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’ 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. Understanding current outcomes and exploring best practice was part of the everyday work. However, leaders did not always instil a culture of improvement.

We assessed 5 out of 6 quality statements.

At our last assessment, we rated this key question good. At this assessment, the rating has remained 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.

At our previous assessment, we recommended that the service should ensure clinical welfare calls were completed within targeted timeframes. Whilst the service was not yet meeting targets, we reviewed their action plans for improvement. Plans included; support from outside agencies such as the Association of Ambulance Chief Executives in reviewing how to improve answer times, redesigning rotas, increasing the spread of shifts to minimise shift changeover shortages, and increasing clinical support. The service was also completing a remodelling exercise. This included identifying the number of Emergency Call Takers required to deliver the future expected operational demand, an external review of the staffing capacity model, as well as a review of the dispatch model and continued recruitment across operational departments.

Staff followed the system’s algorithms to monitor and record pain levels as described by callers. Staff also advised patients who were waiting for a crew to pack any regular medication. This ensured the patient had a full supply of required medicines should they need transfer to hospital.

If a patient with a mental health concern called the service, they were triaged and added to a call back list. The lists were prioritised into 1 hour, 2 hour and 6-hour time frames, depending on presentation. If a patient required immediate assistance, the dispatch team could allocate an alternative resource of 2 vehicles crewed by paramedics and mental health practitioners. These vehicles were available 7 days a week between midday and 10pm, a third vehicle and crew were available Thursday to Sunday between 4pm and 2am. Staff could access patient mental health records via a shared system with the mental health trusts within the patch.

The service planned and delivered people’s care and treatment in line with legislation and current evidence-based good practice and standards.

Staff were able to access policies via the service’s intranet. We reviewed 10 policies and noted they were appropriately ratified and reviewed within the last 12 months.

The Risk and Policy Group met monthly and maintained oversight of policies to ensure they contained up to date information. This group reported to the Executive Management Committee. The divisional clinical governance meeting chaired by the service director also maintained oversight.

The audit and education team were responsible for reviewing new NHS pathway releases and communicating any changes to staff. Once a new release was due, the team ensured staff were trained and internal testing was completed before going live.

The service worked well across teams and services to support people. Staff shared their assessment of needs when people moved between different services.

The service had a joint arrangement with the police and had a direct line to call them. When the police used the direct line, staff received a ‘pop up’ to show the call was coming via that route. This line could also be used for staff requiring Police support as well as redirecting any ‘misrouted’ calls.

The service had good relationships with the NHS trusts within their patch. If staff had any feedback regarding a specific trust or provider, this could be escalated through their manager. The head of operations met with trusts monthly for engagement meetings.

On each shift, a senior member of staff was allocated as the ‘floorwalker’. It was their job to offer help to staff and support teams if anyone needed any further assistance or escalation.

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 service routinely monitored people’s care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service used up to date methods for assessment and triaging patients. For example, we observed staff used the clinical toxicology database (this database calculates whether a toxic dose has been consumed). Since introducing this tool, the service had seen a decrease in the number of deployed ambulances and attendances to the emergency department (ED) in relation to toxicity.

Since the introduction of ‘Hear and treat’, the service had seen a reduction in the number of minor cases being transferred to hospitals. ‘Hear and treat’ is a system used by ambulance clinicians to manage emergency calls where a patient’s condition indicates ambulance dispatch is not necessary.

We observed clinical staff using camera links on patients’ phones to be able to visually assess a patient, when description was insufficient to determine if help was required, or assistance was needed whilst an ambulance was on-route. The maternity team used this system when supporting a woman and pregnant people giving birth to assess dilation and assist with the birth of their baby if crews could not reach the woman in time. We also observed a clinician use the system to determine whether a child’s rash needed urgent attention, when the mother was struggling with a description. Audits demonstrated this had reduced the length of time taken to assess patients.

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

The service was previously in breach of regulations relating to governance as staff did not have access to a policy specifically related to the Mental Capacity Act (2005). At this assessment, we reviewed the new policy, and found the contents were up to date and ratified. Therefore, improvements were made, and the service was no longer in breach of this regulation.

Staff understood their role and responsibilities regarding applying the Mental Capacity Act (2005). Staff understood they had to assume capacity unless they found evidence to suggest otherwise.

Staff described how they assessed capacity of children and young people. Staff followed best practices in line with Gillick and Fraser guidelines.

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, in order that the crew could assess whilst onsite.