NHS England published its Culture Review of Ambulance Trusts in February 2024, following the National Guardian’s Office Speak Up Review of Ambulance Trusts the previous year.
Both reviews highlighted what many colleagues already knew: there are deep cultural challenges across ambulance services in England, and these challenges affect the experience of our people, their wellbeing and ultimately patient care.
In response, a national culture review delivery board was established to drive improvement across several priority areas. This delivered several important sector‑wide actions, including:
- A bespoke equality, diversity and inclusion plan for the ambulance sector.
- Continued partnership work with trade unions to promote sexual safety and reduce misogyny.
- A stronger balance between people metrics and performance metrics, reflected in the ambulance national outcomes framework.
- The launch of an aspiring operations director programme.
- A sustained focus on employee wellbeing and suicide prevention.
To ensure this momentum continued, a smaller Culture Review Guardians’ Group was formed in summer 2025. This group brings together representatives from across the ambulance sector, the Royal College of Paramedics and NHS England. It is co‑chaired by Tracy Nicholls, Chief Executive of the Royal College of Paramedics, and Anna Parry, Managing Director of AACE. Members are united by a shared commitment to meaningful, long‑term cultural improvement.
Guardians’ Group vision
Our purpose
Building on the national Culture Review, the Guardians’ Group exists to maintain and support sustainable progress in cultural improvement across ambulance services. Our aim is to ensure that national commitments translate into visible, lasting change locally. We want every ambulance service to be a place where people feel safe, respected and able to speak up, and where leadership is compassionate, accountable and inclusive. Evidence shows that when staff feel psychologically safe, patient care is safer too.
Our focus
- Champion local action — supporting each service to deliver an ambitious, credible and staff‑informed cultural improvement plan.
- Strengthen accountability — using board papers, staff surveys and the NHS Oversight Framework to track progress and maintain leadership focus.
- Amplify leadership — identifying and supporting leaders who model just culture, psychological safety and equity.
- Embed sexual safety — ensuring trusts move beyond policy into tangible, measurable action on sexual harassment, bullying, discrimination and equity.
- Create transparency — promoting open reporting, effective use of data and honest storytelling about progress and challenges.
Our commitment
We see ourselves as guardians of progress, not process.
With most national actions now complete, our role is to help secure lasting change by turning intent into impact — locally led, nationally supported, and always centred on improving the culture, safety and wellbeing of the ambulance workforce and the care we provide to patients.
Why this matters – from members of the Guardians’ Group
Anna Parry, Managing Director, AACE:
“Cultural improvement is not a side project — it is fundamental to the safety, pride and professionalism of our people and the care they deliver to patients. When we invest in culture, we invest in the people who keep our services running every day. The Guardians’ Group is here to make sure this work maintains momentum, because our people and our patients deserve nothing less.”
Claire Joss, Deputy Director, Ambulances, NHS England:
“The Ambulance Culture Review is not an optional extra – it is at the heart of how we provide safe, compassionate care, and how we look after one another. A positive, inclusive culture enables people to speak up, to learn, and to perform at their best under pressure. If we want sustainable improvement for our patients and staff, this work must remain a priority, not just in words, but in our everyday actions.”
Jason Evans, Deputy Director, West Midlands Integrated Urgent & Emergency Care Team; Chair – National Ambulance Commissioners Network (NACN):
“It is my personal pleasure to continue supporting this crucial and nationally significant work. The recommendations arising from the cultural review are now clearly embedded at both strategic and operational levels across England’s ambulance providers. The review demonstrates what can be achieved when informed national leadership and sector insight are effectively aligned with organisational assurance, continuous learning, and individual development.”
John Martin, Chief Executive, South Western Ambulance Service:
“One way that culture can be understood is ‘the way we do things around here’. This programme of work is fundamental because some of the way we have done things in the past and continue to do is bad for us. Through continuing this programme, we can build on the work to date and together improve our organisational environment further across the country.”
Kerry Gulliver, Director of People, East Midlands Ambulance Service / Chair, Chief People Officers’ Group, AACE:
“Improving culture in NHS ambulance services matters because our people and our patients matter. A continued focus on cultural development is essential to ensure the creation of a healthy culture that protects staff, supports psychological safety, strengthens teamwork, improves staff experience at work, and ultimately saves lives. When we work together to build a culture of respect, trust and compassion, we can create the conditions for exceptional care.”
Pauline Cranmer, Chief Paramedic, London Ambulance Service NHS Trust:
“Focusing on our culture must remain a priority until everyone in our sector can come to work without fear of discrimination or attack. It is imperative we work together and share areas of good practice to tackle poor cultures and behaviours to collectively make our workplaces safer for all.”
Pritti Mehta, Deputy Director Improvement, People Group, NHS England:
“Improving the experience of ambulance staff is the right thing to do. It is also key to improving performance, productivity and outcomes for patients and communities. And this is an even bigger goal for ambulance staff, where the operational challenges can be the greatest. The Ambulance Culture Review shines a light on this and recommends practical actions to enable improvement. These are even more important today and are at the heart of the forthcoming NHS staff standards. While significant progress has been made across the sector, we need to keep focused on this hugely important work.”
Sharandeep Bandesha, National Officer for Ambulance, UNISON:
“UNISON welcomes the work that is being done to address poor workplace cultures within ambulance services which are often deep rooted and difficult to change. Ambulance staff are expected to be superhuman and deal with whatever is thrown at them, but this comes at a huge personal cost. This work rightly reflects the need to put the health and wellbeing of the ambulance workforce centre stage. UNISON will continue to work in partnership with AACE to challenge unhealthy cultures and to ensure the voice of the workforce is heard so that we can truly make workplaces safe and inclusive for all. “
Tracy Nicholls, Chief Executive, Royal College of Paramedics:
“The Royal College of Paramedics is clear that improving culture within the ambulance service is not a one-off piece of work; it is a sustained commitment that directly affects the wellbeing, safety and professionalism of our workforce, and ultimately the care patients receive. The findings of Siobhan Melia’s Culture Review were a vital moment of reflection for our profession, shining a necessary light on behaviours and systems that too often caused harm or silenced voices.
The ongoing work of the Guardians’ Group is therefore critically important. It provides leadership, accountability and, crucially, reassurance to staff that concerns will be heard and acted upon. Continuing this work is essential if we are to build ambulance services that are inclusive, compassionate and psychologically safe and be places where paramedics and all ambulance professionals can thrive, speak up without fear, and deliver the highest standards of care to the communities they serve.”
For more information, please contact anna.parry@aace.org.uk.
