South Western Ambulance Service NHS Foundation Trust

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our assessment in September 2018 we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Managers promoted the provider’s vision and values to staff. Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. Staff were involved in restructuring staffing roles. Staff had been involved in designing a new computer aided dispatch system due to be implemented in November 2026. This was to ensure it met the professional needs of staff.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had the skills, knowledge and experience to perform their roles. Additional training was provided to support people in management roles.

Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care and potential for adapting services to meet the needs of the population.

Leaders were visible in the service and approachable for staff. There were clear strategies for providing staff support and all managers were focused on providing effective support for staff both professionally and for wellbeing.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Patients and carers had opportunities to give feedback on the service they received. Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements.

Patients and carers were involved in decision-making about changes to the service through the patient participation group.

Staff knew how to access the freedom to speak up champion in the service and named other avenues they could use to raise concerns confidentially. Most staff felt confident to speak with their line manager.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

There are equality and diversity networks within the service including for staff who were neurodiverse and a project for encouraging females to take up leadership roles.

Staff could apply to work flexibly to account for personal circumstances such as caring responsibilities and health issues. A regular panel was held to review applications and staff told us how their working arrangements had helped them to stay in their role.

The provider undertook equality monitoring of staff within the service to ensure it is diverse in its make-up and representative of the patient group.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

There was a clear framework of what must be discussed in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. Actions were identified, reported to appropriate committees and progress tracked.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. These were aligned with national standards. Local audits were developed to provide information for staff of how well they were performing. Staff could access their individual performance with ease.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. Those who had been out with frontline crews gave positive feedback about the experience.

Managers monitored staff performance and used results to provide support and retain staff. Staff who could not perform according to trust values and policies were dismissed from the service.

Managers maintained and had access to the risk register and could escalate concerns when required. Staff concerns matched those on the risk register.

The service had plans for times when demand was extremely high and were planning for anticipated surges in demand for the winter of 2026.

Where cost improvements were taking place, they did not compromise patient care. Impact on patient care was always assessed for safety.

Staff had access to the equipment and information technology needed to do their work.

Information governance systems included confidentiality of patient records. Clinicians had access to more detailed patient records than other staff in the service.

Information was in an accessible format, and was timely, accurate and identified areas for improvement. It was clearly formatted for staff to understand and shared in newsletters.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Leaders engaged with external stakeholders such as commissioners, police services and mental health partners and community services. Staff were designated a relationship role with each of the integrated care boards within the Southwest region. This was to promote understanding of the local population needs and how commissioners could respond. Where any issues were identified these were discussed. For example, when other health organisations made changes to services which might affect how ambulance services contact them. This could be updated on the SWAST systems.

Partnership working with mental health services had developed a more appropriate service than frontline ambulance responses. It also released frontline ambulances to respond to urgent life-threatening situations.

We scored the service as 4. The evidence showed an exceptional standard. The service had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Opportunities for learning were always actively sought. Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery. Staff were given dedicated time to work on improvement projects. Seconded staff were engaging with colleagues to develop the new computer aided dispatch system so that it provides an improved system when implemented. Staff described good involvement opportunities in the transformation programme for restructuring staff levels in the call handling and dispatch teams.

The Quality Assurance Team were proactive in sharing learning with staff. Newsletters were comprehensive and provided information in an easily accessible way for staff. This team was involved in a range of committees for the review of incidents and complaints and what actions could be taken. This developed into projects for improvement. For example, working on how quickly they could support getting CPR (cardio-pulmonary resuscitation) started for patients who needed it. They called this ‘getting hands on chest’ and any small improvement in timing was seen as a patient safety benefit. Staff were regularly seconded to the Quality Assurance Team for a period of 6 months at a time. This secondment activity helped staff to understand the audit process, how their role impacted on the results and supported professional development.

Staff participated in national audits relevant to the service and learned from them. The Quality Assurance Team provided audit information that has led to achieving the status of an Accredited Centre of Excellence for Emergency Medical Dispatch by the International Academies of Emergency Dispatch.

Staff had opportunities to participate in research and innovations were taking place in the service. A focus on staff wellbeing had prompted the team to take part in a research project to reduce stress using virtual reality devices. This was in partnership with a university in the region.

Staff used quality improvement methods and knew how to apply them. A pilot study of using ambient voice technology was being conducted to assess accuracy and efficiency for clinical record keeping.