“it's desperate. i’ve never heard anything like this. a paramedic might have a clinically stable patient on board but if that patient then becomes unstable and you're sitting on scene with perhaps two unstable patients, what do you do? do you separate one of them from the equipment? who do you pick?” in 2018, the trust said it would need 100 more paramedics to meet the new ambulance performance standards. this could cost £5m a year. the midlands and east regional director of nhs england expressed concern in november 2018 that the trust was prioritising category-4 calls in order to meet its targets, at the expense of more clinically urgent patients, and that the trust's winter plan was inadequate. in september 2020 the cqc criticised the poor leadership of the trust for fostering bullying and not acting decisively on allegations of predatory sexual behaviour towards patients. it was required by the equality and human rights commission to sign a legally-binding agreement stating how it will protect its staff from sexual harassment in april 2021. subcontracting in 2019, the cqc reported that ambulance services were relying on private providers because of lack of capacity. the trust spent £9.5m on private ambulances for 999 and non-urgent work in 2018/19, double the amount spent previous year. in 2019, the trust disbanded its health and wellbeing service and outsourced the occupational health function to a new supplier, kays medical. cqc performance rating in its last inspection of the service in june 2020, the care quality commission (cqc) gave the following ratings on a scale of outstanding (the service is performing exceptionally well), good (the service is performing well and meeting our expectations), requires improvement (the service isn't performing as well as it should) and inadequate (the service is performing badly): inspection reports area 2016 rating 2018 rating 2019 rating 2020 rating are services safe?requires improvementrequires improvementrequires improvementrequires improvement are services effective?requires improvementrequires improvementrequires improvementrequires improvement are services caringoutstandingoutstandingoutstandingoutstanding are services responsiverequires improvementrequires improvementgoodgood are services well-ledrequires improvementrequires improvementinadequateinadequate overall ratingrequires improvementrequires improvementrequires improvementrequires improvement