quality Account would be strengthened by setting out more clearly what practical steps will be taken to achieve this improvement. It would also be helpful to explain what additional changes are required across the system for WMAS to remain on the right trajectory to meet national performance targets. We can see a mid-table performance for H&W ICB, we are unable to see the performance by hospital. In particular, we would welcome more localised reporting, including breakdowns by hospital and Integrated Care Board area, so that people in Worcestershire can better understand performance in their area. 

(b) Clinical Practice and Supervision Review  

We support the proposed review of clinical supervision. This is an important area, with the potential to improve both staff support and the quality of patient care.  

Our main concern is that the measures currently described appear to focus more on actions being taken than on how success will be judged. A review and a dashboard is not a patient outcome. We would therefore encourage WMAS to set out more clearly how the impact of this priority will be measured, including how improvements in supervision will translate into better patient outcomes, safer care, and stronger clinical practice.  

(c) Patient Experience to include Equality, Diversity and Inclusivity for communities  

With regard to patient experience, equality, diversity, and inclusion, we welcome the intention to improve how people experience WMAS services.  

We have looked back at WMAS QA for last year’s EDI objectives: 

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  

In this year’s QA WMAS have been unable to compare data from previous years to the new complaint standards and have scored this metric as green: ‘actions on schedule and expected outcomes being achieved’. This report does not indicate whether on reviewing EDI access to services any gaps have been identified or not. HWW would welcome some commentary on progress on EDI since last year as this was a priority for WMAS last year. 

• (d) Use of Alternative Pathways for Patients  

There are many examples of a range of referral pathways, call before you convey with associated use of single points access which together redirect patients to more appropriate services, with better outcomes for patients. These approaches can help ensure that patients receive the right care in the right place. Scored green, achieved. 

Section 2: Feedback from Healthwatch Herefordshire  

Healthwatch Herefordshire continues to hear generally positive feedback from patients and families regarding the professionalism, compassion and responsiveness of West Midlands Ambulance Service staff.  

However, feedback also suggests there are opportunities to strengthen how WMAS works as a wider system partner, particularly in supporting older frail people and those at end of life to avoid unnecessary conveyance and admission where this is not aligned with advanced wishes or best outcomes. We hear concerns that out of hours decision-making can at times become overly risk averse, resulting in avoidable tests, urgent care attendances and hospital stays.  

There is also an opportunity to improve local urgent care NHS111 decision-making pathways and confidence in alternatives to A&E where clinically appropriate. Findings within Healthwatch 

Herefordshire’s 2026 Urgent Care Report highlighted that current approaches can feel overly risk focused, with limited utilisation of community alternatives (community pharmacy and primary care enhanced access) and personalised care planning.  

We would welcome continued partnership working across the system to strengthen person-centred, proportionate responses that better balance safety, patient wishes and avoidance of unnecessary hospital attendance. 

Section 3: Feedback from Healthwatch Coventry  

Performance against indicators: Healthwatch recognises the significant pressure facing West Midlands Ambulance Service during 2025/26 and acknowledges the hard work of staff responding to very high demand. We welcome the continued focus on the most seriously ill patients and note that response times for life-threatening emergencies remain better than the national average.  

We are encouraged to see recent improvements in response times, particularly for Category 2 calls, and welcome the positive impact of the Call Before You Convey approach at some hospitals. This shows that joint working across the system can make a difference.  

However, we remain concerned about long waits for other patients, especially those classed as Category 3 and 4. These delays can last several hours and may cause distress, discomfort, and worsening health for people waiting for help.  

While we understand that hospital pressures are a major cause, the impact on patients and families is significant. Healthwatch believes continued system-wide action is needed to reduce delays, improve patient flow, and ensure clear communication with the public.  

We will continue to listen to people’s experiences and work with services to help improve ambulance response and patient care across the region.  

Learning from deaths: Although the figure of 0.8% may appear small, from a patient, family and Healthwatch perspective any death linked to problems in care is one too many. Behind every percentage is a real person and a family who may be experiencing loss, grief and unanswered questions. People consistently tell Healthwatch that they want services to be open, honest, and willing to learn when things go wrong. It is therefore essential that every death linked to care concerns is carefully reviewed, that learning is shared transparently, and that clear actions are taken to prevent similar harm from happening again. The aim must always be to reduce the risk of avoidable harm to zero wherever possible, by listening to patients and families and ensuring that learning leads to meaningful and lasting improvements in care.  

Section 4: Feedback from Healthwatch Warwickshire  

Looking back over our records we have not received a large amount of feedback on WMAS. This is probably not surprising, and within that the feedback was evenly spread between positive and negative feedback.  

Almost all of the feedback relates to patient experience, – mostly relating to waiting and response times. This particularly applied in rural areas such as in outlying areas of Rugby, in the south of the County and in rural North Warwickshire. What I think is needed is a greater acknowledgement and understanding of the effect that those delays have on the anxiety levels experienced by patients and on their feelings of reduced psychological safety. This increased understanding could perhaps be reflected in the protocols and communications that are in use.  

This also has an impact on the family and friends of the patient awaiting the ambulance – perhaps to an even greater extent  

We have also heard concerns about eligibility for, and availability of NEPT, but that has already been reflected in the QA.  

Section 5: Are there any important issues missed?  

Overall because the way WMAS QA is written as an amalgamation of all the West Midlands ICB performances it is not possible to see the WMAS performance for our local area. At best we see ICB performances as a number however commentary on underlying reasons and plans for improvements are not given.  

Healthwatch Worcestershire would like to see not only overall scoring but evidence of the spread of performance with outliers being identified with appropriate commentary.  

Section 6: Has the provider demonstrated that they have involved patients and the public in the production of the Quality Account?  

There should be clearer evidence of how patients and the public have been involved in producing this Quality Account, beyond routine feedback such as complaints and compliments. A dedicated contribution from the patient experience team would strengthen this considerably. 

Section 7: Is the Quality Account clearly presented for patients and the public?  

We would also encourage WMAS to make the document more accessible for patients and the public by reducing the use of acronyms or by explaining their meaning. A summary version of these quality accounts would benefit patients and the public by providing an overview of delivery and performance over last year. 

Overall, Healthwatch Worcestershire supports the direction of travel set out in these priorities. We hope these comments are helpful and we look forward to continued engagement with WMAS as this work develops. 

Statement from the Council of Governors received 06/05/2026

Acting on behalf of the Council of Governors, I would like to applaud all the staff members and volunteers of our Service, for their hard work and dedication over the past year.   It is a fact that each and every member of staff, and the many volunteers, all work with the ultimate goal of helping our patients in their hour of need. 

Of course, the public are well aware of front-line ambulance crews, also control room staff taking calls and despatching ambulances to where they are needed, but there are many members of staff who work unseen, and mostly unknown to the public.  They include various departments and teams, such as mechanics, stores, facilities, training school, emergency planning, research and the many teams within corporate services, to name but a few.    All doing an amazing job, working together to enable the smooth running of the Trust.   

It is unfortunate that hospital handover delays around the region continue to present a serious problem for the Service. The delays are not only incredibly difficult for patients and ambulance crews, but they also put pressure on those working within the Control Rooms answering calls from patients, and relatives of those who are unwell, knowing they may be waiting longer for a crew to become available to despatch to them. 

The Council of Governors being regularly kept up to date by the Trust Leadership team on such issues, is aware of how important this topic is, and the impact on the Service, its staff and its users, and we welcome that it has formed part of the Trust priorities again this year. Also, that the Trust continues to work closely with colleagues and other healthcare organisations to implement initiatives with the aim being to reduce and resolve these issues. 

As part of our Governor role, we are encouraged to undertake observational shifts and to meet with staff at the Trust, as are the Directors of the Trust.   This provides us all with the opportunity to listen to staff and to provide feedback to management teams.  This listening has led to many positive initiatives being implemented by the Trust to help improve working life.  There is always one thing that stands out when being on such shifts, which is that without doubt everyone at the Service is proud of the work they do at the Trust, and that patient care is central to all. 

Eileen Cox 

Lead Governor/Public Governor for Staffordshire.

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 2025/26 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 2025 to March 2026 
• papers relating to quality reported to the Board over the period April 2025 to March 2026 
• feedback from commissioners dated 7 May 2026 
• feedback from governors dated 06 May 2026 
• feedback from local Healthwatch organisations dated April and May 2026 
• feedback from Overview and Scrutiny Committee dated April and May 2026 
• the Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated 27 May 2026.
• the [latest] national staff survey published March 2026 
• 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 9 June 2026, 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 09 June 2026.  This meets the requirements of the Quality Account and is referenced in the Statement of Directors Responsibilities. 

Glossary

A

• AACE: Association of Ambulance Chief Executives 
• AAR: After Action Reviews 
• AHP: Allied Healthcare Professionals 
• AQI: Ambulance Quality Indicators 
• AQIs: Ambulance Quality Indicators

B 

• BAF: Board Assurance Framework 2 
• BAME: Black and Asian Minority Ethnicities
• BASICS: British Association for Intermediate Care
• BME: Black and Minority Ethnicity
• BREEAM: Building Research Establishment Environmental Assessment Method

C 

Cat 1: Category 1 Emergency Incident

Cat 2: Category 2 Emergency Incident

Cat 3: Category 3 Emergency Incident

Cat 4: Category 4 Emergency Incident

CBYC: Call Before You Convey

CD: Controlled Drugs

CO2: Carbon Dioxide

COOs: Chief Operating Officers

CPR: CardioPulmonary Resuscitation

CQC: Care Quality Commission

CS1: Clinical Supervision 1

CTMs: Clinical Team Mentors

CVT: Clinical Validation Team

D

DGH: Dudley Group of Hospitals 

DISAG: Diversity and Inclusion Steering Advisory Group

DSPT: Data Security and Protection Toolkit

E

E&U: Emergency and Urgent

ECG: Electrocardiogram

EDC: Equality Delivery Council

EDI: Equality Diversity and Inclusion

EDS: Equality Delivery System

EDS3: Equality Delivery System

EOCs: Emergency Operations Centres

ESR: Electronic Staff Record

F

FFT: Family and Friends Test

FTSU: Freedom To Speak Up

G

GTN: Glyceryl Trinitrate

H

HART: Hazardous Areas Response Team

HWB: Health and Wellbeing

I

ICBs: Integrated Care Boards 

ICS: Integrated Care System

IUC: Integrated Urgent Care

L

LED: Light Emitting Diode

LGBT: Lesbian, Gay, Bisexual, Transgender

LTC: Long Term Condition

M

MDT: Multi Disciplinary Team

MERIT: Medical Emergency Response Incident Team

MHFA: Mental Health First Aid

MNSI: Maternity and Newborn Safety Investigations

N 

NADG: National Ambulance Diversity Group

NCSPET: National Centre for Suicide Prevention, Education and Training

NEOC: Non Emergency Operations Centre

NICE: National Institute for Clinical Excellence

NIHR: National Institute of Health and Care Research

NQB: National Quality Board 

P 

PALS: Patient Advice and Liaison Service

PFD: Preventing Future Deaths

PGD: Patient Group Direction

PHEA: Pre Hospital Emergency Anaesthesia

PHSO: Parliamentary and Health Service Ombudsman

PPCI: Primary Percutaneous Coronary Intervention

PPH: Post Partum Haemorrhage

PSII: Patient Safety Incident Investigations

PSIRF: Patient Safety Incident Response Framework

PSLG: Professional Standards and Learning Group

PSLL: Patient Safety Learning Leads

PTS: Patient Transport Services

PV: Photovoltaic 

PVA: Polyvinyl Alcohol

PVAG: Peoples Voice Action Group 

R

ROSC: Return of Spontaneous Circulation

S

SATH: Shrewsbury and Telford Hospitals 

SDEC: Same Day Emergency Care

SEIPS: System Engineering Initiative for Patient Safety 

SIDD: NHS Safeguarding Integrated Data Dashboard 

SJR: Structured Judgement Review

SPoA: Single Point of Access

Stemi: ST Elevation Myocardial Infarction

STEMI: ST Elevation Myorcardial Infarction

T 

Treble 9: Staff Intranet Site

U 

UEC: Urgent and Emergency Care

UHB: University Hospitals Birmingham

UHNM: University Hospitals North Midlands 

W

WAHT: Worcestershire Acute Hospitals Trust

WDES: Workforce Disability Equality Standard

WRES: Workforce Race Equality Standard

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.