Secure Ambulance Standards in the UK: What Good Looks Like

Thousands of secure ambulance journeys take place in the UK every year, carrying people who are frightened, unwell and frequently detained under the Mental Health Act. There is no published national standard defining what the vehicle should look like, how the crew should be trained, or what should happen if a journey goes wrong.

The result is a market where two providers can hold the same registration, bid for the same contract at a similar price, and deliver something completely different once the doors close. This is what to look at, and what to ask for, when the decision is yours.

Why Secure Ambulance Standards Vary So Much

Any organisation transporting patients in England must register with the Care Quality Commission and is inspected like any other care service. That registration is meaningful, and the reports are public. What it does not do is define the interior of the vehicle, the depth of crew training, or how a journey is planned.

Two structural pressures then push quality downward. The first is that mental health transport is increasingly bundled into general patient transport tenders, so it is bought as though it were the same commodity. The second is that tender scoring weights price heavily. A provider investing in bespoke vehicles and a multi-level training programme carries a cost base that a provider running converted vans does not, and in a price-led evaluation the second one wins.

That is the reason Secure 24 exists in its current form. Over a decade ago our founder went into the sector and found the balance between managing risk and actually supporting the person had been lost, particularly in how vehicles were designed. The company was built to prove a different specification was commercially possible, not just clinically preferable.

The Four Things That Separate Secure Transport Providers

Most of the meaningful difference between providers sits in four places. Everything else is presentation.

1. Vehicle Design and the Alternative to Restraint

The industry default for higher-risk conveyance has long been a Category B cell compartment, borrowed directly from custodial vehicles: small, dark and barred. It contains risk, but the containment itself is frightening, and where a vehicle offers no alternative, staff fall back on prolonged seated physical restraint for the length of the journey.

Our vehicles use a full-height reinforced Perspex screen instead of bars, creating a lit, climate-controlled safe space with standing room, padded seating, a media screen and an integrated communications system. The person is contained but visible, and the crew can keep talking to them throughout. The detailed specification is set out in our walk-through of the fleet.

2. Crew Training, and Whether It Is Continuous

Ask whether crews are trained for mental health work or trained in it as an add-on. Ours are recruited as secure technicians rather than general patient transport staff, and train through a four-level progressive framework with our group training partner RISKA, supported by an ongoing monthly development plan rather than an annual refresher. Basic Life Support is rechecked every twelve months, enhanced DBS checks apply throughout, and there are child-specific checks for CAMHS work. How our crews are trained covers the structure.

3. Risk Assessment Before the Crew Is Allocated

A provider that dispatches the nearest available vehicle is not running a specialist service. The assessment should happen at the point of booking and should shape crew size, vehicle class, whether a gender-matched crew is appropriate, and whether uniform would heighten anxiety.

4. The Audit Trail

If a transfer is later reviewed by a board, a coroner or an inspector, what evidence exists? Recording with audio, live tracking and complete handover documentation turn a contested account into a reconstructable one. This is the part commissioners tend to value only after they have needed it once.

What to Ask a Secure Transport Provider Before You Award

Five requests will tell you more than any tender response:

• The full CQC inspection report, not the headline rating, and the scope of registration
• The training framework document, including how often crews train and what triggers a reassessment
• A redacted sample risk assessment for a real high-risk job
• A redacted incident record, showing how an escalation was handled and what changed afterwards
• A vehicle walk-around, in person. Photographs are chosen; vehicles are not

A provider who cannot produce the middle three quickly is telling you something. Providers who do this properly have the documents ready, because the same documents are what they use internally.

Why Bundling Mental Health Transport Into General PTS Fails

General patient transport is a volume business measured on journeys completed and time per job. Mental health conveyance is a risk business measured on incidents avoided. Put them in the same contract and the volume metrics win, because they are the ones being reported on.

The practical outcome is a crew with a target arriving at a Mental Health Act assessment they are not trained for, in a vehicle with no safe alternative to restraint. The transfer usually completes. What accumulates instead is staff injury, patient distress, family complaints, and eventually a serious incident review that traces the decision back to a procurement document.

Where the two are commissioned separately, mental health work can be scored on the things that actually predict safety. That single structural decision does more for outcomes than any clause about response times.

How Secure 24 Approaches the Standard

Our position is that mental health patient transport is a distinct discipline and should be resourced as one. In practice that means a fleet in three classes, covering most risk levels, patients with combined physical and mental health needs, and the highest-risk journeys. It means crews recruited for mindset and trained continuously. It means a control room that runs a real assessment on every call rather than allocating the nearest vehicle. And it means not adding crew or upgrading the vehicle unless the risk profile genuinely calls for it, which is as much a standard as anything in the specification.

We work this way with NHS trusts and ICBs, police forces, local authorities, private hospital groups and families across the UK, through ad hoc bookings, service level agreements and full procurement contracts. Our NHS and ICB page sets out how those arrangements are structured.

Related Reading

• Inside Our Secure Ambulances
• What Is a Mental Health Ambulance? How They Work in the UK
• Section 135 and Section 136 Support
• Why Secure 24

Secure Ambulance Standards FAQs