South East Coast Ambulance Service: Bullying and 'sexualised behaviour' raised in CQC report

The Care Quality Commission (CQC) has rated the leadership at the trust inadequate, following an inspection in February.

The trust is responsible for the 999 call centres, ambulances, Hazardous Area Response Team, NHS 111 and community first responders.

Inspectors looked at management and leadership of the trust to answer what it described as the ‘key question’: is the trust well-led?

The inspection was undertaken after CQC received a high number of whistleblowing concerns relating to culture and leadership, including inappropriate sexualised behaviour, bullying and harassment, leaving staff feeling scared to speak out, and a failure by the trust leadership team to address concerns raised.

Inspectors also conducted a comprehensive inspection of the emergency operations centre (EOC) and the NHS 111 service provided by the trust. Following this:

The overall rating for the NHS111 service remains good. Responsive has moved from good to requires improvement. The ratings for being safe, effective, caring, and well-led remain as good.

The overall rating for the emergency operations centre moved down from good to requires improvement. Caring remains good, however, safe, effective, responsive and well-led, which were previously rated good, have dropped to requires improvement.

Inspectors also undertook an inspection of parts of the emergency urgent care service as part of a wider system review of urgent and emergency services across the Kent and Medway integrated care system, this is planned for publication later this week. As this area of the trust was not inspected in full, the ratings were not changed.

While CQC carries out further checks on this provider and its registered locations, it has suspended the trust’s overall rating.* This will be reviewed once the checks are complete.

Amanda Williams, CQC’s director of integrated care, said: “We carried out this inspection of South East Coast Ambulance NHS Foundation Trust in response to concerns raised with us around culture and leadership.

”Our inspectors found that staff on the front line were doing their utmost to provide safe and effective care and treatment of patients across Kent, Surrey and Sussex. They were doing a good job, especially in light of the additional pressures on the service caused by the COVID-19 pandemic.

“But while staff were doing their very best to provide safe care to patients, leaders often appeared out of touch with what was happening on the front line and weren’t always aware of the challenges staff faced. Staff described feeling unable to raise concerns without fear of reprisal - and when concerns were raised, these were not acted on.

"This meant that some negative aspects of the organisational culture, including bullying and harassment and inappropriate sexualised behaviour, were not addressed and became normalised behaviours. I want to praise those staff who were brave enough to come forward, as speaking up in these circumstances is not easy, but it is important that it happens.

“There was a clear disconnect between leaders and staff, leading to a poor and unsupportive culture, As a result, the leadership for the trust as a whole has been rated inadequate, while the emergency operation centre, and NHS 111, was rated as good overall.

“It’s clear the trust needs help to ensure significant improvements in leadership are put in place to give hardworking staff the support they need and deserve to deliver good care. I am therefore recommending to NHS England and Improvement that South East Coast Ambulance NHS Foundation Trust should be placed in segment four of the system oversight framework and receive additional support via the recovery support programme.

"This is the highest level of support that is offered and should give the trust the extra support needed to make the required improvements in leadership. We will continue to monitor and review progress to check that sufficient improvements are made.”

Inspectors found: There had been a significant rise in numbers of 999 calls, and demand had exceeded what the trust was capable of managing. This, combined with ambulance crews being delayed at emergency departments, meant the trust was unable to reach all patients in a timely way. As a result, the service was not meeting any NHS ambulance response times. This situation was not unique to South East Coast Ambulance NHS Foundation Trust, as ambulance services nationally were experiencing overwhelming demand, but it was becoming unsustainable for staff across the service.

There were additional risks for patients from handover delays for ambulance crews at emergency departments which were unable to take patients due to their lack of capacity.

The leadership team was not always aware of the risks in their service or themes and trends in patients’ complaints.

In 2021, an audit was undertaken into all allegations following a rise in reported cases of inappropriate sexualised behaviours. In response to the report, the trust launched a sexual safety at work programme. However, at the time of the inspection, many staff were unaware of the programme. Not all staff felt that when concerns relating to inappropriate sexualised behaviours were raised, they were always heard, understood or tackled equally across all levels of the organisation. Additionally, some staff raised concerns about the grievance process and the introduction of policies that may unfairly discriminate against some groups of staff.

The reporting systems at the trust were not operating in a way that protected patients or staff from the risk of harm. Risk, issues and poor performance were not always dealt with appropriately or quickly enough and there was a backlog of 1,500 incidents on the incident reporting system.

Staff did not feel they were empowered to make decisions or lead in a constructive way. Staff told inspectors decisions were made in isolation by a small number of individuals rather than using the expertise, experience and clinical knowledge inside the organisation. Decisions were frequently made outside of the trust’s own policies, governance and risk systems.

However, inspectors also found: While inspectors found trust wide issues the EOC had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.

The EOC regularly reviewed how effective and appropriate the care it was providing was. It made sure that care and treatment was delivered according to evidence-based guidelines.

Staff in the EOC were focused on the needs of patients receiving care. They involved people and treated them with compassion, kindness, dignity and respect.

Patients contacting the EOC were able to access care and treatment from an integrated service with specialisms to meet their needs.

The service had made some progress in promoting equality and diversity in the organisation.