South Western Ambulance Service NHS Foundation Trust

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

We assessed all 6 quality statements from this key question.

At the last inspection we rated this key question good.

At this inspection the rating has remained good.

This meant people’s needs were met through good organisation and delivery.

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 4. The evidence showed an exceptional standard. The service was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People’s care fully reflected their physical, mental, emotional and social needs. We observed staff introduce themselves to patients and families and ask how the patient would like to be addressed. Crews adapted their body positioning when speaking with patients and their families. All staff completed mandatory training on Equality, Diversity and Human Rights. All regions had a compliance rate at or above the trust’s target of 85%.

People who used the services and those close to them were involved in planning and making shared decisions about their care and treatment so it centred around them and their needs. We observed staff treat a patient who refused to be conveyed to hospital for a heart condition. The individual had dementia but was assessed to have capacity. The staff spoke with the patient and his wife about social and medical support available and recommended next steps to call the GP. Staff ensured the patient had all information before following the patient’s wishes to be discharged.

Staff used communication resources to ensure people understood their condition, care and treatment options. Staff used a visual facial scale for communication with non-verbal patients and a phone interpreter to communicate with patients who did not speak English. Records showed staff across the provider had accessed the interpretation service over 5,900 times across 68 languages in the 12 months prior to our assessment. This meant staff could assess people’s needs.

The service listened to patients with lived experiences and adapted their care to meet their needs. South Western Ambulance Service NHS Foundation Trust (SWAST) had co-created their Learning Disability and Autism Plan 2025-2028 with community members who had learning disabilities and/or autism. The plan established the role of Learning Disabilities and Vulnerabilities Lead who was in post dedicated to improve the care SWAST delivers to people with learning disabilities and autism.

Staff worked with external services to support patient needs. One of SWAST’s 2025-2026 priorities was increased shared decision-making. SWAST encouraged staff to seek additional forms of support from the patients GP, the Clinical Support Team and Specialist Paramedics when the decision was made to not convey the patient to the emergency department. These clinicians provided crews with additional clinical support and advice based around individual patient needs.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People’s care and treatment was delivered in a way that met their assessed needs from services that were co-ordinated and responsive. SWAST had business continuity plans for all aspects of operations with clear lines of responsibility and escalation. Staff had access to specialist staff for clinical advice through a single point of access through the care co-ordination hub.

People received care and treatment from services that understood the diverse health and social needs of the local communities. The service offered access to care pathways closer to home for patients. However, there were differences in pathway options dependent on region. There were limited pathway options in north Devon for physical and mental health support. As a result, staff highlighted there was a risk for delays to care.

The trust offered local care services to the Bristol and Somerset area using community doctors’ schemes. In Bristol, SWAST operated a Community Emergency Medicines service (CEMS) with University Hospitals Bristol and Weston (UHBW). This service provided emergency department clinicians to treat patients in the community and avoid conveyance to the emergency department where possible. The service saw about 10-12 patients per day and had prevented 60% of all eligible incidents they attended from being conveyed to the hospital. The trust was pursuing expanding the service to increase the trust’s capability to support patients in the community.

In Somerset, SWAST provided a GP-led Somerset Ambulance Doctor scheme since 2014. This service was commissioned by the integrated care board (ICB) and provided 7-day a week service of an Ambulance GP with an Emergency Ambulance Associate (EAA). This service provided enhanced clinical care including bloodwork and diagnostic ultrasound and decision-making to treat patients in the community. The scheme managed around 2,500 cases each year. Eighty percent of the patients treated avoided attending the emergency department.

Staff praised the mental health resources available. Staff were able to speak to a mental health nurse through the hub 24/7 to gain clinical advice for incidents. The trust had mental health vehicles staffed by a mental health nurse from the mental health trust and an emergency care assistant (ECA) Wednesday to Saturday 2pm-2am. Staff felt these vehicles and resources helped patients access mental health pathways. However, there was inconsistent funding across ICBs so not all staff had equitable access to request mental health vehicle support.

Although the Helicopter Emergency Medical Services (HEMS) in the SWAST region did not provide 24-hour coverage, SWAST had access to 24-hour coverage through air ambulances outside of the patch.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff provided information to patients in a timely manner. Patients and relatives told us staff kept them up to date on issues and answered all their questions.

Staff provided information to patients and their families in a compassionate manner following distressing events. Staff ensured patients and their families were not left alone to cope with distressing events.

Staff ensured patients could obtain information on treatments and local services. Information was shared through posters, bulletins, and verbal explanation in languages spoken by patients.

People could expect information to be tailored to individual needs. This included making reasonable adjustments for disabled people, interpreting and translation for people who did not speak English as a first language and for deaf/Deaf people who use British Sign Language. Staff had access to interpreter services and visual communication aids. Crews adapted their communication to suit the patient needs.

Complaints and duty of candour processes were embedded, and feedback shared locally and trust wide. Staff provided patients information on how to make a complaint. However, information pamphlets on how to submit a complaint was not available inside a few ambulances we inspected.

Learning from complaints directly informed training. Learning from incidents was consistently shared to the operations teams through meetings, emails, and one to one conversations. Investigations were conducted by multi-disciplinary teams with a focus on patient safety.

Information about people that was collected and shared met data protection legislation requirements. SWAST maintained confidentiality of patient records. However, we found Great Western Air Ambulance Charity (GWAAC) relied on online documents for checklists with an insecure electronic environment and no clear online document controls in place apart from restricted access.

The service made notifications to external bodies as required in line with statutory requirements.

We scored the service as 4. The evidence showed an exceptional standard. The service was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. They always involved people in decisions about their care and told them what had changed as a result.

SWAST sought out patient feedback and involved patients and their families to improve the service. Patient engagement was an annual quality priority and was detailed in their Annual Plan 2026/2027 as such. The trust’s enhanced patient engagement brief detailed multiple workstreams to increase patient engagement, including strengthening feedback mechanisms.

The trust captured patient voice through multiple avenues including investigations, forums and local engagement. The Community Feedback Forum was run by patients to provide feedback and improve SWAST’s services. SWAST published a newsletter titled ‘Your Voice…Our Actions’ to show how public feedback had shaped improvements and research.

The service had a clear complaints policy and staff knew how to handle complaints and compliments. Patients we spoke with knew how to complain or submit a compliment.

People knew how to give feedback about their experiences of care and support including how to raise any concerns or issues. While complaints information was available in every ambulance, hard copy of information on how to make a complaint were not always available in ambulances. Staff directed patients and their relatives to the SWAST website or QR code on the back of every ambulance which, when scanned, took users to the feedback section of the trust’s website. However, elderly patients or patients being conveyed to hospital may struggle to access and retain the website and could benefit from hard copy.

SWAST’s patient feedback group, the Community Feedback Forum, supported the complaints process through increasing accessibility. They had worked with an animation team to develop an informative animated video detailing how to submit comments, concerns and complaints. This video was available with subtitles for those with difficulty hearing and was available in multiple languages. There were also easy read leaflets and forms on the SWAST website for submitting complaints and compliments.

Learning from complaints and concerns was seen as an opportunity for improvement and staff could give examples of how they incorporated learning from daily practice. SWAST continuously engaged with the public to inform their learning and investigation process. Patient engagement informed the trust’s Patient Safety Incident Response Plan 2025-2026 and 2026-2028. In the Patient Safety Incident Investigations (PSIIs) we reviewed, we found SWAST worked closely with patients and their families to inform investigations. SWAST followed dedicated investigation processes following incidents, involving the affected patients in a compassionate manner.

Duty of candour processes were embedded, with feedback shared locally and trust wide.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

People could expect their care, treatment and support to be accessible. This included making reasonable adjustments for disabled people, addressing communication barriers and having accessible premises. People with mobility issues were provided with walking aids and assistance to get on and off the ambulance. Patients were encouraged to bring mobility aids and shoes with them so they could continue to mobilise if they required a stay in the hospital.

The trust sought to provide equitable access to bariatric patients. All stretchers were capable of accommodating bariatric patients weighing less than 400kg with 6 stretchers available to request for patients weighing more than 400kg. At the time of the inspection, the trust had purchased and, following the inspection, deployed 16 new bariatric stretchers to support patients weighing more than 400kg.

However, people could not always access care in a timely manner. The trust did not reach category 1 and 2 national target response times because of continued health system pressures. In instances where the trust faced significant delays to attending an incident, the service was transparent with patients waiting and co-ordinated a taxi for patients who were eligible, to convey the patient to the emergency department.

The service was not always able to provide equity in access to care for patients in rural areas compared to populated areas. There was inconsistent ambulance coverage of rural areas away from major hospitals. Without a local major hospital, North Devon patients were transported outside the region. The number of ambulances provided in the rural region would decrease as a result, affecting how quickly an ambulance could be dispatched. Staff who worked in North Devon told us this happened frequently and they would be assigned incidents around major cities and towns, making it difficult to support patients in this region.

SWAST recognised that hospitals across the area they covered had different pathways for medical conditions. For example, Medical Assessment Units (MAU) were not always available for each hospital and each MAU had different criteria for the medical conditions that could be seen. An MAU is a dedicated hospital department that provides streamlined care for patients referred with identified acute medical conditions. To address this, SWAST had developed a resource for staff on pathways available for patients and criteria of acceptance to streamline decision-making and increase transparency on the existing care pathways.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The provider completed equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage. Leaders and staff were alert to discrimination and inequality that could disadvantage different groups of people using their services.

The service had targeted programmes to improve health inequalities. These included providing rural coverage through increasing community first responder volunteer recruitment to areas of need and increasing defibrillator access to remote areas. SWAST partnered with schools to install defibrillators. System redesign, specialist services, increased senior clinical support and learning systems aimed to improve equitable access and outcomes, particularly for complex patients.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. Staff were required to complete Equality, Diversity and Human Rights training every three years. At the time of the inspection, the compliance rate for operations staff was 90.4%, above the trust aim of 85%.