Hampshire and Isle of Wight Air Ambulance

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

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

The service actively managed safety and drove improvement in patient care. Learning culture was exceptional and sought every opportunity for improvement, to ensure this was maximised. Leaders embedded and maintained a culture to continuously improve and encouraged openness and collaboration, and safety was everyone’s top priority. Staff demonstrated a clear commitment to improve safety and there were clear roles, responsibilities and structures to meet safety goals.

The service always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. Leaders ensured there were enough skilled staff to deliver safe care and could demonstrate adaptive strategies for responding to demand and capacity issues.

This service scored 88 (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 had a strong, proactive and positive culture of safety, based on openness and honesty. They actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons learned continually identified and embedded good practice.

Hampshire Isle of Wight Air ambulance operate as a service under University Hospital Southampton NHS Foundation Trust. There was a clear incident reporting policy at trust level which supported staff to report incidents. The service also reported all safety incidents identified in line with trust policy. All staff knew how to report incidents and how to access the policies to support this process.

The service recognised the need for a robust clinical quality programme. Staff undertook a full case review of all patient incidents they attended in line with the case review policy. This enabled them to develop and improve their clinical standards and ensured key learning was gained at every opportunity.

The initial responsibility for case reviews was with the lead of the day (LOTD). This was the senior clinician on a shift. Any cases not able to be reviewed within a shift, for example due to clinical activity, were handed over to the oncoming shift in team shift handovers. Initial reviews were held as a discussion and if learning points could be identified at this stage these were documented. Once the initial review of the case was completed this was documented on a review form for oversight by the duty team and ensure handover to the clinical quality team. Case reviews were then carried out by the HEMS (Helicopter Emergency Medicine) Clinical Quality team in line with the trust Mortality and Morbidity process (MM).

Each case was reviewed with the starting approach that the best decision for the patient had been made. Informal discussions for every case were undertaken to establish team learning. There was a case review code of conduct which promoted respect and active engagement. All team members involved in discussions were offered support and guidance should they require it. The impact of the case review process was also monitored to ensure adherence to the policy and staff experience. Staff told us they felt case reviews were a positive experience and gave them a clear and simple way to share experiences and gain learning. They told us they felt the process was informative and supportive.

Case reviews had clear timelines for initial review within 72 hours and senior case review within 21 days. The service provided data that demonstrated these targets were consistently met. Learning points from case reviews were disseminated through the HIOWAA Monthly and Quarterly Reports and scheduled Clinical Governance and Education Meetings.

The service provided data for all safety incidents reported for 3 months prior to inspection. These had been correctly graded in accordance with NHS England guidance. Evidence showed these had been reported, reviewed and actions documented in a timely manner. The service had reported no serious incidents within the last 12 months. Data provided showed the most commonly reported safety incidents were related to equipment and were responded to immediately and resolved.

Staff described how they received feedback from investigation of incidents, both internal and external to the service. Clinical Governance and education days were held on a monthly basis and provided a meaningful opportunity for staff to reflect, and support improved clinical practice. Staff told us they were supported to attend these sessions either in person or virtually. The service included relevant national reviews in these sessions to ensure learning from external sources was shared such as the Maternity and Newborn Safety Investigations (MNSI) investigation of emergency resuscitative hysterotomy after out of hospital cardiac arrest. This is an emergency surgery performed on a pregnant woman in cardiac arrest to rapidly deliver the baby, to improve blood flow and resuscitation effectiveness, thereby increasing survival chances for both mother and baby.

Agendas for the October and September 2025 Clinical Governance meetings demonstrated they were well structured and provided considerable value to staff and leaders. The service also shared learning in bimonthly Clinical Quality Mornings, a monthly online Journal Club. In addition to this, joint major incident training was undertaken annually with local system partners such as the Police and Ambulance service.

Stakeholder feedback praised the service for a positive learning culture and an openness when things have gone wrong. We were told the service was extremely responsive and easy to talk to if problems occurred or more detailed debriefs were required. We heard how they willingly received feedback and acted on it. Staff from the service attended after action reviews and participated in joint working groups created to develop a shared governance forum.

We scored the service as 4. The evidence showed an exceptional standard. The service always collaborated with people and healthcare partners to design, establish, and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

The service had senior clinical and paramedic leads. These staff were highly qualified and experienced in pre-hospital and emergency medicine. The clinical lead also worked in a role in the NHS and was able to bring any learning and experience for patient safety. The clinical quality team were focused on all aspects of patient care, and reviewed all clinical guidance for new or amended information to be distributed throughout the service.

Advanced paramedics from the service were based at the NHS ambulance’s call centre and provided a critical care triage and response service for incidents. The service worked alongside the local NHS ambulance service to screen 999 calls and, in some cases, provide verbal support to calls that came in.

Staff told us how they proactively screened calls in real time, to determine if they could provide support or assistance. Due to the highly qualified nature of staff, they were able to provide call handlers and ambulance crews on the ground with advanced knowledge and support. Decision making was supported by a clear inclusion criterion to ensure resources were deployed consistently.

The service had identified challenges within the region providing prehospital emergency medicine to patients suffering from life threatening conditions in densely populated areas. The service determined, for these areas, helicopter attendance was not always practicable or the most responsive option. They therefore developed a critical care response team, with a ground-based vehicle, to attend these patients. A standard operating procedure set out the skill mix requirements for dual working, of both air and ground vehicles, to allow full critical care interventions.

Calls which required air ambulance or critical care car attendance were immediately communicated to the duty teams and the relevant vehicle would be deployed for response. Specialist staff also provided advanced support to other service frontline staff remotely. This meant the local ambulance staff had instant access to advanced clinical advice and supported staff to further deliver high quality patient care and treatment.

When crews attended to convey or deliver care, they ensured all clinical information was handed over to necessary healthcare services to ensure patients had continuity of safe care, both within the service and post-discharge. Post incident debriefs at scene were a well-established process. Stakeholders told us this was done in an open inclusive way with all staff involved. The service had clear handover agreements with NHS trusts to support information sharing at all handovers.

Stakeholder feedback said the service demonstrated a commitment to working closely with them and responding rapidly to any and all changes and concerns.

We scored the service as 3. The evidence showed a good standard. The service collaborated with people to improve people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. The service shared concerns quickly and appropriately.

Staff had received the mandatory training appropriate to the role and could explain the safeguarding referral process and how these were recorded. We heard how if patients and families or carers had concerns, staff members could signpost to appropriate external agencies to provide support.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. Staff also told us if they suspected any safeguarding issues, such as neglect or abuse, they would raise this with the safeguarding lead who would make the appropriate referral to the local authority.

When safeguarding cases were discussed in local authority meetings, staff strived to attend these meetings. However, this was not always possible as rapid reviews often took place in a short timeframe and often that meant staff were on clinical duty. If they could not attend, the service ensured all observations and relevant information was communicated to the local authority in advance of the meeting.

Staff could give clear examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff followed safe procedures for children visiting the service. Patients who the service had treated, and who had recovered, were supported to attend the air base should they wish, to meet the team. They could bring their family or loved ones with them. If the person attending was under 18, they would always be accompanied by an adult they were attending with.

Staff also received separate newsletters from the Hospital based Adult and Children's Safeguarding teams which provided details of relevant education events that were happening, useful information on recent trends, sign posting, and quick 1-minute guides to relevant documents.

We scored the service as 4. The evidence showed an exceptional standard. The service always worked well to fully understand and manage risks. They provided care that fully met people’s needs and was safe.

Staff from the service were hosted by the local ambulance trust 999 call centre to support joint dispatch decision-making for both Hampshire and the Isle of Wight. This allowed more rapid decision making and dispatch of specialist resources. They would also provide remote assistance where staff did not have critical care skills at an incident. This meant that they reduced the risk of a delay in treatment for patients.

Staff used nationally recognised tools to identify deteriorating patients and escalated clinical concerns appropriately. Patients were assessed using the National Early Warning Score (NEWS2) or for under 18’s the Paediatric Early Warning System (PEWS). This was used in conjunction with the Glasgow Coma Scale (GCS). The Glasgow Coma Scale (GCS) is used for the neurological assessment of patients with acute brain injury and impaired consciousness.

The service used standard operating procedures based on national guidance and clinical research to support clinicians to respond to deteriorating patients or those requiring emergency treatment. Staff attended incidents for a range of conditions associated with suspected or identified stroke, cardiac arrest, haemorrhage, and major trauma.

Patients who were airlifted to hospital were handed over to an emergency department team. As part of the handover, staff shared information about the patient’s condition and deterioration, and risks observed. Patients who were not airlifted and instead followed the same handover process at the incident to an NHS ambulance service for transport to an emergency department.

Patients and loved ones were advised of the risks and benefits of the treatment and transfer options at the scene of an incident. Staff checked other people involved were also looked after before leaving an incident. Staff were encouraged to listen to patients and loved ones but ensure they were given the best advice to manage the risks they were facing.

Individual risks to people were assessed, and people were involved in this process as much as possible. There was a balanced and proportionate approach to risk in individual care and treatment that supports people and respects the choices they make about their care. A dedicated after care team asked patients, or in some instances loved ones, for their feedback about the decisions taken in after-care meetings.

Staff knew and dealt with any specific risk issues including major trauma to vulnerable people. All incidents were attended by an emergency medicine or anaesthetic doctor as part of the team. Equipment carried by the clinical teams was used to provide rapid testing and monitoring to enable care and treatment to be provided quickly and efficiently. For complex incidents they were not attending, dispatch staff were able to support with advanced knowledge in critical care and emergency medicine.

There were senior clinical medical staff on duty during operational hours, this team could be contacted by any staff for guidance and advice. The senior clinician took full responsibility for all patient’s care and treatment, even if this was managed remotely.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service had enough suitable equipment to care safely for people. The service operated from premises at a working airfield. The premises comprised of staff offices, clinical storage areas, meeting rooms, a large training room and a rest area for staff. Vehicles included the air ambulance and 4 critical care cars. The helicopter was stored in a hanger on site when not in operation.

The premises were secure from unauthorised access with a keypad. Visitors were met at the entrance and signed in. There was security onsite and CCTV coverage of all operational areas and the car park.

Staff told us the aircraft, vehicles and equipment were monitored daily, with appropriate testing and calibration carried out. At the time of the inspection, the main helicopter was undergoing its annual maintenance service, and a replacement helicopter was in use.

The helicopter and response vehicles were all in working order. The base area was clean and well organised. The base has a practical layout of the base, which included a physical pathway to enable staff returning from an incident to go through suitable environmental control procedures before entering the main office area.

Staff told us if there were any safety concerns with equipment or a vehicle, it would be taken out of service and a request promptly made for repair/replacement. The helicopter was licenced and regulated by the Civil Aviation Authority. This included the regulation and requirements for the pilots, landing areas, and flight operations.

We observed the aircraft and crew leaving and returning to base in response to a call out. We saw how staff took steps to maintain safe environments such as closing internal and base doors. Protective equipment for staff remaining at base, such as ear defenders and glasses were readily available. We observed the take-off flight of the air ambulance helicopter and saw staff complying with required safety checks, including standing safely away from the helicopter when starting, and only boarding when given the all-clear by the pilot. Staff wore personal safety equipment when travelling by helicopter or rapid response vehicle which followed national guidance. Aircraft operators received live real time notifications and any hazards uploaded onto the map held on the computer device inside the aircraft which could be seen by the pilot. This meant staff could be kept updated of changing risks to the helicopter in relation to travelling by air.

A pilot completed safety checks each shift to determine the how much could be loaded onto the aircraft and where it should be loaded, the level of fuel and medical equipment which could be carried and for how long. Staff told us how there were limitations on helicopter deployment when flight visibility was affected, this was to ensure the safe usage of the aircraft. The service had a standard operating procedure in the event of adverse weather conditions preventing flight. This set out the use of the rapid response vehicles, meaning the service could still respond in as timely and efficient way as possible.

Clinical consumables, such as syringes, airway apparatus and bandages, were securely stored at the base with access restricted. The service had implemented a system which allocated each item used an alphanumeric reference code. This meant staff were able to locate stock quickly and without delay. Item codes were displayed on storeroom shelving and restocking lists. Staff replaced and replenished kit bags following each call. Staff also checked equipment at the beginning of each shift, any issues were handed over from the outgoing staff in dedicated meetings. Staff described how the restocking system ensured time spent replenishing kit bags had been minimised.

We scored the service as 4. The evidence showed an exceptional standard. The service made sure there were always enough qualified, skilled, and experienced staff, who received thorough support, supervision, and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

The service had strategic plans, audits and policies to ensure there were the right number of fully trained staff to care for patients. There were safe levels of staff who were trained, qualified and experienced. Staff told us there was a well-managed system of training to ensure they were appropriately skilled for their role. Staff undertook refresher training and cases were regularly reviewed with staff for learning purposes.

Mandatory training was closely monitored by local leaders. Monitoring of mandatory training was also overseen at provider level within the division that the service sat in. Mandatory training completion rates met the service’s compliance with clinicians at 95% and dispatchers at 100%. The service acknowledged recognised risks to staffing such as on-going recruitment, and training and development of new staff. This was on the corporate risk register, which described how the service would fully manage the situation.

The service had recently undertaken a recruitment day for paramedics. This was well attended with a substantial number of applicants. To ensure the most appropriate and skilled staff were recruited a number of assessment stages were undertaken. This helped determine clinical competence and suitability. The service were proud to have attracted such a significant number of applicants and made sure to ensure it was a positive experience for all, including those unsuccessful in being appointed.

Staff undertook mandatory training days which were held 4 times a year, there was a responsibility for all staff to attend at least one of the days per year. Annual major incident training was held and was attended by staff from multiple organisations. All attendances were reviewed with staff for learning purposes. This supported staff professional development.

There was a standard operating policy for staff when attending incidents. Managers told us if staff members had any concerns about clinical treatment or care at the scene of an incident, they could contact the on-duty consultant doctor for guidance.

Staff sickness rates for the service for the 6 months prior in inspection were on average 1.8%, this included all staff employed at the service including administrative staff. This was below both the national average of emergency and urgent care staff (5%) and lower than the trust average (4%). Staff had yearly appraisals, and 3 monthly check ins. Documentation showed all staff had received an appraisal in line with trust policy. Staff appraisals included conversations about career development and how it could be supported.

The service had a policy to deal with poor staff performance promptly and effectively. Leaders told us they had not needed to use this but were aware that they could if necessary.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There was an effective approach to managing the risk of infection and people were protected as a result. Staff we spoke with confirmed infection prevention and control was integral to their role. Staff adhered to infection control principles, including handwashing. Staff also carried sanitising gels to be used before commencing patient contact as this would be in public spaces and undertaking handwashing with water would not be practicable. The service used the infection prevention and control policy for the trust which applied to all staff. There was also a Helicopter emergency medicine (HEMS) standard operating policy for infection prevention and control (IPC) that encompassed the additional factors of the service, such as the ambulance control desk and service vehicles. This had been developed with the local NHS ambulance service.

Due to the nature of incidents attended, staff undertook a number of interventions using aseptic non touch technique (ANTT). ANTT is used to avoid the contamination of equipment by adopting a ‘non-touch’ technique and maintain sterility, this keeps procedures free from organisms and reduces the risk of infection. This is essential in emergency response medicine where the environment is unpredictable and unfamiliar. All clinical staff undertook mandatory training in ANTT to ensure the principles of this were incorporated into practice.

There was a trust level policy in place that meant all intravenous administration lines put in by HEMS staff should be removed within 48 hours to reduce the risk of infection.

Staff maintained equipment well and kept it clean. Equipment within the service base was visibly clean and cleaning products were readily available. When staff returned from a call, they used the service hangar to unpack and clean equipment. There was a shower and changing area easily accessed from this space meaning it could be used without staff entering into other areas and minimising cross contamination.

IPC measures were grouped into clear stages. Acute cleaning, this was the stage of cleaning reusable devices following patient contact. The second stage of this was if there had been blood or bodily fluid spillages, or a risk of cross contamination. Spillages within the aircraft would be cleaned immediately, should there be heavy contamination, staff could request a return to base or delay to service to enable deep cleaning to take place. Staff gave examples of this happening and how no patient calls would be undertaken until the helicopter was determined to be risk free.

Cleaning records were up to date and demonstrated all areas were cleaned regularly. Checklists reviewed at the time of the assessment confirmed that waste bins, hand hygiene, uniforms, premises and vehicles were all visibly clean and correctly maintained. We inspected the service vehicles and helicopter and found them to be visibly clean and well maintained.

The service had reported no IPC incidents or concerns in the 12 months prior to our assessment. The case review process meant any infections that may be attributable to the service could be identified and acted upon.

There was clear guidance around staff cleanliness and personal hygiene to minimise the risk of cross contamination. This included guidance on temperature to wash uniforms and replacement of uniform if heavily contaminated. Compliance with this policy was audited on a 6 monthly basis.

Spaces within the base were well maintained and contained furniture was appropriate to the setting. Fire risk assessments and legionella checks were completed in line with national requirements. Sharps and clinical waste was stored safely and in line with guidance. Medicines waste was securely stored and would be removed by the NHS trust when required.

The service conducted regular audits throughout the year around infection prevention and control. Audit results were reported to the divisional trust board to ensure that any non-compliance was identified and actioned appropriately. Due to the nature of the service, observational IPC audits were not undertaken. However, leaders said they were committed to looking at ways this could be achieved. They would work in collaboration with other HEMS services to understand how they could do this.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences.

Staff followed good practice in medicines management and did it in line with national guidance. The service had an in-date medicines policy and there was clear guidance around who could dispense certain medications. Where it was appropriate, patients were informed about which medication was being given. The policy also provided instructions relating to informing patients of any proposed medication and made it clear how patients had the right to refuse medication.

Staff told us all medication information was recorded on the patient record form and the service-to-service handover sheet. The use of any controlled drugs was also noted on the controlled drug register.

The service used Patient Group directions (PGD’s) to administer some medicines. PGD’s are a legal framework in the UK that allows certain healthcare professionals to supply or administer medicines to groups of patients without a specific prescription for each individual. We reviewed the PGD’s for the service and saw they were in date and had been approved by the chief pharmacist for the NHS Trust. Records showed all relevant clinical staff had reviewed these documents and signed to say they had done so. All relevant staff had also undertaken additional non mandatory training on PGD’s to enhance their understanding. Staff told us how PGDs to provide advanced analgesia meant that pain was more controlled for patients when they were involved in traumatic incidents.

Staff from the service situated in the control-room would also support colleagues from other organisations with verbal advice on controlling a patient’s pain when they were not physically attending. There were clear policies in place for this which were agreed with other ambulance organisations.

Patients said how their pain levels were monitored and reduced their distress. One patient said ‘‘Words cannot express the gratitude I will forever have to yourselves for the massive emotional, mental and physical support given to me at that time. Keeping me from pain throughout the journey to hospital was amazing.”

Medicines were securely stored on aircraft, vehicles and on the premises and these were in date.There were clear oversight measures for controlled medicines to ensure these were accounted for. This included logbooks for signing them in and out, and a record of medicines disposed of. We reviewed these records and found them to be complete and accurate. Pharmacists from the NHS Trust undertook controlled monthly medicines audits to ensure consistency and best practice. These audits demonstrated full compliance with policy.

Medicine stock levels were monitored daily by 2 staff members. Any errors or incidents around dispensing would be logged as an incident.When checks identified inaccurate records, this was investigated. For example, when a controlled drug stock level differed to the logbook, leaders reviewed patient records. This demonstrated this medicine had been given to a patient, but the returning sheet from the crew had not recorded this. Staff were reminded of the need to ensure records were completed accurately.

The service had a stock of blood for transfusion and records showed this was temperature controlled and monitored. When blood was returned from a call and not used, staff would undertake checks to ensure it was either marked for disposal or returned to usable stock. There were also oversight measures in place to ensure that all blood stock was in date.

All medicines fridges had temperature controlled and effective oversight in place, this included twice daily monitoring and monthly review of records.