South Western Ambulance Service NHS Foundation Trust

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that people were always treated with kindness, empathy and compassion. We checked that people’s privacy and dignity was respected, that they understood that they and their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them.

We assessed all 5 quality statements from this key question.

At the last inspection we rated this key question outstanding.

At this assessment the rating has remained outstanding.

This meant people were truly respected and valued as individuals; and empowered as partners in their care in an exceptional service.

This service scored 90 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at treating people with kindness, empathy and compassion and in how they respected people’s privacy and dignity. Staff always treated colleagues from other organisations with kindness and respect.

Patients felt they were treated with kindness, compassion and dignity in their day-to-day care and support. We witnessed a staff member recognise a patient was chilly. The staff member warmed up a blood pressure cuff so it was not cold on a patient’s arm and turned on the heating in the van.

People felt that staff listened to them and communicated with them in a way they could understand. We witnessed staff use humour to place a patient and family at ease. One patient we spoke with stated they ‘could not fault the crew.’

Staff supported patients to understand and manage their care, treatment or condition. Staff patiently explained everything to patients multiple times if needed. We saw an emergency care assistant (ECA) sit with a patient who was suspected of having early onset dementia. The ECA sat quietly while the patient spoke, even when the patient repeated themselves.

We saw staff ensure patients were comfortable with individuals of other genders in the room. Prior to a clinical exam, we observed staff ask a patient if she was comfortable if a member of the opposite sex was in the room during an examination.

Staff directed patients to other services and, if required, supported them to access those services.

People were assured that information about them was treated confidentially and they knew that staff respected their privacy. We witnessed staff speak with an individual who had overdosed and confirmed that their incident would remain confidential as the patient wished.

People’s privacy and dignity was respected and upheld at all times and at all stages of life. We witnessed staff pull curtains around the bed to protect patient’s dignity when transferring patients between stretcher and hospital bed. When discussing sensitive information, we saw staff speak privately and quietly with emergency department staff. We witnessed staff speak in hushed tones to respect the patient’s dignity when transferring a deceased patient to the mortuary.

We scored the service as 4. The evidence showed an exceptional standard. The service treated people as individuals and was exceptional in how they made sure people’s care, support and treatment met people’s needs and preferences. The service took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

People’s personal, cultural, social and religious needs were understood and met. Staff told us they captured patient religious needs and if the patient died while in their care, they were mindful to certify the death to allow for storage and treatment of the deceased in line with religious requirements. Staff sensitively communicated with the family when this was not possible due to coroner examinations.

South Western Ambulance Service NHS Foundation Trust (SWAST) recognised the importance of delivering high quality care to people with learning disabilities and recognised how they could be impacted by health inequalities. The organisation worked with members of the public with learning disabilities to ensure their voices were heard.

Staff sought to ensure the patient was comfortable throughout their treatment. Patients were able to request same-sex attendance. Crews were mindful of cultural modesty requirements and gender preferences and accommodated the patient where feasible.

Staff treated people as individuals, considering their needs and preferences. Staff demonstrated awareness of noise impact on patients, and reduced radio and satellite-navigation volume to avoid distraction and improve patient experience.

People’s communication needs were met to enable them to engage in their care, treatment and support to maximise their experience and outcomes. Crews adapted communication to patient needs and surroundings. Staff and patients had access to interpreters and/or signers 24/7. This included using plain language and adjusting tone and body positioning. Visual communication aids were accessible on handheld electronic tablets. We witnessed staff switch their questioning to a yes or no and asked the patient to nod or shake their head when interacting with a patient who was having an asthma attack and could not breathe easily.

We saw patient care was informative and not rushed. Staff took their time to verbally confirm with the patient and their family if they understood the situation. Staff answered questions as they arose and asked about the patients’ personal life to make conversations and put them at ease. We witnessed a crew member repeat themselves multiple times for a patient. As the patient was being discharged, the patient told us ‘the patience [the crews] have for patients was remarkable.’

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at promoting people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

People were supported to have choice and control over their own care and to make decisions about their care, treatment and wellbeing. Crews provided clear information to patients and supported informed choices. We witnessed staff provide a patient with explanation of their health condition and the value of conveying to hospital. Following the patient declining multiple times, staff worked with the patient to ensure the GP and their support network were aware of next steps should their condition worsen.

We witnessed staff interact with a patient who was highly anxious to go to the emergency department. The crew contacted the care coordination hub who arranged for the patient to be directly referred to a specialty with direct access to the medical admissions unit. The patient told us they were ‘delighted’ and ‘grateful’ for the way the crew interacted with her and listened to her to avoid visiting the emergency department.

People had access to resources that supported their needs. We witnessed staff support a high functioning autistic patient in a state of delirium. The crew communicated with the patient and asked his preferences, receiving consent from the individual at every step. The crew communicated with the hospital prior to conveyance so the individual had a quiet space in the emergency department to meet their needs. On arrival, the handover was immediate and the individual was given a private room.

Staff supported the patient’s families and friends to make decisions in instances where the patient did not have capacity or died. Staff were sensitive in helping one relative cope and understand what happened next following the sudden death of their spouse.

Crews we spoke with had a good understanding of end-of-life plans and each plan’s legally binding status. Across the 7 counties SWAST covered, each integrated care board (ICB) had a different form to indicate a pre-arranged end of life plan. Staff followed the trust’s procedure for managing incidents for patients with a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) or terminal illness and submitted any concerns regarding deviation as an incident. A DNACPR is a medical decision and official document which tells healthcare professionals to not attempt to restart your heart if it stops.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff recognised when people needed urgent help and used appropriate tools and technology to assist.

People’s needs, views, wishes and comfort were a priority and staff quickly anticipated these to avoid any preventable discomfort, concern or distress. Staff made sure patients were comfortable and warm when receiving treatment. We saw staff turn on the heat in the vehicle when treating a patient because they were cold.

Staff were alert to people’s needs and took time to observe, communicate and engage people in discussions about their immediate needs. Staff conducted risk assessments and planned patient care according to risks identified. Staff regularly monitored patients’ pain levels using an assessment tool to evaluate pain in people who have cognitive impairment impacting their verbal communication.

Staff had access to ambulance records however, not always full GP records. Every patient received a comprehensive assessment even if the crew had been asked to stand down by the person who had called them. Where a patient had specific risk such as falls or pressure ulcers, crews made sure this information was recorded and transferred to wherever the patient was conveyed to.

Staff ensured patients’ needs were met prior to discharge. We witnessed staff confirm a patient had access to nutrition and hydration prior to discharging the patient at home.

Staff received training in conflict management and were comfortable in de-escalation techniques. However, staff we spoke with did not always feel equipped to restrain patients.

We scored the service as 3. The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

People received safe, effective, and person-centred care as the provider recognised and met the wellbeing needs of staff. SWAST had been awarded a £200,000 grant in autumn 2025 to support the Wellbeing Hub, part of staff wellbeing resources. The 2025 National Education and Training Survey (NETS) results showed SWAST was the 2nd highest ranked English ambulance trust for wellbeing.

Staff had access to a comprehensive wellbeing support package to meet their physical and emotional health needs. Staff had access to counselling and physiotherapy.

However, stress and pressure from work and managers affected staff wellbeing. In the 2025 NHS Staff Survey results, 53.11% of staff reported in the last 12 months they have felt unwell because of work related stress. Thirty nine percent of staff with a long-term condition or illness and 27.01% of staff without a long term condition or illness had felt pressure from their manager to come to work despite not feeling well enough to perform their duties.

Support was available to staff who attended distressing situations. However, some staff felt the length of time for support and the quality of support immediately following a challenging situation could be improved. Some staff told us they did not receive meaningful recovery time following traumatic incidents because of operational pressures. When requesting time to stand down following a traumatic incident, staff were given between 8-15 minutes before being sent a new job. Staff found this time frame inadequate and lacking compassion.

Most staff we spoke with felt positive and proud about working for the provider and their team, especially in remote stations where there was a sense of family. All management we spoke with were proud of their teams and felt they had good working relationships.

Some staff felt valued by their teams, but not all staff felt valued by the organisation. Sixty percent of staff who responded to the 2025 NHS Staff Survey said they felt valued by their team, however 26.62% reported they were satisfied with how the organisation valued their work.

Managers monitored welfare indicators including sickness and burnout risk using stress risk assessments. Following high sickness rates across the trust in the winter period, a sickness task group was created to address these rates. As a result, sickness rates fell from December to March 2026. In December 2025, the sickness rate for frontline operational staff was 7% and in March 2026, the sickness rate fell to 5.72%. However, this was still above the Trust target of 5.5%.

Many staff told us they felt valued by their colleagues and managers. Managers offered one to one support shifts. Staff told us these shifts were adapted to reduce perceived power imbalance following staff feedback. Clinical team managers (CTMs) we spoke with felt the new management structure with fewer people directly reporting to them meant they could get to know their staff well and provide additional support.

However, not all staff felt their annual appraisal conversations were a productive use of time. Some staff said these felt rushed and were often done by a form followed by a brief conversation. Some staff we spoke with were confused over some aspects of career development and access to additional training. In the 2025 NHS Staff Survey results, 50.04% staff agreed there were opportunities to develop their career in the organisation and 44.14% felt supported to develop their potential.

Staff did not always feel safe when interacting with patients. In the 2025 NHS Staff Survey, 31.55% of staff reported they experienced at least one incident of violence from patients or members of the public and 41.55% of staff reported they experienced at least one incident of bullying, harassment, or abuse from patients or members of the public.

However, the trust had mechanisms to monitor violence and aggression and protect staff. Staff reported patient violence and aggression by an online reporting system. There was a dedicated crime and violence reduction team who monitored patient violence and aggression and ensured clear flags and triggers were noted on the patient profile for staff’s awareness. The service provided body-worn cameras for staff. Staff told us they felt the cameras protected their safety, although there were not enough cameras for staff. However, the trust had an action plan to address the lack of cameras.

SWAST had taken action to address sexual harassment within the organisation and had a strict zero-tolerance stance. SWAST signed the NHS Sexual Safety in Healthcare Organisational Charter in August 2023 and embedded mechanisms to monitor and address sexually inappropriate behaviour. Almost all staff we spoke with felt sexually safe and the culture had improved. However, we were told of a few instances of sexually inappropriate behaviour which were being dealt with through the trust disciplinary process.

Staff found the scheduling process very frustrating. Staff felt the central scheduling system removed the human element of planning. Staff who requested leave or swapping shifts within a short period were not always approved off with little to no explanation.

Staff we spoke with were unhappy they had to take breaks away from their base at times. When staff were told to take their break at a different station, staff frequently did not have access to the station due to key code or swipe access.

Staff faced barriers when pursuing flexible working arrangements, however the trust was taking action to address this. In the established process, flexible working arrangements were reviewed and decided by a central committee. As a result of a report raised by the staff union in January 2026, leadership proposed a three-month pilot in the Somerset region to decentralise decision-making of flexible working requests to local leaders.

Leadership took staff concerns seriously and there was clear leadership buy-in to prioritise improving the workplace for staff. Following this, the trust published an improvement action plan, with an initial focus on practical issues including scheduling and break timing, then a focus on psychological safety, and lastly a focus on sustainable growth.