Lincs and Notts Air Ambulance Charity

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This is the first assessment for this service. This key question has been rated outstanding. We rated well led as outstanding. Leaders and staff understood and embodied the culture and values of the workforce and the organisation. They had the skills, experience and credibility to lead the service well and were compassionate and inclusive. Staff felt confident they could speak up and knew how to do this. Staff were given comprehensive training and career development, and managers encouraged research and innovation. There was a clear system of governance and risk management based around delivering safe and prompt care and treatment. The service promoted equality for patients and families and had policies to guide managers and staff to ensure equality and diversity was encouraged within the workforce. The service worked closely with external partners and stakeholders and was well respected in the local community.

This service scored 96 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they felt the service respected them and valued their work and there was a strong and shared culture of excellence. Managers provided support to staff throughout their time with the service. Staff understood and had contributed to the organisation's values of ‘teamwork, respect, innovation and compassion’. Staff confirmed that equality, diversity and inclusion was promoted within the workforce. The policy on this guided staff on their work with their patients and wider community. Staff said they could challenge operational decisions and if they had any concerns, there were clear pathways to enable these to be shared with managers. Managers said they operated an ‘open-door’ policy. Staff found senior managers were visible and approachable. Staff also told us they believed the service helped them to develop their careers, by encouraging training and promotion. At the annual clinical away day in 2024, the team gathered the feedback shared among the staff and recognised six key words which kept recurring. These were the service being: supportive; innovative; collaborative; empowering; reflective; and excellent.

The service had devised a team charter, which explained how staff and management could demonstrate the organisation’s values. It also had policies covering dignity at work, whistleblowing, wellbeing and stress management. These outlined how the leadership team would support staff at work. Freedom to Speak Up Guardians were available for staff to approach if they had any concerns at work. The service had a wellbeing group and designated mental health first aiders, which included staff members from all levels of the service.

Staff told us they believed the leaders of the service to be open, honest and understood the challenges faced by the service. They said the ‘open-door’ policy of the management team encouraged staff to interact with the leadership team and that there was a ‘family’ feel about the service. Staff said that managers considered their welfare one of the most important areas for careful monitoring. Colleagues agreed team working was strong at the scene of incidents and support in the de-brief meetings was helpful. Staff members considered managers were appropriately skilled for their roles. Office based workers noted that although they worked in different areas of the building, there was an open culture with clinical and administrative staff mixing well.

There was a clear managerial structure, with an external board of trustees and affiliations with appropriate regulators and authorities. The senior leadership team included staff who also worked operationally. The leadership therefore had up to date and current frontline experience which supported their credibility and integrity. The service offered flexible working for staff, which was welcomed by those with caring responsibilities. It had also set up initiatives to promote wellbeing at work, including a walk route around the HQ building and regular social events for all staff and their families. A garden of reflection was being planned on site for future use. We found the senior leadership to be positive, compassionate and deeply committed to staff wellbeing. They promoted a listening culture that promoted trust and commitment between staff at all levels. The service was exceptionally focused on learning, development and improvement and being at the forefront of observation in patient care. They were highly experienced and well-recognised in their clinical practise for the seniority and credibility. Senior leaders were clear in their responsibility to protect their staff from psychological harm in often a difficult and challenging working environment. To that end, there was a considerable level of respect for all staff and providing support. Senior leaders felt they had such a close working relationship with one another that they were aware when a member of staff was not their usual self. They would also pick up the phone to staff involved in a particularly difficult case. The service offered TRiM care for staff. This was a ‘trauma risk management’ peer support system with trained staff offering support following a traumatic or potentially traumatic event. The senior management did all it could to ensure staff were not constantly exposed to dramatic situations.

Staff told us there were clear, defined routes for staff to voice concerns about their work or how the service operated. However, staff said if they had concerns which could not take to their line manager, they were free to approach other senior colleagues. They were pleased the service had appointed Freedom to Speak Up Guardians. They believed this demonstrated the leadership’s commitment to openness and that leaders would take staff concerns seriously. The senior leadership were clearly committed to staff speaking up being incredibly important. They felt the service operated a flat hierarchy where staff of all levels were encouraged to speak up and share. This was encouraged by an annual clinical away day where all staff were provided with a forum to discuss issues openly and honestly.

The service had clear lines of communication staff could use to raise concerns. It also had policies covering wellbeing and dignity at work and well-established Freedom to Speak Up Guardians. The remit of these roles was covered in the whistleblowing policy.

There was a clear commitment from senior leaders to provide and value diversity in the workforce. There was ongoing work to implement initiatives around equality, diversity and inclusion including appointing a champion around equality and had set up a wellbeing committee for staff. The service provided support for any pregnant staff who wished to continue frontline working for as long as was safely possible and in line with their wishes.

The service had a policy covering equality, diversity and inclusion, and the dignity at work policy outlined guidelines to ensure all staff were treated with respect.

There was a clear and committed strategy around governance and risk management articulated to us. There were clear responsibilities among staff which interconnected and ensured governance was fundamentally strong. The service acted on the best information to ensure it understood its risks, performance and outcomes. The system managed performance well and too a proportionate approach to managing risk which allowed new and innovative ideas to be tested and well researched. The service held weekly ‘death and disability’ meetings (often called mortality and morbidity meetings in the NHS). Incidents to discuss were selected by the consultants and teams to bring. The consultants were enabled to describe a case all the way through so the team could look at the detail and ask questions around how decisions were made. All of this was intended to share excellent practice and where things could have been managed better. It was also key to the senior staff to understand how the patient was treated throughout and keep them at the centre of care and treatment decisions. We were told everyone involved in a case was willing to have their case reviewed and valued the discussion. Senior leaders told us they had a clear strategy for the service for the next five years, which covered short and long terms developments, sustainability and risk management. This strategy included input from all staff and other stakeholders. The compliance manager told us the implications of risks were regularly assessed and updated. Leaders and staff agreed how funding for the charity and recruitment were the main risks to the service. Managers told us they had good links with external stakeholders and used internal and external systems to measure quality of performance. Staff told us how they had learned much from the governance processes which at times they had taken back with them to other roles in the NHS to share and bring good practice.

The service had a clear governance framework and regularly reported to its board of trustees. It also provided information and reports to external bodies, including the Care Quality Commission, the Charities Commission and Civil Aviation Authority. The service provided feedback and shared information with external clinical forums to ensure it kept up to date with best clinical practice. Internally, there were specific committees set up to govern research and innovation, recruitment and training, clinical safety, and safeguarding.

There was a clear commitment from senior leaders to provide and value diversity in the workforce. There was ongoing work to implement initiatives around equality, diversity and inclusion including appointing a champion around equality and had set up a wellbeing committee for staff. The service provided support for any pregnant staff who wished to continue frontline working for as long as was safely possible and in line with their wishes.

The major trauma network representative told us they considered the service very engaged within the network. They said patients benefitted most from the on-scene clinical skills of the team. They also observed the service was "well thought of by the local population". They believed the service worked well within the wider integrated care system. Historically, the service operated under the local NHS ambulance service, but in 2022, the service became independent. At the time of the assessment, the two providers were in the process of formalising an official contract to plan the operational side of this co-working arrangement. The local NHS ambulance service confirmed both organisations’ teams worked well together at the scene of incidents.

The service had established good working relationships with the local police and fire services, as well as trauma centres and hospitals. The service also worked with search and rescue services and community first responders. When first responders were on a scene then attended by the air ambulance service, the deputy medical director advised that their staff were asked to “wrap around them” to provide support and feedback. Clinical staff members regularly attended workshops with other air ambulances and pre-hospital emergency care providers to share learning and good practice. The service worked with several local agencies and stakeholders, including the integrated care service, and local road safety partnerships. They also liaised with national organisations, such as the National Helicopter Emergency Medical Services Research and Audit Forum.

There was an exceptional focus on learning, improvement and innovation. This was at the forefront of this service and centred on delivering the best patient care. Learning included both immediate learning from positive and negative experiences, but also a long-term focus on development and innovation. Staff were supported to prioritise time for developing their skills and abilities. Staff were encouraged to make suggestions for improvements in processes or how to manage risks. The clinical team were proud of their innovative work, such as the advancement of the use of blood transfusion incidents. They were also advanced in their research and governance around the proposed future use of the Endovascular Resuscitation (EVR) intervention. Staff had attended various UK and international events where they shared learning from these initiatives with other helicopter emergency medical services. Staff also enjoyed working with the local medical school to help conduct research and support learning for trainee doctors. There was an annual clinical away day where staff were encouraged to bring any new ideas or thoughts for sharing and consideration around improvement and innovation.

All staff had access to ‘the hub’, an online system where all policies and updates were stored and accessible to all. Clinical staff attended post-incident de-brief meetings to analyse actions and outcomes to help learning. There were also wall boards around headquarters with updated information. The service had clear pathways and supervision arrangements to enable the ongoing development for doctors. Paramedics also had a development plan to ensure they had the skills to provide safe pre-hospital critical care.