South Western Ambulance Service NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

At our last assessment we rated this key question as outstanding. At this assessment the rating has changed to good. This meant people received safe care and treatment.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The trust had up-to-date incident reporting policy and patient safety incident response framework (PSIRF) which included duty of candour and never events (events that should not happen if safe processes are followed). PSIRF is a framework used to focus on how the system learns from an incident rather than assigning blame.

Staff understood what would make an event reportable as an incident. In the 12 months prior to our assessment, there was a total of 68 incidents reported. This included 20 near misses. The service included incidents that were under the categories of patient safety events, health and safety, and violence and aggression.

Staff understood what duty of candour was and why it was important. All staff we spoke with told us it was important to be open and honest when things went wrong. They said this enabled learning and supported patients who had experienced something that was not intended. Leaders involved in reviewing incidents understood duty of candour was a legal requirement. Duty of candour was promoted with posters at the HART bases, detailing what duty of candour was and the steps involved.

The trust’s website provided information for members of the public about patient safety events. This included information of what is meant by duty of candour, and the trusts approach to investigating safety incidents.

Staff received learning from incidents in a variety of communication methods, including weekly team calls. Staff told us that each specialism had a lead who would keep them informed of relevant safety information. The 2025 staff survey showed over 90% felt they were encouraged to report incidents and near misses. This was higher than the trust’s overall average.

During major incidents, commanders had access to loggists (staff who were trained to record accurate details of incidents and the decisions that were made in an incident response). Staff said this helped them in the decision-making process and to enable learning after events. The service carried out debriefing after incidents to enable the sharing and learning of incidents.

The service took learning from exercising (testing processes in a training environment) to make improvements to policies, processes and training provided to staff. Records showed each exercise created recommendations to make improvements to service performance and patient care. At the time of our assessment, the service was reporting full compliance with learning lessons requirements of the EPPR interoperability standards.

There were processes to share information, safety alerts, and learning from incidents. The service had set meeting agendas which included incidents as a section.

The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service had processes to identify incidents and events requiring a coordinated response. The service was identified through emergency calls to the Emergency Operation Centre (EOC), or direct contact with other emergency services and national agencies. There were systems and processes to confirm a major incident and share information with system partners and other emergency services.

There were up-to-date plans to respond to major incidents, events, business continuity and the deployment of resources. For example, there were plans for pandemic response, CBRN, Hazmat, and extreme weather.

The service had a command-and-control structure when responding to major incidents. A command-and-control structure is the framework used to manage major incidents. They deployed operational, tactical and strategic commanders where required. There were processes to rotate commanders during ongoing incidents. Staff said they would be supported if they needed rotation due to fatigue. Staff felt empowered to make decisions.

The service used a variety of tools to give staff useful guidance that could be used under time pressured situations. For example, staff had access to a variety of ‘action cards’ which gave quick steps to follow in certain situations, such as attending a railway incident or submerged person. Staff understood actions and processes that needed to be followed.

The deployment of specialist teams was decided using deployment policies. To support emergency and urgent care services, HART staff were deployed to category 1 incidents (incidents where a person has life-threatening injuries or illness such as cardiac arrest). Specialist staff could be redeployed from these calls within national time frames should a major incident be declared.

Staff worked with other paramedics providing emergency and urgent care to ensure patients received high quality joined up care. They recorded care and treatment given to ensure key information, such as HART specific medications that had been administered, were recorded. This meant information was available for clinicians at hospitals to make ongoing care decisions.

The service involved the support of independent health ambulance providers. If required, these providers would provide support in case of a major incident. The service had processes to review the independent health providers ability to support if required.

Staff did not always maintain up-to-date safeguarding training. However, the service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The service shared concerns quickly and appropriately.

Staff were not always up-to-date with safeguarding training. The service required staff to be trained to level 3 in safeguarding adults and safeguarding children and young people training. Records showed that at the time of our assessment 95% of staff were up to date with safeguarding adults training. However, only 64% of staff were up-to-date with safeguarding children and young people, which was below the trust’s 85% target. Compliance had dropped below target in June 2025 and remained below target.

In the 12 months prior to our assessment, 11 safeguarding referrals were raised by the HART team. Managers were confident training staff received, and their experience enabled safeguarding concerns to be identified and raised effectively.

Staff told us they were well supported in identifying safeguarding concerns. Staff said they worked with colleagues and other professionals to identify concerns and would report concerns when they are identified. They also had access to safeguarding advice from a safeguarding lead. The service promoted safeguarding and had a named safeguarding leads that could be accessed by phone or email.

The service carried out recruitment checks. This included checks with the Disclosure and Barring Service (DBS) for both adults and children barred lists. There was a process to review identified risk in recruitment checks which stopped people with serious offences from working with patients.

Staff understood the importance of the Human Rights Act 1998 in their role when dealing with major incidents such as a marauding terrorist attack (MTA). They understood the right to life for everyone involved including the perpetrator.

Staff received training to understand threats from terrorism or extremism and support people susceptible to radicalisation. At the time of our assessment, records showed most staff were up-to-date with training.

Staff received training in the prevention and management of violence and aggression. Staff said this training focused on basic hold and escorting techniques. At the time of our assessment, records showed 81% of staff had received the training. However, 91% of staff were up to date with the training on average over the 12 months prior to our assessment.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff were aware of the current UK threat level and that the trust was under major pressure due to high demand for the ambulance service.

Staff were trained to communicate information effectively with other emergency services. Staff followed principles set out in the Joint Emergency Service Interoperability Principles (JESIP). JESIP is a framework designed to ensure that emergency services work together effectively to save lives and protect people during a major incident. Staff received training in JESIP and the principles were tested during exercises (practicing responses to scenarios and testing systems and processes).

During our assessment, we observed staff attending 2 incidents. We observed staff assessing risks and making sure they were able to treat patients in a safe way. Staff worked with other emergency services to manage risks in the environment.

There were systems to monitor and respond to the distribution of patients in case of a mass casualty incident. This was to manage the capacity of acute hospitals to treat patients in a timely way. System partners told us that the trust worked well with others to roll out the software.

The command-and-control structure provided the ability to coordinate and respond to major incidents. Commanders told us systems and processes enabled good lines of communication to ensure that information was shared during incidents to manage risk. Commanders had access to specialist advice when needed, which supported their decision making. Staff acting in a command role, told us they felt empowered and supported to make decisions.

Staff had access to high level clinical advice to provide care and treatment to patients. There were systems and processes to manage the risk of life saving interventions. For example, when staff needed to use freeze-dried blood product.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes. Staff used the New Early Warning Score (NEWS) as a way to observe and identify deterioration in a patient.

The HART bases were located to provide prompt response across the area the service served. Due to the size of the geographical area, there were longer response times for remote areas. However, the service was supported by other emergency providers to cover these areas..

The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There were systems and processes to keep equipment secure. Vehicle keys were kept secure when not in use. Access to equipment used by HART teams was restricted to authorised staff only.

Equipment was checked to ensure it was safe to use. Vehicles and equipment were serviced. Vehicles had up-to-date MOTs (legally required annual safety checks for vehicles over 3 years old), and staff completed daily visual checks. Portable electrical appliances had safety checks. Specialist equipment was serviced and in good condition. There were systems and processes to report faulty equipment.

The service stored chemicals or substances hazardous to health (COSHH) safely. COSHH was stored securely and staff had access to specific COSHH risk assessments.

The service had equipment for the use by specialist teams. This included mass casualty, paediatric and maternity bags. HART teams had a variety of personalised personal protective equipment (PPE) for working in different environments. Staff checked their equipment daily to ensure it was safe to use. During our assessment, we found vehicles stocked with required equipment. The service had equipment should an incident response require, such as a chemical, biological, radiological or nuclear (CBRN) or hazardous material (HAZMAT).

Fire safety equipment at bases were available and had been serviced. Fire exits were clear and free from obstruction. However, at 1 base there were 2 free standing extinguishers in a corridor. During our inspection we saw that 1 decommissioned fire door at a base which still had fire exit signs displayed. Staff removed these signs immediately. Records showed that most staff were up-to-date with mandatory fire training.

There were processes to check dates of consumable equipment. During our assessment, all consumable items for use on vehicles were in date and in original packaging. However, we found 3 items out of date in the storeroom. These were found on the floor under shelving. Staff removed and disposed of these immediately.

The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff who received effective support. They worked together well to provide safe care that met people’s individual needs.

The service was required to meet the national emergency preparedness, resilience and response (EPRR) interoperable capability standards, which covered training requirements and staffing levels. In the previous year, the service reported it met all requirements for training and staffing level. System partners told us that last year the service reported 88% compliance for having the minimum amount of SORT staff on duty during specific times, against the national average of 88% for the previous year.

The service was required to maintain a minimum of 6 HART operatives per base at all times. Records showed that the service planned a total of 6 staff, at each base, for each day and night shifts. System partners told us the service maintained this requirement 79% of the time against a national average of 79% for the previous year. However, in the 12 months prior to our assessment the data showed the service had improved to maintain the minimum staffing levels 87% of the time.

At the time of our assessment, the service was partially compliant for SORT staffing establishment and staff training competency. However, they were in the process of reviewing the SORT model with system partners to have a local model that was a deviation from current standards but compliant with safety and interoperability requirements.

The service had a turnover of 7.1% and sickness rate of 4.6% over the last 12 months. This was better than the trust targets. Staff in HART teams had to complete training to specific intervals to comply with national training standards. Where staff returned to work following a prolonged absence, there were training action and recovery plans.

Commanders at all levels received training and continued development to support them to perform their roles. Commanders performed specific organisational roles to manage incidents. Staff told us that command training was current, based on learning from major incidents, and suited to meet demands they face when performing the role. Most staff said that training had improved significantly in recent years. They felt they had access to enough refresher training and exercising to helped maintain competencies.

Staff were required to meet specific training requirements for them to be competent in their role. Where staff moved between teams, managers were able to easily track what restrictions a member of staff had.

Staff were required to meet minimum fitness standards, so they were able to use PPE and perform care in hazardous environments safely. Staff who did not meet these standards were offered fitness programs to meet the standards. Physical fitness was essential for the role which meant staff were provided designated time in their shifts to maintain fitness levels.

Staff received blue light training as part of training when joining the trust. HART staff also completed additional driver training to cover convey response.

The service had a recruitment process to check staff had the skills experience and qualifications to perform care. Paramedics were registered with The Health and Care Professions Council (HCPC), which is the regulator for paramedics in the UK. We reviewed staff recruitment files and found the service was completing necessary recruitment checks.

Staff received yearly appraisals supported by up-to-date policies and guidance. Managers monitored appraisal compliance. Records showed most staff had received an appraisal. However, the 2025 staff survey showed only 10% felt their appraisals helped them improve how they did their jobs.

Staff received training in supporting individuals with learning disabilities or autism. Staff who had contact with patients in person or on the phone were required to complete 2-tiered training. Most staff had completed tier 1. However, only 4% of staff had completed level 2. The trust had plans to improve training in learning disabilities and autism by introducing a new tier 2 training package which went live prior to our onsite assessment in April 2026. Their target was to have trained, by March 2027, over 85% of staff who required this training. This training is important to enable staff to reduce significant health inequalities.

The evidence showed some shortfalls. The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

The service did not always control the risk of spreading infections. At vehicle bases there were items stored directly on the floor, this included equipment for training, items stored in plastic boxes, and paper hand tissues. After our onsite assessment, the service took action to resolve the issues.

Sinks in sluice rooms at 1 base had the presence of rust. The presence of rust makes cleaning less effective and increases the risk of spreading infections. One tap was missing a leaver handle which is used to minimise hand contact with potentially contaminated surfaces. After our onsite assessment, the service took action and repaired the issues.

The service had cleaning schedules for HART bases. Records showed that cleaning was being completed. However, during our assessment we saw cleaning was not always completed to standard. In a storeroom at 1 base, there was dust and debris under the storage shelves. At 1 base, the cleaning room light was not working as designed. Staff were using torch light to find items used for cleaning. After our onsite assessment, the service took action to repair the issues.

The service had an up to date infection prevention and control policy, and compliance process. Records showed that infection prevention and control risks were being identified and resolved. However, they did not identify the issues found during our assessment.

Vehicles were visibly clean and well maintained. The service had cleaning schedules for vehicles and records showed this was being completed.

Staff had access to cleaning equipment. The service had colour coded cleaning equipment to be used in specific areas. This helped to prevent the spread of infections.

The service managed clinical waste and sharps safely. Clinical waste was stored securely at both HART bases. Vehicles had suitable bins for the disposal of sharps. Staff followed infection prevention control procedures when attending a call.

The service had equipment and used national processes for decontamination should an incident response require, such as a CBRN or HAZMAT. Staff told us they had practiced doffing (taking off) PPE during a multi-agency exercise for infectious disease transfer.

Staff followed infection prevention control principles. Staff were bare below the elbows, which enabled effective hand hygiene and reduced the risk of spreading infections. Also, they followed the trust’s uniform and jewellery standards. Staff had access to shower and changing facilities at bases.

The service had a process to prevent pests at HART bases. There were health and safety checks carried out at the bases, and they had support from a third-party company to prevent pests.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Medicines were stored safely and securely in areas with restricted access for authorised staff only. These areas were monitored by CCTV to support the safe management of medicines.

Staff carried out regular monitoring of the safe and secure management of medicines. Controlled drugs were checked daily to ensure there was a robust audit trail. During our assessment, we found all controlled drugs were accounted for. The service had a process to identify and review controlled drugs incidents. Records showed that in the 12 months prior to our assessment, there were 4 controlled drugs incidents relating to the service. These incidents all related to accidental manual handling of controlled drug which led to broken vials.

There were processes to check medicines were in date and stored at the correct temperature. During our assessment, all medicines we checked were in date.

The trust had different processes to manage medicines at the 2 HART bases. There were either prepacked medicines bags or staff were required to check their own bags. Checks on prepacked bags showed all medicines were correct. However, 1 medicine bag was missing 2 paper cups used to give medicines to patients.

The trust had up to date patient group directions (PGD’s) which are written instructions for the administration of authorised medicines to a group of patients. There was a well-established PGD group to review all the PGDs. This meant that medicines were administered to patients by staff with the legal authority to do so. Records showed staff recorded medicines administered.

Medical gases were stored safely and securely. There was clear segregation between full and empty cylinders. Warning signs were visible to ensure people were aware and to ensure safety around medical gases. However, 1 oxygen cylinder was missing from a primary bag (bag with lifesaving equipment). Staff replaced this cylinder during our assessment.