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. Safeguarding processes and triage systems had improved.

At our last assessment in 2016, we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (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 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.

Learning was promoted to improve the service. From February to May 2026, 7 incidents had been reported, reviewed and actions noted. Staff were knowledgeable about reporting incidents. Managers and staff reviewed incidents and made changes to improve systems and patient experience. Staff gave examples of how they had provided apologies if things went wrong and informed patients of their actions. Learning from across the trust was shared with staff. Managers supported staff and provided opportunities for debrief after an incident.

We scored the service as 3. 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’s referral processes ensured that all essential information about the patient was received to determine if their needs could safely be met. Patients could access the service through a number of routes including NHS 111 , GP or other health professional and self-referral.

Booking in processes indicated if patients had any existing issues through an alert on the electronic system.

On discharge from the service, staff informed all the necessary health and social care services to promote continuity of care for the patient. This was done either electronically, by phone or a written summary.

Safety messages were shared with staff, and learning was highlighted in newsletters and daily huddles.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Safeguarding processes had improved since our last inspection in 2016. Safeguarding processes were streamlined and staff were supported to safeguard patients. Staff were trained and knowledgeable about safeguarding for adults and children, knew how to make a safeguarding alert, and did this when required and with sensitivity.

Staff described actions they had taken to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. This had included working with partner agencies to keep people safe.

Managers and safeguarding specialists provided staff with clinical supervision, updates to procedures, and emotional support following distressing situations.

We scored the service as 3. The evidence showed a good standard. 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 communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties. A language line was available if patients’ language was not English. We observed staff providing patients with choices about their care which was based on a holistic assessment of risks. Patients felt informed of their choice of treatment. For example, if there was a long wait for x-ray services, staff would assess if the condition could be managed at home overnight and book an appointment for the following day.

Patients who attended with mental health conditions were treated with respect and calmness which helped to reduce anxieties and promote patient safety.

We scored the service as 2. The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. However, they did make sure equipment, facilities and technology supported the delivery of safe care.

The urgent treatment centre was located within a hospital building which was not owned by SWAST. Some areas within the urgent treatment centre’s environment were the responsibility of the hospital to clean and maintain. Managers observed cleaning and maintenance activities carried out by the hospital and audited the effectiveness of these processes and collaborated with the hospital to solve issues identified.

The area used by the urgent treatment centre comprised of 4 treatment rooms, a dirty utility room, an accessible toilet/shower room, a staff station and an individual office. The service made the most of the space available by using lockable storage cupboards in corridors and behind screens. We saw no detriment to the equipment stored and staff and patients were able to walk along the corridor unhindered. Staff described the area used as being short of space for the number of patients they treated and the equipment they needed to store.

Patients waited in the hospital waiting area before they were seen by urgent treatment care staff and during our visit all patients were able to access a seat.

Bathroom pull cords, which were the responsibility of the hospital, were designed to reduce any risk of being used as a ligature by patients who presented a self-harm risk. However, the hospital had installed a shower on a hose, which had not been assessed for ligature risks. Senior managers felt the cohort of mental health patients who attended the department would not be at risk of this level of self-harm. However, no formal risk assessment had been completed. Risk would be assessed and managed at an individual level by staff who were providing care and treatment.

Storage and cleaning of equipment owned by the service was well managed. We found no items beyond their use by date and all areas appeared clean and tidy. Staff cleaned equipment between patient use and indicated it was ready for re-use.

Managers embraced the use of technology to improve the patient journey with speedier diagnostic testing equipment using Point care testing devices. These individual testing devices had been purchased to support diagnoses within the department instead of needing to wait for laboratory results. Due to the lack of space they were stored in the dirty utility room. Staff cleaned it before and after use to mitigate risk of contamination.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Managers had calculated the number and grade of clinicans, nurses and healthcare assistants required and reviewed staffing levels needed for each shift. There were no staff vacancies and uncovered shifts were offered as overtime to staff or covered by a small bank of staff. Staff worked within their scope of practice and were able to access senior medical support when they needed clinical advice. Medical staff in the form of GPs were on site for most of the daily opening hours and senior medical advice was available if staff needed it when a GP was not on site. There was clear guidance for staff on when and how to access senior advice and what conditions were in their scope of practice both when a GP was available on shift and when there were no GPs on shift.

Staff had received and most were up to date with mandatory training. There was good staff compliance in training for learning disability and autism part 1 and the trust were implementing a plan to provide level 2 for all staff.

Managers reviewed sickness themes, reasons for staff leaving the service and appraisal completion rates. There were no current concerning themes. Sickness was lower than the trust target and more than 76% of staff had received an appraisal. Staff confirmed appraisals were supportive to their needs.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

All areas which were the responsibility of urgent treatment centre staff, looked clean, had labels indicating they had been cleaned or maintained making them available for patient use.

Staff adhered to infection control principles, including handwashing and being bare below the elbow in clinical areas.

Patient waiting areas had enough seating for the volume of patients seen. Patients waited less than 15 minutes before being triaged, were seen in individual rooms and infection risks assessed before advising of further treatment.

We observed some broken joints at floor to wall level which would be difficult to clean and could present a risk of harbouring infection. However, this was not within the control of the urgent treatment centre and needed to be raised with the hospital estates department who maintained the buildings.

We scored the service as 3. 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.

Staff followed good practice in medicines management and did it in line with national guidance.

Medicines, equipment, processes and stock levels were audited each month. Any discrepancies were investigated and shared with staff for learning and improvement.

Staff were either trained to prescribe medicines from a defined list, were medical prescribers or used patient group directions (PGDs). PGDs are written legal instructions that allow specified, registered healthcare professionals to safely supply and administer pre-approved medicines to predefined groups of patients without a doctor's prescription. They are designed to streamline patient care in clinic situations and allow patients to receive required medicines promptly. Patient group directions were reviewed and updated according to need and national guidance and staff compliance with processes was checked.