Isle of Wight NHS Trust

On this page

• 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

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question requires improvement due to governance structures and performance data being in their infancy so it was difficult to establish their effectiveness. At this assessment the rating has changed to good. This meant the service had effective governance to deliver consistent safe and high-quality, person-centred care and they used performance data to evaluate services and drive improvements.

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 looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question requires improvement due to governance structures and performance data being in their infancy so it was difficult to establish their effectiveness. At this assessment the rating has changed to good. This meant the service had effective governance to deliver consistent safe and high-quality, person-centred care and they used performance data to evaluate services and drive improvements.

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.

Leaders had the skills, knowledge and experience to perform their roles and had a good understanding of the services they managed. There was representation from the ambulance service at trust board level. The service was led by the director of ambulance service and there was a head of quality and governance for the ambulance service. Clinical leadership was provided by a consultant in emergency medicine/pre-hospital emergency medical doctor.

The service was managed by a clinical operations manager and leads in areas such as specialist paramedic team leaders, education, driving standards, resourcing and fleet management. Day to day service leadership was provided by operational station managers who supported logistics within the service. There were clinical support officers providing support with clinical supervision and resilience support to frontline staff.

Staff told us leaders were visible and approachable. Most staff told us they felt listened to by leaders and were able to contribute thoughts and ideas to the service as a result. Staff understood their roles and responsibilities and there were clear reporting structures within the service.

Senior leaders within the ambulance service had participated in a structured, facilitated improvement development programme designed to strengthen leadership capability in quality improvement. There were plans for the coming year for a range of staff in leadership roles to complete a people management programme.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Friends and Family Test (FFT) results showed that 93% of people completing the survey would recommend it to their friends and family. Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements.

There was a confidential freedom to speak up service that staff could access. Staff we spoke with understood how to do this and we saw posters in staff areas with contact details. Staff could raise concerns anonymously if they wished and received support to address their concerns as needed.

Freedom to speak up themes were identified and an anonymised report fed back to the leadership team. Themes included those relating to patient safety, bullying and harassment, behaviour and relationships and discrimination and inequality. Action was taken to address individual concerns and staff were supported through this.

Staff were made aware of the freedom to speak up process and availability of freedom to speak up guardians. This included in person contact with staff on site and in presentations to explain how the service works and make it more accessible to them. Regular planned meetings with key senior staff were held to discuss themes and plan actions to address these.

Some staff we spoke with told us they had made use of the freedom to speak up process and that they were supported and felt listened to.

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.

There are equality and diversity champions within the service and equality staff networks, such as those for race, LGBTQ+, disability and neurodiversity. The trust had achieved disability confident leader status, which meant all candidates who met the minimum requirement of an advertised role would be offered an interview.

Managers put reasonable adjustments in place for staff members to help them carry out their role. For example, through role changes when impacted by temporary limitations on their ability to carry out their normal duties.

Staff had a good understanding of equality, diversity and inclusion and recognised that diversity was valued within the workforce. They had received training and compliance was between 98% and 100% for different staff groups.

Staff were able to apply to work flexibly e.g. flexible working agreements to account for personal circumstances such as caring responsibilities and health issues. Staff told us there was a process of applying to work flexibly and an appeals process should the initial application not be successful. We did hear from some staff who had concerns around flexible working requests being rejected in recent weeks and a potential impact of planned shift changes on those with young families and caring responsibilities.

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.

There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. For example, we saw that discussions during training and team sessions included learning from things that went wrong, as well as discussions and training sessions around changes to practice when necessary.

Staff had implemented recommendations from reviews of deaths, incidents and complaints. For example, the service had a mortality oversight group and reviewed all deaths that occurred within 24 hours of the receipt of the 999 call or the handover to the emergency department. The review included any care concerns whether considered contributable to death or not. We saw that reviews included debriefs with relevant staff and teams and shared learning to ensure improvements where necessary.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. There were clear operational policies and procedures that directed staff on joint working processes. Collaborative working was reviewed as part of governance processes, and we saw involvement from relevant stakeholders in regular meetings.

Staff maintained and had access to the risk register at divisional level. Staff had an understanding of the risks and action taken to mitigate these. Their concerns matched those on the risk register. We heard from many frontline staff about their concerns due to the age of the fleet of ambulances and risk of breakdowns. We saw that action taken had included borrowing vehicles from other ambulance services. We also saw there were new vehicles on order, with imminent delivery due. The risk register was reviewed as part of service governance processes.

The service had plans for emergencies such as adverse weather or a flu outbreak. They had a business continuity plan that included arrangements for escalation. They worked collaboratively with local and mainland emergency and transport services to ensure patients continued to receive emergency care. Daily tactical meetings were held with representation from all ambulance departments. Demand and capacity of the service were reviewed as part of the meeting and included notable events, staffing, demand, weather, national threats and critical services. We observed this meeting as part of our assessment and saw that leaders worked closely together to evaluate demand and capacity and plan for this.

Staff had access to the equipment and information technology needed to do their work. Information governance systems included confidentiality of patient records. Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care.

Service and trust leads reviewed ambulance quality indicators and these were included in quality governance reports. Health and safety reports included information on incidents and accidents, risks and issues, training compliance, fleet and driving performance, audit updates, research updates and learning from deaths.

Information was produced and available in accessible formats, and was timely, accurate and helped leaders to identify areas for improvement.

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.

Emergency and urgent care services 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.

Directorate leaders actively engaged with external stakeholders and maintained strong partnerships. This included other emergency services such as the fire service, police, air ambulance, coastguard and mainland emergency services. In addition, they regularly engaged with island transport providers as part of emergency planning to ensure patients got the quickest, most appropriate treatment and care, including on the mainland. Managers also held regular Integrated Care Board (ICB) meetings with regional partners to review performance and identify system improvements.

The ambulance service was integrated into the community and worked closely with other services to identify and plan for events that impacted on emergency services. This included local events and festivals as well as identifying pressures on services and working together to address these.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback. Staff had the opportunity to feedback on the service through the staff survey and there were huddles and meeting structures that supported engagement. This included regular 6 weekly training days and annual individual learning sessions where staff were encouraged and supported to share their experiences as part of arrangements for continued development of the service as well as individuals.

Staff regularly engaged with members of the community. This included the training team who attended local businesses, schools and other organisations to provide first aid and resuscitation training. In addition, they provided support to the local community post cardiac arrest, including offering support to people following successful resuscitation, family members of someone experiencing cardiac arrest, and also bystanders.

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.

Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery. Examples of improvements since our last inspection included the streamlining of safeguarding referrals which meant processes had less of an impact on front line services.

Innovations were taking place in the service. This included local collaboration for pre-hospital transfers of critically unwell cardiac patients requiring emergency care on the mainland. This integrated critical care pathways project was highly commended at the Health Service Journal (HSJ) 2023 Patient Safety Awards.

The education and community response team provided first aid at work training to local business and schools which helped to fund the community first responder volunteer service and to increase the availability of public defibrillators on the island. This included mapping of ‘hot spots’ on the island to ensure defibrillators were in the most appropriate place. In addition, the service provided a ‘life after cardiac arrest’ support to the local community. This included peer support, bystander debrief and feedback from survivors and their loved ones.

Staff had opportunities to participate in research. Current research projects included a collaborative research programme with the Hampshire and Isle of Wight Air Ambulance (HIOWAA) to improve survival rates for patients in cardiac arrest with new treatment for patients with a persistent shockable heart rhythm. The service also participated in research in relation to evaluating the use of paramedic administered nerve block injections for patients with a hip fracture, as well as participation in research relating to spinal injuries and minor head injuries.

Staff participated in national audits relevant to the service and learned from them. This included out of hospital cardiac arrest, ambulance quality indicators, non-conveyance audits, as well as incidents and complaints processes.

The service had been recognised externally for innovations. The volunteer community first responders were shortlisted for the NHS Parliamentary Awards 2024 in the volunteer awards category. The ambulance training and engagement lead was awarded the Kings Ambulance Medal in the New Year’s Honours list. The care dog team was a finalist in the 2024 HSJ awards.