Marked improvement at London Ambulance Service as CQC rates it Good

Professor Ted Baker, England’s Chief Inspector of Hospitals said: 

“I’m very encouraged by the improvements in the quality of care provided by London Ambulance Service. The progress the trust has made is a real testament to the hard work of staff and leaders. 

“The trust has developed a number of innovative changes to the way it operates, such as the ‘hear and treat’ service, which provides clinical assessments over the phone to more callers with less serious illnesses and injuries. More importantly, inspectors found that the culture of the trust had improved significantly, with staff feeling more able to raise concerns. Overall, staff are better supported to carry out their crucial work – and we have rated the trust as ‘Outstanding’ for caring.

“The improvements the leadership and staff of LAS have made are especially commendable – and especially necessary – given the major incidents the trust has responded to over the past year, including terrorist attacks and the Grenfell Tower tragedy.

“We have now recommended to NHS Improvement that the trust be taken out of special measures.”

The LAS covers an area of approximately 620 square miles. It is the busiest ambulance service in the country and one of the busiest in the world.

This inspection included the core service areas of emergency operations centres (EOC) and emergency and urgent care (E&UC). These core services had a number of areas which Required Improvement and this inspection was designed to assess what progress had been made.

Inspectors found examples of outstanding care at the trust, which has treated people that have been involved in major incidents in London in recent years. Staff often went above and beyond their expected duties in order to meet patient needs. Inspectors saw and heard about examples of the commitment of staff from patients.

Staff working across all parts of the service demonstrated care which was consistent with the underpinning values of the trust. Patients were treated with a calm and professional manner, with kindness and empathy.

The immediate physical and emotional needs of patients were considered and taken into account by staff. Staff ensured the results of their initial assessment were discussed with their patients and they were informed of any treatment or action required. Family were involved as appropriate.

Staff afforded patients privacy and respected their dignity. Where staff had the opportunity to provide patients with choices they did so through the sharing of information and checking individuals understanding.

In addition CQC undertook a well-led inspection. At a previous inspection CQC rated well-led as Requires Improvement. At the time inspectors were not sufficiently assured of progress made to remove the trust from special measures, which had been in place since 2015.

Now highly trained ambulance personnel, staff with specialised skills and expertise including; maternity, mental health and safeguarding were available to advise and support staff.

The trust had worked hard to reinforce the organisational vision and its strategic aims, and most staff understood how they contributed to the achievement of this. A great deal of work had gone into engaging with a broad range of staff, stakeholders, patient groups and representatives to the development of a new strategy. Information arising from this was shared through various channels.

The culture had improved since the previous inspection and staff were generally proud to work for LAS. Staff strived to provide the best patient care, and generally staff were able to speak up and bring matters to the table where they could not provide the right care or things went wrong.

Staff worked collaboratively with others in order to improve services and to bring about future sustainability. There were some excellent examples of positive engagement with stakeholders, external agencies, patients and the public. Work related activities arising from this engagement were in evidence.

However, the trust must address staffing shortages in emergency operations centres, and shifts should be staffed to planned staffing levels.

There are other areas where the trust should ensure that sufficient attention is given:

  • The recruitment and retention of staff working in EOC

  • Exploring ways of increasing the ability of staff to have their annual performance reviews outside of periods of high activity and demand.

  • Improve the recruitment of, development and progression opportunities for BME staff.

  • Review and address gaps in staff knowledge and confidence to deal with people in mental health crisis.

You can read the report in full at when it is published on our website.