Hampshire and Isle of Wight Air Ambulance

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This is the first assessment for this service. This key question has been rated Outstanding.

This meant that patients were truly respected and valued as individuals. They were always treated with respect and kindness during their care, and this extended to their loved ones, friends and families and others at the scene. Staff made sure to protect people’s dignity.

The service kept in touch with patients and families by contacting them after the incident if appropriate, answering questions and providing support and pastoral care. Staff felt valued, respected and supported at work and were enabled to be their best.

This service scored 95 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at treating people with kindness, empathy, and compassion and in how they respected people’s privacy and dignity. Staff always treated colleagues from other organisations with kindness and respect.

Patient feedback for the service was overwhelmingly positive. Patients praised staff for their kindness and compassion. A patient said how they were now recovering with thanks to the ‘astonishing team’ who cared for them. Staff attitudes and behaviours when interacting with patients showed they were discreet, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it.

Staff said treating people with kindness and dignity was a key part of their work. Staff described how they took time to reassure patients who were distressed and ensure they felt safe. A family praised their prompt arrival said the ‘treatment felt like the gold standard, and we could not have asked for more’.

Staff maintained the confidentiality of information about patients. Modern-day privacy pressures, such as members of the public filming with mobile phones, meant staff worked with the police and fire service to cordon off areas to ensure patient dignity was maintained as much as possible. All patient records were electronically stored, and access was restricted. Access of information was audited to ensure it was only viewed for clinical or governance relevant reasons.

Staff supported patients to understand and manage their care, treatment or condition. Patients and their loved ones told us they were always kept informed. A family member said, ‘I was very well looked after, informed and supported all the time.’ Another family said they couldn’t thank the team enough for saving their loved one. Families told the service ‘Without your amazing work, our Mum, wouldn't be here’.

Due to the nature of the service staff sometimes attended to incidents where patients had passed away or had injuries that were not survivable, such as cardiac arrests or catastrophic trauma. When this happened, staff supported loved ones in the immediate aftermath of an incident with compassion and empathy. Feedback demonstrated how loved ones valued this. One person stated ‘The crew worked extremely hard and were very supportive through this process so I would just like to thank them from the bottom of my heart for trying to save’ their loved one.

Patients said staff treated them well and behaved appropriately towards them. A family said, ‘We are extremely grateful for the service provided and the efforts you made to try to save a life that day.’ After incidents, every patient and their loved ones were invited to the service headquarters to meet the staff who had looked after them and ask questions or raise any concerns. This was also offered to all bereaved families and loved ones. We heard from staff how these visits meant a lot to everyone involved. One patient said ‘“I have no memories of when I was injured and much of what happened to me was totally unknown. To be able to speak with the aftercare team and then meet with the paramedic who saved my life was amazing. They answered all my questions and gave me a really good understanding of everything that happened to me on the day. It has helped me process what happened.’

Feedback from staff of other organisations demonstrated clear respect and kindness among colleagues. A staff member from another ambulance service said ‘It was great working with them, and they included us as part of their team. I'd love to work with them again’. Another piece of feedback regarding dispatch staff said mutual support was exceptional throughout the shift and asking for mutual aid. We reviewed feedback from an incident where staff supported ground crew with a patient with challenging behaviour. Staff from the other organisation said ‘HEMS crew were just fab and really supportive. We would never have been able to manage that patient without their help. They were also very informative and inclusive of the crew and police already on scene’. Staff from other services told us that that staff embodied the trust value of 'working together'’.

We scored the service as 4. The evidence showed an exceptional standard. The service treated people as individuals and was exceptional in how they made sure people’s care, support and treatment met people’s needs and preferences. The service took account of people’s strengths, culture and unique backgrounds and protected characteristics.

Staff ensured patients had access to appropriate spiritual support if required. A dedicated aftercare team provided post treatment support to all patients and their loved ones. We heard how this also included signposting to support services if needed.

Leaders provided examples of when staff supported vulnerable young people, and we saw feedback from these groups. Feedback from a parent of a young person said how they ‘could not speak highly enough of the care and compassion experienced on scene from the whole crew. They not only felt in very safe hands and expertly cared for it made a huge difference to a terrified, injured person having the worst day of their life.’

The service had policies to support staff when delivering treatment to patients with protected characteristics such as disabled people, autistic people and people with a learning disability. Staff and leaders gave examples of care given to adults with learning disability. Evidence showed how dignity and best interests were upheld and compassionate handling of highly vulnerable individuals was given. There were also examples of how staff recognised the emotional impact on other residents in care homes who were vulnerable. These examples demonstrated the understanding, patience, and empathy of staff towards the patient.

The service made adjustments by meeting patients’ specific communication needs. There was a clear operating policy for dispatch staff to follow when supporting patients and their loved ones with communication difficulties. Managers ensured staff and patients had easy access to interpreters. This included interpreting services, text messaging or video calling for those with hearing or verbal communication difficulties. These services could also be used when dispatch staff supported other organisations who were responding to calls to provide remote assistance and support.

Staff told us how video calling had also been invaluable at a multiple casualty incident where a member of the public’ verbal description of the patient’s conditions did not convey how seriously ill all those involved were. In this incidence air ambulance staff were able to reassess the scene, immediately deploy, and provide lifesaving care.

Staff made information leaflets available in languages spoken by patients. Aftercare staff told us they were able to utilise the trusts interpreting services to ensure written communication was given in the language spoken by the patient or their loved ones.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional, so people knew their rights and had choice and control over their own care treatment.

Staff told us how people’s needs, wishes and comfort were a priority and staff acted urgently to manage pain and discomfort, concern or distress. Patients and their families told us staff asked permission and explained what they were going to do before starting care and treatment, where this was clinically possible. However, in cases where patients were unconscious, the care and treatment they received at the scene was explained by the as part of the aftercare strategy. A patient said ‘I didn't have full memory, but I do know you were able to care for me and get me to hospital. My family I wish to express our sincere thanks.’

Staff had completed training in understanding people’s rights and supporting them to maintain their independence, while making their own choices where possible.Staff told us how the rationale to transfer a patient by air ambulance was always explained carefully to patients. Staff discussed each case in the immediate aftermath to debrief and evaluate the care provided. This also gave an opportunity to check, where appropriate, this reflected the patient’s preferences at the time.

Staff received updates around national guidance in care for patients who may not be aware of their rights and choices, including people with a learning disability, dementia, or people with mental health needs. This was discussed in a variety of methods including face to face meetings, email notifications and education sessions. Leaders provided an example of care given to a patient who was unable to communicate their needs. Supporting documentation showed how staff had considered the full picture of the patients’ needs and wishes to determine a treatment plan.

Patient feedback praised the service for the positive impact it had made. A patient said, ‘Without you on that day, my ongoing positive recovery would certainly not have been such a smooth transition.’ Another patient said ‘They were all incredible and I will remember their professionalism and kind manner for a very long time. They even checked in on me the next morning in hospital.’

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional in how they listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern, or distress.

Staff went to great lengths to make sure that people’s needs, views, wishes and comfort are their utmost priority. They gave examples of how they go above and beyond to anticipate people’s needs and take steps to ensure preventable discomfort, concern or distress for people. This was further supported by feedback. Patients told us staff listened to them and kept them informed about what was happening throughout their care. They confirmed staff gave pain relief quickly and made sure patients were comfortable.

We heard how the focus and priorities of staff was ensuring patients were stable and continually monitored. Staff were able to anticipate when someone needed urgent care or support and offered this immediately, using the most up to date tools and technology as required. An internal audit had identified that two thirds of patients would benefit from accurate invasive blood pressure monitoring (IBPM) but had not received it due to time-critical constraints or clinician availability as this was only performed by doctors. In response to this, the service had developed and implemented an extended scope of practice for specialist and trainee specialist paramedics to perform arterial line cannulation and monitoring. This meant it increased the availability of critical monitoring in high-risk patients and improved patient safety and outcomes.

A family member said how the actions of the staff in spotting deterioration had contributed to saving their loved one’s life. We heard how continual monitoring of patients meant that risks were spotted and acted upon without delay.

Leaders said staff members always explained their plan of care and treatment to patients, where possible. However, if a person was unconscious or unable to respond, the service adopted a ‘best interests' treatment pathway to enable the best outcome. Staff said they would ask patients if there was anything else they could help with. A family member said staff ‘provided reassurance that their loved ones really did get the best care possible, and we could not have asked for more’.

We also heard how staff had supported a parent and young child when attending an incident. They did this by distracting the child in order that his parent could speak with staff and understand that their partner has passed away. This minimised distress for both the parent and young child at a traumatic time.

The service had a clear standard operating procedure to support delivering care when a patient was distressed. This included those wanting to harm themselves or others. This laid out all stages of the pathway from call handling to at scene liaison with other organisations.

We scored the service as 4. The evidence showed an exceptional standard. The service always cared about and promoted the wellbeing of their staff and was exceptional at supporting and enabling staff to always deliver person-centered care.

Staff feedback of the service was exceptionally positive and spoke of the way managers cared for staff wellbeing and promoted a safe and caring culture. We spoke with over 30 members of staff for the service. They told us how they felt respected, supported and valued. We heard how the team provided continual support to one another without question.

Staff felt positive and proud about working for the provider and their team. There was an acknowledgement that working for the service was a desirable position and this was a driving force behind delivery excellent care and outcomes for patients.

The service’s staff sickness and absence was 1.8%, this was significantly lower than the Hospital trust average at 4%. Staff had access to support for their own physical and emotional health needs through a range of options which included Trauma Risk Management (TRiM), psychological counselling, occupational health, crisis support and peer discussion. TRiM is a trauma-focused peer support system designed to help people who have experienced a traumatic, or potentially traumatic, event.

The service had developed a ‘Crewcare’ platform where staff could track their risk of burnout, secondary traumatic stress and compassion fatigue using a validated scoring system. All self-help resources were located within this platform. At the time of assessment, the platform was undergoing development and in the interim all resources could be accessed through a dedicated team channel. All referrals made by staff for counselling were strictly confidential and no identifying detail or information was communicated to the employer.

Peer support was provided through post incident discussion, case reviews and a facilitated discussion group. This allowed smaller to discuss topics including self-help, PTSD and issues that have arisen in the year and allowed staff time to discuss and share thoughts.

The training and education team provided a safe space for discussion of traumatic incidents by having open and honest discussions at team meetings. These events had a clear set of rules to support open sharing and honest reflection and support a positive wellbeing culture.

Staff attended away days and annual wellbeing days to foster team working and promote togetherness. The most recent wellbeing day involved a countryside-based activity day with group tasks. These ended in a group meal which each task contributed to in various ways such as building the table, collecting foods, cooking ingredients. Staff told us they felt tremendous value was gained from this event. We also saw evidence of events such as team surfing, fitness activities, and meals. Staff also had use of a dedicated gym space at the service to support personal health and fitness.

Managers supported staff to discuss protected characteristics to identify the best way to work with individuals. The service made adjustments to enable staff to perform to the best of their ability. We reviewed examples of leaders responding to reasonable adjustments for equipment and measures to support staff to continue in their roles.

The provider recognised staff success within the service – for example, through staff awards. University Hospital Southampton NHS Foundation Trust, there held award ceremonies for achievements and recognition of meeting trust values. In October the trust had celebrated Allied Health Professionals Day, and awards were given to staff in this group. Within the service a specialist paramedic had won the research award for their work to help shape national best practice, improve patient outcomes & demonstrating the power of evidence-based innovation in pre-hospital care.

Staff took time to champion one another’s achievements and contributions. They could send feedback regarding their colleagues, and this would be recognised and praised. We saw considerable evidence of messages from staff praising each other’s contributions and patient care. When speaking to staff we also saw how positively they spoke of each other’s achievements and celebrated success.

We reviewed the trust level wellbeing plan this set out a clear set of objectives related to fulfilment at work, environment, relationships and personal health/wellbeing.