Isle of Wight NHS Trust

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• 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 service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant the service was consistently managed and well-led. Managers and the culture they created promoted high-quality, person-centred care.

This service scored 85 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The trust had developed a strategy “Working Together, Improving Together”, that set out the trust vision, values and aims. The trust vision was “Working together to deliver excellence in care for our patients and communities.” The vision was supported by the trust values of working together for patients, working together with compassion, working together as a team and always improving. The vision and values aimed to support the trust’s strategic aims of meeting the needs of the community, supporting safe, high quality, patient focussed care, responsibility for the delivery of care now and in the future, supporting their people to deliver the trust vision and enabling teams to deliver the best care.

The ambulance service had its own strategy, which was developed in line with the principles of the trust strategy, values and vision. The current strategy was dated 2021 to 2026. The service was currently developing their strategy for the next 5 years. They were developing this in collaboration with stakeholders to ensure it met the needs of the local population.

All staff commented positively about the culture at a local level, describing it as supportive, with lovely colleagues and supportive managers.

The evidence showed a good standard. 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.

The trust had an overarching executive leadership team, which included the director of the ambulance service. This meant the voice of the ambulance service was heard at the executive board. Each function of the ambulance service had its own head of service and there was a head of quality and governance who supported the whole ambulance service.

Leaders had a good understanding of the service they managed. They understood the challenges and had plans to address these. The plans they discussed reflected the detail in the ambulance strategy about how the service was working to address challenges of meeting the needs of the local population, due to the geography of the island and the size of the service.

All staff spoke positively about the local leadership and told us they had good working relationships. Staff said the senior leadership team was visible and supportive.

Leadership training was available for leaders, including aspiring leaders. Leadership training included in house training and apprenticeship courses facilitated by external training providers. Staff described how they could progress their career with training and told us they had progressed from health advisors to hub duty manager.

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

The trust had a freedom to speak up process that allowed staff to speak up or raise concerns about anything that got in the way of patient care or affected their working life. A Freedom to Speak Up Guardian is a designated individual in an organisation who supports workers to raise concerns they may have, especially when they feel unable to do so through normal channels. The guardians act as a safe point of contact and help ensure that workers are heard, their concerns are addressed, and feedback is provided on any actions taken. Staff we spoke with knew about the Freedom to Speak Up process and how to contact the Freedom to Speak Up team. Staff we spoke with also said they were able to raise concerns with their immediate leaders and that their concerns would be acted on.

Information provided by the service showed that staff had contacted the Freedom to Speak up Guardian for a variety of concerns and relevant advice and guidance had been given to the staff members contacting the guardian.

The evidence showed a good standard. 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.

The trust had an equality, diversity and inclusion policy that set out their commitment to diversity and inclusion. Staff had access to a reasonable adjustments policy. This gave guidance about how to support staff with reasonable adjustments to enable them to work and reduce the risk of staff experiencing discrimination due to protected characteristics. Staff completed equality, diversity and inclusion training as part of their mandatory training.

Staff had access to support from several staff network groups. These included a Disability Staff network, a LGBT+ network, a race equality network and a neurodiversity network.

Staff described how the service and leaders supported them with reasonable adjustments to meet their individual circumstances. This included flexible working to support caring responsibilities and individualised working arrangements to support staff who were neurodiverse.

The evidence showed a good standard. 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 governance structure with lines of accountability through the ambulance service to the trust board. The ambulance service had a divisional board meeting each month. Information from the ambulance quality group and the performance subcommittee service fed into this divisional meeting. Information from meetings such as pre-hospital emergency transfer meetings, ambulance risk review meetings and workforce and operations development meetings fed into these 2 groups. The ambulance service reported to the bi-monthly trust board meetings and there was a monthly ambulance performance review with the trust executive team. This ensured there was good oversight and challenge of the performance of the ambulance service and the emergency operations centre.

Records of governance meetings at divisional, subcommittees, and of the hub duty managers and senior health advisors demonstrated the quality, performance and safety of the service was monitored and reviewed. This included the monitoring and review of safety incidents, risks, staffing and training.

Information was shared with health advisors and other Clinical Coordination Centre (CCC) staff in team briefings, emails and handovers. The service was reintroducing CCC team meetings, to support improvements with sharing of information.

The ambulance division risk register included identified risks for all functions of the ambulance service, including the CCC. This included risk relating to business continuity in the CCC if there was a system failure. Failure of the CCC could result in the loss of public access to 999 and 111 calls and disruption of the ambulance service, potentially posing risk of harm to the public. The risk register clearly detailed the processes to mitigate any risks associated with failure of the CCC systems. Staff in the CCC knew what they needed to do if the computer systems or telephony systems failed to support continuity of the service.

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.

The Isle of Wight ambulance service was proactive in working and collaborating with stakeholders and partners. Leaders and staff viewed collaborative working as an essential part of providing a safe and sustainable service for the island population. The service shared many examples where they worked collaboratively with other organisations to support the resilience of the service.

The service worked closely with a neighbouring NHS ambulance trust to develop a Strategic Partnership Board. The partnership provided structured oversight to ensure safe, sustainable ambulance services for the Isle of Wight and supported alignment of pathways, quality standards and clinical practice across both organisations. In the Clinical Coordination Centre, the computer aided dispatch system (CAD) used by the health advisors was part of the neighbouring ambulance trust’s CAD system. The CAD is a specialised software used by emergency services to process 999 and 111 calls, prioritise incidents and efficiently dispatch the nearest available ambulance and resources.

The service worked closely with the helicopter emergency medical service (HEMS) to ensure critical care pre-hospital emergency treatment was available to the population of the Isle of Wight. A HEMS service provides rapid, advanced pre-hospital care for critically injured patients. This service can be delivered by helicopter or by rapid response vehicles. In November 2024, the Wessex Trauma Network peer review of the Isle of Wight ambulance service had made several positive comments about collaborative working and how it had brought improvements to the service provided. This included the appointment and development of critical care paramedics in conjunction with the HEMS. Critical care paramedics were stationed in the control room, as well as being on the front line, to advise and identify calls that required pre-hospital critical care treatment. The review also identified a pre-hospital emergency group, which was a collaboration between this trust, a neighbouring NHS trust ambulance service and HEMS, as an excellent example of collaborative working to improve patient care and treatment. This included staff in the Clinical Coordination Centre, as they were the staff who initially received the 999 calls and who coordinated and dispatched the appropriate vehicles and resource.

The service worked with other transport providers to support transfer of patients to the mainland for emergency treatment. Arrangements and agreements were held with cross Solent transport and the coastguard to support timely transfer of patients to the mainland. Leaders described improvements in meeting national standards for treatment of myocardial infarction (heart attacks) because they now had a swifter process to transfer patients to the mainland for treatment. This involved the collaboration of cross Solent transport providers and the neighbouring NHS ambulance trust.

The service also worked collaboratively with other services on the island. The service worked with the island’s Fire and Rescue Service. The ambulance service had provided training in cardiopulmonary resuscitation to the fire service, and the on-call fire service responded to patients with breathing difficulties, who were unconscious or were in cardiac arrest. Dispatchers in the CCC requested fire and rescue service attendance for some specific types of category 1 dispositions. The service had an operational procedure that defined 5 types of category 1 calls fire and rescue crews had been trained for. This meant in some circumstances the fire and rescue crews could reach the patient before the ambulance crews and start cardiopulmonary resuscitation if needed.

The Director of Ambulance engaged regularly with police and fire service leaders to support joint operational planning, incident response and community safety initiatives. Informal blue light meetings took place bi-monthly, where any concerns or joint working could be discussed.

As part of the development of the new ambulance five-year strategy, leaders undertook targeted engagement with multiple external organisations to understand their experience of the service and their expectations for the future. Stakeholders identified what worked well highlighted a strong community commitment and provided clear feedback on areas for future focus.

As well as working with external providers and organisations, the ambulance service worked collaboratively with acute service within the trust. The medical director of the ambulance service was also a consultant in the emergency department. They were working with the acute service in the trust to improve patient pathways, helping to reduce pressure on the acute service and improve the experience of patients requesting assistance through the ambulance service.

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.

The ambulance service was proactive in improving the service. Leaders and staff recognised that due to the small size of the ambulance service and the geography the service covered, they had to act innovatively to make changes to the service to ensure the needs of the local population were met.

The ambulance service used the trusts quality improvement programme, “Delivering Excellence” to support quality improvement in service. The ambulance service also used the nationally recognised Plan-Do-Study-Act (PDSA) quality improvement methodology to test, evaluate and make changes to clinical and operational practices in the service.

As part of this work, the Ambulance Clinical Lead (an emergency department consultant) was co‑located in the control room alongside Specialist Paramedics in Urgent Care, clinicians on the Clinical Support Desk, and dispatchers. This allowed the team to trial new approaches aimed at safely reducing conveyance to ED, increasing the use of validated alternative care pathways, and improving decision support for front‑line crews. The service provided presentations that showed they had followed the PDSA methodology to trial and evaluate these new processes.

The ambulance service also worked in partnership with other organisations to innovate and make changes to improve patient outcomes and reduce unnecessary conveyance to hospital. Through their partnership with the neighbouring HEMS the service had expanded their Critical Care Paramedic (CCP) function. Critical Care Paramedics now rotated into the control room to support clinical overview of dispatch. This approach prevented avoidable ambulance deployment and ensured the right resources were sent to the right incidents. The service had expanded their volunteer model by introducing trained on‑call firefighters to respond alongside the Community First Responder network.

These changes and innovations strengthened the ability of the service to provide the right care first time and improve Category 1 response performance.

Other examples of working with other providers to make improvements included the creation of a quarterly newsletter that is sent to stakeholders promoting the NHS service finder and sharing new available pathways, working with Named GP for Safeguarding and Named Nurse for Safeguarding Children to create a clinical workaround to ensure all injuries to non-mobile infants received a face-to-face assessment which was now incorporated into Safeguarding standard operating procedure, and working with safeguarding midwives to develop a system that flags unborn babies with child protection plans and women with high risk pregnancies to the CCC in case a 999 call is received.