Isle of Wight NHS Trust

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• 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

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected.

At our last assessment we rated this key question as good. At this assessment the rating has remained good. We found evidence of a positive culture of learning and improvement. Systems and pathways supported the transition of care and there were robust arrangements between services to ensure access to treatment on the island and outside of it. Staff ensured patient’s safety by recognising and acting on risks. There were clear arrangements for medicines optimisation. However, there was no risk assessment for single checks of controlled drugs which was not in line with best practice.

This service scored 68 (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 had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff listened to concerns about safety and investigated and reported safety events. Lessons were consistently learnt to continually identify and embed good practice.

Patient safety incidents were managed well. Staff understood how to identify, report and record incidents and recognised the importance of using information to support learning and improvement. A new reporting system had been implemented in 2025 and staff reported this was easy to use.

There had been approximately 158 events across the ambulance service reported between October 2025 and February 2026. Themes related to ambulance response times, capacity, treatment delays and medication. The service followed the NHS Patient Safety Incident Response Framework (PSIRF) approach to focus on learning from incidents to provide safer care and plan safety priorities.

We saw evidence that actions taken following events included a full investigation. Staff undertaking investigations received training and had the skills to do this. We saw evidence of discussion and reflection, shared learning and feedback to all staff following an incident. Improvements to processes were implemented. For example, improved communication processes with the hovercraft operator about estimated arrival times when acutely unwell patients needed to be conveyed to the mainland. We also saw that results from investigations were included in sharing best practice principles as part of regular ‘training Tuesdays’.

Staff understood the duty of candour and their responsibilities in relation to being open and honest with patients and those close to them. We reviewed ‘after action’ review documents where incidents were discussed with senior leaders and staff involved in the incident. We saw that Safety System improvement Plans (SSiPs) were created with a view to focusing on learning and improvement.

Staff described an environment that was focused on learning and improvement. They gave examples of off-site training simulations, such as neonatal and midwifery emergencies, where staff had the opportunity to work together to learn and improve their processes when responding to emergencies.

Incidents were reviewed as part of the service’s governance processes. Themes were identified and reviewed and improvements made.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

There were systems in place to ensure continuity of care and effective collaboration between services, including NHS and other ambulance services. Leaders recognised that good communication and understanding of roles and responsibilities was important to ensure safe care for patients.

There were clear care pathways that took account of the unique geography of the island and the challenges this presented to maintaining safe systems of care. This included partnership working with transport operators to support patient movement and emergency transport coordination to the mainland. For example, patients suffering from cardiac chest pain and an electrocardiogram (ECG) showing a heart attack. There were clear processes involving direct liaison with the cardiology team at mainland hospital and rapid transfer via hovercraft or air ambulance for direct transfer, where possible, within 2 hours of symptoms. Patients were accompanied by Isle of Wight frontline staff for continuity and handover to mainland ambulance crews.

There were regular meetings with ambulance, critical care, helicopter emergency medical services, coastguard and transport services colleagues to review standard operating procedures and performance. Service leads engaged regularly with police and fire service leaders to support joint operational planning, incident response and community safety initiatives.

The service had clear transportation pathways providing instruction on where patients should be taken to. These included adult, children, maternity, same day emergency care (SDEC) and major trauma pathways. In addition, there were onward referral pathways for non-conveyed patients. These included GP practices, community nursing teams, hospice care, urgent community response, community falls team and mental health teams. The service had a mental health rapid response vehicle for patients with acute mental ill health. There was a specialist paramedic team pathway for patients requiring pre-hospital urgent care. Care pathways were accessed by ambulance crews on their mobile devices.

The service used trained volunteer community first responders to respond to emergencies quickly while an ambulance or other response was on route to the scene. This was to support emergency responsiveness due to some rural island locations. There was clearly defined criteria regarding the type of call these volunteers could attend.

The service’s assessment processes ensured that all essential information about the patient was received to determine how the patient’s needs could be safely met. Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, including for those patients not conveyed to hospital.

Staff shared key information through patient handovers to keep patients safe when handing over their care to others. We observed patient handovers and saw these were comprehensive.

The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving 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 received safeguarding training, were aware of the process for making a safeguarding referral to the local authority and followed this process when required. At our previous inspection we found that safeguarding referral processes were time consuming and impacted the time frontline crews were away from responding to emergency calls. At this assessment we found the process for making a safeguarding referral had been streamlined and staff told us it was less time consuming.

Paramedics and specialist paramedics were trained to safeguarding adults level 2 and safeguarding children level 3. Training achievement was between 93% for specialist paramedics and 97% for ambulance emergency services. We saw that newly qualified paramedic competencies included those relating to safeguarding, these were signed off by senior staff as part of a 2-year competency programme.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff used the electronic patient record system to highlight safeguarding concerns, which prompted safeguarding referrals to local authorities when required. However, not all staff received feedback after raising a referral.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. They understood their responsibilities to share concerns quickly and appropriately. We observed staff caring for patients who were vulnerable, including children and older patients. We saw that concerns for safety were acted on. For example, when conveying a patient to hospital, paramedics took action to ensure the safety of a vulnerable adult remaining at home.

Safeguarding concerns were captured as part of the routine review of incident reporting within the service, where themes were identified. This meant that safeguarding incidents were reviewed to ensure that learning from them was identified and shared with relevant staff.

Frontline staff received Association of Ambulance Chief Executives (AACE) training in restraint, de-escalation and positive approaches to behaviour. We saw that 84% of staff had received this training in 2024. We were told there had been some issues with completing annual training updates due to a lack of available instructors. There were plans to complete the annual training update in 2026.

The trust wide safeguarding policies, for children and adults was in the process of review. These had been submitted to the safeguarding committee as part of a review, ratification and approval process.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service worked with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There were holistic patient assessment processes in place that included an assessment of physical, social, emotional and psychological needs. Staff included a comprehensive assessment of risk for each patient. Joint Royal Colleges Ambulance Liaison Committee (JRCALC) Guidelines were followed. Staff had access to the JRCALC app through electronic devices so they could access up to date guidance when they needed to. There were specific risk assessment processes that included moving and handling, pain, frailty and whole system assessments such as circulation and breathing. We saw that risk assessments were undertaken routinely as part of assessment processes.

The service used nationally recognised assessment tools such as the national early warning score (NEWS2) that helped clinical staff recognise deteriorating patients and we saw that these were completed appropriately on calls we observed. Where audits showed incomplete use of the NEWS2 assessment tool, we saw that clinical support officers (CSOs) raised this with individual staff as part of their learning and development.

The service used a ‘sepsis six’ care bundle which enabled paramedics to identify and treat sepsis before arrival in hospital. Paramedics received training on the identification and treatment of sepsis. They used a patient group direction (authority to administer specific medication to a pre-defined group of patients) to administer antibiotics and they obtained blood samples prior to hospital admission.

Staff could access additional clinical support from the service’s clinical support desk. This was staffed by clinical staff with additional training and skills and included medical staff and critical care and specialist paramedics.

Staff took account of patient’s wishes and adapted treatment and care to suit their needs where possible. For example, we saw a patient who did not wish to be conveyed to hospital was supported to access community care and support. Staff facilitated access to clinical and follow up support through a virtual ward service where the patient could receive additional care at home.

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 design of the environment followed national guidance. The Isle of Wight ambulance station was on the same site at the hospital in a dedicated ambulance station that included a make ready function with staff responsible for daily checking and stocking of ambulances.

Staff had communal areas to eat and relax, and there were separate toilet, shower and changing facilities. There was a dedicated quiet room and one to one space for confidential discussions.

The ambulances we checked were restocked and refuelled. Records showed all vehicles were taxed, insured, were regularly maintained and had valid MOTs. However, the vehicle fleet was ageing and so the trust had purchased new vehicles. There was a delay in receiving these and one new vehicle had to be returned as did not meet the specification of the service. Staff reported issues with the age of the vehicles and increased risk of maintenance problems. There were vehicles on loan from other services as part of the service’s fleet management plan. The age of the vehicles was on the service risk register. In October 2025 there had been 4 incidents relating to vehicle issues. However, there had been none in the following months. Leaders told us the new vehicles were arriving imminently.

Ambulances we inspected had appropriate equipment for the safe transport of patients, this included harnesses, chairs and trolleys and equipment for the safe transportation of children.

All ambulances we inspected contained essential emergency equipment and there were appropriate checks of this. We reviewed defibrillators, cardiac monitors, suction machines and blood glucose monitors. Equipment was serviced and calibrated in line with manufacturer recommendations, and we saw records of this. The trust maintained all equipment and there was an effective process to replace any defective equipment.

Ambulance crews had access to up-to-date satellite navigation systems. They had access to electronic devices that enabled them to record relevant information and access patient records.

The ‘make ready’ areas (where vehicles were checked and stocked with equipment) were only accessible by electronic swipe card given to authorised staff. Keys to ambulances were stored securely and signed in and out at the beginning and end of shifts.

Staff disposed of clinical waste safely in secure clinical waste areas when returning the ambulance to the station.

All products subject to the Control of Substances Hazardous to Health regulations were stored securely in dedicated, locked and clearly labelled storage cabinets.

Staff worked together well to provide safe care that met people’s individual needs and made sure staff received effective support, supervision and development. However, the service did not always make sure there were enough qualified, skilled and experienced staff as some mandatory training modules had low compliance.The trust had a vacancy rate of 4.26% for frontline services. They had a staff turnover rate of 1.52% and a sickness rate of 8%. Leaders told us they had recently undertaken a targeted paramedic recruitment campaign resulting in five Newly Qualified Paramedics (NQPs) being offered substantive contracts with planned induction for April 2026.

Managers calculated the number and grade of paramedics and emergency care assistants required. Rosters were planned by the forward planning team regular meetings were held to discuss roster issues. Rosters were signed off by operational station managers. Planning included seasonal events where capacity needed to be increased temporarily. For example, there was a reduction in annual leave approved during the annual Isle of Wight festival to help manage capacity and demand.

Volunteer community first responders worked within the service, providing an initial response to patients. These were volunteers who were trained to assess and feedback their findings so appropriate resources could be deployed. Volunteer community first responders received accredited training delivered in-house by qualified tutors, to a minimum of a Level 3 award for first responders on scene (ambulance service community responder) or equivalent. This was supported by monthly refresher training and regular supervised clinical practice shifts alongside frontline ambulance crews to maintain and enhance knowledge, skills, and competence in responding to emergency situations. Volunteer community first responders carried first aid oxygen, defibrillators and first aid kits.

Recruitment processes were aligned with NHS Employment Check Standards and included disclosure and barring service (DBS) checks, references, right to work and employment history checks. Recruitment checks were carried out for substantive, bank and voluntary frontline staff.

We reviewed rosters and saw the number of paramedics and emergency care assistants mostly matched the established number on shifts. When there where gaps, for example, due to short term sickness, managers requested additional staff. Occasionally 2 emergency care assistants would work together as a crew. When this happened, they received support from the clinical support desk and critical care paramedic. Their default in this situation was to transport patients to the emergency department if the patient’s needs were outside of the scope of the emergency care assistant role.

The service had a bank of paramedics and emergency care assistants to support staffing. Operational station managers adjusted staffing in response to escalating needs. For example, in line with increases in operational pressures escalation levels where a resource escalation action plan (REAP) level was reached. Bank staff received the same induction, training and supervision as permanent staff.

Staff received and most were up to date with appropriate mandatory training. Overall mandatory training compliance for ambulance emergency service staff was 82% against a trust target of 90%. Leaders told us a recent standardisation of training profiles across the trust meant there had been a recent drop in overall compliance. While we saw good compliance in areas such as infection prevention and control, equality diversity and inclusion and paediatric basic life support, there were other areas where compliance was low. Adult basic life support was 56% and moving and handling was 66%. The service had action plans to address this over the coming months. This included a schedule of resuscitation training being rolled out throughout the months of April, May and June this year. Leads told us that staff had completed local level 3 moving and handling training, but that the trust had changed the mandatory requirement to an alternative module and internal trainers were being identified to deliver this. The service had also provided face to face training on the use of stretchers and power loads that were being fitted to the new ambulances due to be delivered.

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.

Staff maintained equipment well and kept it clean. All ambulances and vehicles we inspected were visibly clean, tidy and well stocked. Records showed that vehicles were cleaned and re-stocked in between use. They were deep cleaned on a monthly basis and vehicle audits showed compliance with cleanliness and infection prevention and control procedures. Audits undertaken between November 2025 and February 2026 showed a compliance of 97%.

We observed make ready staff cleaning and re-stocking vehicles, and frontline staff cleaning equipment in between patients. Staff had access to appropriate materials for cleaning and decontamination including spill kits that were in date.

Staff had access to appropriate personal protective equipment (PPE) to prevent and control the spread of infection and meet hygiene principles. They also had access to clean linen and we saw this was readily stocked on ambulances. Sterile single use supplies were stored appropriately with intact packages and were in date.

Staff adhered to infection control principles, including hand hygiene. We observed staff cleaning their hands in between patients and on arrival in the emergency department. Hand hygiene audits were carried out monthly. However, we reviewed the results of the last 3 months’ audits and found that results were variable, between 69% and 100%. Leaders told us they observed hand hygiene of ambulance crews on arrival in the emergency department and when issues were identified this was addressed with individual staff. A personal protective equipment (PPE) audit undertaken in the last 6 months showed compliance of 100%.

We were told that any infection prevention and control incidents were reviewed by the trust’s infection prevention and control committee. There had been no recent incidents relating to frontline ambulance services.

Staff undertook regular infection prevention and control training and compliance was 100%.

The evidence showed some shortfalls. The service made sure that medicines and treatments were safe and met people’s needs and preferences. However, the service had not completed a risk assessment for the use of single checks of controlled drugs which was not in line with best practice.

Staff followed good practice in relation to the storage of medicines. Medicines were kept in a locked cupboard within a temperature controlled automated medicines cabinet. Temperature checks were within the required range and records showed these were carried out daily. Only staff with approved access could access medicines, through an electronic fingerprint identification system. In the event of electrical failure, the system was accessed by a key which was stored securely in a cabinet in the operational station manager’s office. Medicines were signed out and unused items signed back in.

We observed the process of medicines access in relation to morphine. We saw that only 1 registered professional accessed controlled drugs, with no second checker. This was not in line with best practice. Leaders acknowledged there was no risk assessment of this process and the potential risks this incurred. Staff told us that when the automated system was first brought in, controlled drugs were required to be second checked, however, due to difficulties accessing a second checker and the delays caused, single checking was brought in. We were told the trust acknowledged this issue and had established a working group to review this process in January 2026. This was led by the trust pharmacy lead who also sat on the national ambulance pharmacy group. Subsequently, the working group were overseeing a review of other local ambulance processes to ensure appropriate alignment with safe practices, considering the unique nature of the Isle of Wight single ambulance station model.

We saw records relating to the administration and reconciliation of medicines. Operational station managers (OSM) carried out a daily audit of controlled drugs and a report from the automated medicines system was shared daily with pharmacy for oversight.

In the event of controlled drug discrepancies, the OSM reconciled the records against the staff who had accessed the system. Identified crew members were then called back to the station to verify the stock count and action taken as appropriate. All incidents were reported through the trust incident reporting system. We viewed incidents and saw these we properly investigated. For example, we saw errors relating to recording of controlled drugs and that individual staff received feedback on this and actions taken to improve. There had been no morphine drug inconsistencies with the current system.

We reviewed a November 2025 pharmacy led controlled drug audit. This included the identification of controlled drug denaturing kits being used for more than the single use for which they were designed. An action from the audit was that a review of the use of denaturing kits and associated standard operating procedures should be undertaken.

Non controlled drug medications were pre-packaged by the pharmacy department and tag sealed before being brought to the station and placed in locked drug stores. Pharmacy visited daily and removed used and seal broken medicines bags in order to resupply and re-tag them. Medical gases were locked in fireproof cabinets.

The service had effective processes for the administration of medicines. This included the use of patient group directions (PGDs), which allow some healthcare professionals to supply and administer specified medicines to pre-defined groups of patients without a prescription. For example, we viewed PGDs for the treatment of sepsis and for the treatment of heart attacks. These were valid and appropriately authorised and signed by staff. In addition, training scenarios were used as part of staff ‘training Tuesdays’ as part of staff induction and ongoing competency based training.