Hampshire and Isle of Wight Air Ambulance

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

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

People and communities were always at the centre of how care was planned and delivered. Patients and their families received person-centred care. The service worked closely with other emergency services to deliver a multidisciplinary approach.

Staff provided information to patients and their families at the time of the incident and in follow up contact. Patients were able to give feedback about their experiences. Staff understood knew about duty of candour and how to apply it. Due to the nature of the service, it was highly responsive to patients in their time of need.

This service scored 100 (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 making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff told us the patient was at the very centre of everything they did and what the service stood for. Staff told us good communication was key to providing person-centred care. They aimed to make speaking with patients and their friends or families as easy as possible and used various tools to help with this, such as online translation services. Patient were always made aware of the reasons they were being treated, or where this was not possible best interest decisions were made in line with guidance.

Staff provided care tailored to the individual patient. The service had a standard operating policies which contained details on privacy, dignity and which provided guidance on care for specific patient groups, those with urgent such as those with mental health diagnoses, pregnant patients or children.

The service wanted to ensure it was responsive to the different needs of individual patients and their wider community. There was a dedicated critical care outreach team which used a rapid response vehicle to attend time critical incidents such as cardiac arrests in the densely populated areas the service covered. This meant patients received fast access to critical care paramedic care, with verbal clinical support from a skilled doctor, faster than if they were transported to a hospital by ambulance. The service had undertaken a review of 999 calls to determine where the highest rate of these calls was received. From this data they determined a middle geographic point and positioned the team in this area to attend and act faster. This meant that patients would receive ‘out of hospital’ critical care treatment faster than if they were brought in by ambulance.

We saw feedback where staff had challenged a decision made at an incident by another service’s staff to not wait for an air ambulance to attend. This meant that the paediatric patient had then needed to be transferred after arrival to a trust more suited to their needs. The case review contained clear rationale for decision making and evidence demonstrating air ambulance staff fully complied with policies. This was reviewed and communicated with mutual respect and clear actions taken to ensure all future paediatric patients would follow the same admission route. This meant that these patients would receive the care they needed without delay and reduce the risk of harm.

We scored the service as 4. The evidence showed an exceptional standard. The service had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff described how they had been taking steps to further improve their relationships with staff who worked for 2 local NHS ambulance services. This included attending ambulance stations to give rapid education sessions to staff. We heard from staff receiving these sessions that they were welcomed and enjoyed.

The local NHS ambulance services told us the service provided effective geographical cover which ensured patients were transferred to the most appropriate care facility within the region. The service provided essential urgent transport for patients on the Isle of Wight to the mainland for time sensitive treatment not available on the island for example, spinal cord compression, stroke and neurosurgical interventions. It also ensured patients who had received traumatic injuries would benefit from advanced paramedic and medical care at scene before taking them to a mainland hospital with a higher acuity trauma service.

Stakeholders told us the air ambulance service had supported the training of critical care paramedics which helped to build clinical capability and resilience for patients on the Isle of Wight.

Leaders provided examples of when staff had raised concerns about an adult patient not being taken to the most appropriate service based on their needs. This was because a ground crew had conveyed the patient to a local NHS trust, but it was subsequently determined a transfer would then be required to a higher-level care site. Leaders raised this directly with the NHS ambulance service in a respectful way to ensure it was not seen as criticism and instead a learning opportunity, so the circumstances were not repeated. Leaders described this as a ‘changing hearts and minds’ opportunity so improved collaborative understanding and working would provide direct benefit to patients.

We reviewed the journey of a transfer from the Isle of Wight for a patient with life threatening condition that required a time critical approach. The patient was able to be operated upon at the mainland trust without delay. This showed how the crew responded to a request made without hesitation to provide an emergency transfer. This further demonstrated how the service provided the means to ensure care was joined up and directly benefitted patient outcomes.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at developing appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Patients and families said staff were clear when explaining next steps during their care. The service trained staff to ensure they kept patients informed about their care and treatment actions at the time. Staff ensured carers and families were regularly updated about the patient’s progress.

Staff described how they talked to patients and explained what treatment and care they would be providing before they carried this out. Staff used language translation tools on their devices to help them communicate most effectively when working with patients who did not speak English.

All patients or loved ones were contacted by the aftercare team for follow up care. Part of this process would involve providing patients with a full overview of what happened and when in the course of their treatment. This was especially important when patients had little recollection of the events due to trauma. Any concerns and questions regarding care would be picked up immediately and acted upon.

Staff also confirmed the service could share information using translated documents after incidents with patients and their families about their care and actions taken. Aftercare staff could also signpost to other agencies that could help patients and their families with ongoing care and treatment.

Patient information was held confidentially and in accordance with data protection legal requirements. Information governance systems included confidentiality of patient records. Staff made notifications to external bodies as needed through the online reporting system. This information would be monitored through the trust level incident reporting data that was shared with NHSE and CQC.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment, and support. They always involved people in decisions about their care and told them what had happened.

Patients knew how to complain or raise concerns. When patients complained or raised concerns, they always received feedback. All concerns raised to the service were initially acknowledged and then responded to in accordance with the service complaints policy.

If patients had care concerns at the scene of an incident, staff managed this process. Where patients were admitted to a hospital, they could complain about this service using the hospital’s local complaint process. Staff told us they could provide these details to family members at scene, or the patient would have provided them at the acute trust they were admitted to. If there was any information of concern or positive feedback shared with other partners, this would be fed back to the service. Patients who raised concerns or complaints were also safe from discrimination and harassment under the NHS policies used to respond to complaints.

The case review process meant that all opportunities for feedback were sought. The service had received 1 patient complaint in the last 12 months regarding a conveyance of a patient across trusts, this complaint was resolved locally. This was a multi organisational complaint that involved 2 NHS trusts and the HEMS service. Leaders acknowledged the concerns raised and took time to respond to them explaining the rationale and clinical decisions made around not attending. This was because the air ambulance was already attending another incident.

Staff received feedback on the outcome of investigation of complaints and acted on the findings. The case was used to complete reflective learning for staff around decision making and also highlight to all staff to now transfer all paediatric cases directly to the higher trauma level centre. This was communicated in the next governance meeting. The case was also referred to the local trauma network for shared learning in the region.

The service also offered an aftercare service to give information to patients and their families after an incident. Patients and family members said staff gave further explanations during the aftercare meetings and would respond to any further questions or concerns.

The aftercare team recognised the benefit gained from celebrating the value of organ donation. The team had established links with the organ donation service to receive outcome updates from patients the service had cared for. These updates gave staff anonymised details of the patients who had benefitted from the gift of organ donation and the value it brought them.

University Hospital Southampton NHS Foundation Trust monitored patient satisfaction through the Friends and Family test. However, patient responses about care related to a patient’s whole pathway. This meant it was too broad to identify any specific improvement areas for the Air Ambulance service. In response to this the aftercare team had submitted a proposal to the Trusts Audit and Improvement System as part a project to seek direct feedback from aftercare patients and families so that they could identify further improvement by obtaining feedback specific to the service.

We scored the searvice as 4. The evidence showed an exceptional standard. The service was exceptional at ensuring people could access the care, support and treatment they needed when they needed it.

The service attended all patients who needed it within the area it was commissioned for. The service was commissioned by the NHS trust and charity it operated under. There was no discrimination as to who received the service and there was equity in access for all. The only barriers in access in availability were due to safety and wellbeing, such as restricted flight visibility, or if the aircraft was already deployed. In instances where the service could not attend for these reasons, specialist staff in the dispatch centre could still provide advanced treatment triage and support on a remote basis.

The service had specialist equipment which could be used to support patients requiring them such as pregnant people, children and bariatric patients. Leaders and staff were alert to discrimination and inequality. At the scene of incidents staff considered each patient as an individual and adapted their communication methods and care to provide the best outcome for that person at that time.

The case review process undertaken for all incidents meant that the service utilised every interaction as an opportunity to improve access and remove barriers to care. The aftercare team provided a dedicated service to support patients and their loved ones following an incident. The aftercare team consisted of experienced paramedics and nurses. Support was offered on an ongoing basis as required. Staff told us how support was continuous and open ended. This service could also be used by members of the public and staff from other emergency services who may be traumatised by witnessing an incident or its aftermath.

Staff from the service told us how they also supported other region’s air ambulances with mutual aid where required and had attended multiple major incidents in the 12 months prior to inspection.

We heard how staff were keen to expand the operational hours of the service so they could provide services 24 hours a day. At the time of this inspection the service was not commissioned to operate between 2am-7am and there was only one helicopter emergency medicine service (HEMS) service in Southern England currently operating 24 hours a day. This meant that during this time the ambulance service had no access to physician and critical care paramedic teams. Non mainland populations in this region were at significant risk as there was no dedicated means to transfer patients to specialist care during this time.

This was out of the control of the service, but the service had discussed these concerns alongside other HEMS services and stakeholders, such as the local trauma network. The service had reviewed data for the region to evidence the need for this provision to be commissioned. They had reviewed data of calls received during this time window that met the services inclusion criteria such as major trauma and cardiac arrest. This data was being analysed to determine the level of need. It was hoped this would lead to a shared provision across the regions HEMS services to ensure access was equitable to other regions in England.

We scored the service as 4. The evidence showed an exceptional standard. Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptional support and treatment.

The focus of staff was on ensuring patients in all circumstances received the best outcomes which avoided any discrimination and took account of inequalities. By the nature of the service, patients received care without delay wherever they were. Leaders and staff told us they were alert to people suffering inequality in outcomes if they were from disadvantaged groups. They said it was a priority to ensure patients all had a consistent level of high-quality care regardless of their background. Adjustments were made to ensure outcomes were as positive as they could be in all circumstances, this included advocating for increased specialist and critical care services.

The service had proactively worked with a non-mainland NHS Trust to improve resilience and capability. This included hosting critical care paramedics on the dispatch desk. Stakeholders told us this arrangement had significantly improved the responsiveness and coordination of cross-Solent transfers, ensuring patients receive timely access to specialist care on the mainland. This meant outcomes for patients were improved, and they did not experience inequality due to their location. The Solent is a strait of water separating the Isle of Wight from the south coast of mainland England

Staff and leaders within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. Staff were trained in equality, diversity, inclusion and human rights. The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage. The service aimed to provide the best care for individuals, ensuring the input into care and treatment was adjusted to give the best outcomes. Policies and procedures and staff training reflected this.