Executive summary
The panel would like to thank the senior leadership team at South East Coast Ambulance NHS Foundation trust (SECAmb) for accommodating this Senior Leadership Conversation and for their positive engagement in discussions around the quality of education and training for paramedic science learners within their organisation. The visit and subsequent discussion focused on the Trust’s response and actions regarding escalating concerns around sexual safety and the recommendations from the NHSE Education quality review of placement experience within Trust in 2024.
The panel heard that the Trust support six-hundred and five UCAS students from seven Higher Education Institutions (HEIs) and seven hundred active Practice Educators (PEds) across the southeast region. The Trust recognised that longstanding cultural issues are affecting both learners’ and educators’ learning and working experience.
The panel heard that there has been improved training for managers undertaking investigations concerning sexual safety and that the HR triage process around reporting concerns now includes a Freedom To Speak Up (FTSU) Guardian. The Trust reported that the challenges they are working on improving relate to inconsistent and delayed feedback to HEIs and learners regarding staff tribunals and what feedback looks like.
The Chief Paramedic Officer presented a comprehensive Education Improvement Plan (EIP). An overview of the actions taken to address concerns highlighted by the 2024 NHSE Education Quality review of the Trust was provided; further details are outlined under the relevant domains of this report. The panel recognised that a considerable amount of work had been undertaken and was planned for the foreseeable future.
The panel concluded that the senior leadership team at SECAmb were appropriately sighted on the existing issues around education placement quality raised and discussed during the visit. The Trust shared formative actions toward goals already outlined in their EIP to address and improve upon areas of concern raised during the discussion, these were mapped against a clear set of timescales to initiate and evaluate progress towards improvement. The panel issued six mandatory requirements conveyed to the Trust as of 10th April 2025 detailed within this report mapped to the Education Quality Framework domains, with a deadline for submission of documentary evidence in October 2025 to align with the Trust’s own timeframes for completion of work outlined in their EIP. NHSE WT&E Education Quality will liaise with SECAmb to arrange a follow up meeting in July 2025 to review progress against requirements issued in this report and will further monitor progress and challenges via other fora as appropriate.
Review overview
Background to the review
This Senior Leadership Conversation was arranged, in part, as a result of the NHSE Work, Training & Education (WT&E) Education Quality Review of learner placement experience undertaken during 2023-24, the report of which provided the Trust with seven recommendations. At the time the intervention took place, there were also six open concerns with Higher Education Institutions (HEIs) regarding a culture of inappropriate behaviour and the Trust’s timeliness and robustness in responding to these concerns.
Feedback from learners-on-placement focus groups held between December 2023 and March 2024 combined feedback from 2nd and third year direct entry learners from four HEIs around unprofessional behaviour, including racism, inappropriate behaviour, being denied opportunities within their scope of practice, consistency of clinical supervision, and poor communication from the Trust to learners regarding shifts/rostering. KSS Education Quality did not receive the assurance from the Trust that they had management of issues raised.
Who we met with
- Chief Paramedic Officer
- Chief Medical Officer
- Chief Nursing Officer and Deputy CEO
- Chief Operating Officer
- Consultant Paramedic for Clinical Education
- Associate Director of Operations West
- AD HR Business Partners
- Head of Education
- Senior Education Manager
Review panel
Education Quality Review Lead
- Postgraduate Dean for Kent, Surrey & Sussex
Specialty Experts
- Associate Dean
- Deputy Director – Clinical Professions
- Senior Education Specialist – Clinical Education/Practice Learning
- Faculty Lead for Advancing Practice
- Senior Education Specialist – Urgent & Emergency Care
NHSE Education Quality Representative
- Education Quality Lead for Clinical Placements
- Education Quality Intelligence Manager
- Education Quality Project Officer
Lay Representative
Scribe
- Education Quality Project Officer
Review findings
Quality Domain 1: Learning Environment and Culture
Induction
When asked how the Trust are implementing the Safer Learning Education Charter (SLEC), the panel heard the Trust is working with other southeast Trusts to understand how SLEC can be embedded meaningfully into their Education Improvement Plan’s (EIP) long- and short-term milestones. The Trust reported that there has been a significant recruitment in the clinical education team in order to allocate two Band 7 educators per site (28 in total across the Trust sites) to act as an on-site conduit between the education and operational teams and learners. They will provide access to wellbeing support and promote a culture of speaking up.
When asked about the induction process, the Trust reported that there is a five-day face-to-face induction where psychological and sexual safety is a focus, followed by an individual station induction. These can be led by a team leader or champion that meets learners on the day whilst some stations have learner noticeboards. The Trust acknowledged that there is a gap in individual station inductions, and this is a part of their EIP. The panel heard that the feedback on induction from current learners has so far been positive. Please see Mandatory Requirement MR-06.
Learning environment
The panel asked about the recent change of ambulance manufacturer which has made communication between the front crew and cab (where learners are often assigned) difficult. This meant that the learners were unable to hear the cab radio, and learners have reported arriving to incidents unprepared. The Trust reported that implementation of the National Mobilisation Application (NMA) will enable learners to gain access to job information utilising the software built into the NMA app. Trust staff / learners who have an iPad can access incident details on their work issued device until they have cleared from the scene. Please see Mandatory Requirement MR-03.
Quality Domain 2: Educational Governance and Commitment to Quality
Safeguarding concerns and reporting processes
The panel heard that Trust leadership are addressing safeguarding concerns raised by learners and HEIs. Going forward the Chief Paramedic Officer and/or Senior Education Manager will contribute to the work of the multidisciplinary team (MDT) which will include an HR business partner, a senior member of the operations team, and a consultant paramedic (depending on the issue raised). The Trust are also considering whether an HEI representative should be included to help determine the formality of the investigation. The Trust reported that they are working with the Association of Ambulance Chief Executives (AACE) to provide external training for investigators and commissioning managers on understanding the nuances of professional boundaries and navigating sensitive discussions around sexual safety. The Trust reported 60 members of staff have undergone this training so far.
The panel heard that the MDT conducts a fact-finding mission around a raised concern, acknowledges it with the learner, and talks them through the process and next steps. The investigation report goes to the commissioning manager who ultimately decides the final outcome. To ensure impartiality, sexual safety cases are evaluated by external law firm. Other cases are managed within the Trust HR policies and procedures route.
When asked about the Trust’s means of data reporting concerns, the panel heard that the sexual safety dashboard is updated monthly, and that the senior education team have introduced weekly and monthly meetings with HEIs to keep them up to date of ongoing initiatives and the status of concerns. The senior education manager will inform NHSE Education Quality of concern investigation outcomes. Please see Mandatory Requirement MR-05. When asked how this process was being communicated to learners, the Trust reported that the senior leadership team encourage an open-door policy, and that staff and learners are included in all outgoing communications. The Trust reported that they could go further to feedback to learners. Please see Mandatory Requirement MR-04.
Quality Domain 3: Developing and Supporting Learners
Changing scope of practice
The Trust were asked how they communicate to learners the changing scope of practice between apprentice and non-apprentice shifts. The panel heard that on apprentice shifts a learner is under direct supervision of their PEd so as to ensure the learner gains the required hours. Outside of those hours they act as their employed role as associate ambulance practitioner. This is communicated to learners by both HEI partners as well as the Trust.
When asked how the Trust manages those who step outside scope of practice, the panel heard that, depending on the situation, a professional or learner discussion may be required. The Trust reported that they follow official procedure of informing the Health and Care Professions Council (HCPC) of any dismissals. Please see Mandatory Requirement MR-02.
Quality Domain 4: Developing and Supporting Supervisors
Supporting staff through service demand
When asked how the Trust are managing service demand against educational supervision, the Trust reported that a new model of clinical supervision is being introduced from 1st April 2025. The panel heard that previously ten hours of overtime was paid out to PEds to make up for their supervision time which was organised on an ad hoc basis. The panel heard that the new model of integrated care will signpost virtual care for those cases that are neither immediate nor time sensitive. From 2025, 10 hours protected supervision time for Peds will be allocated and formally rostered. With the allocation of the education team to individual operating units to support both learners and staff, appropriate resources such as desk space will be identified.
Please see Mandatory Requirement MR-01. The panel heard that this model has not yet been communicated to HEIs or learners.
Quality Domain 5: Delivering Programmes and Curricula
Advanced Practice learners
The panel heard that there are currently 60 Advanced Practice (AP) learners at the Trust. The Trust recently trialled maintaining a database that tracks the episodes of AP learner supervision (a minimum of 1 hour-per-week per individual) to ensure meeting the minimum standards of AP funding.
The Trust reported the employment of 8a Clinicians, each with a job plan and paramedic consultant level supervision, to provide support for the AP line of study. The panel heard this is to encourage retention of AP graduates as educators (three years post-qualification). It was reported the Trust will offer a minimum of 0.3 shifts-per-week as a means to attract those interested in portfolio careers. This will enable learners to have 7.5 hours of supervision time over four weeks.
The panel heard that the Trust are researching whether to implement an Apprenticeship lead for AP.
Quality Domain 6: Developing a Sustainable Workforce
Workforce modelling
The panel heard that the Trust have scheduled an internal review of placement capacity as part of their improvement plan with a view to working alongside HEIs to ensure any reduction in capacity does not impact placement quality. A possible reduction of ambulances on the ground would affect the number of undergraduate learners. However, the use of virtual spaces for care could provide another learning placement opportunity and an alternative deployment of Band 6 paramedics. Most HEI calendars work from September to May/June, so there could be an opportunity for the Trust to offer a June to September placement.
It was reported that a majority of the Trust’s education team have been provided with development such as suicide prevention and mental health first aid.
Requirements
Immediate mandatory requirements
No immediate mandatory requirements were issued.
Mandatory requirements
| Description | Domain(s) and standard(s) |
|---|---|
| Induction All learners positively described the processes for the trust and departmental inductions, sharing that they helped in preparing them for their placements. Learners also advised that they had received orientations to each of the clinical placement areas before they started their shifts. These orientations provided key information needed for their learning. | 3.9 |
| Learning opportunities Opportunities to learn and achieve proficiencies within the department were positively described by learners. Learners are invited to multi-disciplinary training, and they can join the Perinatal Mental Health Team, the Neonatal Unit and the Transitional Care Unit as part of their extended placements. At our last visit in March 2024, learners raised concerns about not gaining appropriate exposure to meet their clinical placement hours whilst experiencing the continuity of carer model. During this visit, learners shared improvements to their experience, reporting that the trust has implemented mitigations to ensure that their clinical placement hours are achieved. | 1.12, 5.4 |
| Raising concerns All learners were aware of the mechanisms to raise concerns. Where issues had been escalated, learners felt that they were supported by the team and received feedback regarding how their concerns were managed. | 1.7 |
| Culture Overall, learners described positive cultures and behaviours within the maternity department. All felt that they had been welcomed into the different clinical areas and that they had been able to build good relationships with the midwives. The Practice Facilitators were praised by all learners, practice supervisors and practice assessors for their support. Learners shared that the Practice Facilitators are visible, undertaking daily walk arounds of the clinical areas, and they also hold a bleep so they can be urgently contacted if needed. Learners also shared other mechanisms of support that are offered by the department including access to the PMAs after potentially traumatic events and being able to speak with the student link midwives if they need help. | 1.1, 2.4 |
Report approval
Report completed by: Alex Bamford-Blake, Education Quality Project Officer
Review lead: Jo Szram, Postgraduate Dean for Kent, Surrey & Sussex
Date approved by review lead: 9 April 2025
NHS England authorised signature: Jo Szram, Postgraduate Dean for Kent, Surrey & Sussex
Date authorised: 9 April 2025
Final report submitted to organisation: 22 May 2025