CQC inspectors find that Salisbury NHS Foundation Trust requires improvement

The Chief Inspector of Hospitals has told Salisbury NHS Foundation Trust that it must make improvements following its first comprehensive inspection by the Care Quality Commission.

Overall Salisbury Hospital has been rated as Requires Improvement. Although inspectors found that the trust provided services that were Good for being caring and effective, improvements were needed for services to be safe, responsive and well led. Full reports, including ratings for all core services can be found on this website.

The team of inspectors and specialists including doctors, nurses, managers and experts by experience visited the hospital over a period of five days during December.

Following the inspection CQC issued a warning notice requiring the trust as a priority to assess, monitor and improve the quality and safety of its spinal services and to take action to minimise the risks facing patients who were waiting for attention.

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

"During our inspection we found an extremely positive culture within Salisbury Hospital. Many of the staff have worked in the trust for some time, they feel respected and valued and know each other well. They frequently referred to themselves as being like a family and were very supportive of each other.

"I note that overall the trust has performed well in meeting national targets, including the time patients spend in the emergency department and referral to treatment times. Most patients receive effective care and treatment that meets their needs.

"Patients’ individual needs were not consistently met. In spinal services there was disparity between the experiences of some patients; while some made good use of the gardens and awaydays, others felt lonely and bored. Spinal patients waited too long for specialist services but there was little risk assessment of the patients who were waiting.

“We will continue to monitor the trust's performance, and we will return unannounced in due course to check that the improvements we require have been made.  If we find that the trust has failed to address this issue, we will consider taking further action for the benefit of the people who depend on the service.”

The trust has been told that it must make improvements in 19 main areas, including:

• The trust must review nurse staffing levels and skill mix in specific areas including emergency and urgent care, surgical wards, services for children and young people, including the neonatal unit, critical care, maternity and the spinal unit.
• A review of triage arrangements in the emergency department must be completed without delay, to ensure that all emergency patients are clinically assessed promptly by a healthcare practitioner. The trust must improve the observation of patients waiting to be assessed so that those who are seriously unwell, anxious or deteriorating are identified and seen promptly.
• Steps must be taken to manage the numbers of spinal patients waiting for video uro-dynamics and outpatient appointments, assessing and reducing the risk of harm to these patients.
• The trust must ensure that the need to meet targets for performing surgery does not have an impact on individual patients. They must not be discharged home from main theatres and surgery must not be undertaken if there is clearly no safe pathway for discharging the patient.

The inspectors identified a number of areas of outstanding practice, including:

• There was a strong culture of reporting and learning from incidents. Staff understood their responsibilities to raise concerns, record safety incidents and near-misses and to report these appropriately. Staff received feedback and lessons were learned to improve care.
• There was an outstanding level of support from the consultant surgeons to the junior and trainee doctors and other staff including the student nurses.
• Nurse-led pathways were being used to improve patient treatment. Salisbury came top in a national audit for patients with early arthritis where the evidence showed that the quicker patients were diagnosed with arthritis, the quicker treatment could start and the quicker patients could go into remission.  Staff had presented their service at national and international conferences.
• The Benson bereavement suite which provided sensitive care to patients experiencing loss had been developed with the involvement of previous patients and their partners. The facilities allowed patients and their families’ privacy and personalised care and support.

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.

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For further information please contact CQC Regional Engagement Manager John Scott on 07789 875809 or, for media enquiries, call the press office on 020 7448 9401 during office hours. Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here. (Please note: the duty press officer is unable to advise members of the public on health or social care matters). For general enquiries, please call 03000 61 61 61.