South Western Ambulance Service NHS Foundation Trust

Updated 27 May 2022

Our rating of the trust improved. We rated it as good overall because:

Caring was rated as outstanding. Effective, responsive and well-led were rated as good. Both effective and well-led improved from requires improvement at our 2016 inspection with responsive remaining as good. Well-led at trust level was rated as good. However, safe remained as requires improvement.

• We rated well-led at the trust as good. There was effective, experienced and skilled leadership, a strong vision for the organisation, and embedded values. Leadership had strengthened, and the new structure in frontline services would being local leadership closer to staff, patients and stakeholders. Patient care was a top priority for the trust. There was mostly effective governance around performance, but this had not resolved some previous issues and led to the emergence of others in frontline services. The culture within the staff was enormously variable, although those we met were committed and highly professional. Nevertheless, some felt unsupported in certain aspects of wellbeing, communication and change. There was good and detailed management information available, and strong financial governance and audit. There was commitment to engagement with stakeholders, although the trust needed to move away from public relations to the public supporting service delivery, improvement and change. There was a strong and deep commitment to learning, development and innovation.
• Emergency and urgent care remained rated as requires improvement overall. The questions of safety, effectiveness and well-led remained requires improvement, with responsive remaining good, and caring remaining outstanding. These ratings have not changed since our previous inspection, and although we saw several key improvements since then, there were some problems unresolved, and others emerging. Concerns included the trust failing to meet the standard response times to reach patients, although this was improving recently for the most urgent category. Vehicles and premises were not always secured in accordance with trust policies and procedures. Some consumables and medicines were not in date or secured, and not always disposed of correctly. Not all patient records were always protected. Again, storage of some confidential medicine records failed to meet trust policy and legal requirements. Some improvements were needed in outcomes for patients, particularly those being treated for a stroke. The governance of these issues had not recognised or addressed them. However, there was outstanding care to patients and those who were with them, or involved in an incident. The service was designed to meet people’s needs and care for those who needed more individual support. We recognised the leadership and structure in frontline services was relatively new and needed time to embed.
• Emergency operations centres remained rated as good overall. The questions of safety, responsive and well-led remained good. Effective improved from requires improvement to good. Caring remained as outstanding. We found improvements in several areas since our last inspection, although some of these had recently dipped for operational reasons, and needed to be restored. There was a safe service, with systems and process protecting people from harm. This included improved and good levels of staff. There was good multidisciplinary teamworking, and adherence to national guidance and evidence-based practice. There was outstanding caring for people, often in difficult circumstances for both the caller and the staff talking with them. The managers had the experience and skills to lead the service and ensure it was giving safe and quality care. The poor number of regular staff performance reviews were a significant concern at our previous inspection. These had significantly improved, although there was still some progress to be completed to meet targets. Clinical and non-clinical call audits were again not meeting the targets, but were back on track to improve.
• On this inspection we did not inspect Out of hours services, Resilience, or Urgent and emergency care (the Tiverton urgent care centre). The trust no longer provides Patient transport services. The ratings we gave to these services on the previous inspections in October 2016 are part of the overall rating awarded to the trust this time.
• Our decisions on overall ratings take into account, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating.

Updated 27 September 2018

Our rating of this service stayed the same. We rated it as good because:

• The trust provided a safe service to patients and made sure they were protected from abuse. There were safe levels of staff who were trained to provide safe care, and records maintained, infection control practices, the systems used, and how staff recognised and managed patients risks assured us of a safe service.
• Staff were competent to carry out their role and there was good multidisciplinary working within the clinical hubs.
• Callers were consistently treated compassionately and staff made sure patients understood what was going to happen and supported them emotionally.
• Services met the needs of the local population and the prioritisation system ensured patients received the most appropriate response. Complaints were also investigated thoroughly.
• Risk was understood and managed and there was a proactive approach to reviewing and improving quality and safety. Morale had improved and there was a strong commitment to improving the quality of the service both locally and nationally.

However

• Not all staff demonstrated an understanding of learning taken from incidents. The trust needed to make improvements to call audits to make sure care was effective for patients and good outcomes.
• The needs of frequent callers were not always met.
• Improvements were required to ensure a consistent and timely response to complaints.

Updated 6 October 2016

Overall we rated resilience planning as outstanding because:

• There were robust systems in place to keep equipment and vehicles clean, well maintained and fit for purpose.
• The numbers of staff, the training they received and the policies they followed was compliant with national recommendations from the National Ambulance Resilience Unit (NARU).
• The EPRR teams worked well and had good co-ordination with a range of other agencies including NHS Providers, other emergency services, local authorities, commercial operators, voluntary organisations and the different departments within SWAST.
• Specialist computer applications had been developed for managing staff training records (i-auditor) and for use in major incidents (Commander).
• The special operations team were supported by six air ambulances provided by five charities providing cover for the whole of the geographical area covered by SWAST.
• Staff treated patients with respect, patience and sensitivity. The paramedics were calm and professional in their approach but remained friendly to quickly build a rapport with the patient.
• Staff took time to listen to patients and their families and consistently explained what they were doing and continually offered reassurance.
• Robust governance and assurance systems were in place across the EPRR teams to share information across the teams and the trust board.
• Leaders were both supportive and visible, inspiring and motivating staff across all EPRR teams. Staff welfare was of great importance and various services such as traumatic risk monitoring and the ‘staying well service’ were available to staff should they need it.
• There was a proactive approach to change and innovation. A dedicated events team had taken responsibility for planning, resourcing and managing SWAST attendance at public events.
• A computer application ‘SWAST Commander’ had been developed for iPad and Android platforms. This was used by operational commanders during major incidents.

Updated 6 October 2016

We gave an overall rating of requires improvement for the patient transport services. This was because:

• There was a lack of consistency around incident reporting. There was no evidence of feedback or learning from incidents during the 12 months preceding our inspection.
• There were infection control risks caused by vehicle defects such as ripped seat covers and punctured internal walls.
• Vehicle daily inspections (VDI) were not consistently completed on a daily basis. VDI checklists were not reviewed or audited leading to a lack of assurance regarding vehicle safety.
• Staff administered nitrous oxide and oxygen gas mixture (a medical gas that is used to relieve pain) to patients. There were no clinical pathways or set protocols to guide the clinical reasoning of staff using this gas. Staff did not record when they gave this treatment to patients. Leaders of PTS could not provide assurance that this gas was administered safely. Immediately following our inspection, the trust withdrew this treatment from PTS.
• Staff administered oxygen to patients and adjusted oxygen levels according to their assessment of the patients need during their journey. There was a flowchart for staff to guide their clinical reasoning, but this was insufficiently comprehensive. Staff did not record their interventions.
• Staff did not participate in the learning development review process and compliance with appraisals was poor.
• The process of gaining patient consent for treatment was not documented.
• There was very limited oversight of quality in the PTS other than performance against key performance indicators. Some aspects of governance related to safety issues were not monitored effectively.
• Staff told us they did not feel supported or valued by their management team or their employer.
• Staff described the culture as insensitive and poor communication was frequently highlighted by staff as a concern.

However:

• The service had performed well against the key performance indicators set by commissioners. These related to patient and commissioner satisfaction, timeliness and responsiveness of journeys and management reporting.
• Managers were working closely with local hospitals to improve turnaround time when dropping off and collecting patients.
• Compliance with mandatory training was good at 95.9%
• There were high levels of patient satisfaction and low numbers of complaints reported.
• Staff showed compassion and understanding toward patients and carers.

Updated 27 September 2018

Our rating of this service stayed the same. We rated it as requires improvement because: