Isle of Wight NHS Trust

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence people and communities had the best possible outcomes because their needs were assessed. We checked people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service provided effective care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 11 patient records during the assessment. Staff completed a comprehensive health assessment of each patient. This assessment focused on physical, social and emotional aspects of their health and wellbeing. Assessments included past medical history, a physical examination, current medicines and treatments, mental capacity, social history and carer’s needs.

The national early warning score (NEWS2) was used as part of the assessment for all patients. The score is a recognised tool that is derived from a range of physical observations such as respiratory rate, temperature, blood pressure, heart rate and level of consciousness. The score enables staff to identify patients at risk of deterioration. We observed staff using the score, recording results appropriately and undertaking repeat observations as part of ongoing assessment processes.

We observed staff undertaking mobility assessments and frailty scores.. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief advice in a timely way. We observed staff asking patients about their level of pain at initial assessment and throughout their care. They assessed patients’ communication needs and used adapted pain assessment tools such as the a facial expression rating scale for patients unable to verbalise their level of pain.

Decisions about ongoing treatment and care were made using clinical assessment findings. Care was planned using a personalised and holistic approach and focused on meeting the needs identified during the assessment.

The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff followed up to date policies that were centred on evidence-based practice. They used recognised tools to support assessment and decision-making processes. They followed relevant pathways and both National Institute for Health and Care Excellence (NICE) and Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidance when providing care and treatment to patients.

Staff could access up to date JRCALC guidance using electronic devices. Advice and support was also available from the clinical support desk, specialist paramedics for urgent and emergency care and critical care paramedics, as well as medical staff located within the emergency operations centre.

Evidence based pathways were available and could be accessed via the electronic record system. These included specific pathways for patients presenting with certain symptoms, including those of a heart attack, stroke or severe infection. Pathways were regularly updated in line with national guidance. For example, the cardiac chest pain pathway had been updated in line with JRCALC changes.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. Paramedics received clinical supervision and assessed clinical practice where they had a day annually to undertake an individual learning plan review with their clinical support officer (CSO). All staff, including bank staff had access to regular training Tuesdays which happened every few weeks for relevant staff. They received training and updates through this process and included external speakers who provided up to date training and guidance.

Staff were experienced and had the right skills and knowledge to meet the needs of the patient group. They had undertaken qualifications to enable them to register with the Health and Care Professions Council (HCPC) and were thus able to practice under protected title in the United Kingdom.

Managers provided new staff with appropriate induction. There were structured induction processes. For example, newly qualified paramedics (NQPs) worked double paramedic shifts in the first 6 months of qualifying and for longer when needed. Frontline staff attended training and group induction that included an introduction to all aspects of the service. NQPs completed a portfolio of 93 competencies across their first 2 years in post. They were invited to provide regular feedback and evaluate their progress and action plan with support from the clinical support officers (CSOs).

CSOs provided clinical support to the frontline team including one to one support to paramedics. The CSOs were responsible for providing clinical supervision and support as required and through supervision, appraisals, audits, observed practice and the development of individual learning plans (ILP) that were developed annually through one-to-one days for paramedics.

Although emergency care assistants received direct supervision in their day to day work from paramedics, they did not have access to dedicated one to one supervision (individual professional support sessions). Staff we spoke with acknowledged this was a gap in structured support, however, this was partly was mitigated by the training offered and that staff could request one to one support when they felt they needed it. Leaders told us they were reviewing this approach.

Staff had annual appraisals. The percentage of paramedic staff who had received an appraisal in the last year was between 92% and 100%. This was lower for emergency care assistants where achievement was at 80% against a target of 90%. Service leads acknowledged this was due to capacity and demand pressures on the service, however, there were plans to address this in the coming months.

We scored the service as 4. The evidence showed an exceptional standard. The service always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.The emergency and urgent care service built strong internal working practices by using its position within the Isle of Wight NHS Trust, which managed both emergency ambulance and acute health services. The ambulance service medical lead was both an ED Consultant and a pre-hospital emergency medical (PHEM) doctor. This shared clinical leadership fostered effective daily communication between the Clinical Coordination Centre, the frontline ambulance service, and the ED. This helped to remove organisational barriers. By aligning emergency ambulance and hospital operations, staff improved working practices, which enabled patients to receive treatment and care in the most appropriate place within the shortest amount of time.

Recognising the difficulties of transferring patients off the island for specialist treatment, the service secured agreements with ferry companies and the coastguard. As a result, the service maintained continuous, reliable emergency care and transport links to and from the mainland, ensuring patients received emergency care as they needed it.

The service maintained continuity and balanced its daily workload through participation in daily multi-team tactical meetings. Frontline teams met regularly with patient transport services and the control centre to review transport demand and resource availability over the next 24 to 72 hours. This collaborative approach provided early visibility of potential pressures. By sharing operational data, managers identified potential vehicle and staffing shortfalls in advance, allowing them to adjust booking schedules, manage demand and secure support across teams before delays occurred.

Staff shared information about patients at effective handover meetings when transporting them to the emergency department (ED). They had effective working relationships with ED and other staff. We observed handovers and saw they were comprehensive and staff shared relevant clinical, social and risk information. Staff used the SBAR framework (situation, background, assessment and recommendation) to communicate a patient’s condition. Nursing staff within ED told us ambulance staff were consistently professional and supportive and worked well with the wider healthcare team.

The teams had effective working relationships with other relevant teams within the trust and externally. We were given examples of joint working with other services such as the police and fire service, coast guard, air ambulance, GPs and community services. This included engagement around operational performance and practice, training and emergency planning activities.

We observed a daily ‘situation report’ meeting where leads met to discuss key information including risks, staffing, capacity and demand pressures and other information that impacted on daily operations. There were also regular huddles between frontline staff and control room staff where long waits, incidents, complaints and other relevant issues were reviewed. We saw that staff communicated effectively and worked well as a team.

Staff supported patient to live healthier lives. Assessment processes included identifying what was normal for individuals, including asking questions about their mobility and usual levels of activity.

Frontline staff gave ‘see and treat’ advice to patients if their condition did not require a transfer to hospital. This included organising referrals to other services, for example GPs, community and specialist services through the emergency operations centre as necessary.

When patients were not conveyed to hospital staff provided additional advice such as contact 111 for advice or dial 999 if their condition deteriorated or they were concerned.

The service routinely monitored some aspects of people’s care and treatment to continuously improve it. However, audits of electronic patient records were inconsistent with evidence of gaps in the frequency of monitoring.

In the 11 patient records we reviewed we saw that staff had administered timely treatment and care and had clear justification for the course of action taken.

Patient records were audited to check the effectiveness of the care and treatment provided. The audit checked that records included appropriate recording of assessments, treatment, consent, mental capacity, safeguarding and ongoing monitoring. The audit process did not identify overall service performance but focused on individual practitioner standards and compliance. We saw that areas for improvement were identified and discussed with relevant staff. For example, where there were gaps in assessment processes or repeat observations, as part of patient monitoring, these were reviewed as part of staff ongoing development.

We found that the process for ongoing audits, where monitoring of patient outcomes and any subsequent improvements, was not clear. For example, some staff had received an annual audit of their electronic patient record entries. However, others had not had an audit for over a year, including some who had not received an audit since 2024. Leaders told us this was due to the pressure of work on the service and capacity within the clinical support officer (CSO) team. We therefore found there was a lack of oversight, monitoring and tracking of EPCR forms and subsequent patient outcomes relating to these.

Audits of non-conveyance of patients were routinely undertaken. These included a review of action and decision making and whether quality escalation and improvement was required.

The most recent published data (2024) from the Out of Hospital Cardiac Arrest Outcomes (OHCAO) project showed the cardiac arrest 30-day survival rate was 33.3%. The trust had worked to improve access to public access defibrillators by providing first aid and resuscitation training to local businesses and schools. We were told that in a 9-month period they had trained 2,500 members of the Isle of Wight community and helped to increase public access to defibrillators to 597 across the island. They had undertaken mapping exercises of areas across the island to ensure defibrillators were in the right place. They also worked with the local fire service to support emergency response for cardiac arrest in order to ensure a faster emergency response. Other initiatives to improve out of hospital cardiac arrest survival rates included providing training to people living in more deprived areas due to data showing that residents in these areas were less likely to survive.

The service monitored the use of a return of spontaneous circulation (ROSC) care bundle. The bundle is a standardised set of resuscitation interventions designed to stabilise patients after cardiac arrest. Data showed the service achieved 80% in the use of the care bundle against a national average of 79.8% in August 2025. The service also monitored the use of a falls care bundle, a set of measures aimed at reducing falls. We saw that data between September 2024 and June 2025 showed achievement of the care bundle was similar to the national average, between 47% and 49%, compared with between 44% and 51% nationally.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Summarise your findings here using the topics below:

Staff took all practical steps to enable patients to make their own decisions. For patients having difficulty making decisions about their care or treatment, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis regarding significant decisions. For example, where a patient wished to stay at home rather than go to hospital. We saw that staff informed people of their options, including risks and benefits and possible outcomes of decision making.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Staff had completed training in mental capacity and understood their responsibilities in relation to this. Training compliance was at 95% for frontline services.

We observed staff informing patients and family members of each step in relation to their treatment and care. They sought verbal consent and ensured information was shared appropriately.