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 that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

Health advisors followed the NHS pathways to assess a patient’s condition during calls. Dependent on the callers answers the pathways guided health advisors to facilitate the most appropriate clinical response (disposition) to meet the patients need. This could be dispatching an ambulance and crew to the patient, getting a clinician to call the patient back or signposting the patient to other more suitable services.

We observed staff following these pathways. Depending on the answers given by patients or callers, staff signposted patients to other health care services. Alternatively, the dispatcher allocated resources such as an ambulance crew and community first responders to attend to the patient. Following the NHS pathways, some calls were transferred to a clinical advisor, which could be a nurse or paramedic. They asked further assessment questions which could result in the patient being signposted to other health services, known as ‘hear and treat’, or an ambulance being dispatched to the patient. Records showed the number of ‘hear and treat’ services occurring were improving, with more patients receiving ‘hear and treat’ advice. Between January 2025 and December 2025, the rates had ranged from 9.5% to 12% of patients received ‘hear and treat’ advice. This reduced the need of other resources such as ambulances to be dispatched and reduced the pressure on the trust’s emergency department.

Staff followed processes to reassess and change plans for patients. For patients who had to wait long periods of time for ambulances, welfare checks were carried out. These involved clinicians calling the patient to check on their wellbeing. If during that call the clinician assessed the patient’s condition was changing or deteriorating, the category of ambulance (the time the ambulance should take to get to them) was altered.

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.

The trust’s clinical guidelines and policies had been developed and reviewed in line with national guidance. Staff accessed policies and protocols on the trust’s intranet. We reviewed 10 policies and except for 1, they were in date, appropriately ratified and reviewed with clear future review dates noted.

An audit team conducted regular call handling audits of all staff groups. This supported early identification of any safety concerns in call handling, particularly for high‑risk call types such as 999 and cardiopulmonary resuscitation (CPR) related calls. It also helped to ensure staff correctly followed the NHS process for call handling. CPR calls automatically triggered an audit to ensure that any life‑critical interactions are reviewed promptly and safely. The audit team used the national health advisor competencies framework to determine what should be audited and how performance should be measured. This ensured audits were consistent, evidence‑based, and aligned with national expectations. Health Advisors who took both 111 and 999 calls received at least one 999 audit per month to maintain competence across both pathways. All call handling staff received 6 audits per month when they commenced work and if they consistently achieved the pass mark this was gradually reduced to 3 per month. There was a clear process to support health advisors who did not pass audits to improve.

The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service was in a unique position as the ambulance service was part of the Isle of Wight NHS Trust which also provided acute health care services to the island’s population. This supported effective working relationships with departments in the acute hospital. The ambulance medical lead of the ambulance service also worked as a consultant in the emergency department at the hospital. This meant there was improving working practices between the ambulance service, including the Clinical Coordination Centre (CCC) and the trust acute services including the emergency department.

The service had strong working relationships with other emergency services and travel services on the island. Recognising the challenges associated with moving patients to and from the island for treatment, the service had agreements with the ferry companies and coastguard to help with the transfer. Recognising the limitations to the number of staff available to respond to calls and the remote geography of some of the island, the service worked collaboratively with their community first responders, the fire and rescue service and the local coastguard to enable patients to be reached and treated in a timely manner. This meant the dispatchers working in the CCC had a breadth of resources they could use to support the permanent ambulance crews.

The service worked closely with the local air ambulance service. Due to weather conditions and capacity, the service recognised that access to the air ambulance service was not always available. Joint working, training, shared protocols and rotation support for critical care paramedics meant the Isle of Wight ambulance procedures, equipment and training were consistent across both organisations. A critical care paramedic worked in the CCC, who could screen calls and ensure the appropriate resources went to patients to deliver prehospital care and treatment.

Within the CCC staff of all roles and grades worked together to support effective delivery of the service. We observed senior health advisors listening in to calls and giving support to health advisors. We observed the dispatcher and the hub duty manager working together to arrange ferry bookings and transfer of patients from the hospital to NHS services on the mainland.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service monitored their performance through audit and national benchmarking. This supported them to work towards meeting key performance indicators to meet the needs of the local population.

They followed the national Ambulance Quality Indicators (AQIs). These were introduced in April 2011 for all ambulance services in England and look at the quality of care provided as well as the speed of response to patients.

Data showed there was a steady improvement with the number of Hear and Treat responses. This meant ambulances were not sent to patients when they did not need to be, releasing them to attend to more critically ill patients.

National data showed that 999 call response times, were similar to other NHS ambulance services, with a range of 4 -5 seconds for staff to answer 999 calls. During the assessment we observed staff immediacy answering 999 calls.

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.

Staff had access to a consent policy. The policy was kept under review by the trust and referenced relevant legalisation and national guidance. There was clear guidance for staff about when and how to obtain consent, how to manage consent for a patient who lacked capacity to give informed consent about a specific decision.

Health advisors sought verbal consent from patients to ask questions about their presenting condition and to agree the pathway. This included forwarding the call to a clinical advisor for clinical advice, booking an appointment in the urgent treatment centre or sending an ambulance crew to assess their condition. Health advisors sought permission to share information with the patients GP.

Staff understood their role and responsibilities regarding the Mental Capacity Act (MCA) (2005). Staff always assumed patients had capacity to speak with them or to make decisions unless they found evidence to suggest otherwise. Staff did not conduct mental capacity assessments whilst on a call with a patient. If staff had reason to question a patient’s capacity, this was communicated to the crew via dispatch, so that the crew could assess whilst onsite.