Trust loses ‘outstanding’ rating

Inspectors visited West Midlands Ambulance Service in August last year to assess its leadership and emergency and urgent care services.

Following the inspection, the trust had its ratings for effectiveness, responsiveness and leadership moved from “outstanding” to “good”, along with its overall rating.

Its rating for its emergency operations centre was upgraded from “good” to “outstanding”, making it the best in the country for answering 999 calls. 

Inspectors also praised leaders’ ability to run services well and said they were visible and approachable.

However, assessors cited some deteriorations in culture, with some staff telling inspectors they remained concerned about speaking up.

Inspectors wrote that only 63 per cent said they felt secure raising concerns about unsafe clinical practice in the NHS staff survey, which was worse than the average for ambulance services of 66 per cent and had fallen in the past two years.

Some senior managers and those with oversight recognised CQC’s concerns about culture, and demonstrated commitment to proactive learning, although others “still rejected” these issues.

Assessors noted key indicators from the latest workforce race equality standard report around experiencing harassment, bullying, and abuse (from both the public and other staff), equal opportunities, and discrimination, placed WMAS among the worst 10 per cent of trusts in England.

They added such concerns were not effectively reflected in the trust’s board assurance report or through other assurance mechanisms.

A 2022 independent inquiry, commissioned by NHS England but never made public, found WMAS staff had their ability to speak up as whistleblowers stifled.

Meanwhile, WMAS’ rating for “effectiveness” in emergency and urgent services fell to “requires improvement”, largely due to deteriorations in performance on responding to category two 999 calls and pressure caused by ambulance handover delays.

At the time of the inspection, average performance on category two calls was 48 minutes and 12 seconds, compared with the 18-minute mean response time target.

This was a significant deterioration from the previous year but the overall figures were generally better than other ambulance services, the CQC said.

In a press response headed “trust remains most successful in the country,” WMAS CEO Anthony Marsh said the loss of its outstanding rating, achieved in 2019, was “disappointing” but accepted the trust has “further work to be done”.

He added: “The biggest change the inspectors noted was in our effectiveness, which has dropped from ‘outstanding’ to ‘requires improvement’.  The report is very clear that the root cause of this change is as a result of hospital handover delays…

“Given this inspection happened at perhaps the most challenging time within the history of the NHS, there is much to be proud of. However, we do also note comments about our culture. 

“Trust has been working hard over the last 18 months with staff fully involved in creating a new cultural statement, the launch of our sexual safety charter, development of our six staff networks and the substantial increase in the health and wellbeing support available to individuals.”