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 people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

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 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.

Trust policies and procedures gave staff guidance about reporting, managing, investigating, and learning from incidents. The trust’s incident reporting and management policy was published on their website and met the requirements of the National Patient Safety Incident Response Framework. The Patient Safety Incident Response Framework (PSIRF) is focused on learning from incidents to provide safer care to patients. Following the requirements of the PSIRF, the trust published their Patient Incident Response Plan on their website. Following their analysis of reported incidents, the trust identified patient safety priorities and outlined how they would respond to them. Of the 6 identified patient priorities, 2 of them were relevant to the ambulance service and the Clinical Coordination Centre (CCC). These were ambulance delays, this included delays in call handling and interfacility transfers which included the logistical planning and dispatch of vehicles and staff by the CCC. Information provided by the service, including minutes from meetings and discussions with staff, demonstrated the service was aware of the priorities, kept them under review and took action to make improvements.

There had been approximately 158 events across the ambulance service reported between October 2025 and February 2026. Of these, 6 related to services provided by the CCC. Of the 6 incidents 3 were classed as near misses, 1 as no harm, 1 as low harm and 1 in which the patient died. Information provided by the service showed appropriate actions were taken to investigate these incidents and learning was taken and shared from the incident. This included shared learning with other health care providers who were involved in incidents relating to failed pathway processes.

Staff knew how to report incidents on the trust electronic incident reporting process. Staff described the type of incident they would report, which was mainly experiencing abusive language from callers. There were mixed opinions from staff about whether they received feedback or acknowledgment of incidents reported. Discussion with senior leaders of the service showed the reasons for this were due to a new system being recently implemented and staff learning the functionality of the system.

The evidence showed a good standard. 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.

Health advisors, following the NHS pathways, asked callers a series of questions about their health condition. 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.

If the pathway indicated an ambulance and crew needed to be dispatched, the pathway guided staff about which category of ambulance was needed. The category determined how quickly the ambulance and crew should get to the patient.

Pathways were universal across all systems. This ensured that both the Clinical Coordination Centre (CCC) staff and ambulance crews had access to the same information and medical records.

Staff kept electronic records, which enabled other staff to have immediate access to important information. For example, a senior health advisor helping a junior colleague had access to electronic patient records immediately. Specialist paramedics located in the CCC could access the electronic patient records and use their professional judgements to amend ambulance dispositions, such as change the category of ambulance response or contact the patient to offer alternative advice and treatments.

The service’s systems supported consistency of care across providers. Clinicians were able to arrange GP appointment/call backs and appointments in the trust’s urgent care services. Clinicians had access to patients GP records, which meant they could review patients’ medical history to support decisions about the most appropriate disposition, treatment or advice.

Due to the geography of the area the Isle of Wight ambulance service served, some health care services were not available on the Isle of Wight and patients had to be conveyed to the mainland for treatment at other NHS trusts. This included major trauma and certain cardiac conditions. Staff followed pathways and processes to liaise with the relevant health care provider and arrange suitable transport to convey patients to mainland hospitals. This included ferries, air ambulance, and the coastguard.

Health advisors had access to a variety of data on their screens. For example, they could see how long the current wait for ambulances was, which they could explain to patients during calls. This was useful in managing expectations and reducing the number of callbacks from patients asking where the ambulance was.

Staff in the CCC could provide cover nationally. We observed health advisors receiving and responding to calls from other areas of the country, other than the Isle of Wight.

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 had access to the trust safeguarding policy to give them guidance. All staff completed safeguarding training. The health advisors and dispatchers completed level 2 safeguarding training for children and adults, the clinical advisors and advanced paramedics complete level 3 training for adults and children safeguarding. Records provided by the service showed that 92% of staff had completed safeguarding training. This met the trust’s target of 85%.

Staff also completed Oliver McGowan training. This is specialised training to equip health and social care workers with the right skills and knowledge to provide safe, compassionate and informed care to autistic people and people with a learning disability. By having this knowledge, it reduced the possibility of neglect of care and treatment for autistic people and people with learning disability, because staff had a better understanding of indicators of ill health in this group of people.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. All staff we spoke demonstrated a good understanding about safeguarding, including how to identify if a patient on a call might be at risk of harm. Staff knew how to make a safeguarding referral, and we observed staff making safeguarding referrals.

The service had worked with other healthcare professionals to improve the identification and service for safeguarding children. Staff worked with the named GP for Safeguarding and named nurse for Safeguarding Children to create a clinical workaround to ensure all injuries to non-mobile infants receive face-to-face assessment. This was now incorporated into Safeguarding Standard Operating Procedure. They had worked with safeguarding midwives to develop a system to flag unborn babies with child protection plans and women with high-risk pregnancies to the CCC in case a 999 call was received.

The evidence showed a good standard. 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.

When people called 999, the health advisors in the clinical co-ordination centre (CCC) assessed them using the NHS pathways tool to determine what actions to take to provide the most appropriate level of care. This ranged from signposting to another service, arranging a follow-up call by a clinician, to dispatching an ambulance.

Health advisors always tried to speak with patients directly. For example, if a friend or relative called 999 for help, health advisors started the assessment immediately to establish whether an immediate response was needed. If they had time, they asked to speak with the patient. This helped establish what help was needed, for example, health advisors hear things like patients’ breathing, speech, and confusion.

The NHS pathway tool provided health advisors with strict scripts. Towards the end of a call, the script instructed health advisors to give advice to patients. This included action patients should take if they thought their condition was changing. Patients were advised to call the 999 line again if they thought their condition was deteriorating, so a second assessment could be carried out and if required a change in ambulance disposition could be made. For example, if a patient who was awake on the initial call deteriorated and on a second call was now drowsy and/or unconscious an ambulance would be dispatched to attend to the patient sooner than originally planned.

Staff responded appropriately when they recognised a deterioration and risk. We witnessed a call in which the healthcare advisor started to guide the caller through cardiopulmonary resuscitation (CPR) as the caller could not determine whether the patient (a member of the public) was breathing or not. At this stage the ambulance category was changed to category 1 and the healthcare advisor could see on the screens that the appropriate resource had been dispatched to the patient.

Some patients calling 999 required a clinical advisor callback to assess what type of response or advice they needed. The service employed registered nurses and paramedics in clinical advisor roles as well as having a team of Urgent and Emergency Care Specialist Paramedics in the CCC. The service did not have dedicated maternity or mental health specialists. The critical care paramedic had an overview of all immediately life-threatening cases, including major trauma, serious illness and complex maternity cases. Specialist maternity support and guidance was provided by a neighbouring NHS ambulance trust. Mental health support and guidance was provided by the mental health service from a different neighbouring NHS trust. Staff reported varying levels of support and guidance from this service, which they believed was mainly due to unavailability of mental health staff. One clinical advisor described a situation where a caller needed mental health input. They were told by the mental health liaison team they had no capacity and that the ambulance service would have to manage it on their own.

The service worked to ensure that a crew with an appropriate skill mix was dispatched to meet the care and treatment needs of patients. Dispatchers saw crews and vehicles available for dispatch on their screens and chose the most appropriate team to attend to patients. They diverted crews as required. For example, if a category 1 call was received, dispatchers could divert the crew closest to the patient in need even if that crew was on their way to another patient. This was to allow the quickest response time to patients in need. Dispatchers also utilised community first responders to attend to patients. Community first responders are trained volunteers who attend 999 calls in their local area, providing immediate lifesaving care before an ambulance arrives.

The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff ensured they kept their desks tidy. They ensured no cables got in the way of their workspace. All staff had multiple computer screens, allowing them to work through the triage tool whilst accessing other relevant information on other screens.

The trust adhered to The Health and Safety at Work Act 1974 and The Health and Safety (Display Screen Equipment) Regulations. They ensured staff completed Display Screening Equipment (DSE) assessments regularly. This assessment covered computers and workstation assessments to ensure staff had suitable set ups to prevent strain and injury.

Staff had access to height adjustable desks, adjustable chairs and foot stools. This meant staff could sit or stand and adjust their desks, chairs and footrests according to their individual needs. We saw many staff worked standing up.

The service ensured all equipment was safe to use. Electrical equipment was checked for safety in line with national guidance and recommendations.

The service prepared for times when equipment failed. Business continuity plans were in place to follow when systems failed and staff knew about them and where to access them. Staff shared examples when computer or telephony systems had failed and they had to invoke the business continuity plans. It was evident from their conversations this was a seamless process and everyone understood their roles.

The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staffing in the emergency operations centre consisted of a wide range of staff with varying roles. Health advisors received both 999 and 111 calls. They followed the national NHS pathways to determine the best plan for each caller, whether that was to arrange the dispatch of an ambulance or refer to clinical advisors or to other healthcare facilities. Senior healthcare advisors provided support and supervision to the health care advisors. Dispatchers had responsibility to allocate and dispatch ambulances and other resources to incidents. Clinical advisors included nurses with a range of clinical experiences and specialist paramedics. They provided additional support and guidance for health advisors and in line with national recommendations validated certain requests for ambulance dispatches. A hub duty manager had an overall leadership role for each shift.

The ambulance service medical lead who was both an ED Consultant and a pre-hospital emergency medical (PHEM) doctor, worked between the hospital emergency department and the clinical co-ordination centre (CCC). Critical care paramedics based in the CCC supported clinical interrogation of dispatch and ensured the right resource was sent to incidents.

The hospital switchboard was located within the CCC with dedicated switchboard staff overseen by the duty manager. The dedicated switchboard staff had responsibility for responding to switchboard calls, including emergency calls from the hospital between the hours of 11pm and 7am. Some staff expressed concerns about this additional role they had to cover. However, all staff knew how to respond to emergency calls from the hospital. Leaders said that the CCC staff did not have to respond to many switchboard calls. Except for emergency calls, the switchboard was automated, with callers being put through to the department they required automatically. Data provided by the service showed that the emergency calls CCC staff had to answer ranged from 0 to 4 per night.

The service ensured all staff had essential training to ensure their safety and the safety of patients. Mandatory training topics included safeguarding adults and children, equality, diversity and human rights, conflict resolution and training about learning disabilities and autism. Staff said they were allocated time to complete mandatory training. Records provided by the service showed overall CCC staff were 88% compliant with mandatory training, which was above the trust target of 85%.

The service had a target they were working towards that 90% of all staff should receive an annual appraisal to give them protected time to reflect on their role, discuss challenges, and identify any support needed. At the time of the assessment 86% of staff had received an annual appraisal.

Staff confirmed they received a comprehensive induction process when they started employment in the CCC. This included completing the NHS pathways health advisor competencies and a comprehensive mentoring programme before a new member of staff was signed off as competent to take calls independently.

At the time of the assessment, there were no vacancies in the CCC. The sickness rate for the past 12 months was 9% and the turnover rate for the past 12 months was 7.6%. However, due to staff sickness, there were occasions when actual staffing numbers were less than planned. The service did not use agency staff but did utilise bank staff who knew the service and had been assessed as competent to fill gaps in rotas.

However, there was no 24-hour access for staff in the CCC to access pre- hospital consultant level advice. This had been identified in the most recent Wessex Trauma Network peer review of the service. It was also identified by the review that it was an aspiration of the trust to have 24-hour access to pre-hospital consultant advice, but that this was difficult to achieve. The ambulance service risk register identified this as a potential risk of harm to patients. The risk register details the actions taken to reduce the risks of harm to patient. This included, if pre-hospital consultant level advice was not available to convey the patient to hospital if there were any concerns for the health of the patient. Pathways in the emergency department that meant patients were promptly assessed on arrival at the department.

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.

The provider had an up-to-date infection, prevention and control (IPC) policy, which outlined staff roles and responsibilities and referenced several legal frameworks.

Staff kept the Clinical Coordination Centre (CCC) environment clean and tidy, free of clutter. They had their own headsets. Each desk had disposable wipes for staff to wipe down their workstations.

Staff accessed patients’ health records on the clinical triage tool which included information about infections. If patients had known illnesses, such as hepatitis or COVID-19, this flagged on the system. When healthcare professionals called 999 about a patient, staff asked about infectious disease risks. This was important information to pass to ambulance crews so they could plan for patient care appropriately.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Staff in the CCC did not prescribe or administer medicine. However, were guided by the NHS pathways assessment process, health advisors and clinical advisors gave patients information about the use of medicines they could purchase from pharmacies.