An ambulance service's centralised operating model had become ineffective, with a disconnect between local operations and their central supporting functions such as Scheduling, Make Ready, Fleet. These departments operated in siloes, and staff feedback suggested there was a lack of clarity and operational grip of the tasks required to maintain a high-performing service. The operating model was no longer fit for purpose and bred an 'us versus them' culture that left local and central teams feeling disempowered.

This issue was reflected in Trust performance, specifically in its out of service (OOS) data. The Trust saw a high rate of 'singles' without a crewmate, with long lead times to pair up with a colleague and an increase in vehicle related OOS. A lack of accountability at the local level, coupled with limited oversight and on the ground detail from central teams, led to delays in resolving these issues.