NHS England: Culture review of ambulance trusts

Summary

This is an independent review commissioned by NHS England, chaired by Siobhan Melia, Chief Executive, Sussex Community NHS Foundation Trust, to support the improvement of the culture within the ambulance service.

The review considers the prevailing culture within ambulance trusts in England. It considers the core factors impacting cultural norms and offers actionable recommendations for improvement.

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

Content

1. Balance operational performance with people performance at all levels

NHS England

• Embed expectations of cultural improvement in the ambulance sector alongside operational delivery using policy levers, such as the urgent and emergency care recovery plan, and maintain grip on cultural progress through an effective oversight process in line with the corporate position set out in the NHS oversight framework. 
• Work with the Association of Ambulance Chief Executives to review the role they play in embedding culture improvement in the ambulance sector.
• Ensure people and operational performance is reviewed in the round via national and regional quality and performance committees. Oversight should consider key metrics and qualitative insights (eg peer-reviews), across the main themes for improvement.

Integrated care boards

• Review effectiveness of lead integrated care board commissioning arrangements.

Ambulance trusts

• Ensure Boards routinely review workforce culture alongside operational performance, taking account of the main themes for improvement.

2. Improve leadership and management culture and develop the ambulance workforce

NHS England

• Collaborate with ambulance trusts to develop and deliver a bespoke ambulance leadership, management and cultural offer, to include Michael West style of ‘compassionate and inclusive leadership’.
• Review existing career development frameworks for the ambulance workforce and develop pathways for ambulance staff to improve retention. 

Integrated care boards

• Prioritise and enable cultural change through greater collaboration and shared learning between ambulance and integrated care board teams.

Ambulance trusts

• Develop clear vision and values and role model these from board to floor. 
• Have a registrant paramedic on every ambulance trust Board to represent the paramedic voice.
• Provide protected time for individuals to receive appropriate leadership and management training and invest in specialist management skills and training programmes. 

3. Improve operational environment, line management and undergraduate training

NHS England

• Review national health and wellbeing frameworks to ensure they take account of the operational context of ambulance trusts and impact on patient safety.
• Continue to collaborate with partners/college of paramedics to ensure undergraduate training fully represents the patient case mix.

Integrated care boards

• Provide opportunities for portfolio working to ensure paramedics are supported to work across organisational boundaries.

Ambulance trusts

• Review the operating environment of paramedics, ensuring the operational rota is people-centred and collaborative.
• Review management models and bring teams together in more collaborative way, eg team-based working. 
• All staff to have clear and direct access to a line manager.
• Continue to develop and deliver health and wellbeing schemes for all staff.

4. Translate the NHS equality, diversity, and inclusion (EDI) improvement plan into a bespoke plan for ambulance trusts

NHS England

• Collaborate with the Association of Ambulance Chief Executives to translate the NHS equality, diversity, and inclusion (EDI) improvement plan into a bespoke ambulance sector EDI improvement plan and include short, medium, and long-term actions. 

Integrated care boards

• Monitor and oversee the implementation of ambulance trust EDI improvement plans. 

Ambulance trusts

• Deliver EDI priorities. To include tackling barriers to recruitment, working on adverts and job profiles to improve diversity.

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

NHS England

• Monitor delivery of the national sexual safety charter and consensus statement for reducing misogyny and improving sexual safety, paying particular attention to the ambulance sector

Integrated care boards

• Prioritise tackling bullying and harassment including sexual harassment and continue to take action where needed.

Ambulance trusts

• Uphold all ambulance policies and take appropriate action and ensure all ambulance staff act with integrity to their colleagues, students, volunteers, and contractors.
• Ensure all staff receive sexual safety and bystander training, and equip managers to have difficult conversations, building moral self-efficacy and self-regulation within the workforce.
• Boards to ensure the effectiveness of Freedom To Speak Up (FTSU) functions to allow staff to report discrimination and harassment without fear of reprisal.

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

NHS England

• Partner with national trade union leaders on a collaborative statement to support cultural change and empower human resources and organisational development functions.
• Work collaboratively with integrated care boards to develop and deliver a bespoke human resources and organisational development offer accounting for the cultural and employee relations challenges within ambulance services. To include guidance on the right ratio of human resources business partners.

Integrated care boards

• Work collaboratively to develop and deliver bespoke human resources and organisational development package of support accounting for the complexity of the ambulance service and large employee relation cases.

Ambulance trusts

• Implement appropriate infrastructure for an effective speak up culture which includes trained investigators for the most complex of cases.