Executive summary
The East of England Ambulance Service NHS Trust (EEAST) was formerly on the NHS England Workforce, Training and Education (WT&E) Quality Improvement Register from 2017- 2023 as the result of concerns regarding the quality of the clinical learning environment and governance. During this period, a number of interventions took place, with corresponding improvement plans monitored via a programme of support, which included regular reviews of progress on the trust improvement plan and supplementary evidence, and supportive meetings between NHS England WT&E and EEAST established in recognition of the required pace for improvement.
Following notable improvements, the trust was removed from the WT&E Quality Improvement Register in October 2023, on subject of the conditions outlined below:
- 40% learner annual uptake of the NHS England National Education and Training Survey (NETS).
- NHS East of England WT&E Quality representation at EEAST board meetings.
- Annual learner engagement events
- A request that the trust sign up to the NHS sexual safety charter (now completed), and ongoing assurance regarding the policies for the sexual safety for learners at the trust derived through the provider annual self-assessment
- Ongoing monitoring through NETS and focus on sexual safety questions.
- Ongoing monitoring through regional Business as Usual (BAU).
EEAST actioned the above improvements, however we note the 40% uptake for NETS was not achieved in 2024, though the trust was the top-performing Ambulance Trust in the country for NETS update (RC1) and this report follows the annual learner engagement meetings held between 24 October 2024 – 14 January 2025 with Paramedic learners and practice educators (PEds) at EEAST. The purpose of the meetings was to capture the learner and PEd perspectives on the quality of the clinical learning environments at EEAST and ensure progress continues to be embedded and sustained following the closure of the improvement plan in October 2023.
Overall, the meetings were positive indicating the changes made are being embedded and sustained. Geographical variations were noted however, indicating there are further opportunities to imbed good practice consistently across the region.
The meetings demonstrated areas of good practice which included:
- Most learners (from both direct entry and degree apprenticeship groups) perceived their colleagues are supportive and felt their PEds enabled them to try their skills to achieve firsthand experience.
- PEds reported they can flexibly adapt to learner needs and learning styles to effectively support learners to put theory knowledge into practice.
- Overall learners felt most PEds were empathetic and reported if they make a mistake they are supported and given constructive feedback.
- In some areas apprenticeship learners reported they were able to choose their PEd, and the education manager secured protected shifts for the learner with their specific PEd.
- Many learners and educators noted the culture has improved and the organisation feels more open to acknowledging and addressing issues.
- 3rd year BSc learners reported the notice provided before shifts are given has improved.
- The Mentoring, Support and Training Team (MST) in Cambridgeshire and Peterborough was highly praised for being both supportive to learners and for facilitating university learners to be able to attend continuing professional development (CPD) training offered to staff. The MST groups were also noted to be proactive in identifying and providing additional support to learners with additional learning requirements, as well as support to newly qualified staff.
- PEds in Norfolk and Waveney (N&W) reported the University of East Anglia sends a ‘thank you’ pdf to every educator before placements that also includes a video link to outline the learning expectations for the placement for each year group. Educators highlighted this as good practice they would like to see replicated across areas as they felt it supported them to be better educators and clarified expectations with learners.
- North Kempston was praised for the delivery of simulation training at the station provided by ambulance staff who had experiences they could use to enhance simulation, which learners felt was very useful.
- The ‘Call before you Convey’ support for newly qualified practitioners was felt to be a mitigation for the perceived lack of time on placement and many learners felt fortunate that EEAST provide this support, and reassured knowing this support would be available to them when they qualify.
- Learners from different BSc university programmes reported variable experiences in the support available regarding careers advice. The process cited by learners at the University of Suffolk was highlighted as good practice, with learners from University of Suffolk reporting the process in 2024 changed with the job application process starting in April, when this had previously begun in Autumn. The learners felt the April start took some of the pressure off during a stressful time at the end of their programme.
While continuing progress was reported, the meetings also demonstrated continuing challenges including:
- Areas of good practice were variable with many dependent on geography. NHS England WT&E recommends the trust look for opportunities to spread areas of good educational practice consistently across all areas of the trust.
- No learners reported bullying or undermining, but some had experienced working with PEds who did not want to be educators and made it known, which left them feeling unwelcome and unvalued.
- Many apprenticeship learners described feeling valued by colleagues, but not by the trust, primarily due to feeling their educational requirements are not prioritised and concerns about a lack of work-life and study balance.
- Apprenticeship paramedic learners felt education is negatively impacted if pressure on the trust is high, and that the ability to be paired with an appropriate PEd suffers when pressures are high. Learners noted that due to service pressures they were frequently paired with Emergency Care Assistants and were the more senior member of the team, although it does provide good exposure to a variety of cases, if not paired with a paramedic PEd who can mentor, it impacts their progression and learning Apprenticeship learners highlighted protected time with their PEds can depend on geography and varies from area to area.
- Learners reported hearing disrespectful and racists comments made about patients and other team members and felt there was little pushback on these types of comments. This seemed most common in the Bedfordshire/Luton area.
- Some female learners reported a few male colleagues had told them they are careful about what they say in front of them at times. These learners were very careful not to accuse colleagues of sexism. The panel noted the comments may indicate early stages of an improved level of awareness and attempts at ensuring consideration is made for women learners, but it did raise the question of what may have been said if no woman was present.
- Few learners could describe a defined escalation pathway, and most were seemingly unaware of the Freedom to Speak Up Guardian.
- Many learners described inconsistent support following traumatic calls.
- Learners and PEds reported there is limited time in shifts to complete PADs and that signoff is frequently completed outside of shift hours.
The following sections contain a more detailed overview of the outcomes from these meetings and the suggested recommendations.
Throughout the meetings, learners used the terms ‘mentor’ and ‘practice educator’ interchangeably. For consistency within the report, the term practice educator (PEd) has been used.
Review overview
Background to the review
The purpose of this engagement was an annual review to triangulate the experience of EEAST Paramedic learners across the BSc (Hons) Paramedic Science and the Degree Paramedic Apprenticeship programmes, and practice educators (PEds), against other quality intelligence to review the clinical learning environment, and to gauge the success of the improvement strategies implemented to date. The review meeting was conducted in accordance with the NHS England WT&E Education Quality Framework Domains and Standards for Quality Reviews and the report written in a manner that preserves the anonymity of learners.
It is acknowledged that the meetings took place during a time of significant ongoing pressures for ambulance services. We were unable to capture the voice of University of East Anglia learners, due to no learners being available at the time of the two scheduled meetings.
Evidence utilised
- NHS England WT&E internal governance documentation which includes reports from previous engagement meetings
- Placement evaluation feedback
- National Education and Training Survey (NETs) 2023 outcomes, and partial NETS 2024 outcomes (the survey was closed during the engagements, but results were not publicly available).
- CQC Inspection Report July 2022
Who we met with
Learners
- 32 Degree Apprenticeship students, all with University of Cumbria
- 26 Year 3 BSc Students
- 10 Year 2 BSc Students
- BSc Students were from Anglia Ruskin University, University of Suffolk, University of Bedfordshire, and University of Hertfordshire
Review panel
- Marjorie Casey, Education Quality Manager – Education Quality Review Lead
- Angela Gouck, Paramedic Placement Capacity and Diversity lead – Specialty Expert
- Agnès Donoughue, Education Quality Coordinator – Quality Support
- Ryan Collins, Education Quality Intelligence Analyst – Education Quality Review Lead
- Hayley Peacock – Education Quality Officer – Quality Support
*Review panel – please note that panel membership varied according to availability but consisted of a minimum of a qualified paramedic specialty expert and Education Quality Review Lead for consistency.
Review findings
1. Learning environment and culture
Most BSc learners reported they felt welcomed and supported by their colleagues. Most learners from both groups felt their PEds enabled them to try their skills to achieve firsthand experience, and PEds reported they can flexibly adapt to learner needs and learning styles to effectively support learners to put theory knowledge into practice.
Some BSc learners reported being paired with a Newly Qualified Practitioner (NQP) and found this to be a positive experience as it enabled them to see the job as they will have to do it. The relative lack of experience of their mentor was not seen as a negative as it enabled the learner to see decision making modelled, and to feel part of the decision-making process. Experienced paramedics were also praised and valued for sharing their experience and knowledge. Overall learners felt most PEds were empathetic and reported if they make a mistake they are supported and given constructive feedback (RC2, GP1).
While most BSc learners reported feeling valued, many apprenticeship learners reported they did not feel valued as learners, though they did feel valued as colleagues and appreciated for the skills they have. For both groups of learners feeling valued was very much PEd dependent. Some learners reported having fantastic mentors who want to teach and train them.
Both learners and educators perceived that taking on the PEd role was mandatory to be promoted to a Band 6 with some paramedics only taking on the role to be promoted. No learners reported bullying or undermining, but some had experienced working with PEds who did not want to be an educator and made it known, which left learners feeling unwelcome and unvalued (RC3). Where learners reported they had escalated their concerns, these learners were supported to find an alternative PEd who was better able to support them.
Many learners from both groups (BSc and apprenticeships) noted there is variability in how much time learners may spend with their PEds, with some learners spending most of their time on placement with the same PEd and others working with a variety of paramedics. Learners noted there were positives and negatives with both approaches, as moving around gives them the opportunity to see many different examples of good practice and to get to know the wider team but moving around can also make it harder to get assignments signed off, and to tailor learning to requirements. It was felt this should be more standardised.
Apprenticeship paramedic learners felt education is negatively impacted if pressure on the trust is high, and that the ability to be paired with an appropriate PEd suffers when pressures are high. Apprenticeship learners highlighted protected time with their PEds can depend on geography and varies from area to area. Some learners reported limited shifts with a paramedic due to operational demand and staffing. In some areas this was more positive with learners reporting they were able to choose their PEd, with the education manager securing protected shifts for the learner with their specific PEd (RC3, GP2). However, this was variable and other learners noted that due to service pressures they were frequently paired with Emergency Care Assistants and were the more senior member of the team, although it does provide good exposure to a variety of cases, if not paired with a paramedic PEd who can mentor, they perceived it impacts their progression and learning.
Culture
Many 3rd year BSc learners felt support had improved over the years. PEds also described the trust on an improvement trajectory and felt people are more willing to talk about issues, and if issues are highlighted by a learner the trust is quick to respond.
While the culture appears to be improving, there were some noted challenges from learners reported (from both BSc and apprenticeship groups) of disrespectful and racist comments made about patients, other staff, and learners, by team members. Leaners felt there was very little pushback to these types of comments and seemed especially prevalent in the Bedfordshire/Luton area (RQ1). In another area some female learners reported a few male colleagues had told them they are careful about what they say in front of them at times. These learners were very careful not to accuse colleagues of sexism, but it did raise the question of what may have been said if no woman was present (RQ1).
There was variability in how welcoming some areas/stations were with some stations perceived to be ‘cliquey’ with managers showing preference to some colleagues over others and this was felt to be unsupportive to those outside of the ‘in group’ (RQ1).
Raising concerns
Though many BSc learners indicated they would feel comfortable raising a concern, and believed the process was covered in induction, few could describe a defined pathway, and most were seemingly unaware of the Freedom to Speak Up Guardian (RQ2). If they needed to raise a concern most learners indicated they would go to a Leading Operations Manager (LOM), Clinical Practice Specialist (CPS) or University Lecturer.
2. Educational governance and commitment to quality
None of the learners or PEds we met with in these meetings referenced the Learner Reference or Learner Voice Groups which were in place during the previous engagement in 2022, indicating these networks may no longer be taking place and may be a missed opportunity to elicit feedback and address concerns (RC5).
3. Developing and supporting learners
Health and wellbeing support
Many learners described inconsistent support following traumatic calls and other learners reporting being well supported by TRIM referrals. Some reported TRIM referrals did not go through after being referred or that support was not offered. While apprenticeship learners appeared familiar with the processes for accessing support, many BSc learners were unsure how they could access a TRIM referral but felt support would be available from their university programme if required. Many learners felt supported by LOMS following difficult calls, and described how they were contacted to offer debrief support and to take time out when needed. However, this support was inconsistent and depended on the manager (RC6). PEds also voiced concerns about learner wellbeing as there is limited down time for learning due to operational demands increasing.
Workload
Apprenticeship learners voiced concerns regarding a lack of work-life balance and a desire for more paid study leave (additional days), to support them to complete assignments and access needed rest time (RC4). This was very similar to concerns raised in the 2022 review meetings, when apprenticeship learners suggested their learning experience would be enhanced by EEAST facilitating more study time and paid study leave in a model similar to that used in London.
Some PEds also worried about the pressure on apprenticeship learners and were concerned the trust may not be providing sufficient support to apprenticeship learners and felt this would be aided by applying consistent paid time off to achieve educational requirements (RC4).
Practice assessment documents
Both groups of learners reported there is limited time in shifts to complete PADs and that signoff is frequently completed outside of shift hours (RC7). While assignments can sometimes be done between jobs or while waiting at hospitals, it was noted that on placement shifts the focus is on doing the job. Many learners and PEds highlighted they meet during time off to go through assignments and achieve sign off. While learners were grateful to their PEds for providing this support on rest days, both learners and educators noted this support can be inconsistent, with both groups feeling the trust should not be relying on good will to enable learners to complete assignments.
Developing and supporting supervisors
Most PEds reported feeling valued by learners/students and enjoyed being educators but many did not feel valued by the organisation (trust). Many reported they support learners outside of work hours as there is not sufficient time to cover sign off during placement hours. They also noted a lack of education space and equipment and felt service pressures are prioritised at the expense of education. Time was highlighted as the biggest challenge for education, and it was felt the trust should not be relying on good will and long hospital waiting time for learners to achieve sign off (RC7).
A small number of educators expressed it was mandatory to be an educator to be promoted to a band 6 and that once they were promoted, they felt there was a continual allocation of learners, resulting in not being able to work directly with patients (because learners are hands on), which they found wearying. Some educators felt the PEd role should be recognised as a formal role and thought the clinical supervisor role would aid with this. They also felt a PEd course would be useful (RC3).
Some PEds expressed frustration at perceived ‘failure to fail’. Some felt learners with insufficient skills and aptitudes were passed and then become registered paramedics in spite of feedback on their assessment. Some PEds felt there is more support to report concerns for BSc learners, but that this was more challenged for apprenticeship learners who are EEAST employees. Other educators reported this has improved and that issues are picked up more and there are more support measures in place. In Cambridgeshire and Peterborough where support from the Mentoring, Support and Training Team (MST) is available this improvement was most pronounced (RC2, GP3).
EEAST covers six counties, and it was reported that operational areas have different processes. Many educators highlighted regional inconsistency in what is allowed regarding learners’ scope of practice (an example of wound closure was provided). They also felt there was inconsistency about who can teach and sign off assessments.
Good practice
PEds in Norfolk and Waveney (N&W) reported the University of East Anglia sends a ‘thank you’ pdf to every educator before placements that also includes a video link outlining the learning expectations for the placement of each year group. Educators highlighted this as good practice they would like to see replicated by all HEIs as they felt it supported them to be better educators and also clarified expectations with learners (RC2, GP4).
5. Delivering Programmes and Curricula
Many 3rd year BSc learners reported improvement in the notice given regarding their placement shifts and felt when there are last minute changes (due to PEd sickness for example) they are able to access support to find alternative arrangements.
Placements
Many learners across both groups stated they would value more varied placement opportunities, with maternity and accident and emergency placements repeatedly cited as desirable to broaden their experiences. Halo placements were not felt to be useful, though these were the most common placements offered to apprenticeship learners. One learner noted they had organised a shift on the mental health car in their area, another learner described a multidisciplinary placement experience in a clinic where they were able to take time to practice cannulation, both of which were felt to be very beneficial to the learners (RC2, GP5).
Good practice
Many learners and PEds voiced concerns about learners (particularly BSc learners) getting enough experience during practice placements due to time constraints and waits at hospitals, taking them away from time on the road. Some areas were felt to provide very good mitigation to this challenge with North Kempston praised for the delivery of simulation training at the station provided by ambulance staff who had experiences they could share to enhance simulation, which learners felt was very useful (RC2, GP6).
Further mitigation for the perceived lack of time on placement is the ‘Call before you Convey’ support for newly qualified practitioners which learners praised. This support available from the trust enables NQPs to ask for support and clarification about decision making. Learners reported calling for decision support is built into NQP years (required during this period) and many felt fortunate that EEAST provides this support and reassured that this support would be available to them when they qualify (RC2, GP7).
The MST teams in Cambridgeshire and Peterborough (C&P) were also highly praised for being both supportive to learners and for facilitating BSc learners to attend continuing professional development (CPD) training offered to staff. The C&P MST teams were also reported by PEds to be proactive in identifying and providing additional support to learners with additional learning requirements, as well as support to newly qualified staff. C&P was unique in providing this support to learners indicating there are also opportunities to expand this support consistently across all areas for the trust (RC2, GP3).
6. Developing a Sustainable Workforce
Careers advice
Learners from different BSc university programmes reported variable experiences in the support available regarding careers advice, with many unsure and anxious about next steps. The process cited by learners at the University of Suffolk was highlighted as good practice, with learners from University of Suffolk reporting the process in 2024 changed with the job application process starting in April, when this had previously begun in Autumn. The learners described they were provided with coaching to get a job, and that the April start took some of the pressure off learners during a stressful time at the end of their degree programme. This change also supported colleagues to see learners as ‘one of the team’, as they had already accepted conditional job offers (RC2, GP8).
Many BSc learners would recommend EEAST as a placement and reported they would pursue a career with a trust. However, apprenticeship learners were less likely to recommend EEAST due to the perception that their education is not prioritised by the trust.Most learners from both groups would recommend patient care and thought the Trust provides a high quality of care to patients.
Areas that are working well
| Description | Education quality domain(s) and standard(s) |
|---|---|
| Most learners (from both groups) perceived their colleagues are supportive and felt their PEds enabled them to try their skills to achieve firsthand experience. | 1.1, 1.4, 1.13 |
| PEds reported they can flexibly adapt to learner needs and learning styles to effectively support learners to put theory knowledge into practice. | 1.1, 3.5, 4.4 |
| Some learners reported being paired with a Newly Qualified Practitioner (NQP) and found this to be a positive experience as it enabled them to see the job as they will have to do it. The relative lack of experience of their mentor was not seen as a negative as it enabled the learner to see decision making modelled, and to feel part of the decision-making process. | 1.1, 3.8 |
| Where learners reported they had escalated their concerns about support from PEds, these learners were supported to find an alternative PEd who was better able to support them. | 1.3, 2.3 |
| Many 3rd year BSc learners felt support had improved over the years. PEds also described the trust as on an improvement trajectory and felt people are more willing to talk about issues, and if issues are highlighted by a learner the trust is quick to respond. | 1.1, 2.1, 2.2, 2.3 |
| Many 3rd year BSc learners reported improvement in the notice given regarding their placement shifts and felt when there are last minute changes (due to PEd sickness for example) they are able to access support to find alternative arrangements. | 1.1, 5.6 |
Good practice
| Description | Reference number and domain(s) and standard(s) |
|---|---|
| Overall learners felt most PEds were empathetic and reported if they make a mistake they are supported and given constructive feedback. | GP1 Education quality domain(s): 1.1, 1.4, |
| In some areas apprenticeship learners reported they were able to choose their PEd, and the education manager secured protected shifts for the learner with their specific PEd. | GP2 Education quality domain(s): 1.1, 1.2, 1.13 |
| The Mentoring, Support and Training Team (MST) in Cambridgeshire and Peterborough was highly praised for being both supportive to learners and for facilitating BSc learners to be able to attend continuing professional development (CPD) training offered to staff. The C&P MST groups were also reported by PEds to be proactive in identifying and providing additional support to learners with additional learning requirements, as well as support to newly qualified staff. | GP3 Education quality domain(s): 1,1, 1.12, 3.4, 3.7, 3.8 |
| PEds in Norfolk and Waveney (N&W) reported the University of East Anglia sends a ‘thank you’ pdf to every educator before placements that also includes a video link to outline the learning expectations for the placement for each year group. Educators highlighted this as good practice they would like to see replicated across areas as they felt it supported them to be better educators and also clarified expectations with learners. | GP4 Education quality domain(s): 4.4, 4.6 |
| One learner noted they had organised a shift on the mental health care in their area, another learner described a multidisciplinary placement experience in a clinic where they were able to take time to practice cannulation, both of which were felt to be very beneficial to the learners. | GP5 Education quality domain(s): 5.1, 5.4 |
| North Kempston was praised for the delivery of simulation training at the station provided by ambulance staff who had experiences they could use to enhance simulation, which learners felt was very useful. | GP6 Education quality domain(s): 5.1, 5.4, |
| Further mitigation for the perceived lack of time on placement is the ‘Call before you Convey’ support for newly qualified practitioners which learners praised. This support available from the trust enables NQPs to ask for support and clarification about decision making. Calling for decision support is built into NQP years (required during this period) and many learners felt fortunate that EEAST provide this support, and reassured knowing this support would be available to them when they qualify. | GP7 Education quality domain(s):1.1, 3.5, 3.8, |
| Learners from different BSc university programmes reported variable experiences in the support available regarding careers advice, with many unsure and anxious about next steps. The process cited by learners at the University of Suffolk was highlighted as good practice, with learners from University of Suffolk reporting the process in 2024 changed with the job application process starting in April, when this had previously begun in Autumn. The learners described they were provided with coaching to get a job, and that the April start took some of the pressure off learners during a stressful time at the end of their degree programme. | GP8 Education quality domain(s): 6.2, 6.4 |
Areas for improvement
Mandatory requirements
| Review findings | Required action | Reference number and or domain(s) and standard(s) |
|---|---|---|
| While culture appears to be improving, there were some noted challenges with learner reports (from both BSc and apprenticeship groups) of disrespectful and racist comments made about patients, other staff, and learners, by team members. Leaners felt there was very little pushback to these types of comments and seemed especially prevalent in the Bedfordshire/Luton area. In another area some female learners reported a few male colleagues had told them they are careful about what they say in front of them at times. These learners were very careful not to accuse colleagues of sexism, but it did raise the question of what may have been said if no woman was present. There was also variability in how welcoming some areas/stations were with some stations perceived to be ‘cliquey’ with managers showing preference to some colleagues over others and this was felt to be unsupportive to those outside of the ‘in group’ | NHS England WT&E require EEAST to: Continue the positive work being undertaken by the trust to address the perceived cultural issues. Ensure the zero-tolerance policy is clearly communicated to all existing and future learners and learners are encouraged to report cultural concerns. Continue to ensure that educators and other staff are trained and supported to appropriately challenge poor behaviours from staff and/or patients. Ensure that the expected values and professional practice that learners are exposed to are aligned with professional, regulatory and NHS Values. | RQ1 Education quality domain(s): 1.1, 1.3, 1.7, 1.8, 2.2 |
| Few learners could describe a defined escalation pathway, and most were seemingly unaware of the Freedom to Speak Up Guardian. | NHS England WT&E requires the trust to: Ensure all learners and NQPs know who the Freedom to Speak up Guardian is and how to contact them. Ensure all learners are aware of how to escalate concerns and complete a DATIX report. Ensure any escalation actions are fed back and learners, and PEds are included within the feedback loop. | RQ2 Education quality domain(s): 1.7, 1.10 |
Recommendations
| Recommendation | Reference number and domain(s) and standard(s) |
|---|---|
| NHS England WT&E recommend the trust annually promote the NHS England National Education Survey (NETS) and aim for at least 40% learner annual uptake to ensure robust survey feedback. | RC1 Education quality domain(s): 1.1, 1.4 |
| NHS England WT&E recommends the trust look for opportunities to spread areas of good educational practice identified in this report consistently across all areas of the trust. | RC2 Education quality domain(s): 1.1, 1.4, 1.12, 1.13, 3.4, 3.7, 3.8, 4.4, 4.6, 5.1, 5.4, 6.2, 6.4 |
| No learners reported bullying or undermining, but some had experienced working with PEds who did not want to be educators and made it known, which left them feeling unwelcome and unvalued. In order to further support learners and PEds NHS England WT&E recommend the following: The trust review the induction training procedures for new PEds to ensure they are appropriately supported to take on an educational role. The trust review the opportunities for training that PEds undertake to enhance the effectiveness of them undertaking an education role and ensure appraisals include feedback on their performance as educators and a review of their PEd role. | RC3 Education quality domain(s): 1.1, 1.4, 4.2, |
| Many apprenticeship learners described feeling valued by colleagues, but not by the trust, primarily due to feeling their educational requirements are not prioritised and concerns about a lack of work-life and study balance. NHS England WT&E recommends EEAST review supports available to apprentice learners to retain a health balance between study and home life and wellbeing support is regularly signposted to all learners. | RC4 Education quality domain(s):1.1, 3.1 |
| None of the learners or PEds we met with in these meetings referenced the Learner Reference or Learner Voice Groups which were in place during the previous engagement in 2022, indicating these networks may no longer be taking place and may be a missed opportunity to elicit feedback and address concerns. NHS England WT&E recommends these meetings be reinstated if they have stopped, and that its existence is highlighted to all learners, and they are actively encouraged to participate and share their experiences. | RC5 Education quality domain(s): 1.4 |
| Many learners described inconsistent support following traumatic calls. NHS England WT&E recommends EEAST review support to learners following difficult calls (and learner ability to access TRIM) to ensure support is provided where appropriate, including opportunities to debrief. WT&E recommend learner feedback be sought regarding the perception of what constitutes a ‘difficult call’ and that resources to support PEds to understand their roles include this information recognising that those who have been in the job for a period of time may not be equally affected by calls that may impact learners, who are less experienced. | RC6 Education quality domain(s): 1.5, 1.6, 3.1 |
| Learners and PEds reported there is limited time in shifts to complete PADs and that signoff is frequently completed outside of shift hours. NHS England WT&E recommends EEAST consider if there are opportunities to enable protected time for learners and their PEds to debrief and review learning requirements, and where possible protect this time via shift rosters. Further to the above apprenticeship learners perceived they were sometimes disadvantaged or negatively impacted by service pressures, when it was sometimes more difficult to be paired with a paramedic who could review and sign off assignments. NHS England WTE recommends the trust review the time that PEds are allocated to undertake their educator role and identify any opportunities where this may be increased, and or, standardised across the region, and look to share good practice strategies that support protected time status with apprenticeship learners and their PEds across all geographical areas. Additionally WT&E recommend EEAST regularly share updates to the University of Cumbria and (also now the University of Bedford) the numbers of degree apprentices meeting their programme requirements for supervision/or by exception provide a report regarding those who are not meeting current programme standards for supervision, with an action plan to ensure that they catch up. | RC7 Education quality domain(s): 1.1, 5.1, 5.6 |
Report approval
Report completed by: Marjorie Casey, Education Quality Manager
Review lead: Tracy Wray, Regional Lead for Education Quality
Date approved by review lead: 5 March 2025
NHS England authorised signature: Prof Bill Irish, Regional Multiprofessional Dean/Regional Postgraduate Dean
Date authorised: 5 March 2025
Final report submitted to organisation: 28 March 2025
NHS England education quality domains and standards for quality reviews
| Quality standard | Education quality domain 1: Learning environment and culture | Requirement reference number |
|---|---|---|
| 1.1 | The learning environment is one in which education and training is valued and championed. | GP1, 2, 3, 7, RQ2, RC1, 2, 3, 4, 7 |
| 1.2 | The learning environment is inclusive and supportive for learners of all backgrounds and from all professional groups. | GP2 |
| 1.3 | The organisational culture is one in which all staff are treated fairly, with equity, consistency, dignity and respect. | RQ2 |
| 1.4 | There is a culture of continuous learning, where giving and receiving constructive feedback is encouraged and routine. | GP1 RC1, 2, 3, 7 |
| 1.5 | Learners are in an environment that delivers safe, effective, compassionate care and prioritises a positive experience for patients and service users. e.g., Patient safety discussions | RC6 |
| 1.6 | The environment is one that ensures the safety of all staff, including learners on placement. | RC6 |
| 1.7 | All staff, including learners, are able to speak up if they have any concerns, without fear of negative consequences. e.g., Freedom to Speak up Guardians, Survey intelligence including GMC NTS/NETS/PARE/GoSWH etc. | RQ2, 3 |
| 1.8 | The environment is sensitive to both the diversity of learners and the population the organisation serves. | RQ2 |
| 1.9 | There are opportunities for learners to take an active role in quality improvement initiatives, including participation in improving evidence-led practice activities and research and innovation. e.g., Programme Review representation discussions, Learner Educator representation discussions | |
| 1.10 | There are opportunities to learn constructively from the experience and outcomes of patients and service users, whether positive or negative. | RQ3 |
| 1.11 | The learning environment provides suitable educational facilities for both learners and supervisors, including space and IT facilities, and access to library and knowledge services and specialists. e.g., Facilities, IT provision, Library and knowledge services | |
| 1.12 | The learning environment promotes multi-professional learning opportunities. e.g., Multi-professional discussions around opportunities | GP3 RC1 |
| 1.13 | The learning environment encourages learners to be proactive and take a lead in accessing learning opportunities and take responsibility for their own learning. | GP2 RC2 |
| Quality standard | Education quality domain 2: Educational governance and commitment to quality | Requirement reference number |
|---|---|---|
| 2.1 | There is clear, visible and inclusive senior educational leadership, with responsibility for all relevant learner groups, which is joined up and promotes team-working and both a multi-professional and, where appropriate, inter-professional approach to education and training. e.g., GoSWH discussions i.e., Learner Forums | |
| 2.2 | There is active engagement and ownership of equality, diversity and inclusion in education and training at a senior level. e.g., Discussions about racial discrimination/undermining – Trust engagement | RQ2 |
| 2.3 | The governance arrangements promote fairness in education and training and challenge discrimination. e.g., Discussions about racial discrimination/undermining – promotion and actions within Trust | |
| 2.4 | Education and training issues are fed into, considered and represented at the most senior level of decision making. | |
| 2.5 | The placement provider can demonstrate how educational resources (including financial) or allocated and used. | |
| 2.6 | Educational governance arrangements enable organisational self-assessment of performance against the quality standards, an active response when standards are not being met, as well as continuous quality improvement of education and training. e.g., SAR | |
| 2.7 | There is proactive and collaborative working with other partner and stakeholder organisations to support effective delivery of healthcare education and training and spread good practice. e.g., good practice discussions | |
| 2.8 | Consideration is given to the potential impact on education and training of services changes (i.e., service re-design / service reconfiguration), taking into account the views of learners, supervisors and key stakeholders (including NHSE and education providers). |
| Quality standard | Education quality domain 3: Developing and supporting learners | Requirement reference number |
|---|---|---|
| 3.1 | Learners are encouraged to access resources to support their physical and mental health and wellbeing as a critical foundation for effective learning. | RC4, 6 |
| 3.2 | There is parity of access to learning opportunities for all learners, with providers making reasonable adjustments where required. | |
| 3.3 | The potential for differences in educational attainment is recognised and learners are supported to ensure that any differences do not relate to protected characteristics. | |
| 3.4 | Supervision arrangements enable learners in difficulty to be identified and supported at the earliest opportunity. | GP3 RC2 |
| 3.5 | Learners receive clinical supervision appropriate to their level of experience, competence and confidence, and according to their scope of practice. | GP7 RC2 |
| 3.6 | Learners receive the educational supervision and support to be able to demonstrate what is expected in their curriculum or professional standards to achieve the learning outcomes required. | |
| 3.7 | Learners are supported to complete appropriate summative and/or formative assessments to evidence that they are meeting their curriculum, professional standards, and learning outcomes. | GP3 RC2 |
| 3.8 | Learners are valued members of the healthcare teams within which they are placed and enabled to contribute to the work of those teams. | GP3, 7 RC2 |
| 3.9 | Learners receive an appropriate, effective and timely induction into the clinical learning environment. | |
| 3.10 | Learners understand their role and the context of their placement in relation to care pathways, journeys and expected outcomes of patients and service users. | |
| 3.11 | Learners are supported, and developed, to undertake supervision responsibilities with more junior staff as appropriate. |
| Quality standard | Education quality domain 4: Developing and supporting supervisors | Requirement reference number |
|---|---|---|
| 4.1 | Supervisors can easily access resources to support their physical and mental health and wellbeing. | |
| 4.2 | Formally recognised supervisors are appropriately supported, with allocated time in job plans/ job descriptions, to undertake their roles. | RC3 |
| 4.3 | Those undertaking formal supervision roles are appropriately trained as defined by the relevant regulator and/or professional body and in line with any other standards and expectations of partner organisations (e.g., education providers, NHS England). | |
| 4.4 | Clinical Supervisors understand the scope of practice and expected competence of those they are supervising. | GP4 RC2 |
| 4.5 | Educational Supervisors are familiar with, understand and are up to date with the curricula of the learners they are supporting. They also understand their role in the context of learners’ programmes and career pathways, enhancing their ability to support learners’ progression. | |
| 4.6 | Clinical supervisors are supported to understand the education, training and any other support needs of their learners. | GP4 RC2 |
| 4.7 | Supervisor performance is assessed through appraisals or other appropriate mechanisms, with constructive feedback and support provided for continued professional development and role progression and/or when they may be experiencing difficulties and challenges. |
| Quality standard | Education quality domain 5: Delivering curricula and assessments | Requirement reference number |
|---|---|---|
| 5.1 | Practice placements must enable the delivery of relevant parts of curricula and contribute as expected to training programmes. | GP5, 6 RC2, 7 |
| 5.2 | Placement providers work in partnership with programme leads in planning and delivery of curricula and assessments. | |
| 5.3 | Placement providers collaborate with professional bodies, curriculum/ programme leads and key stakeholders to help to shape curricula, assessments and programmes to ensure their content is responsive to changes in treatments, technologies and care delivery models, as well as a focus on health promotion and disease prevention. | |
| 5.4 | Placement providers proactively seek to develop new and innovative methods of education delivery, including multi-professional approaches. | GP5, 6 RC2 |
| 5.5 | The involvement of patients and service users, and also learners, in the development of education delivery is encouraged. | |
| 5.6 | Timetables, rotas and workload enable learners to attend planned/ timetabled education sessions required to meet curriculum requirements. | RC7 |
| Quality standard | Education quality domain 6: Developing a sustainable workforce | Requirement reference number |
|---|---|---|
| 6.1 | Placement providers work with other organisations to mitigate avoidable learner attrition from programmes. | |
| 6.2 | There are opportunities for learners to receive appropriate careers advice from colleagues within the learning environment, including understanding other roles and career pathway opportunities. | GP8 RC2 |
| 6.3 | The provider engages in local workforce planning to ensure it supports the development of learners who have the skills, knowledge and behaviours to meet the changing needs of patients and service. | |
| 6.4 | Transition from a healthcare education programme to employment and/or, where appropriate, career progression, is underpinned by a clear process of support developed and delivered in partnership with the learner. | GP8 RC2 |