South Central Ambulance Service NHS Foundation Trust

On this page

• 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 and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

We assessed all 6 quality statements from this key question.

At the last inspection we rated this key question as requires improvement.

At this inspection 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 service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Ambulance crews explained when they were assigned an incident to attend, certain information was available to them, for example, location of the incident, nature of the emergency and if available additional information such as keypad entry codes. This information allowed the crew to prepare for the specific situation they were arriving to.

Staff completed dynamic risk assessments for each patient on arrival. These included on-the-spot evaluations of hazards and risks for both themselves and the patient. Based on the assessment, crews would implement immediate and appropriate control measures to mitigate identified risks. This could be something simple like putting a family pet into another room, to more complex situations which support would be needed from other emergency services, such as the police or fire service.

Staff assessed the communication needs of the patient to make sure there was effective communication, for example making sure they talked directly to the patient if there were hearing issues.

Crews would complete their initial assessment of the patient following set protocols and use this, with their clinical judgement, to provide the appropriate medical care, for example, administering pain medication or oxygen.

If the patient was assessed as needing further medical care beyond what the crew could provide at the scene, the crew would convey the patient to hospital or other healthcare facilities using established clinical pathways. Clinical pathways were available for ambulance crews on their mobile device.

If the decision was made not to convey the patient, the ambulance crew told us they would give appropriate advice and guidance for the patient, for example, to contact the patient’s GP or talk to the local pharmacist. In some circumstances, the crew could make referrals, with the patient’s consent, to other services such as the urgent community response team.

In addition, crews told us they would always assess for potential safeguarding issues for patients and other members of the household, such as carers or children, and would make safeguarding referrals according to SCAS policies and procedures if required.

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.

Patient care and treatment followed evidence-based guidance. Clinical guidelines and policies used in the service were developed and reviewed in line with national guidance from the National Institute for Health and Care Excellence (NICE) and the Joint Royal Colleges Ambulance Liaison Committee (JRCALC).

Staff had access to the JRCALC guidelines, which were clinical guidelines used by paramedics to support practice. The JRCALC guidelines were regularly reviewed and updated to reflect the latest evidence and best practices in pre-hospital care.

Policies and protocols were accessible on the trust’s intranet, with some being available on crew’s electronic handheld devices.

Policies and procedures were approved by either a committee, group or trust board, depending on the type of document and service area to which it related and in accordance with the trust's scheme of delegation. This ensured they contained current and best practice guidance. Governance meetings provided evidence of updates being made to procedures and policy documents.

There were a variety of up to date, evidence-based pathways used in the service which staff had access to on their electronic handheld devices.

Staff were updated on changes to clinical practice in various ways, email, newsletters, memos and bulletins. We observed some displayed in crew rooms at ambulance stations. Several staff explained there could be much information to keep on top of, and it was difficult when they were operationally busy to read it all. We were unsure how senior staff ensured all staff had received, read and understood the clinical or procedural updates.

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 worked with many teams both internally and externally to deliver their purpose of providing and coordinating emergency and urgent care to the public. Staff we spoke with told us open communications, mutual respect and keeping the patient at the centre of what they did helped the teams work together.

There was effective working between the teams at the emergency operations centre, where emergency calls were answered and resources dispatched and the ambulance crews. Crews told us it was important to understand each other’s role and they felt there was good working relationships between the teams.

Specialist paramedics staffed the urgent care desk and supported ambulance crews in complex clinical assessments and decision-making regarding patient disposition and safety. Crews said this mostly worked well but out of hours it could sometimes be hard to get immediate support.

Staff at ambulance stations worked closely with the make ready teams, a team responsible for ensuring ambulances and other emergency vehicles were cleaned, restocked with essential supplies and equipment fully operational before each shift. These teams were employed by a service partner rather than SCAS but worked closely with SCAS personnel. SCAS staff reported good working relationships with the make ready teams, minimum issues and when issues did arise, they would be sorted quickly and efficiently.

The service worked in partnership with two helicopter emergency medical services (HEMS) to provide critical care provision and with the Thames Valley Wessex Critical Care Network to provide a dedicated transfer service for patients that needed critical care.

The SCAS hospital ambulance liaison officer (HALO) had been an invaluable member of the team especially over the last few years with growing handover delays seen between the ambulance crews and NHS emergency departments. Their role was to manage the smooth transition of patients from ambulances into hospital care and for optimising the turnaround time of ambulances. HALOs act as a bridge between ambulance crews and hospital staff, facilitating handovers and assessments, and helping to reduce pressure on both ambulance and the hospital teams. We were told they had been instrumental in the success of the release to respond initiative.

During the inspection, we observed good interactions between emergency department staff and ambulance crews during handovers and when sharing information regarding patients.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

The service supported patients that made multiple calls to 999. Frequent callers were defined as patients aged 18 or over who made 5 emergency calls or more relating to individual episodes of care in a month or 50 or more urgent care incidents in a 12-month period. Some frequent callers had long-term physical and/or mental health conditions, and the trust gave examples of where staff worked with partners across the system to try and ensure patient’s unmet needs were met, and frequent callers were reduced. The complex care team had responsibility for supporting frequent callers and whom the operational team would make referrals to.

Ambulance crews had access to the NHS directory of services. This was a platform developed by the NHS to provide a comprehensive directory of health, social care, and voluntary sector services. Staff used this platform to find and direct patients and members of the public to a range of services that they might find helpful to their health and social care needs. For example, dentists, opticians and sexual health services.

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 had systems and processes in place to monitor, audit and benchmark the quality of services, and the outcomes for patients receiving care and treatment. Data was collected, analysed and tracked over time to understand how the service was performing against key performance indicators, NHS standards, the Association of Ambulance Chief Executives (AACE) standards and locally derived standards. Managers and staff carried out a comprehensive programme of repeated audits to check improvement over time. Data was reviewed and discussed by the relevant groups and committees, for example the clinical review group, which would then feed into the board sub-committee meetings.

The service participated in the Ambulance Quality Indicators (AQIs) which are a set of measures used to assess and improve the quality of care provided by all ambulance services in England. System indicators focused on efficiency and timeliness of ambulances responses, and clinical outcomes which including measures like ‘return to spontaneous circulation’ (ROSC) after cardiac arrest and survival rates for patients with specific conditions such as stroke and heart attack, were reported each month. This gave a monthly up to date picture on how ambulance services were performing individually, and when combined, an overall picture for England. Data presented showed variation each month and was influenced by early detection of condition in the community, vehicle availability and severity of handover delays.

Key performance indicators were used to track the service’s performance, for example, time to respond to category 1, 2, 3 and 4 calls, time on scene, see and treat, and conveyance rate. Where performance was not optimal, the service looked to see if there were reasons and what the service could do to improve performance. For example, the serviced had developed and launched the release to respond initiative, which had seen a significant reduction in the response times of all 4 category of calls. Data from October 2024, prior to the launch of release to response, showed time to respond to category 1 calls (life-threatening) was 00:09:11hrs compared to 00:08.06 hrs in March 2025, with a target of 7minutes. Data from October 2024, prior to the launch of release to respond, showed time to respond to category 2 calls (emergency) was 00:38.31hrs compared to 00:21:42hours in March 2025, with a target of 30minutes. Data from October 2024, prior to the launch of release to respond, showed time to respond to category 3 calls (urgent) was 07:52:44 hours compared to 03:13:19, with a target of 90% of these calls responded to within 120 minutes (2 hours). Data from October 2024, prior to the launch of ‘release to respond’, showed time to respond to category 4 calls (less urgent) was 07:58:54 hours compared to 04:22:59, with a target of 90% of these calls responded to within 180 minutes (3 hours).

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service had up-to-date policies and procedures regarding consent and the Mental Capacity Act (2005). Staff received Mental Capacity Act (MCA) training as part of their mandatory training, and was delivered in 2 modules, MCA level 2a and MCA level 2b. Registered clinical staff, paramedics and ambulance nurses, were 69% compliant with MCA level 2a, which was lower than the trust target of 95%, and 98% compliant with MCA level2b. Emergency care assistants were not compliant with either MCA level 2a or MCA level 2b, with rates of 78% and 90% respectively. The trust explained that the MCA 2a eLearning module was not available from June 2024, a replacement eLearning module was now live on the platform, and there was a trust focus to get staff to complete this module.

Many staff thought the mental health training they received was not appropriate or adequate for the situations they encountered in the community and said they would benefit from additional training. We were told there was access to mental health support within the service, however this was inconsistent, and improvements would be welcomed by the crews.

Staff understood the importance of consent when delivering care to patients. We observed staff seeking consent from patients prior to examination and treatment. In most cases, this was implied consent and not documented. When patients did not have capacity to consent, for example if they were unconscious, staff followed legislation and guidance and made decisions in their best interests. The service had carried out a deep dive audit to ensure staff were compliant with the consent to assessment and treatment policy. Data from April to June 2023 and January to March 2024 was analysed and reviewed, and showed compliance of the recording of consent to be 85%. The service was due to reaudit in January 2025. The trust did not supply the results from this audit. Audits of the electronic patient records were also completed in the operational teams, but we were not supplied with findings from these more localised audits.

The electronic patient record system had a mandatory field to ensure MCA had been considered and assessed and contained tools for guidance. Staff we spoke with understood the Fraser guidelines and Gillick competency. Fraser guidelines and Gillick competency must be considered when offering treatment to children less than 16 years old to decide whether a child is mature enough to make decisions about their own care.

Staff we spoke with were aware of Mental Health Act (1983) holding power and section 136 requirements. Section 136 is an emergency power which allows patients to be taken to a place of safety from a public place, if the police considered the patient was suffering from mental illness and in need of immediate care. Police officers would ride with ambulance crews in these situations.

Ambulance crews had received additional training in restrictive interventions and acute behavioural disturbances (ABD). Data supplied by the trust showed between November 2024 and April 2025 there were 17 reports where restraint had been used on patients. In 9 of these cases, patients had been restrained by the police with ambulance crews in attendance, and 8 cases were where SCAS staff had used restraint. Where restraint was used these cases were reviewed internally to make sure the use of restraint was appropriate, and the least restrictive method had been used. Of the 8 cases, staff actions had been deemed to be proportionate, and there had been safe outcomes for the patients.

Staff received training on the circumstances when resuscitation would not be commenced, and the documentation that needed to be in place for that decision to be made.