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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement.

This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulations for the governance of the service.

This service scored 62 (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.

The service operated under the trust’s vision and values. The trust’s vision was: “Together, we will deliver the best care when you need us most.” The vision was built on a strategy based on people, patients, partners and the organisation. The vision was underpinned by 3 values which were, to work together as one team, to be compassionate with patients and colleagues, and to be innovative to continually develop.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. They told us they could raise concerns without fear of negative consequences.

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. They understood the services well and explained clearly how teams worked to deliver high quality care. Leaders were proud of the teams and described them as being passionate and committed.

Leaders were described as being as visible as possible considering the challenge of the geographical location of the island. Staff reported good relationships with senior leaders, who were approachable and honest about the realities of working in an isolated setting.

Staff said local managers were easy to contact, visited regularly, and offered support such as one-to-ones when needed. They felt there was always someone available to speak to and that urgent support or resources could usually be arranged quickly.

Some staff told us they felt there was inconsistent communication from leaders about future plans.

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.

People had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements.

Staff said they could raise concerns openly, especially about vehicles, staffing and logistics, even if these were not always easy to resolve. They were aware of Freedom to Speak Up arrangements and felt there were clear ways to escalate concerns if needed.

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.

Managers put reasonable adjustments to help staff carry out their roles. All staff were required to complete equality and diversity training. Leaders took action to review and improve the organisation’s culture, with a focus on equality, diversity and inclusion.

We scored the service as 1. The evidence showed significant shortfalls. The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There were not clear and effective governance, management and accountability arrangements. Staff understood their role and responsibilities, but managers did not have a system to monitor performance of the service.

There was limited evidence of effective monitoring, audit, or performance oversight, including a lack of clear key performance indicators or structured review mechanisms.

Although there were systems and processes for managing equipment and the environment, they were not effective in identifying or managing these risks. Issues such as out-of-date and damaged medical gases, unsecured cylinders, and environmental concerns had not been identified through routine checks or audits. There was a lack of effective oversight and assurance, with governance systems failing to detect and address risks. Sufficient actions to address the issues with the premises had not been taken in a timely manner.

However, contingency plans were established for business continuity, including managing adverse weather and system disruptions. Information governance systems ensured confidentiality, with clear policies for the secure storage and appropriate retention or destruction of records.

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.

Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care. Staff described partnership working with the local hospital, transport providers and emergency services.

Staff and leaders engaged with people, communities and partners to share learning with each other that results in continuous improvements to the service. Staff told us supporting the local community was an important part of the service. They took an active role in community initiatives, including running engagement sessions with local schools and events.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery. One example was the introduction of a stretcher plane to reduce the need for relying on other emergency services to transfer patients off the islands. There was a system so that staff could give feedback on how the new system was working and whether it could be improved.

There were plans to improve access to diagnostic services and reduce unnecessary mainland travel. Examples of innovation included developing staff roles. One staff member had an honorary contract with a healthcare centre to gain practical experience at a blood clinic. There were plans to replace the older vehicles which included exploring electric options.