South Western Ambulance Service NHS Foundation Trust

Updated 27 May 2022

Our rating of the trust improved. We rated it as good overall because:

Caring was rated as outstanding. Effective, responsive and well-led were rated as good. Both effective and well-led improved from requires improvement at our 2016 inspection with responsive remaining as good. Well-led at trust level was rated as good. However, safe remained as requires improvement.

• We rated well-led at the trust as good. There was effective, experienced and skilled leadership, a strong vision for the organisation, and embedded values. Leadership had strengthened, and the new structure in frontline services would being local leadership closer to staff, patients and stakeholders. Patient care was a top priority for the trust. There was mostly effective governance around performance, but this had not resolved some previous issues and led to the emergence of others in frontline services. The culture within the staff was enormously variable, although those we met were committed and highly professional. Nevertheless, some felt unsupported in certain aspects of wellbeing, communication and change. There was good and detailed management information available, and strong financial governance and audit. There was commitment to engagement with stakeholders, although the trust needed to move away from public relations to the public supporting service delivery, improvement and change. There was a strong and deep commitment to learning, development and innovation.
• Emergency and urgent care remained rated as requires improvement overall. The questions of safety, effectiveness and well-led remained requires improvement, with responsive remaining good, and caring remaining outstanding. These ratings have not changed since our previous inspection, and although we saw several key improvements since then, there were some problems unresolved, and others emerging. Concerns included the trust failing to meet the standard response times to reach patients, although this was improving recently for the most urgent category. Vehicles and premises were not always secured in accordance with trust policies and procedures. Some consumables and medicines were not in date or secured, and not always disposed of correctly. Not all patient records were always protected. Again, storage of some confidential medicine records failed to meet trust policy and legal requirements. Some improvements were needed in outcomes for patients, particularly those being treated for a stroke. The governance of these issues had not recognised or addressed them. However, there was outstanding care to patients and those who were with them, or involved in an incident. The service was designed to meet people’s needs and care for those who needed more individual support. We recognised the leadership and structure in frontline services was relatively new and needed time to embed.
• Emergency operations centres remained rated as good overall. The questions of safety, responsive and well-led remained good. Effective improved from requires improvement to good. Caring remained as outstanding. We found improvements in several areas since our last inspection, although some of these had recently dipped for operational reasons, and needed to be restored. There was a safe service, with systems and process protecting people from harm. This included improved and good levels of staff. There was good multidisciplinary teamworking, and adherence to national guidance and evidence-based practice. There was outstanding caring for people, often in difficult circumstances for both the caller and the staff talking with them. The managers had the experience and skills to lead the service and ensure it was giving safe and quality care. The poor number of regular staff performance reviews were a significant concern at our previous inspection. These had significantly improved, although there was still some progress to be completed to meet targets. Clinical and non-clinical call audits were again not meeting the targets, but were back on track to improve.
• On this inspection we did not inspect Out of hours services, Resilience, or Urgent and emergency care (the Tiverton urgent care centre). The trust no longer provides Patient transport services. The ratings we gave to these services on the previous inspections in October 2016 are part of the overall rating awarded to the trust this time.
• Our decisions on overall ratings take into account, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating.

Updated 8 July 2026

Date of assessment: 21 April – 23 April 2026

We assessed all 32 quality statements across the safe, effective, caring, responsive, and well-led key questions. We rated the service overall as good.

At the last inspection there were breaches of regulation in relation to person-centred care, safe care and treatment, safe equipment cleaning and storage, and governance processes.

At this assessment, we found trust-wide improvements and the emergency and urgent care service was no longer in breach of these identified regulations.

We rated safe as good. We found the emergency and urgent care service embedded a positive learning safety culture based on openness and honesty where events were investigated and staff felt psychologically safe to raise incidents. There were safe systems and pathways to co-ordinate patient care in a timely manner. Patients were safeguarded from harm, and staff knew how to protect them. Staff had access to equipment to carry out their role. However, equipment did not always function, affecting some timely care. Patient records were stored securely. Staff almost always received support, supervision, and development opportunities. Staff received appropriate training for their role. However, staff were not always up to date in their mandatory training. Ambulance vehicles we checked were clean and a new vehicle preparation process was established, streamlining efficiency. However, some ambulance stations did not always follow infection prevention and control guidance. There was good oversight of medicines management.

Patients were assessed and treated in line with national clinical guidance. Services worked together to provide integrated care. Staff supported patients to live healthier lives. The service monitored patients’ care and treatment to improve outcomes.

However, there was room for improvement in providing equitable access to patients.

Staff treated patients with kindness and respect. The service placed the patient at the centre of care and care decisions. Patients were treated as individuals, and the care was adapted to each patients’ needs. The service provided a large variety of comprehensive wellbeing support to staff.

The service had a shared organisational direction. Leaders were capable and visible, leading by example. Managers understood the challenges patients faced. There were effective governance systems to monitor and manage performance and safety. The service had strong relationships with partners which drove joint decision-making, improving patient care. There was a clear focus on continuous improvement and innovation across the service.

Updated 8 July 2026

We carried out a comprehensive two-day assessment on 29 and 30 April with follow-up remote interviews on 5 and 6 May 2026.

The service was inspected in September 2018 and rated as good overall. It was also inspected in November 2021 but not all key questions were reviewed and the rating of good remained

South Western Ambulance Service NHS Foundation Trust (SWAST) provides emergency response to 999 calls for injuries and illnesses. They do this using two Emergency Operations Centres (EOCs), which receive calls, triage need and dispatch ambulance responses, emergency vehicles manned by a range of clinicians, air ambulance services and other specialist teams such as the Hazardous Area Response Team and mental health specialists.

Safe:

The service had a good learning culture and staff and patients could raise concerns. Managers investigated incidents thoroughly and lessons learned and improvements were identified and shared with staff. Patients were protected and kept safe because staff understood local safeguarding arrangements and safe systems of working.

There were enough staff with the right skills, qualifications and experience to ensure high quality care and treatment. Managers made sure staff received training and had regular appraisals to maintain high-quality care.

Staff supported patients to manage medicines safely. Staff identified and reacted to unexpected deterioration in a patient’s condition. Staff understood and managed risks from the environment. The facilities and equipment met the needs of staff who were supporting patients.

Effective:

Patients, and where appropriate those close to them, were involved in assessments of their needs. Staff reviewed assessments taking account of patients' physical, emotional, communication and personal care needs. Care and treatment were based on the latest evidence and good practice guidance. Patient outcomes were monitored to identify where improvements could be made. Staff made sure patients understood their care and treatment to enable them to give informed consent.

Caring:

Staff treated patients with kindness and compassion. Staff protected their privacy and dignity. They treated patients as individuals and supported their preferences. Staff responded to patients in a timely way. Patients had the opportunity to ask questions and were given access to specialist services, including from allied health professionals. The service supported staff wellbeing.

Responsive:

Patients, or their representatives, were involved in decisions about their care and treatment. The service provided information which patients could understand. Patients were invited to give feedback, knew who to speak with if they had concerns and were confident the service took their concerns seriously.

The service monitored and worked to improve access. Services were adjusted to meet the needs of people with conditions which could create a barrier to access.

The service worked to reduce health and care inequalities through service planning, quality monitoring, staff training and feedback. Patients were involved in planning their care and understood options around choosing to withdraw or not receive care.

Well led:

Leaders and staff knew the service’s local vision, aims and objectives and understood how their service aligned with this. There was a culture based on speaking up, listening, learning and trust.

Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment.

Staff understood their roles and responsibilities.

Leaders had sound oversight of the quality of service being delivered through effective governance and risk management systems.

Staff with protected characteristics felt supported.

There was a culture of continuous improvement with staff able to contribute ideas through a quality improvement programme.

We found staff wellbeing was supported and processes were constantly under review to improve working lives of staff. Staff morale had improved since our last assessment. Staff received training in all aspects of their role and were trained in supporting people who called in with mental health issues. However, staff felt they would like more training in this field. People who were high volume users of the service were identifiable to call handlers and plans of how to manage their issues were visible to SWAST staff.

Staff were knowledgeable about incident reporting systems. Managers reviewed each complaint to identify learning points. Staff were involved in transformation programmes for the service and demonstrated how they contributed to improvements. All staff showed a calm attitude with kindness, respect and individual care for patients and their families/carers.

Technology was being used to improve systems of record keeping and develop greater efficiencies in the service. There was evidence of partnership working across the Southwest region and beyond which contributed to providing care that was needed for patients who called 999 for help. These did not always need a hospital visit but did need some form of support. Leaders assessed what future demands on 999 services were likely to be using a range of data collection. Governance processes monitored and supported staff to meet their targets of activity and ensured it was provided safely using evidence-based practices.

We did not identify any breaches of regulation at this assessment.

Updated 8 July 2026

The patient transport service at South Western Ambulance Service NHS Foundation Trust provides non-emergency transport for adults and children on the Isles of Scilly who were unable to use public or other transport due to their medical condition. Eligibility criteria were applied by the healthcare professionals who made the referral to the patient transport service.

The service had a fleet of 7 vehicles and a boat. This included vehicles that could cater for stretchers and wheelchairs, and all-terrain vehicles for transporting patients around the islands. The patient transport service provided 65 patient journeys in the 12 months before our assessment.

The service was provided by the emergency 999 crew on the Isles of Scilly including paramedics and emergency care assistants. There were community first responders based on the outer islands and boat captains for the sea ambulance.

The patient transport service was previously inspected in June 2016 and rated as requires improvement, this patient transport service contract has now ended. The assessment in 2016 did not include the patient transport service on the Isles of Scilly. The patient transport service currently provided is just a service on the Isles of Scilly. We carried out an announced comprehensive inspection on 23 April 2026. We rated the service as good.

The service had effective systems and processes to provide safe and high‑quality care. Staff ensured people were treated as individuals and their care, support, and treatment were aligned with their needs and preferences. Staff were appropriately skilled and understood their responsibilities in relation to safeguarding and safety. Staff treated people with kindness, compassion, and dignity.

Communication with partner organisations, including the hospital, was effective. Staff showed a strong commitment to delivering safe care and worked collaboratively and flexibly as a team to meet people’s needs within a geographically isolated setting.

However, we found the provider was in breach of 2 legal regulations related to safe care and treatment and good governance. The premises and equipment were not always safe or appropriately maintained, posing risks to staff and service delivery. There were systems and processes, but these were not always effective, resulting in lack of oversight and assurance and insufficient action to mitigate environmental and equipment risks.

We have asked the provider for an action plan in response to the concerns found at this assessment.

This inspection/assessment was included as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations. AI was used to support the creation of notes during some of the conversations, with human oversight and review to confirm factual accuracy. This was conducted with the consent of the provider and people interviewed.

Updated 8 July 2026

We assessed resilience planning at South Western Ambulance Service NHS Foundation Trust on 20 to 21, 23 and 30 April 2026.

We carried out the assessment of resilience due to the age of ratings. The service was previously inspected and rated in 2016 where we rated the service as outstanding. At this assessment we assessed under a different methodology. We assessed all 33 quality statements across the key questions: Are they service safe? Are they effective? Are they caring? Are they responsive to people’s needs? And are they well-led?

Resilience planning covers the provider’s major incident planning and response as a Category 1 provider under the Civil Contingencies Act 2004, as well as planning for and responding to other major emergencies. It also includes preparedness for, and the support for events and mass gatherings. A category 1 provider is an organisation which are core to emergency responses. They are subject to the full range of civil protection duties, including assessing risks, maintaining emergency plans and warning the public.

The service was responsible for the trust’s emergency preparedness, resilience and response (EPPR), which is the ability of the trust to demonstrate they can deal with anything from extreme weather conditions, infectious disease or a major incident. The service included business continuity management of the service and the national interoperable capabilities including Hazardous Area Response Teams (HART), Special Operations Response Teams (SORT), Chemical, Biological, Radiological and Nuclear (CBRN), hazardous materials (HAZMAT), Marauding Terrorist Attack (MTA), Mass Casualties, and Command and Control.

As part of this assessment, we looked at specialist equipment, spoke to staff, gathered the views of system partners. We visited the provider's 2 HART bases, head office and the Emergency Operations Centre (EOC). At our previous inspection we included air ambulance (also known as helicopter emergency medical services) services as part of resilience. We have not assessed air ambulances as part of this assessment as this is covered under emergency and urgent care assessments.

Safe:

The service had a learning culture where staff and patients could raise concerns. Managers investigated incidents thoroughly. Patients were protected and kept safe because staff understood safeguarding arrangements. There were enough staff with the right skills, qualifications and experience in the service to ensure high quality care and treatment. Managers made sure staff received training and had regular appraisals to maintain high-quality care. Staff managed medicines safely. Staff understood and managed risks from the environment.

However, the service did not always provide full training in learning disabilities and autism. Infection prevention and control processes were not always effective as equipment was not always stored correctly. Equipment to prevent the spread of infection was not always well maintained, and cleaning was not always completed effectively at bases.

Effective:

The service had processes for working with other emergency responders. Patient outcomes met expectations. Staff made sure patients understood their care and treatment to enable them to give informed consent. Care and treatment was based on latest evidence and good practice guidance.

Caring:

Patients were treated with kindness and compassion. Staff protected their privacy and dignity. They treated patients as individuals and supported their preferences. Staff responded to patients in a timely way. Patients had the opportunity to ask questions from allied health professionals. The service supported staff wellbeing.

Responsive:

The service provided information which patients could understand. Patients were invited to give feedback, knew who to speak with if they had concerns and were confident the service took their concerns seriously. Patients were involved in making decisions about their care and understood the need for the recommended diagnostic procedures.

Well-led:

There was a culture based on speaking up, listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. Staff understood their roles and responsibilities. The service had a governance structure to manage risks.

Updated 8 July 2026

We carried out a comprehensive one-day assessment on 25 June 2026, with follow-up remote interviews on 7 and 8 July 2026.

The service was inspected in June 2016 and rated as good overall. There were no breaches of regulations but there were some concerns about staff competency in triage systems, lack of space for people waiting to be seen, and staff skills in safeguarding adults.

South Western Ambulance Service NHS Foundation Trust (SWAST) has provided urgent and emergency care services from Tiverton District Hospital since July 2014.

At this inspection we found some improvements had been made.

Safe:

The service had a good learning culture and staff and patients could raise concerns. Managers investigated incidents thoroughly and lessons learned and improvements were identified and shared with staff. Patients were protected and kept safe because local safeguarding arrangements had improved, which staff understood and used along with safe systems of working.

There were enough staff with the right skills and qualifications to ensure high quality care and treatment. Managers made sure staff received training and had regular appraisals to maintain high-quality care.

Staff supported patients to manage medicines safely. Staff identified and reacted to unexpected deterioration in a patient’s condition. Staff understood and managed risks from the environment. The facilities and equipment met the needs of staff who were supporting patients.

Effective:

Patients and those close to them were involved in assessments of their needs. Staff reviewed assessments taking account of patients’ physical, emotional, communication and personal care needs. Care and treatment were based on latest evidence and good practice guidance. Patient outcomes were monitored to identify where improvements could be made. Staff made sure patients understood their care and treatment to enable them to give informed consent.

Caring:

Staff treated patients with kindness and compassion. Staff protected their privacy and dignity. They treated patients as individuals and supported their preferences. Staff responded to patients in a timely way. Patients had the opportunity to ask questions and were given access to specialist services, including from allied health professionals. The service supported staff wellbeing.

Responsive:

Patients or their representatives were involved in decisions about their care and treatment. The service provided information which patients could understand. Patients were invited to give feedback, knew who to speak with if they had concerns and were confident the service took their concerns seriously.

The service monitored and worked to improve access. Services were adjusted to meet the needs of people with conditions which could create a barrier to access.

The service worked to reduce health and care inequalities through service planning, quality monitoring, staff training and feedback. Patients were involved in planning their care and understood options around choosing to withdraw or not receive care.

Well-led:

Leaders and staff knew the service’s local vision, aims and objectives and understood how their work contributed to the service development. There was a positive culture based on speaking up, listening, learning and trust.

Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment.

Staff understood their roles and responsibilities.

Leaders had oversight of the quality of service being delivered. However, risk management systems did not always focus specifically on the urgent treatment centre risks.

Staff with protected characteristics felt supported.

There was a culture of continuous improvement with staff able to contribute ideas.

We did not identify any breaches of regulation at this assessment.