With a focus on culture, staff and patients benefit from the WAST way in Wales

The Welsh Ambulance Service is quietly reshaping what cultural change can look like in a national emergency service, with Director of Culture Change Angie Lewis and Head of Culture and Organisational Development Sara Mills playing key roles in a broader organisation-wide effort.

Both are quick to emphasise that progress has only been possible through the commitment of colleagues, leaders, managers, and trade union partners across the Welsh Ambulance Service (WAST) who have helped develop and deliver the organisation’s approach. I spoke to them both before their appearance at The Emergency Services Show next month to find out more.

Deeply personal connections

They told me that their work is rooted as much in personal experience and moral purpose as it is in strategy and structure. It’s also a story that needs to be seen against a backdrop of stark culture reports from other blue-light organisations.

Both leaders came to WAST with a deep, personal connection to ambulance services. Sara tells me about how her late father’s illness shaped her commitment to the organisation she now serves. She saw at first hand the real sense of genuine compassion and a relentless focus on patient care. “I thought, well, if I can maybe help to improve something here for them in terms of their workplace experience, then that sounds like somewhere that I would like to work.”

Angie’s story is similarly personal. She recalls: “My father had a heart attack at 55, and he was saved by paramedics who got to us very quickly, and that never left me.” She jumped at the chance to join WAST four years ago, adding: “Imagine being able to influence culture change across a national organisation and be able to make a difference to the working lives of this amazing group of people.”

Together, alongside colleagues across the organisation, they help champion an agenda that puts culture, safety, speaking up and team experience at the heart of how WAST operates.

Cultural reviews

Angie is clear that the wave of culture reports across the UK emergency services formed part of the environment they were operating in when she arrived. But she is equally clear those reports were not the primary driver of WAST’s approach.

Their enthusiasm and passion is palpable during this conversation, which comes just two months before Angie retires.

“When I joined in 2022, we just had the Casey review of the Met Police, and we also had the South Wales Fire Service review,” she says. “But you know what we were focused on is how does it feel here? We don’t want to be an organisation that is subject to an external cultural review. This is something that we want to lead and co-create and deliver ourselves.”

The service had already confronted issues like sexual safety and the experience of women at work, choosing to be open about the challenges rather than waiting to be forced into change. “We’d launched our new behaviours,” Angie explains. “We had rich insight and feedback that said, ‘Look, things aren’t great. We’ve got lots to do.’ So it was absolutely clear that that’s where we needed to put our attention.”

Learning from others

Sara is very open about learning from others and tells me she is part of an informal ‘blue lights culture group’ across Wales. It is a space where she and others in similar roles discuss and share and on occasion, ‘steal with pride’ as she confesses, from one another’s work. But, she reminds me, the emphasis is always on what makes sense for WAST’s own people, in their own context.

Central to that context is a deliberate shift away from talking about resilience as an individual burden, and towards building systems, behaviours and conversations that sustain staff in a demanding and often traumatic environment. “Individual resilience isn’t a word that we use a lot in WAST,” Sara reflects. “I’ve probably never worked anywhere where there’s more of a resilient workforce than here. I think resilience can sometimes be something that feels like it’s on the individual only.”

Instead, this work is framed through a People and Culture Plan, developed and delivered with colleagues across WAST, built around three themes: culture, capacity and capability. Under that umbrella sit initiatives on wellbeing, speaking up, leadership, change management and more traditional support for staff exposed to trauma. The aim, Angie says, is not to encourage people to be ‘tough’ but to ensure they are supported, where they feel “my organisation values me, my manager values me, and I know where to go if I’m struggling.”

Essential conversations

One of the most practical expressions of this is the ‘essential conversations’ programme, developed with colleagues and managers across WAST, to embed regular, person-centred one-to-ones and equip managers to hold crucial conversations early, before issues escalate. The line manager is a critical role in WAST, Angie tells me, with a vast geography that sees staff working in remote places, that relationship is key and fundamental to support staff in their day-to-day work.

“It’s not just about KPIs and performance measures. It’s about ‘how are you?’” Sara says. “We’re developing managers with the skills and the tools and some frameworks to help them enter into those conversations with more confidence. And through doing this, we hope to avoid the need for escalation because formal processes don’t always support well-being.”

All of this work sits under a simple cultural construct known as Our WAST Way, which has been shaped and brought to life through the involvement of colleagues across the organisation. It’s built around three principles: care, connect, and value everyone. Importantly, WAST has avoided complex competency frameworks. Instead, teams are encouraged to interpret those principles locally, sometimes turning them into team charters that feel real in a specific station, contact centre or service.

At the same time, a new CEO has come on board. Emma Wood joined WAST in October 2025 after Jason Killens move back to London to lead LAS. Formerly a Chief People Officer, Emma has strengthened the focus on drawing a clear line from behaviours to team culture to patient outcomes. Sara says one of the big challenges moving forward is to “tell that story better and evidence it for our staff so they can see why culture work matters to patient care, not just to personal experience.”

This conversation continues at The Emergency Services Show where Sara, Angie will be joined by colleagues to explore the topic of cultural change in more depth. They are speaking on the People & Skills stage at 1355 on 17 September. Register to attend here.