South Western 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 79 (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 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Assessments considered the person’s health, care, wellbeing and communication needs, to enable them to receive care or treatment that had the best possible outcomes. We witnessed staff review medication and medical history with each patient and family members to inform diagnosis and treatment. These plans were personalised and holistic and updated when necessary. From the electronic care records we saw, they were comprehensive, contemporaneous, and complete.

People were involved in the assessment of their needs and support was provided where needed to maximise their involvement. We saw staff assess capacity and confirm consent with patients living with dementia.

Staff used assessment tools to monitor patient deterioration and escalated care when needed. We saw staff conduct regular physical observations and verbally checked in with the patient during transfer.

However, staff did not always provide clinical and social support to patients who had fallen. The proportion of patients who had fallen and were eligible to receive a falls care bundle to prevent further falls was consistently below 50% for December 2024 to December 2025. This meant patients who had suffered falls might not have received comprehensive and holistic care to prevent further falls.

Staff faced operational pressures to complete records quickly. Some staff told us there were frustrations around the amount of repetition in the electronic patient record and length of time it took to complete the record.

We scored the service as 3. The evidence showed a good standard. 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.

People received care, treatment and support that was evidence-based and in line with good practice standards. We saw treatment and transport decisions were made in line with national clinical guidance across the ambulance service. We saw staff followed the trust Hospital Handover policy on escalating care in deteriorating patients.

The provider’s systems ensured staff were up-to-date with national legislation, evidence-based good practice and required standards. Staff had access to up-to-date JRCALC clinical guidance, senior clinical advice, and mandatory training. We saw staff consult the JRCALC guidance when treating patients. Managers issued reminders to support training compliance.

Staff were experienced and qualified with the right skills and knowledge to meet the needs of the patients they treated. Staff showed understanding of capacity, consent, and mental health.

Staff had access on their handheld device to a database of clinical health pathways available for the location they were treating the patient. We observed staff use this database to identify the correct service to transfer a patient to.

Staff completed paperwork accurately using a structured medical model approach. Controlled drugs administered were consistently noted in the controlled drugs book.

Managers provided staff with supervision and appraisal of their work performance. As part of the One Team Model, clinical team managers (CTMs) told us they had fewer line reports so they could spend more time supporting staff performance and growth. However, this worked better in some areas than others. Some CTMs reported being able to get out and conduct ride along with their staff, which staff told us worked well. However, in remote stations where some of the automated processes such as AVP and medicines packing had not yet been adopted, some CTMs felt overwhelmed by additional duties expected of them.

We scored the service as 3. The evidence showed a good standard. 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.

When people received care from a range of different internal and external teams and services, it was co-ordinated effectively. Staff had access to a single point of access care hub where frontline staff could speak with clinicians to support decision-making and co-ordinate care. The hub minimised frontline staff’s administrative time and provided joined up care. We saw a crew call the hub, who then arranged blood testing through the urgent community team. The bloodwork results were sent to the GP who followed up with the patient locally. This demonstrated health services worked collaboratively to meet people’s needs.

The AVP services worked well to support staff and streamline stocking and cleaning processes. Staff who worked out of sites where the AVP was used told us this new programme had saved a significant amount of time at the start and end of shifts.

Localised community support teams such as the Community Emergency Medicines Service team (CEMS) team provided care and reduced admissions to hospital. The CEMS team identified eligible patients from incidents and provided care to 11-12 patients per day on average.

Volunteers provided valuable clinical and organisational support. We saw a Community First Responder (CFR) respond to incidents in the community and provide necessary immediate care.

The mental health vehicles provided quality care to patients during time of crisis. Some staff praised the positive impact the mental health resources had to supporting patients and the ease in requesting support. Staff had access to 24/7 mental health desk support and to mental health vehicles staffed by mental health nurses.

There was a good team culture between management levels in supporting each other’s wellbeing and workload. There were effective multi-disciplinary team meetings and network involvement to inform management decisions.

Frontline staff did not always feel they worked as a team with emergency operations centre (EOC) staff. The EOC received incoming incidents, allocated incidents to frontline staff, and dispatched external services. Crews told us there was a disconnect between the emergency operations centre and frontline crews regarding expectations for length of time incidents took, geographic borders, and breaks.

The service had effective external relationships with police services, fire services, military, hospitals, integrated care boards (ICBs), urgent care partners, and out of area ambulances.

Incident scenes with internal and external teams were calm and structured. We attended a cardiac arrest incident where a community first responder, police, Helicopter Emergency Medical Services (HEMS), and another ambulance crew were on scene. The teams worked closely together with respectful communication and a clear leader. We observed community first responders and the HEMS pilot support the police at the incident to ensure the road was blocked from all traffic and the public were removed from the scene to protect the patient’s dignity. Once the incident concluded, the CTM called the crew to conduct a welfare call.

Multi-disciplinary team debriefs happened following incidents on scene to inform learning.

When people moved between services, all necessary teams were involved to maintain continuity of care. Staff had positive relationships with emergency departments across the region, even when the handover process was impacted by delays in the hospital. There were good relationships across all levels of each trust. The Hospital Ambulance Liaison Officer (HALO) role facilitated smooth handovers between ambulances and emergency departments across the region. There were clear lines of escalation for staff and they worked collaboratively in the patient’s best interest.

Hospitals who did not have HALO staff members had informal processes relying on communication between emergency department clinicians and South Western Ambulance Service NHS Foundation Trust (SWAST) staff. Staff told us, and we observed two handovers which showed a good working relationship ensuring continuity of patient care.

SWAST worked closely with commissioners across the region to support the population needs. SWAST attended monthly Integrated Care Board (ICB) commissioner meetings with each ICB to discuss SWAST’s performance and areas for partnership improvement.

However, information was not always shared with emergency teams in a timely manner outside of SWAST’s geographic region due to electronic communication difficulties. Communications between other ambulance services and SWAST ambulances were not always provided promptly and directly to crews to support patient care.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

People were encouraged and supported to make healthier choices to promote and maintain their health and wellbeing. We witnessed staff speak to patients regarding participation in smoking cessation schemes, healthy eating advice and social prescribing.

The service supported people to live healthier lives to reduce future care needs. SWAST developed a Complex Care Policy to support frequent callers and ensure trust resources were used correctly and individuals received the care they needed.

People were empowered and supported to manage their own health, care and wellbeing needs by staff who understood their needs and preferences. Staff provided healthier living guidance to patients. We witnessed staff provide a patient with a ‘Looking After Yourself’ pamphlet with instructions on healthier living and when to call NHS111 or emergency services.

We scored the service as 3. The evidence showed a good standard. 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 trust used a structured action plan to monitor performance and communicate with partners the pressure the service was under.

The service monitored category response times and had improved category 1, 2, and 3 response times since the previous inspection even with activity levels above commissioned levels. However, the service did not reach national response standards for all category response times. This was a national issue across NHS ambulance services. In March 2026, SWAST’s category 1 average response time was 8 minutes 54 seconds, below the national standard of 7 minutes. SWAST’s category 2 average response time was 30 minutes 15 seconds, below the national standard of 18 minutes but bordering the 30-minute improvement target for 2025/2026. SWAST’s category 3 average response time was 1 hour 30 minutes, below the national standard of 60 minutes.

SWAST had increased treatment to patients over the phone (Hear and Treat) or in-person (See and Treat) without conveyance to the emergency department to alleviate pressure on the health system. The overall rate of Hear and Treat incidents increased from 13.8% in April 2025 to 19.5% in March 2026. In all counties, except for Devon, the overall percentage of incidents where patients were conveyed to the emergency department was lower in March 2026 than a year prior in April 2025. The trust supported frontline operations through targeted efforts in treating patients over the phone or in-person during periods of peak activity such as the winter period. This alleviated pressure on frontline staff and on emergency departments.

Quality and outcome information for patients treated with a stroke informed improvements in the service. As a result of investment in the stroke pathway and improved category response times, the mean time from 999 call to hospital arrival for stroke patients had improved from 2 hours 20 minutes in November 2021 to 1 hour 41 minutes in November 2025.

The service made continuous improvements to people’s care and treatment. SWAST monitored patient care pathways to understand barriers. SWAST’s clinical team conducted a monthly review across the counties and hospitals to understand where attempts to access alternative care pathways to the emergency department were unsuccessful, to work with the acute trust and provide targeted improvements.

The HALO role was critical to maintaining flow despite challenges between ambulance and hospital demands. Since the Timely Handover Process 45 minutes (THP45) rolled out on 8th October 2025, the average handover times across the acute trusts in the southwest region decreased overall compared to previous years. SWAST leadership worked directly with acute trust leadership at hospitals struggling to accept handovers within the 45 minute time frame. There was clear oversight of the patient within the handover process.

There were processes to support patient care during periods of delays. When there were delays in the handover process, we saw staff use pressure-relieving mattresses at emergency departments to reduce the likelihood of pressure ulcers while waiting for handover.

Staff used technology to support patients effectively. Dedicated teams contributed to managing system demand by supporting non-conveyance of complex medical patients. Within the Bristol area, the CEMS team attended incidents that were potential hospital admissions to decrease conveyance rates. From January 2024 to October 2025, the CEMS team released 1,281 hours of ambulance time with a net saving of £2.4 million.

Staff used recognised tools to detect and respond to deteriorating patients. Staff used the National Early Warning Score 2 (NEWS2) to observe and identify deterioration in patients. However, staff we spoke with were not always aware of the maternity deterioration score, Maternity Early Warning Score (MEWS). There was a risk staff may not recognise deterioration in individuals who were pregnant to provide timely care.

The service had mechanisms to monitor patient outcomes. CTMs conducted monthly audits of electronic patient clinical records to ensure staff adhered to clinical standards and patients received the care they needed. We reviewed 10 CTM monthly audits which were thorough and focused on learning and growth. However, leadership told us CTMs did not always have sufficient time to complete these audits every month.

Staff sought outcomes from patient care to inform learning. In some cases, staff told us this helped them process what they had seen or treated, as it closed the loop for them.

The trust was aware of areas for improvement in their patient population. The trust’s Clinical Approach Strategic Plan 2026-2029 focused on 4 main patient presentations to improve outcomes: time critical patients, breathing difficulties, falls and frailty, and mental health.

We scored the service as 4. The evidence showed an exceptional standard. The service always carefully explained to people what their rights around consent were, making sure they fully understood them and always fully respected these when delivering person-centred care and treatment.

There were systems and practices to ensure that people understood the care and treatment being offered or recommended. Staff took all practical steps to enable patients to make their own decisions. We observed a crew attend a patient who disclosed they had taken a heroin overdose but refused conveyance to the emergency department. The crew took a comprehensive history and determined the patient had capacity to decline the trip. The crew repeated the risk to the patient and had the patient summarise what the crew had said back to them and what it meant. The crew ensured the patient understood their care options and asked the patient to sign a self-discharge before letting them leave the ambulance.

Staff understood the importance of ensuring that people fully understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment. We witnessed a crew introduce themselves to each patient and family member they attended and seek consent throughout the care process. Consent was documented clearly and staff had access to consent guidance. There was clinical oversight of consent documentation.

People’s capacity and ability to consent was considered and they were involved in planning, managing and reviewing their care and treatment. For patients who had impaired mental capacity, staff assessed and recorded capacity to consent. We witnessed a crew attend a patient who had dementia but refused to be conveyed to the emergency department. The crew assessed the patient’s mental capacity and identified the individual had capacity to refuse. The crew worked with the patient, their family, and GP, to ensure the patient understood their care options.

Staff made decisions in the patients’ best interests, recognising the importance of the person’s wishes, feelings, culture and history and any legal frameworks they might need if they were to convey a patient against their wishes. Staff assessed individual risk when conveying a patient against their wishes and involved other services such as the police if the patient presented risk to others or to the ambulance crew.

Staff supported patients who had been placed on a Section 136. A Section 136 under the Mental Health Act allows police to temporarily detain an individual in need of care for a mental disorder in a public area and bring them to a place of safety. Certain hospital emergency departments are identified as a place of safety. We witnessed staff convey a non-verbal aggressive patient on a Section 136 to a hospital. Throughout the process, staff demonstrated a good consideration of the patient’s mental capacity and developmental concerns and reduced environmental stimuli where possible. Staff used a reassuring tone and non-threatening body language during the interaction with the patient. This ensured the patient received care in a way that met their needs.

Although staff received mental health and mental capacity training to national standards, a few staff told us they did not always feel prepared to support patients with mental health needs but were confident in the resources available to support them.