Isle of Wight NHS Trust

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question as requires improvement. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Managers and the culture they created promoted high-quality, person-centred care.

This service scored 82 (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 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The trust had developed a strategy, “Working Together, Improving Together,” which set out its vision, values and strategic aims. The vision was to work together to deliver excellence in care for patients and communities. This was supported by values of working together for patients, working with compassion, working as a team and continuously improving. These underpinned the trust’s strategic aims to meet the needs of the local community, deliver safe high-quality patient-focused care, take responsibility for care delivery now and in the future, support staff, and enable teams to provide the best possible care.

The ambulance service had its own strategy, which was developed in line with the principles of the trust strategy, values and vision. The current strategy was dated 2021 to 2026. The service was currently developing their strategy for the next 5 years. They were developing this in collaboration with stakeholders to ensure it met the needs of the local population. All staff we spoke with commented positively about the culture at a local level, describing it as supportive, with lovely colleagues and supportive managers.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The trust had an overarching executive leadership team, which included the director of the ambulance service. This ensured the ambulance service was represented at executive level. Each function within the ambulance service had a head of service, supported by a head of quality and governance.

Managers had a good understanding of the services they managed. They understood the challenges and had plans in place to address these. The plans discussed reflected the ambulance strategy, particularly in relation to meeting the needs of the local population and the size of the service.

Staff spoke positively about local leadership and described good working relationships. They said the senior leadership team was visible and supportive. Leadership training was available, including in-house programmes and apprenticeship opportunities delivered by external providers.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The trust had a freedom to speak up process, which enabled staff to raise concerns about issues affecting patient care or their working environment. A Freedom to Speak Up Guardian was in place to support staff to raise concerns, particularly where they felt unable to use usual reporting channels. The Guardian acted as a confidential point of contact, ensuring concerns were heard, addressed and followed up.

Staff we spoke with were aware of the freedom to speak up process and knew how to contact the team. They also told us they felt able to raise concerns with their line managers and these were acted upon. Information provided by the service showed staff used the Freedom to Speak Up Guardian for a range of concerns and received appropriate advice and support.

Staff told us they could raise concerns about disrespectful, discriminatory or abusive behaviour without fear of negative consequences. They described feeling comfortable speaking up and gave examples where concerns had been listened to and acted on.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The trust had an equality, diversity and inclusion (EDI) policy which set out its commitment to promoting diversity and inclusion. Staff had access to a reasonable adjustments policy, which provided guidance on supporting staff to remain in work and reducing the risk of discrimination related to protected characteristics.

Staff completed equality, diversity and inclusion (EDI) training as part of their mandatory requirements and had access to a range of staff networks, including disability, LGBT+, race equality and neurodiversity networks.

Staff told us they were supported with reasonable adjustments to meet their individual circumstances. This included flexible working arrangements to support caring responsibilities and tailored adjustments for staff who identified as neurodiverse.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had a clear governance structure with defined lines of accountability from the ambulance service to the trust board. The ambulance division held monthly board meetings, informed by the Ambulance Quality Group and Performance Sub-Committee. The service also reported to the trust board on a bi-monthly basis and held monthly performance review meetings with the executive team. This supported effective oversight and scrutiny of ambulance and Patient Transport Service (PTS) performance.

The PTS maintained oversight through a structured programme of daily, weekly and monthly meetings, which supported accountability during periods of operational pressure. For example, the Clinical Quality Effectiveness Group met monthly and reported into the Ambulance Quality Committee. Where performance sub-committee meetings were temporarily paused due to operational pressures, managers mitigated this by holding focused sessions covering risk, finance, sickness absence and operational performance. This ensured senior managers remained sighted on key risks and performance.

Managers maintained real-time operational oversight through data-driven daily briefings. Daily tactical meetings brought together frontline services, the Clinical Coordination Centre and PTS teams to review key information, including staffing levels, fleet availability and demand over the following 24 to 72 hours. This supported shared situational awareness and coordinated decision-making across teams.

The service also used consistent communication systems to engage staff across different shift patterns. Managers introduced daily in-person crew briefings, supported by a structured 5-day communication cycle to ensure key messages were reinforced. Staff could raise issues for managers to act on, and briefing summaries were shared more widely through email updates. This approach ensured staff received consistent and timely information on safety, wellbeing and operational priorities.

We scored the service as 4. The evidence showed an exceptional standard. The service clearly understood and carried out their duty to collaborate and work in partnership, and services worked seamlessly for people. They always share information and learning with partners and collaborate for improvement.

The Patient Transport Service (PTS) demonstrated strong and consistent collaboration with internal and external stakeholders through structured daily meetings, proactive engagement with clinical teams, and regular partnership working with commissioners and partner organisations. Managers and staff recognised partnership working as essential to maintaining a safe and sustainable service for the island’s population.

The service worked collaboratively with other organisations to support system resilience. For example, it established a Strategic Partnership Board with a neighbouring NHS ambulance trust, providing oversight to support safe and sustainable services for the Isle of Wight. This arrangement supported alignment of pathways, quality standards and clinical practice across organisations.

The PTS developed and maintained strong partnerships with hospital sites, system partners and the wider community to support coordinated patient care. Senior managers and patient transport liaison officers engaged with key stakeholders, including NHS commissioners, Healthwatch and hospital teams, to align transport capacity with demand. Liaison officers attended daily site meetings to share real-time workload information, resolve discharge barriers and manage scheduling challenges. Managers also held regular Integrated Care Board (ICB) meetings with regional partners to review performance and identify system improvements. These arrangements helped to improve patient flow, reduce discharge delays and support safe movement of patients through the healthcare system.

The service maintained effective communication with GP surgeries, outpatient departments and end of life care providers to ensure coordinated and dignified patient transfers. For example, liaison officers attended clinics in advance to confirm access requirements and patient needs, helping to reduce delays. The service also worked with hospice providers to prioritise urgent transport requests for end-of-life care. In addition, managers and staff engaged directly with patients, families and commissioners through feedback sessions. These approaches helped to ensure patient journeys were well coordinated and responsive to individual needs.

We scored the service as 4. The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The ambulance service demonstrated a proactive approach to improvement. Managers and staff recognised the small size of the Patient Transport Service (PTS), combined with the island’s geography, required innovative approaches to meet the needs of the local population. The service used the trust’s quality improvement programme, “Delivering Excellence,” alongside the Plan-Do-Study-Act (PDSA) methodology to test, evaluate and implement improvements in clinical and operational practice.

The PTS used operational data and frontline feedback to inform improvements to safety and service design. Managers gathered insights from daily operations, audits and staff feedback to address equipment and system risks. For example, following staff feedback, the service introduced equipment and vehicle modifications, including redesigned wheelchair levers, ratchet straps and powered carry chairs, alongside improvements to storage and lighting. These changes supported safer patient handling and reduced risks to staff and patients, although challenges remained in consistently meeting arrival and collection targets.

The service used performance data to inform service planning and improve efficiency. Managers analysed capacity, discharge times and booking patterns alongside regional demand trends. This identified peaks in late-day discharges, morning outpatient activity and ferry-dependent transfers. In response, managers adjusted staff rotas, deployed targeted bank staff and retained a dedicated early ferry shift. Where data showed high levels of cancelled or aborted journeys, managers introduced clearer eligibility criteria, pre-journey confirmation calls and improved communication with GP practices and wards. These changes improved resource utilisation, reduced unnecessary journeys and supported improved timeliness.

The service demonstrated a commitment to patient-centred innovation by integrating clinical safety measures and equality considerations into daily practice. Clinical safeguards were embedded within booking processes, including checks for Do Not Attempt Cardiopulmonary Resuscitation status. These approaches ensured care was safe, responsive and personalised, while supporting continuous improvement and reducing risks across the service.