St John Ambulance - Midlands Region

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

We found a poor culture at the service. Staff told us they felt it was a toxic environment, that morale was at an all-time low, they spoke of what they perceived to be a bullying culture by colleagues and senior staff. Staff also felt leaders did not want to hear about issues, that there was a culture of punishment when things went wrong with a human resource system that was discipline heavy. They spoke of long hours, inadequate rest breaks and unrealistic expectations. They told us they felt intimidated, harassed and unsupported. They spoke of bad leadership, unmotivated coworkers, stifled growth and of no work-life balance. However Leaders recognised improvements were needed and spoke of how they had recently appointed an external consultant to review the culture. Leaders had specific training in place relating to their role. There were processes in place for staff to speak up if they had any concerns. There was Freedom To Speak Up (FTSU) advocates in place who were positive about how leaders tried to address concerns. There was a FTSU framework in place which linked with St John Ambulance - Midland’s Region internal systems. FTSU advocates represented different directorates across the charity. The service had run various courses in relation to equity and diversity. It had been decided to continue with the current strategy 2019-2022 until the new chief executive officer was in place. Staff feedback around leaders was mixed with some staff feeling leaders were visible and approachable, and others feeling that the leadership was ineffective, poor and that issues went unresolved.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with 9 staff including leaders as part of our on-site assessment; we also reviewed feedback from cases we received following the assessment which were mainly anonymous. Feedback mostly indicated a poor culture within the service. Staff felt it was a toxic environment, they felt morale was at an all-time low, they spoke of what they perceived to be a bullying culture by colleagues and senior staff. Staff also felt leaders did not want to hear about issues, that there was a culture of punishment when things went wrong with a human resource system that was discipline heavy. They spoke of long hours, inadequate rest breaks and unrealistic expectations; they told us they felt intimidated, harassed and unsupported. They spoke of bad leadership, unmotivated coworkers, stifled growth and no work-life balance. There had been a recent restructure of the organisation. Leaders felt the changes taking place in the service were affecting the culture, they recognised improvements were needed and spoke of how they had recently appointed an external consultant to review the culture. They also told us there had been an increase in Freedom to Speak Up (FTSU) concerns where themes included staff not being heard or feeling listened to. We reviewed the St John Ambulance pulse survey, July 2023. Due to the survey, management training had been carried out as well as testing of the ethical behaviour framework. However, this was a national survey and not specific to St John Ambulance-Midland’s Region. Throughout 2023 and the start of 2024 the service head of the equity, diversity and inclusion ran training sessions for leaders across the service. These included anti racism workshops, cultural intelligence masterclass and informal awareness of Ramadan. Throughout 2024, the team were developing additional training around allyship, banter and sexual safety.

We reviewed the meeting notes from a roster’s consultation meeting dated January 2024, the notes included reasons for the consultation, proposal of roster examples, and an open forum. The Urgent and Emergency Care Midlands Region leadership meetings had an agenda item named people and culture update. Formation meeting notes highlighted that staff were not happy with the consultations that were happening and that sickness at the service had increased. We reviewed a sample of 4 personal development reviews (PDR’S) and found that 2 staff also raised concerns around poor morale. PDRs included a wellbeing score where leaders asked staff if there were any areas, they would like extra support or information. The service had a set of values in place which included Humanity, Excellence, Accountability, Responsiveness and Teamwork. In relation to the service strategy and vision it had been decided to continue with the 2019-2022 strategy until the new chief executive was in place. We reviewed this strategy and saw it contained topics such as strategic goals, leading standards and inspiring community response.

Staff feedback around leaders was mixed. Some staff felt that managers were visible and approachable and always there for everyone despite the pressures they were under; whilst anonymous feedback received following the on-site assessment was that the leadership was ineffective, poor and that issues often went unresolved. Leaders told us how they travelled to visit different hubs to ensure they were accessible to staff and volunteers as well as going out on front line shifts. Leaders also tried to arrange any meetings in different parts of the country. Leaders told us how they went out on frontline calls and to nationwide events. They told us how the head of leadership and development currently offered level 4, 5 or 6 management courses and that staff will be charted at the end of level 6. We spoke with the service Freedom to Speak Up Guardian who told us leaders responded to concerns very well. They spoke of how leaders tried to address concerns as soon as they were raised and of a receptive leaderships team who were keen to hear concerns.

There was Ambulance Operations leadership team in place which included a director of urgent and emergency care, a regional ambulance lead, an ambulance operations manager and ambulance leads and crew. The chief executive officer (CEO) had recently left the company and there was an interim CEO in place. All managers had attended my development mandatory review training. The plan was for all managers to complete absence management training by the end of April 2024. In March 2023 the people and culture business partner ran HR and management development road shows on how to manage people and have difficult conversations with ambulance operations leaders. In October and November 2023 all ambulance operations leaders attended a bespoke 2-day management development course which covered the following topics. • Being a people manager and how to manage your people inclusively. • What are you accountable for as a manager? • Practical support on how to performance manage your people. • Team building and creating the right culture for your people. In 2024 the leadership development team have developed a course on investigation training and 2 of the ambulance operations leaders have attended, most of these were to be scheduled throughout the year.

We interviewed the service Freedom to Speak Up (FTSU) Guardian as part of the assessment. They told us how they had FTSU advocates; some of which were crew members who represented different directorates across the charity. They spoke of how they had held an awareness month about in relation to FTSU in October 2023 and how following this there was a clear increase in referrals. They also completed an awareness week in February 2023 and raised awareness via a variety of different measures including posters, machine readable code links and email communications. They spoke of how activity levels had increased over the last 3 years going from approximately 6 cases in year 1 to 180 in year 3. Themes and trends identified within the service included a bullying culture, conduct and behaviour. Leaders gave examples of changes that had been made following a staff member being able to speak up. Staff on site told us they felt they could raise concerns including safety concerns to managers without fear.

There had not been any whistleblowing concerns raised for the West Midlands region over the last year; there was a whistleblowing policy in place. There was no Freedom to Speak Up (FTSU) policy in place as the service had a FTSU up framework which was linked to their internal systems. This allowed staff to access the system to review the framework. In addition to FTSU advocates were trained to understand what support St John Ambulance could offer and could direct them appropriately. We reviewed a summary of the recent FTSU concerns and found they were in relation to conduct and found actions had been taken as a result.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Governance, management and sustainability during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.