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 last assessment in 2016, 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 71 (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.

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 urgent treatment centre, especially where the service was changing. Staff feedback opportunities were created by managers who made themselves visible within the unit.

Managers had created an improved openness amongst the staff, health partners and patients. Staff felt the culture within the department had improved in the last 12 months. Staff described how they were proud to work in the service and chose a longer commute time between home and work in order to work within the service. All staff interactions demonstrated a positive culture and teamwork to improve patient outcomes.

Staff and managers focused on providing high quality care for patients who attended the urgent treatment centre. They were aware that treating more patients in the unit would relieve pressures on the emergency care systems across the region. Staff had created improved systems which allowed them to see more patients than they were commissioned for. However, the space in the department did not support the increasing number of patients seen. Managers were working with commissioners to identify potential areas where space could be increased.

The trust website gave clear guidance for patients and professionals on the conditions the service could treat. Managers were working with health partners to promote this guidance and create a system that supported people to access the right care in the right place at the right time, across the regional health system.

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 had worked to develop an inclusive workplace. Staff felt supported by managers and senior leaders. Managers and senior leaders attended the department regularly to provide staff support, maintain their own clinical skills and ensure they were visible and approachable for staff and patients.

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.

Freedom to speak up processes were established across the organisation. There was a freedom to speak up champion for the department, a lead for the organisation, an executive lead and a non-executive lead to provide oversight and leadership. Staff knew how to access their freedom to speak up champion. There was a culture of openness and staff were very happy to raise issues with their line managers and leaders of the department without fear of detriment. Staff felt listened to and were confident that managers would investigate issues raised and take action to resolve them.

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 were equality and diversity champions within the service and within the wider trust and staff had access to these if needed.

Managers supported staff to fulfil their roles in difficult times. Staff were able to apply to work flexibly to account for personal circumstances such as caring responsibilities and health issues.

The trust undertook equality monitoring of staff within the service to ensure its make-up was representative of the patient group.

We scored the service as 2. The evidence showed some shortfalls. The service had clear responsibilities, roles, systems of accountability but governance was not always robust. They did not always identify and act on the best information about risk. Performance and outcomes were monitored and shared securely with others when appropriate.

Staff understood the arrangements for working with other teams, both within the service and externally, to meet the needs of the patients. However, they did not always seek assurance from external providers of the quality of their systems. For example, the partner provider had not been asked to share audit results such as environmental and hygiene, and radiography quality audits.

Not all risks were identified and managed effectively. The risk register was held at trust level and not available as a specific register for the urgent treatment centre which meant some risks could be overlooked. Risks for the urgent treatment centre were incorporated with themes which were monitored by specific teams across the trust. Examples being, abuse towards staff, fire safety, medicines storage and infection prevention and control. We saw some situations had not been risk assessed and managers could not be assured risks were mitigated. For example: patients who presented with mental ill health who may be at risk of self-harming. There was no risk assessment of the environment to provide assurance that the area was safe of ligature risks; point of care testing machines were located and used within a dirty utility room. There was no assessment to demonstrate the location would not present a risk of contamination. A policy was in development but was still in draft form. As a mitigation, staff were trained to use the equipment and instructions for use included cleaning each one before and after use.

However, staff could escalate concerns when required and all staff felt confident in doing so. There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed.

Staff participated in local clinical audits. The audits carried out by the service were sufficient to provide assurance and staff acted on the results when needed.

Where cost improvements were taking place, they did not compromise patient care. Managers used information about the performance of the service to inform commissioners of patient demand and quality of care provided.

Information governance systems included confidentiality of patient 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.

Directorate leaders engaged with external stakeholders. There was a close relationship with commissioners for the service and other emergency services in the region. Managers developed and maintained relationships with other health providers to provide a mutual understanding of services available. This helped to guide patients to the most appropriate care for their needs.

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 used quality improvement methods and knew how to apply them. Staff participated in national audits relevant to the service and learned from them. These results supported innovation within the service. The change in the triage process had markedly improved the whole patient pathway. Clinicians now reviewed patients at triage and were able to request additional tests and x-rays at the time of triage. These results would be ready for the clinician who provided further review and treatment. This was a more streamlined process than the one previously used.

Incidents and staff suggestions were reviewed and actions taken to improve processes. Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery.