Agenda item

Paul Jefferies (Divisional Director-Thames Valley, South Central Ambulance Service NHS Foundation Trust) and Andrew Battye (Head of Operations for Oxfordshire, South Central Ambulance Service NHS Foundation Trust) have been invited to present a report providing an update on the SCAS Care Quality Commission Improvement Journey.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Paul Jefferies (South Central Ambulance Service [SCAS] Divisional Director for Thames Valley) and Andrew Battye (SCAS Head of Operations for Oxfordshire) were invited to present the SCAC Care Quality Commission (CQC) improvement journey update report.

The Committee enquired about the Trust’s exit from the recovery support programme in January 2026 and the removal of the 2024 undertakings by the South East Regional Support Group in April 2026. The Divisional Director for Thames Valley explained that this had followed a period of close regional oversight in which the Trust was scrutinised primarily against three core areas: workforce, operational performance, and financial position. The Trust had achieved financial break-even in the previous financial year, had a formal recovery action plan in place for improving Category 2 response times towards the 18‑minute target applicable to all ambulance services, and had embedded routine executive monitoring of operational, financial and workforce performance.

Members asked which issues identified by inspection remained most significant. The Divisional Director for Thames Valley responded that one of the main areas of ongoing work was medicines management, which had been identified by the CQC as requiring improvement in relation to storage, documentation and process reliability. He explained that the Trust had significantly developed its pharmacy team and had invested in a new site to support improved “make ready” processes and safer medicines management. He described the practical challenge of crews carrying a range of medicines in different bags, including controlled drugs, and said that the Trust was introducing a new personal issue model for morphine management in Oxfordshire, which was due to go live the following week.

The Committee revisited its earlier recommendations on internal assurance, audit and governance. The Divisional Director for Thames Valley explained that the Trust had introduced a Performance Management Accountability Framework, under which each divisional director was required to provide formal monthly assurance to the executive team through internal scrutiny arrangements. He said that for Thames Valley this covered Oxfordshire, Buckinghamshire and Berkshire, each with sector leadership beneath him, including a Head of Operations and a Clinical Operations Manager. He explained that scrutiny included appraisal completion, personal development plans, statutory and mandatory training, and operational quality indicators such as hand hygiene, vehicle cleanliness and medicines management.

Members asked how patient and public voice influenced Board‑level challenge. The Divisional Director for Thames Valley responded that public Board meetings did include lived experience input. He gave one recent example in which a team leader had attended the Board with members of the public involved in a cardiac arrest incident where a pregnant woman had been performing CPR on her husband before ambulance crews arrived and successfully resuscitated him. He explained that such accounts, whether of care that had gone exceptionally well or of care that had raised concerns, were used to inform learning and to bring patient experience directly into governance discussions, alongside the contribution of non‑executive directors. When Healthwatch asked how the service systematically gathered and learned from patient feedback, the Divisional Director explained that the Trust had a dedicated patient experience team which coordinated all positive and negative feedback, allocated it to the relevant teams, and ensured that team leaders and clinical team educators investigated and responded.

The Committee explored the Trust’s implementation of the Patient Safety Incident Response Framework. Members asked what had changed in practice since its introduction, what recurrent risks had been identified, what actions had followed, and what evidence existed that those actions had reduced harm. The Head of Operations for Oxfordshire explained that the principal initial change had been in the training and support given to staff and team leaders in understanding the new process for handling patient safety incidents. He said that patient safety incidents from the previous day were now reviewed every day by the patient safety team in order to identify harm or emerging concerns, and that there was now a much stronger culture of looking proactively for patient safety issues rather than reacting only after serious incidents had occurred.

Members asked about the expansion of the safeguarding team, including whether increased safeguarding capacity had improved the timeliness and quality of referrals and the feedback loops to crews. The Head of Operations for Oxfordshire explained that the Trust had previously had problems with safeguarding referrals because of a mismatch between paper and electronic systems, but that referrals were now made electronically through the patient record at the point of case closure. He said the system had been designed to prompt staff where a safeguarding issue had been identified but a referral had not yet been completed. He added that safeguarding referrals, associated learning and performance were now reported monthly through the Board assurance framework.

The Committee examined the growing problem of violence and aggression towards staff. Members referred to similar concerns raised by OUH and asked whether the ambulance service was facing the same trend. The Head of Operations for Oxfordshire said that regrettably it was, and that the issue had not gone away but had worsened nationally and locally. He described the difficulty of distinguishing between aggression driven by illness and aggression that was deliberate, but stressed that no staff member deserved such abuse.

The discussion focused on workforce, particularly the report’s statement that financial pressures and service realignment had led to a mismatch between clinical and non‑clinical staff. The Head of Operations for Oxfordshire explained that the clinical workforce referred primarily to registered paramedics, while the non‑clinical or clinical support workforce included Associate Ambulance Practitioners and Emergency Care Assistants. He said that, over the previous 18 months to two years, the Trust had deliberately invested in upskilling its own support workforce, with emergency care assistants progressing to associate practitioner roles and associate practitioners progressing through university routes to become paramedics. This had helped to reduce clinical vacancies in Oxfordshire, but had also left non‑clinical vacancies which the Trust could not yet fully backfill.

The Committee scrutinised the Trust’s ‘Freedom to Speak Up’ culture and psychological safety, and asked whether the increase in concerns being recorded indicated a genuinely safer speaking‑up culture or continuing unresolved cultural problems. The Head of Operations for Oxfordshire acknowledged that it felt paradoxical to see rising numbers of concerns as positive, but said the increase suggested staff were becoming more comfortable raising issues. He explained that the organisation had invested heavily in the Freedom to Speak Up process, including local station‑based champions, precisely so that staff did not have to raise issues only through line management and could speak to peers instead. He said the challenge was not only encouraging staff to speak up but also “listening up” and then following through, because if nothing changed the reporting would stop.

The Committee asked what the remaining causes of handover delay in Oxfordshire were and whether rising figures at the Horton General Hospital should be a concern. The Head of Operations for Oxfordshire replied that the main causes remained familiar system issues: acuity, seasonal or weather‑related surges in demand, and the ability of acute hospitals to discharge patients safely into the community. He described ambulance arrivals as having a “tsunami effect”, with several vehicles often arriving in quick succession from different parts of the county, thereby creating episodic pressure in emergency departments. He explained that the Trust also used the release to respond process at 45 minutes where hospitals could not offload patients promptly, transferring responsibility to the hospital so that crews could return to community demand. He said he was not overly concerned about the Horton figures, noting that they remained comparatively good against national standards and that although there had been a slight increase, it was much smaller than elsewhere and broadly linked to increased demand.

The Committee and Healthwatch Oxfordshire also explored the ambulance service’s proactive work with high‑intensity users and alternatives to conveyance. The Head of Operations for Oxfordshire explained that the service had a high‑intensity user function which worked with social care and acute partners to identify better pathways for people who made repeated use of emergency services. He said the service actively encouraged safe non‑conveyance, not as a matter of refusing transport but of identifying better alternative services.

The Committee AGREED to issue the following recommendations:

1. For SCAS and the ICB to escalate the future pipeline issue with staff and challenges with non-availability of training placements.

2. For the Ambulance Service to strengthen opportunities for public and patient involvement. It is recommended that there is coproduction as part of shaping and monitoring the Trust’s improvement journey.

3. For the Trust to ensure that “speaking up” is not merely encouraged or measured per se, but to evidence that actions are followed up and lessons are learned around the themes emerging through “speaking up”.

4. To ensure that there is continued support for staff wellbeing. It is recommended that there are clear, measurable, and transparent outcomes frameworks to demonstrate success in supporting staff and in tackling burnout.