Chief Inspector of Hospitals publishes his findings on Salford Royal NHS Foundation Trust

18 December 2013

England's Chief Inspector of Hospitals has published his first report on the quality of care provided by Salford Royal NHS Foundation Trust at Salford Royal Hospital.

The trust was one of the first to be inspected under radical changes which have been introduced by the Care Quality Commission providing a much more detailed picture of care in hospitals than ever before.

Inspectors found many instances of good practice. They noted that the trust demonstrated exceptional leadership qualities at all levels across the staff groups. The engagement and leadership of the non-executive directors and the governing council were outstanding. This supported a learning culture where everyone was encouraged and able to contribute. The trust said it was proud to enable a learning culture rather than a blame culture. It felt this allowed staff to be responsible for their own errors and to learn from them.

The trust had systems on its wards for being totally transparent about staffing levels. Patients, visitors and other staff therefore could see quite clearly if staffing levels where being maintained

An inspection team which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts spent two days at Salford Royal Hospital during October.  They examined the care provided in accident and emergency, medical care (including older people’s care), surgery, intensive/critical care, children’s care, end of life care and outpatients.  Inspectors also visited the hospital unannounced on one occasion.

The report which CQC publishes today is based on a combination of their findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations.

Read the full report on the Salford Royal Hospital page.

Inspectors concluded that the trust’s services were safe, effective, responsive, caring and well led. The values and behaviour of staff showed that the trust has an excellent culture of learning and openness with a commitment to continuous improvement.

The vast majority of patients were very positive about the care and treatment they received at the hospital. Staff told the inspection team that they were proud to work at Salford Royal and said it was important to them that patients had as good an experience as possible when they were in hospital.

Areas of good practice included:

• The Bereavement Centre (also known as the Pam Wood Suite) provided a service to bereaved families and friends efficiently and with great sensitivity.
• The EPR (electronic patient records) system was extremely well used in all areas (apart from A&E) and provided for a largely paperless organisation.
• Safety ‘huddles’ were a routine part of handover practice across the trust and allowed efficient transfer of information between shifts and outside of normal shift handover. These took place twice daily to ensure that everyone had up-to-date information.

While no significant areas for improvement were identified, CQC has advised the trust where they could improve and suggest the following areas:

• There were some minor issues with the paper-based patient records system in A&E, although these will be addressed with the adoption of the electronic patient records system in January 2014. The inspection team acknowledged that the paper-based system had no detrimental impact on patient care.
• Although policies and procedures were in place, in a small number of areas (A&E and children’s care) some departmental policies were outdated. When inspectors raised this with the trust, it addressed the issue immediately. This had not affected patient care.

The Chief Inspector, Professor Sir Mike Richards said: "Salford Royal strives to be among the best in the country and to deliver care which is safe, personal every time and delivered in a clean environment.   We found it is an extremely well-run trust, with a strong and stable leadership which was embedded at all levels within the trust, across all wards, consistently and without fail.

"Staff were encouraged to be innovative in improving the quality of care. They were able to tell us how quality was given a high priority and that patient care was personalised.

"The trust showed an openness and commitment to continuous improvement, with patient safety at the top of its priorities.  You can read the evidence of this throughout our report.    One small example - the trust had significantly reduced the number of falls on the frail elderly ward by providing one-to-one care for patients at risk. The number of falls was below the national average. This is a remarkable achievement."

Under the new inspections, CQC will always seek to answer five basic questions. The findings are summarised below:

Is it safe?

At Salford Royal Hospital services were safe. The values and behaviour of staff showed that the trust has an excellent culture of learning and openness. This is an important part of making sure patients are safe. Qualified staff assessed patients’ needs.   There were processes for minimising risk to patients, for example falls risk assessments in Accident and emergency (A&E). The trust has reduced the number of falls throughout its services and is significantly below the national target.

Is it effective?

The trust’s services were effective and patient-focused. Outcomes for patients were good and there was a strong quality improvement programme that involved staff across the trust. Patients we spoke with said they felt well cared for and they had received the right treatment.

Are services caring?

The vast majority of people told us about their positive experiences of care. The trust’s patient survey scores match the national averages. Patients said that they were satisfied with how they had been treated, and that doctors, nurses and other staff were caring and professional. Staff respected patients’ dignity and privacy.

Are services responsive to people’s needs?

The services were very responsive to patients’ needs. The trust consistently met all the targets in regards to waiting times and access to treatment such as cancer care. The vast majority of people told us that they had positive experiences of care at the hospital. We saw a passionate, responsive and caring workforce that maintained dignity and privacy for patients throughout their journey through the hospital.

Are services well-led?

The trust was extremely well-led with a strong leadership that focused on quality at all levels. This stable environment had been an important factor in enabling the trust to improve the quality of care for patients. There was good leadership at all levels, and this had had a positive impact on external partners, for example the local clinical commissioning group. The trust leadership team were visible within the trust and walked the wards regularly.

The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.

CQC inspectors will continue to monitor Salford Royal NHS Foundation Trust to follow up any findings and observations from the inspection.

Ends

For media enquiries, call the CQC press office on 020 7448 9401 during office hours or out of hours on 07917 232 143.

For general enquiries, call 03000 61 61 61.

Notes to editors

The Chief Inspector, Professor Sir Mike Richards, announced in July that he will lead significantly larger inspection teams than before, headed up by clinical and other experts including trained members of the public. Sir Mike identified 18 NHS trusts representing the variation of care in hospitals in England. These will be the first hospitals to test the new inspection regime.