For ease, we have created a colour code guide below so you can see which area the question relates to.
| Colour | Area | Colour | Area |
 |
Equipment |  |
Mental health |
 |
EOC |  |
Operations |
 |
Front line |  |
Volunteering (including Community First Responders) |
Trust clinicians are supported to make decisions, in conjunction with patients and/or their carers and family, around transportation to the most appropriate destination. However, as every situation will differ, influenced by a variety of factors, we want to ensure that all our patients receive the right care in the right place. To help guide these decisions, the Trust has a Standard Operating Procedure (SOP) in place. Please see below excerpt for your assurance.
A Care Coordination Hub is a multidisciplinary clinical team (often involving GPs, nurses, and social care professionals) that acts as a single point of access to navigate patient care.
A SPUEC is a Specialist Practitioner in Urgent and Emergency Care, a senior clinical role with the Ambulance Service.
Specialist centres would include, but not limited to, major trauma, cardiac, stroke etc.
As a Trust we utilise the heart monitoring pads (ECG dots) that are compatible with our machines which are used across the whole of the SWASFT footprint. As Trust we face into many different hospitals; some of which will have different machines and therefore different compatibility to those we use. As a Trust our teams work to align elements where possible but due to the number of products available across the NHS this is not always possible.
The Trust as part of the NHS operates within the NHS and has increased its funding available from £262m in 2019/20 to £435m in 2025/26 and increased the level of resourcing on a similar scale.
All NHS Trust have to work within their allocated budgets as a Trust we are constantly working to review and improve our service to meet the needs of our population. As a Trust we have spent time reviewing systems and processes to ensure we are as agile and productive as we are able to ensure we have resources in the place we most need them to support patients. We also work closely with our system partners to collaborate on reducing handover wait times and other associated delays.
The Chief Executive of the South Western Ambulance Service NHS Foundation Trust and the Chief Fire Officers from Avon Fire and Rescue Service, Cornwall Fire and Rescue Service, Devon and Somerset Fire and Rescue Service, Dorset and Wiltshire Fire and Rescue Service, and Gloucestershire Fire and Rescue Service, met on Wednesday 30 July regarding the future of Fire Co-Responding in the South West. Following the meeting, they released a joint statement which can be found here on webpage: Joint statement on the future of Fire Co-Responding in the South West | News | SWAST Website. Any further developments will be released on our website.
We have an internal staff well-being service whereby our colleagues can source immediate access to support for any well-being related challenges. For colleagues who have been exposed to incidents that could be traumatic, we offer specialist trauma therapy in a range of forms, as well as a trauma response via TRIM. This sits alongside the support provided by operational colleagues, such as debriefs. We have also just developed an employee response toolkit for serious incidents that make access to well-being support more swift.
We aim to have the right number of ambulances available for the crews we have on duty each day, and most of the time this works well. However, there are times when things outside our control, like unexpected vehicle breakdowns or crews finishing their shifts later than planned can cause delays. In many cases, we're able to manage this by using spare vehicles, but due to the size and rural nature of our Trust, this isn't always possible.
Category 1 refers to those patients with the most urgent clinical need who are in an immediately life-threatening condition, such as those in cardiac or respiratory arrest (no heartbeat or not breathing), or those with an airway obstruction or ineffective breathing. This category makes up approximately 8% of all '999' calls.
Resources responding to 'Category 1' incidents are crewed by clinicians appropriately trained in the use of a defibrillator and able to give advanced life support. Ambulance resources will respond to 'Category 1' incidents using blue lights and sirens in order to arrive as soon as possible.
The target time as set by the Department of Health is to have a Trust resource on scene to 'Category 1' calls in seven minutes on average and respond to 90% of 'Category 1' calls in 15 minutes.
Category 2 refers to those patients who are suffering a potentially life-threatening condition, such as a heart attack, stroke, or major burn. This category makes up approximately 50% of '999' calls.
Category 2 incidents require an emergency ambulance response from an appropriately trained clinician. Ambulance resources allocated to 'Category 2' incidents should also have the capability to transport the patient to a hospital ED.
Ambulance resources will respond to 'Category 2' incidents using blue lights and sirens in order to arrive as soon as possible.
The response time as set by the Department of Health is to have a Trust resource on scene to 'Category 2' calls in 18 minutes on average and respond to 90% of 'Category 2' calls in 40 minutes.
Category 3 incidents identify those patients who have an urgent problem (not immediately life-threatening) that needs treatment to relieve suffering (e.g. pain control) and who will likely require clinical treatment in hospital.
Ambulance resources capable of patient transport, crewed by an appropriately qualified clinician, will respond to 'Category 3' calls using blue lights and sirens to arrive as soon as possible.
The response time as set by the Department of Health is to have a Trust resource on scene to 'Category 3' calls in 60 minutes on average and respond to 90% of 'Category 3' calls in 120 minutes.
Category 4 refers to those patients suffering from a non-urgent condition, but who still require the presence of an ambulance resource crewed by an appropriately qualified clinician, such as those who have suffered a non-injury fall and require assistance.
As patients in this category may require transport to hospital, an ambulance resource capable of patient transport will be allocated if possible.
The national target from the Department of Health is to attend 'Category 4' incidents in 180 minutes on at least 90 percent of occasions.
Category 5 refers to those patients who require further clinical assessment but who may not require the presence of an ambulance resource.
Patients in this category may be referred to an alternative healthcare provider such as, the NHS 111 Service, GP surgery, Minor Injury Unit or they may receive a call-back from a Clinical Advisors in the EOC to provide an additional assessment or advice.
We have our patient involvement in research group which is one of the main sources of patient input. We meet with them quarterly and in that we will discuss, the feasibility of some of their ideas, how we can work those up into properly set proposals. We also have a contact form on the website where anybody, even if you're not involved in that patient involvement in research group can come to us with an idea. And then we have a team of experts in house that we work that up with so we do have a project where patients aren't co-applicants. There is genuine development with our patients and making sure that we are addressing what patients think priorities.
We do a lot of that promotion from our ambulances and actually we do quite a lot of studies around health promotion. We don't just focus on treating the issue that we're that we're seeing at the time of the incident, but also how can we help patients in the future so that these incidents don't happen again. We are always open to any ideas about promotion of various studies and getting people involved.
With Duty of Candour, it's different as it's our Trust that start the contact. A lot of people when we contact them are unaware that anything has gone wrong and weren't expecting our call. We are acknowledging and responding when things have gone wrong, it's very different from the patient experience complaint where they've contacted us. As soon as we realise that something hasn't gone well, it's up to us to make that contact and make people aware.
We're actually quite supportive of each other's different areas of work. (complaints and duty of candour) There can be situations where the complaints team will deal with the duty of candour and have that conversation with families themselves. Equally, if it starts off as a complaint and we realise there is an error that requires us to do the duty of candour, then we will make that further contact.
When we receive a complaint, we contact the complainant within three working days, in the same way that the Duty of Candour Team engage with the patient, to fully understand their concerns and agree a way forward. The investigations then get sent out to our colleagues who will investigate the issue and then make contact with the patient again to discuss the findings. So the patient is involved from the start, right the way through the process, and then a discussion is had about the findings of the investigation where we share whatever learning is being identified and what impact it's had moving forward. The Engagement team don't generally get involved, but the Patient Experience team, they are the patient's advocate.
When someone calls 999, their call is assessed and categorised based on the urgency of their condition. The core categories we respond to in a timely manner are Category 1, Category 2, and Category 3. Response times can vary depending on where a person lives, particularly in more rural areas. Category 1 calls involve patients who are critically unwell, such as those in cardiac arrest. In March, our average response time to Category 1 incidents across the Trust was 9 minutes. For Category 2 calls, our organisational target is to respond within 30 minutes. In March, we reached these patients in an average of 37 minutes - 7 minutes longer than our target - and we continue working hard to improve this.
As an organisation, we record and monitor patient contact through three key categories: Hear and Treat, See and Treat, and See and Convey.
· Hear and Treat refers to patients who receive clinical advice over the phone without the need for an ambulance to attend.
· See and Treat includes patients who are seen and treated at home without being taken to hospital.
· See and Convey refers to patients who are assessed and then transported to hospital.
We capture and report this information as part of our national reporting requirements. This includes data on patients we treat at home without conveying them to hospital, as well as those we do take to hospital after assessing them in their home.
We are also developing our Care Coordination Hubs in partnership with local health and care providers. This initiative supports our crews while they're with a patient, helping them to explore safe and more appropriate alternatives to hospital care where possible.
There has been targeted recruitment activity in Bristol recently, and the team has successfully filled the allocated CFR positions across the city. Currently, only one area had a CFR assigned who has since withdrawn, as the role was no longer suitable for them. All other areas in Bristol now have Community First Responder coverage in place.
The GoodSam app, has gone out to members of the public and George Pemble-Vincent (part of this program) said that they had that they have had a really great achievement with this so far.
SWASFT is committed to ensuring frontline ambulance staff are equipped to manage mental health incidents effectively. A dedicated training team of mental health professionals delivers a range of specialised mental health training during development training days. Additionally, a variety of Mental Health Continued Professional Development (CPD) courses, designed by experts across the country specifically for ambulance staff, are readily available on the SWASFT intranet.
To further support staff, the introduction of Mental Health Response Vehicles has enhanced supervision both at ambulance stations and during incidents. These vehicles provide frontline staff with the opportunity to call for specialist mental health support directly from the scene, ensuring timely and expert assistance when it’s needed most.
The availability of Mental Health Response Vehicles (MHRVs) will vary depending on local funding. In some areas, such as Bristol, North Somerset, and South Gloucestershire (BNSSG), there will be a 24/7 vehicle in operation. In other regions, the vehicles will be scheduled to cover peak demand periods, ensuring they are available when they are most needed.
The table below provides an update on the current status of MHRV operations. Plans for Devon and Bath, Swindon, and Wiltshire (BSW) are still being finalised.
| ICS | Model Currently Funded |
| BNSSG | 1x 24/7 |
| Somerset | 1x 12/7 (12:00 — 00:00) |
| CIOS | 1x 12/7 (14:00 — 02:00) |
| Gloucestershire | 1x 12/7 (12:00 — 00:00) |
| Dorset | 2x 10/7 (16:00 — 02:00) |
| Devon | TBC |
| BSW | TBC |
There is the option (on The circuit) when registering a defibrillator to put in the exact location and the hours/days that it will be available. If a club is only accessible in the evenings and weekend, when registering they can write this. This will feed into defibfinder for the public and also be shown on the data our call handlers will see in an emergency.
No probably not enough, but it is a good start and is a growing area.
All Paramedics and ambulance staff receive some training as part of their initial training re mental health. But we do now have specialist Mental Health Response Vehicles and specially trained practitioners in the 999 control rooms to advise on care for patients with mental health concerns. The specialist mental health cars will be in all areas at the start of next year.
For organisations, we generally phone the organisation and find another person to look after it e.g. rugby clubs / sports clubs. For individual defibs, we have been leaving letters in defib boxes.
Yes – we have been trialling the use of military responders in both Poole and the Royal Naval Dartmouth College for the past 12 months. The next step is to evaluate these trials, develop a standard model for military responding and potentially roll it out further. We have been having some discussions in Wiltshire with some military units about this issue.
Currently, our Community First Responders submit an application through TRAC which is the same system that is used for paid roles. We recognise that this is not the most volunteer-friendly platform. As we are increasing both the number of volunteers and the range of volunteering roles, we are very keen to look at a Volunteer Management System which may also give us the opportunity to recruit our volunteers in a more appropriate manner. This is a development which we are keen to progress next year, business case permitting.
With regards to the question about already operating at PHEM Level F. It would be helpful to have a conversation with your local Volunteering & Community Services Officer to understand your current role and whether that is in the pre-hospital environment. We have worked with individuals to tailor the course if they are already operating to a more advanced level and have significant pre-hospital experience. In which case, we may just need the final assessments to be completed.
Onboarding obviously also includes the pre-volunteering checks such as DBS which do need to be completed prior to go live together with at least one supervised shift either on a double crewed ambulance or together with an experienced CFR.
It is worth noting that all CFRs, however, operate to an agreed scope of practice. And even though, in a day job, you may operate to a more advanced PHEM Level, as a CFR, you would be governed by the CFR scope of practice.
Currently, the only national network for the co-ordination of public accessible life saving equipment is for defibrillators, through The Circuit. Most of these are privately owned defibrillators.
Work is underway to create a similar platform for ‘bleed kits’ which is likely to be ‘hosted’ by the Police but would allow ambulance services to direct someone to a bleed control kit in the case of a haemorrhage call being received. This does not currently exist.
So, no, there are no plans for SWASFT to supply these kits. Many kits are bought and the challenge for SWASFT is having a reliable source of information about this equipment and its status so that we can give 999 callers clear pre-arrival instructions.
It is essential that you call 999 if you are seriously ill, or injured, or if you feel your life is at risk, so the most appropriate help can be arranged for you, as quickly as possible.
As is commonly made aware by media reports on the subject, the Trust and the wider NHS emergency and urgent care services continue to experience an unprecedented level of demand. For the Trust’s part, this demand can result in delays to some of our patients.
When a ‘999’ call is received in the Emergency Operations Centre (‘EOC’ formerly known as the ‘999’ Control Room), the aim is to quickly identify the clinical needs of the patient and arrange appropriate assistance. The caller is taken through a series of questions developed by national medical experts, and the outcome of those questions determines the category (urgency) of the incident. This is to ensure that emergency medical help is sent to the most life-threatening incidents without delay.
Ambulance resources are prioritised to attend the patients who appear to have the greatest clinical need so the sickest patient will receive help before a less sick patient, even if that less sick patient has been waiting longer.
The system used by the Trust’s EOC to prioritise ‘999’ calls is called the Medical Priority Dispatch System (MPDS) and is an internationally recognised protocol for emergency prioritisation. Emergency Medical Dispatchers (EMDs), formerly known as Call Takers, are appropriately trained and certified to receive ‘999’ calls, provide scripted medical advice over the telephone, and triage (classify and prioritise) calls which may result in the allocation of ambulance resources.
Unfortunately, we are unable to provide an estimated arrival time for non-emergency calls as allocated ambulances can be diverted to patients where there is a more urgent clinical need or risk to life. This is a dynamic process as 999 calls are continually received. Clinical colleagues (within the EOC) have oversight of all calls to help ensure that the clinical priority assigned to the call remains appropriate for our patient’s needs. It is, therefore, important to keep telephone lines open so that we can call patients back unless, of course, there is a change in the patient’s condition, then it is essential they call back 999 for re-assessment.
Coupled with the demand on our service, this is further compounded by hospital handover delays and system pressures within the wider NHS and social care . There is a 15-minute target time frame for hospital staff to take responsibility of a patient from an ambulance crew when that patient is conveyed to the emergency department. Anything above that target constitutes a delay and will have an impact on the availability of ambulance resources.
On 15 November 2021, the Association of Ambulance Chief Executives (AACE) published a report highlighting the impact of handover delays nationally and the potential for harm. In addition to the AACE report, the Trust also commissioned ‘a ‘system’ review into the wider reasons for the significant ambulance delays. This review's purpose was to understand the underlying causes and environmental context of ambulance delays.
A series of recommendations and actions to improve the position were identified from this review, not just for South Western Ambulance Service but for other NHS providers such as acute hospitals, General Practitioner’s, NHS111 and the Integrated Care Boards. Since publication, work has been ongoing, and an addendum report was published in January 2024, providing an update to the current position. This report can be found on our website: https://www.SWASFT.nhs.uk/download.cfm?doc=docm93jijm4n1336.pdf&ver=958
Please be assured that we do not want to see any of our patients waiting longer than necessary for an ambulance and, if the triage of your call determines that an ambulance resource is required, assistance will be sent to you as soon as a resource becomes available.
Further, we continue to work incredibly hard with our partners in the NHS, and social care, to do all we can to improve the service that patients receive.
We know there is a lot more we could be doing in this space. The Trust launched its new five-year strategy in 2023 with a focus on engaging with our communities and patients more, so this is very much work in progress with a commitment from the Trust.
We have introduced a comprehensive mental health service which includes a mental health desk within our Emergency Operations Centres and the implementation of dedicated mental health support vehicles.
We would love to explore other options and would need advice from our IT department. We will keep you updated on our progress.
This is being considered by the Operations, Patient Experience and Emergency Operations Centre teams. Operational leaders visited the Isles in September to meet with key individuals, listen to their feedback, and share what we’re doing as a Trust to improve our services on the islands.
There has been a lot of work done around the meal break policy. We knew that our crews were unfortunately getting a lot of overruns of their shifts, which is not practical with everyday life outside of their working hours. So, by changing the meal break policy, the crews are getting breaks when they require them, and ultimately that has led to an improvement in overruns. The Trust has received positive feedback from staff members regarding the change in policy.
In short, yes. We have had an increase in our staff utilising body worn video over the last two quarters last year, which has shown acceptance towards it, so it is being used more frequently and in a more positive manner, resulting in more incidents being reported. The use of body worn camera has resulted in some staff not having to attend court to give evidence because the video was enough, which is really positive. When body worn camera was first rolled out in the Trust, we noticed that crews would only generally start using it, after they had attended an incident that made them think they needed it. However now staff feel more positively about it and have seen its benefits such as reducing things such as writing statements and going to court which is encouraging.
The implementation of this service has been staggered over the UK with some counties not fully rolling this out until April and May this year. We do not at present have enough data to enable us to see how the ambulance service has been impacted by this service. We do know that the overall demand for mental health into SWASFT has increased by nearly 20% this year, it is unclear at this stage whether this relates to 111#2 or other significant changes, such as police withdrawing from mental health calls under the Right Care Right Person initiative.
Yes, absolutely, we have a link with every police force that lies within the SWASFT area. We meet monthly to discuss trends and patterns to data which we have collected. In regard to operations that may need medical assistance this would lie with our Hazardous Area Response Team (HART), and they would notify them if an operation was taking place.
Statistics show that the types of circumstances you mention make up only a small percentage of violence and aggression cases against SWASFT colleagues. However, bar fights and similar circumstances are normally already being managed by the police, therefore the proportion of violence and aggression is not typically attributed to this. Most of the violence and aggression that our frontline face is usually from situations such as mental health crisis, when patients are not receiving the support they may need, or from patients suffering from dementia. This is why the violence and aggression team work with multiple agencies and not just the police force.
Community First Responders should be dispatched by our Emergency Operations Centre like any other resource with the exception of a few incident types e.g. we do not send them to RTCs because they do not have blue lights to protect themselves.
Community First Responders have a phone with the National Mobilisation App (NMA). This provides patient details, location and other details including mapping to within 2 meters of the location. Community First Responders use this app to book on and off, update and message. The app also has an emergency button. The app tracks the Community First Responders so dispatch can see where they are, and they appear on the list of available resources.
We currently have approximately 600 active CFRs – obviously this figure does fluctuate. We also have approximately 2,000 individuals signed up and validated by SWASFT through the GoodSAM App and this will be extended further before the end of the calendar year. We currently operate with approximately 400 CFR kits so some will be sharing.
We cannot say exactly how many have been to a cardiac arrest, but a very high proportion will have been. Yes, we have had some incredible outcomes and there are individuals who are walking around today who would not have been, had it not been for our volunteers. For example, Mark age 60, featured during Volunteers Week, had a cardiac arrest on his garage roof this time last year and was shocked once by a CFR who was then backed up with a further CFR responding through GoodSAM. Mark is alive today and received treatment approx. 15 minutes earlier than he would have done without our volunteers.
We have CFRs in Chipping Campden, Bourton-on-the-Water, Moreton in Marsh and Upper Rissington. We also have Fire Co Responders in Moreton in Marsh, Northleach and Stow-on-the-Wold.
Whilst there is no specific policy that focuses on CPR and defibrillation training for specific areas, there are many things that we are doing to improve our service for everyone. Our Community First Responders provide an excellent service for rural locations, and we are actively recruiting volunteers for the first time into areas where there can be longer response times. We have carried out some modelling to identify the target areas for recruitment of CFRs. This modelling is based on response times and number of incidents.
Similarly, we have carried out similar modelling to identify priority areas for public access defibrillators. Again, this is based on number of incidents, a measure of deprivation and number of existing public access defibrillators. We are using this modelling to target our work on:
1. Improving the availability and accessibility of public access defibrillators across the South West.
2. Targeting our work around improving the familiarisation with and confidence in using public access defibrillators.
We have also recently recruited a new defibrillator project manager into the Trust who is working hard to bridge the gap in these health inequalities, who will be speaking at the next PPP meeting in December.
We know that there are health inequalities within the communities we serve e.g. if you live in Devon or Cornwall, we know that waiting times for an ambulance are longer, which is why we move our resources around from county to county, to ensure we can reduce the wait times as much as possible.
The Trust’s Patient Engagement team is dedicated to the campaign ‘Saving Lives Together’ which delivers CPR and defibrillator awareness sessions across the whole of the South West from Gloucestershire to Cornwall, Bristol included. To date, defibrillator training has taken place through the Patient Engagement team or as a part of a leased defibrillator package through the Volunteering and Community Services (V&CS) team.
Moving forward the Volunteering & Community Services team will be conducting more public defibrillator training outside of those who have purchased a defibrillator package from us. We are working towards offering two different packages.
Formal training by our current Assistant Community Responder Officers (ACRO) either as part of a defibrillator package leased through SWASFT (existing customers only) or business customers who will be charged a nominal fee.
Awareness and familiarisation sessions which will be offered free of charge but for a requested donation, which can be delivered through our ACRO team or by our existing/new volunteers e.g. our Community First Responders.
Within the next few weeks, we will be placing a notice on our website where individuals can request a familiarisation session.
There are also plans for events in Bristol working alongside the international Restart a Heart campaign. The Engagement team try to get to as many communities as possible. If you would like to set an event up in your local area, please email engagement@swast.nhs.uk.
Our charity website is at South Western Ambulance Charity | Abbey Court, Eagle Way, Exeter (swambulancecharity.org). Alternatively, please do get in touch with us with any questions or thoughts at charity@swast.nhs.uk
Unfortunately, there is no official data for this as there is not a data collection point for the use of the chairs. Capturing this data is now something that has now been put forward as a suggestion.
The annual crime and violence reduction report is currently in the middle of being produced so we will imminently have an updated overview of the position.
Current statistics currently show there has been a rise in incidents reported to the trust, however reporting has recently become a lot easier, which would suggest that prior to this, incidents were going unreported. The next PPP on the 9th of August will be attended by a crime and violence officer who will be able to answer any further questions.
Turnover is reviewed on an ongoing basis within the Trust’s People Committee, Board and Strategic Workforce Group. The most recent data capture is included below to provide an overview of recent years:
Turnover had increased in 22/23, however it has reduced in recent months at around 12.5%. It is recognised by the Trust that the Emergency Operations Centre (EOC) has the highest turnover, and the Assistant Director of the EOCs is working closely with the People Partner and the Staying Well Service and Freedom to Speak Up Team to introduce new initiatives to create the conditions where colleagues want to stay and can thrive within their role.
In terms of the wider Trust, during the past 12 months, the People Partner Team introduced a new and in-depth exit interview process that has enabled our Head of Operations (and People Partners) to better understand why colleagues are leaving at a local and corporate level. It is the exit interviews that resulted in the introduction of the stay conversation, because it was felt that a proportion of the reasons for leaving could have been resolved, prior to them leaving – such as flexible working, and professional working relationships.
The People Partner Team review the exit interview intel on an ongoing basis and have also compared against the staff survey results – which will also result in further local and corporate plans moving forward. Career progression is also an important consideration for us, and one that is being taken forward through the People Partner Team. This has been clearly evidenced through the EMD to paramedic conversion programme, which has retention in excess of 90%.
As a Trust we are constantly reviewing on activity and resourcing levels to plan for the future.
We are currently developing a refreshed clinical operating model to ensure we are developing a service to continue to meet future needs this will link to our 5 year Trust strategy which was released in 2023.
There are no current projects like this that are funded by SWASFT. Initiatives like these are funded by either local councils or integrated care boards which means that where and when they are used is dependent on which areas have funding and which areas do not.
At this time, we have no plans to fund C1 in the Devon area. Unfortunately, we don’t have the same recruitment challenges in Devon as we do in Dorset, Somerset and Wiltshire where we are offering the funding.