All inspections: Salford Royal Hospital

Community & mental health inspection reports for Salford Royal Hospital can be found at Northern Care Alliance NHS Foundation Trust.

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Northern Care Alliance NHS Foundation Trust was formed on 1 October 2021 when Salford Royal Hospital NHS Foundation Trust legally acquired Pennine Acute Hospitals NHS Foundation Trust.

The trust has four hospitals – Salford Royal Hospital, Royal Oldham Hospital, Fairfield General Hospital and Rochdale Infirmary which provide a full range of acute services, including acute medicine, urgent and emergency care, acute frailty units, rehabilitation services, dental services and surgical services, to a population of approximately 1 million people. The trusts had been working in partnership from 2016 until the acquisition. This included a shared executive leadership team.

When a trust acquires another trust in order to improve the quality and safety of care, we do not aggregate ratings from the previously separate trust at trust level for up to two years. The ratings for the trust in this report are therefore based only on the ratings for Salford Royal Hospital and our rating of leadership at the trust level.

Our normal practice following an acquisition would be to inspect all services run by the enlarged trust. However, our usual inspection work has been curtailed by the COVID-19 pandemic.

At Northern Care Alliance we inspected only those services where we were aware of current risks. We did not rate the hospital overall.

In our ratings tables starting on page 30 we show all ratings for services run by the trust, including those from earlier inspections and from those hospitals we did not inspect this time.

Medical Care

The medical care division provided medical care, consisting of general medicine and care of the elderly as well as specialities such as cardiology, endoscopy and stroke are delivered from Salford Royal Hospital.

During our visit our inspection team spoke with patients’ relatives and staff which included consultants, junior doctors, nurses, matrons, pharmacists, discharge coordinators, house keepers and nursing students. We also spoke with the associate director of nursing, the associate director of operations and the clinical director for the medicine care group.

We inspected the service between 8 and 9 August 2022. Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity. As part of the inspection we reviewed information provided by the trust about staffing, training and monitoring of performance.

Since we last carried out a comprehensive inspection of this service, they have become part of a newly formed NHS trust. As such we cannot compare previous ratings.

We rated it as requires improvement because:

The service did not have enough staff to care for patients and keep them safe. Staff did not always have training in key skills. The service was not meeting its mandatory training compliance target.
The service did not always ensure that staff received appropriate support, training, professional development, supervision and appraisals. The service did not offer comprehensive training for staff to ensure they could support patients living with dementia, autism or a learning disability.
People could not always access the service when they needed it or received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not in line with national standards.
There was limited evidence that the medical division monitored the effectiveness of care and treatment and used the findings to make improvements and achieved good outcomes for patients. There were gaps in management and support arrangements for staff, such as staff appraisals.

However:

Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.

Surgery

The division of surgery provides a range of general and specialist surgical services, including trauma and orthopaedic surgery, urology and complex elective and emergency surgery. The surgery division has seven wards, a pre-operative assessment clinic, two surgical admission lounges and a day surgery unit. It includes an intestinal failure unit (IFU) which holds national reference centre status for the treatment of complex intestinal failure. 

There are 20 operating theatres on two levels and a day case theatre; wards and departments are spread throughout the hospital, including different buildings and on different floors.

Between October 2021 and July 2022, the hospital had a monthly average of 766 emergency admissions, 1134 day case admissions, 358 elective admissions and 1291 operations performed.

During the inspection, we visited seven wards, theatres, surgical admissions lounge, recovery areas, the surgical triage unit, and the pre-operative assessment clinic. Due to COVID-19 restrictions we visited wards identified as not having an outbreak at the time of inspection. We observed staff interactions with patients, safety huddles and handovers.

The inspection team spoke with 26 staff, five patients and three carers and relatives who were using the service. Staff we spoke with included senior leaders, consultants, matrons, sisters, registered nurses, junior doctors, health care assistants, porters, and housekeepers. We reviewed ten patient records and ten complaint files.

Our rating of this service went down. We rated it as requires improvement because:

The service did not always have enough nursing staff to keep patients safe. Staff did not always complete mandatory training in key skills. Compliance for some risk assessments did not always meet hospital targets. Not all staff had completed training on how to recognise and report abuse.
Whilst staff monitored the effectiveness of care and treatment, they did not consistently use the findings to make improvements. The service had a higher than expected risk of readmission for elective admissions for urology and general surgery patients when compared to the England average. Managers did not always appraise staff’s work performance or hold supervision meetings with them to provide support and development. Not all staff completed training in the Mental Capacity Act or Deprivation of Liberty Safeguards.
The environment across the surgical wards and theatre areas was not always dementia friendly. People could not always access the service when they needed it or received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not in line with national standards. Complaints were not always responded to within the timescales specified in the trust complaints policy.
Senior leaders were not always visible and approachable in the service for all staff. Not all staff felt there was an open culture where they could raise concerns without fear. Not all staff were clear about their roles and accountabilities. Staff could not always find the data they needed in accessible formats to help them understand performance, make decisions, and drive improvements. Data was not recorded or presented uniformly across the trust and some important data was not captured. Senior leaders were not always actively and openly engaged with staff.

However:

Staff used equipment and control measures to protect patients, themselves, and others from infection. They kept equipment and the premises visibly clean. Staff managed clinical waste well. Staff identified and quickly acted upon patients at risk of deterioration. The service had enough medical staff and support staff to care for patients and provide the right care and treatment. Staff kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
The service provided care and treatment based on national guidance and evidence-based practice, gave patients enough food and drink, and gave them pain relief when they needed it. The service mainly achieved good outcomes for patients. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives and supported them to make decisions about their care. Most key services were available seven days a week to support timely patient care.
Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families, and carers.
The service planned and provided care in a way that met the needs of local people, took account of patients’ individual needs and preferences, and made it easy for people to give feedback.
Most staff spoke positively about the local leadership. Leaders had the skills and abilities to run the service, the service had a vision for what it wanted to achieve and a strategy to turn it into action. Leaders operated effective governance processes, throughout the service and with partner organisations. They identified and escalated relevant risks and issues and identified actions to reduce their impact. The service collected data and analysed it, leaders and staff actively and openly engaged with patients. Staff were committed to continually learning and improving services. Leaders encouraged innovation and participation in research.

Urgent and Emergency Care

Our rating of this location went down. We rated it as requires improvement because:

The service did not have enough staff to care for patients and keep them safe. Staff did not always have training in key skills and did not always manage safety well. Patients with suspected sepsis were not always escalated appropriately or treated in a timely manner. Not all staff completed training on how to recognise and report abuse. The service did not consistently control infection risk well. Staff did not consistently assess risks to patients, nor act on them. The management of controlled drugs in the Majors area was not effective.
Staff did not always give patients enough to eat and drink, nor always give them pain relief when they needed it. Managers did not always make sure staff were competent for their roles. Overall compliance with annual appraisals was 56%, and due to staffing pressures, staff were not always released to carry out face to face training such as immediate life support. Staff did not always support patients to make informed decisions about their care.
Due to staff shortages and overcrowding in the department, staff were not able to respect the privacy and dignity of patients. They were not able to take account of their individual needs, nor help them understand their conditions. They were not able to provide emotional support to patients, families and carers.
People could not access the service when they needed it and had to wait too long for treatment. The service did not always take account of patients’ individual needs.
Leaders did not consistently run services well and did not always use reliable information systems. Staff did not always understand the service’s vision and values, and how to apply them in their work. Staff did not always feel respected, supported and valued. Though staff were committed to improving services we did to see evidence of ongoing quality improvement work or innovation.

However:

The service had enough medical staff to care for patients and keep them safe. Staff mostly understood how to protect patients from abuse. Staff kept good care records. The service managed safety incidents well and learned lessons from them.
Staff mainly provided good care and treatment. Managers monitored the effectiveness of the service. Staff mostly worked well together for the benefit of patients, advised them on how to lead healthier lives. Key services were available seven days a week.
Staff treated patients with compassion and kindness.
The service planned care to meet the needs of local people and made it easy for people to give feedback.
Leaders supported staff to develop their skills. Staff were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged with stakeholders to plan and manage services.

A summary of services appears in the Overall summary section above.

Salford Royal NHS Foundation Trust provides both acute and community services to a population of 240,000 people across Salford and the surrounding areas of Greater Manchester. The trust serves a national population for people requiring some specialist care for the treatment of disease or disorders of the brain, skin, renal system, spine and those with intestinal failure conditions.

Salford Royal NHS Foundation Trust employs around 6,600 whole time equivalent staff across both the acute hospital and the community services. Of these staff, there are 730 medical staff, 2,200 nursing staff, 2,000 care support staff and 350 allied healthcare professionals.

We carried out this follow-up inspection in addition to the comprehensive inspection carried out in October 2013. This is because Salford Royal Hospital was inspected during a pilot period when shadow ratings were not published. In order to publish a rating, we needed to update our evidence and inspect all the core services that Salford Royal Hospital provides. At our earlier inspection in 2013, we had not inspected the community services provided by the trust. Our methodology included an unannounced visit to the hospital on the evening of 27 January 2015. We also held a public listening event, where we heard directly from approximately 60 people about their experiences of care.

We have rated this trust overall as outstanding. The Salford Royal Hospital was rated as outstanding and the community services were rated as good. Of the five key questions that CQC asks, we rated the trust as good for being safe and effective, and we rated it as outstanding for being caring, responsive and well-led. In relation to the core services, A&E, medical care and end of life care in the acute hospital and adult services and end of life care in the community were each rated as outstanding.

Throughout the reports for this trust, we refer to the Nursing Assessment and Accreditation System (NAAS) and the trustwide initiative to provide safe, clean and personal care every time (SCAPE). NAAS is a performance framework system designed to help nurses in practice by measuring the quality of nursing care that teams deliver. The NSSA performance assessment framework is based on the trust’s own SCAPE approach to service delivery and combines Key Performance Indicators and Essence of Care standards. The framework is designed around 13 standards with each standard subdivided into three elements: leadership, care and environment. The assessment consists of observations of care, asking relevant questions of patients and staff, observing how meals are delivered, and receiving feedback from patients. Wards and departments are rated from red (worst) to blue (SCAPE – best). Where we have reported that wards have attained SCAPE status, this indicates that the ward has been assessed over a period of at least 24 months, and during each assessment, had attained at least a green rating (good). Three consecutive green assessments result in SCAPE status being awarded.

For a ward to achieve SCAPE status, it must, as a minimum, have maintained NAAS (green) for 24 months. Further assessments are undertaken using a comprehensive set of standards for nursing care and the teams can then apply for SCAPE. A SCAPE panel (consists of board members, senior multi-professional staff and a member of the public) then reviews the teams and makes recommendations to trust board that will approve, defer or decline SCAPE status for the applying area.

We rated the leadership of the Salford Royal Hospital as good overall. Three core services each demonstrated outstanding leadership; two core services were rated as good and two core services required some improvements to be made. The leadership of the community services was rated as outstanding overall, and the trust-wide leadership was rated as outstanding. The aggregation of these judgements for assessing the well-led question at provider level is outstanding overall. When we combine the overall ratings of outstanding for being caring, responsive and well-led, it results in the overall trust being rated as outstanding.

Our key findings were as follows:

Safe:

The concept of providing safe, harm-free care was considered as a priority by all members of staff. Through the use of quality improvement programmes, we found many examples of how staff had worked together to ensure they provided safe care.
The use of internal governance systems to ensure safe care was well embedded. Nursing assessment and accreditation systems (NAAS) provided a high level of transparency to the trust's board and to patients in relation to clinical performance indicators and measures. This information was publicised throughout the wards and clinical areas for people to consider.
In conjunction with the NAAS initiative, staff spoke positively about ensuring that patients received safe, clean and personal care every time (SCAPE). SCAPE was described as a process lasting 24 months and involving three separate assessments whereby staff delivered on a range of patient focused competencies and considered a range of performance indicators. Clinical leaders and ward-based staff considered the accolade of SCAPE as significant success.
The hospital was visibly clean and staff were witnessed to follow appropriate infection control practices. Audits were routinely undertaken to ensure staff complied with local and national policies and action was taken if areas of concern were identified.

Effective:

Staff based care on best practice guidance. A robust audit programme was in place to demonstrate that action was taken and outcomes monitored to determine effectiveness where improvements were needed. The trust benchmarked itself against a range of national comparators; this demonstrated that the trust generally performed the same as, or better than others in many areas.
Multidisciplinary working was strongly embedded across the trust. The provision of integrated care through the development of Salford Health Care showed the trust's ability to provide care through multidisciplinary working.

Caring:

There was a strong emphasis on providing caring, compassionate and dignified care to patients. Performance against national patient satisfaction surveys was consistently good across of all core services, with the exception of services for children and young people, which needed further work to gather feedback from children and their parents/carers.
People who used the services were actively involved in developing improvements in their care to ensure their care was personal. In January 2013, the trust launched a project aimed at improving the experience of patients, families and carers, as part of the patient experience strategy. This resulted in the concept of ‘always events’, which were things that patients should always expect to happen to them when receiving care from the trust.

Responsive:

Services were able to assess and respond to the needs of the population they served. Feedback was gathered from patients and relevant stakeholders to enhance services.
Provision of religious and spiritual support, and the support of patients during the end stages of life, was noted as being particularly outstanding.
The critical care department provides a combination of ward, telephone and outpatient multidisciplinary follow-up service. The department contributed to the development of NICE guidelines (2009) on critical care rehabilitation. It proactively gathers feedback on the service for evaluation.
The hospital had a multi-faith centre that catered for the religious needs of the local population, including a non-denominational ‘Oasis’ room.
A blue butterfly symbol was introduced within the trust to identify people with cognitive impairment. Patients identified as such, were visited by dementia specialist nurses who also co-ordinated training for staff on dementia awareness. All wards had a dementia champion.
Patient passports were in use across the trust, including passports in different languages.
The trust had a rigorous complaints answering process to address both formal and informal complaints. Each department had a lead nurse in charge of reviewing and acting on complaints and disseminating the learning from the complaints through safety huddles and newsletters.

Well-led:

Quality improvement was a clear focus for the trust through collaboration across all staff groups in quality improvement methods to reduce patient harm, and improve outcomes and patient experience. One ‘collaborative’ focused on gathering patients' views across the whole pathway of care from before admission to the community, to make improvements
Members of the senior management team were fully engaged with ‘front-line’ staff. Strong working relationships had been developed between the trust's executive team and the Foundation Trust Governors. Governors were clear about their roles and purpose, which enabled them to contribute to the success of the trust.
The ambition and vision of the trust to be the safest trust in the National Health Service was understood and embedded in the practices of staff across all professions and at all levels of seniority.
Staff spoke positively about the engagement of the management team, which enhanced a culture of innovation. High staff satisfaction rates were representative of the positive feedback we received from staff during the inspection.
The trust had a clear vision and strategy for quality improvement, both within the trust and for working with partners across Wigan, Bolton and Salford and more widely.
The trust has some of the best scores in the country on the staff survey, reflecting the positive culture in the organisation.

We saw several areas of outstanding practice including:

Nursing assessment and accreditation systems (NAAS) provided a high level of transparency to the trust's board and to patients in relation to clinical performance indicators and measures. This information was publicised throughout the wards and clinical areas for people to consider and scrutinise.
In conjunction with the NAAS initiative, staff spoke positively about ensuring that patients received safe, clean and personal care every time (SCAPE). SCAPE was described as a process lasting 24 months and involving three separate assessments whereby staff delivered on a range of patient focused competencies and considered a range of performance indicators. The accolade of SCAPE was seen as significant success by clinical leaders and ward-based staff.
There was clear evidence that the development of the 'emergency village' with its integrated care pathway approach, including medical in-reach, continued to deliver improved outcomes for people.
Quality improvement initiatives had successfully led to a reduction in the number of hospital acquired pressure ulcers.
Staff were encouraged to undertake research. For example, we reviewed a paper published in respect of improving patient care in a national intestinal failure unit.
The surgical division celebrated its positive arrangement for moving elective orthopaedic work off site, and anticipated that this would improve patient throughput, standardise use of prosthetics and develop a centre of excellence.
The surgical division indicated it had established a link with Central Manchester NHS Foundation Trust, which it anticipated could lead to future partnership working in the developed Manchester Orthopaedic Centre. This was expected to lead to increased pooled volumes of specialist activity with standardised practice leading to improved patient outcomes.
The surgical division's annual plan described the development of a service model for emergency and complex surgery with two other NHS providers.
We saw in the theatre staff newsletter for December 2014 an introduction to the forthcoming ‘Theatre Improvement Programme’. We were told this was due to start at the end of January 2015, with the aim of ensuring that theatres could provide safe and reliable care, provide value and efficiency and deliver a high team performance with high team morale and wellbeing. This work was being co-ordinated and delivered through a Quality Improvement methodology, led by a steering group headed by the Director of Organisational Development and Corporate Affairs. We saw from information provided to us that the programme was based around the Productive Operating Theatre model, developed by the NHS Institute for Innovation and Improvement.
The senior managers within the surgical directorate recognised the areas for further focus, which included interventional radiology, middle grade recruitment to medical staff, the delivery of complex emergency care and making improvements to the discharge process, by reviewing and enhancing the patient pathway.
There was an incentive for staff who wished to be involved in helping the trust to make financial savings to the service. If an idea was adopted, the staff member received 10% of the overall savings as a reward for their innovation.
Junior staff were rotated to other areas across the critical and high dependency care units to facilitate personal progression and encourage staff retention.
Bleeps were provided to relatives so that staff could contact them quickly if they were away from the CCU.
The diabetes outpatient service demonstrated good practice where children in transition from young people to adulthood were seen in a clinic attended by an adult physician and adult specialist nurses, giving dietetic and psychological support. This ensured a continuous and consistent pathway of care through to adulthood.
We were told the trust was actively engaged in the NHS Improving Quality ‘Transform Programme’ (Phase 2).This programme aims to encourage hospitals to develop a strategic approach to improving the quality of end of life care. The trust had piloted the use of AMBER (Assessment Management Best practice Engagement Recovery uncertain) Care Bundles (ACB), which were used to support patients that are assessed as acutely unwell deteriorating, with limited reversibility and where recovery is uncertain. However, it was decided not to continue to implement the ACB after the pilot.
Other improvement areas include Advance Care Planning (ACP), EPaCCS, rapid discharge pathway, meeting the priorities for care of the dying person and effective care after death, including bereavement and mortuary service.
Innovative work undertaken included the access to seven-day Specialist Palliative Care for SRFT since 2009 (only 21% of trusts deliver this nationally). The trust has participated in all four rounds of the NCDAH and was described as above the national average for nine out of 10 Clinical KPIs. The bereavement care delivered across the trust and the trust's awareness around the cultural needs of the population were well met by the HSPC, bereavement and the chaplaincy teams.
The system of daily safety huddles, and intra-team situation reports ensured that important information was passed between teams and shifts.

However, there were also areas of poor practice where the trust needs to make improvements.

Action the hospital MUST take to improve

The trust must take action to ensure that WHO safety checks (or equivalent) are conducted on all patients going through operating theatres and it must take action to ensure that monitoring of WHO safety checks are carried out.
The trust must ensure that the environment is appropriately maintained and fit for purpose; the main outpatient department experienced a regular leaking roof in several areas, and sewage leaks through the ceiling.

Action the hospital SHOULD take to improve

The trust should ensure that safety checks on technical equipment used in the delivery of treatment and care to patients are carried out routinely. This is something that is required as part of Regulation 16, safety, availability and suitability of equipment. It was considered that the omissions related to the checking of anaesthetic machines by theatre staff were not proportionate to support a judgement of a breach of the regulation.
The trust should ensure that the knowledge and application of the Mental Capacity Act and the Deprivation of Liberty Safeguards is consistently applied across all services.
The trust should consider prioritising the improvement of the discharge process for patients from beyond the local area to the wider geographical area.
Whilst we acknowledge that the trust has embarked on a programme of quality improvement within theatres to improve the culture and morale of the department, the trust should ensure that this initiative is both effective and sustainable so that changes are fully embedded for the future.
The trust should consider ways of reducing the rate of surgical procedure cancellations.
The trust should consider a unified strategy for the delivery of children’s services, both medical and surgical. Governance systems, risk management and performance measurement processes should be standardised to ensure that children receive quality, evidence-based care.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Salford Royal NHS Foundation Trust is an integrated provider of acute, community and primary care services with the majority of its services located at the Salford Royal Hospital site. It obtained foundation status on 1 August 2006.. It provides local services to the City of Salford and specialist services to Greater Manchester and beyond, treating about 400,000 patients every year. The trust provides a range of medical, surgical and emergency services, along with specialist care to people from across the UK who need expert help with brain, kidney, bone, intestine or skin conditions.

The trust is based at Salford Royal Hospital and serves one of the most deprived local authorities nationally (rated 26th out of 326 local authorities ). The hospital has 676 beds for the population it serves.

Salford Royal NHS Foundation Trust has been inspected six times since its registration in April 2010. There are currently 15 active locations operating under this trust. The locations which have previously been inspected are:

Salford Royal Hospital: inspected three times. There are no outstanding actions.

The Maples: inspected once. There are no outstanding actions.

Heartly Green: inspected twice. There are no outstanding actions.

The trust was providing services at Salford Royal Hospital which were safe, effective, responsive, caring and well-led. This is an extremely well-run trust, with a strong and stable leadership team at executive and board level. We saw that strong, clear leadership in the trust 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. For example, individual nurses are supported to make contact with relatives following a bereavement, to offer them further support.

The trust had effective structures and systems in place and showed an openness and commitment to continuous improvement. It put patient safety at the top of its priorities. Staff were focused on safety and what it meant in their own particular role.

The trust strives to be the best in the country and to deliver care which is safe, clean and personal every time (which they call SCAPE). All staff regardless of their role work to this ethos. Every member of staff we spoke to could tell us what this meant to them and all took pride in wanting to achieve the status for their ward or their area of work. The trust recognised the achievement of wards that had gained SCAPE status and the staff were rewarded with trust recognition for being a high performing ward. Information provided at the entrance to each ward informed patients and visitors how the ward was performing on being safe, clean and personal. This approach displayed an openness and transparency to visitors in how they were achieving this goal.

The vast majority of people we spoke with were very positive about the care and treatment they received at the hospital. Staff worked hard to involve patients in their own care.

The trust works hard to be transparent with staffing levels. Each ward we visited identified (at the entrance to the ward) the planned staffing numbers for each shift and the actual staffing levels provided. This clearly shows any patient or visitor if the ward is sufficiently staffed. Staff told us that they had regular updates on the numbers of staff and, if necessary, staff were moved to accommodate any shortages. The trust made use of bank and agency staff as appropriate. We did not identify any concerns about staffing levels.

Staff told us that they felt valued and respected in their roles. 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.

The trust had a ‘fair blame’ culture which empowered staff to be fully involved in the way the trust was run. It encouraged all staff to learn from each other and share ideas. For example, we saw evidence of a housekeeper being fully involved in the quality improvement agenda and identifying ways of improving the service and producing savings in the equipment budget. The trust was very proud to explain to us that this “fair blame” culture created a learning organisation which improved the quality of care.

The trust engages effectively with all external stakeholders and works to improve the quality of care provided to patients – both within the hospital and externally through its work with local GPs. We asked a range of stakeholders for their views before the inspection. They all said this was a trust that delivered well. No one identified any concerns. The local clinical commissioning group said that the trust worked well with them and they provided “good value for money”.

The trust performed well on a number of indicators in the NHS staff survey related to patient care and support. They were better than expected for the proportion of staff who would recommend the trust as a place to work or receive treatment.

People told us what it was like to be a patient in Salford Royal NHS Foundation Trust Hospital. We visited five wards, the

emergency assessment unit (EAU), two elderly care wards, a respiratory medical ward and an orthopaedic ward. We spoke with a number of patients, relatives and staff. We were told :

"Staff are very knowledgeable about the care I am receiving, they are kind and helpful."

'I feel that the staff have really communicated well', and 'You don't have to ask, they explain everything to you'.

Patients told us they felt involved in making choices and decisions about their care. Patients felt that the hospital promoted the dignity of people. Patients had their treatment explained and were provided with information in relation to the proposed length of their stay at the hospital.

During the inspection we looked at the arrangements for the safeguarding of patients from abuse and staff training. We also looked at how the Trust monitored the safety and quality of the service.

We met with senior managers at the Trust who were able to demonstrate that the views of patients about their experiences were gathered, carefully considered and used to help shape the development of the service. The Trust had processes in place to monitor various aspects of patient safety and clinical outcomes and to improve patient experience overall.

We found evidence of compliance with all areas we inspected.

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

We spoke with six patients, one relative and eight members of staff and observed the care given to people during our visit to the hospital. We also used information provided by patients on NHS Choices website, complaints that we have been sent, Patient Environment Action Team assessments and patient survey results.

People we spoke to were very positive about their experiences of care and treatment. Many of the people we spoke told us that they trusted the doctors and nurses to make the right decisions about their care and treatment.

Others told us that the doctors and nurses were very good at making sure people understood everything about their illness and their treatments. People said they were kept informed, were involved in making decisions about treatment options and were given enough information both written and verbally to help with this process. Most patients also said that they had their care needs met and had been treated respectfully. The people we spoke to on our visit said that they did not have to wait when they called for staff assistance and all knew how to operate the nurse call system. No complaints were made to us about the time people had to wait for assistance.

The patients told us they were also involved in making decisions about their care. One patient told us that she had been able to discuss her future needs and options about where she should be discharged to had been explained to her.

All of the people we spoke to were aware of the reason for their admission to hospital, the likely length of stay and the treatment options available to them.

Example comments included staff described as being 'excellent',' the care being very good', 'staff were kind and caring'.

Some people told us that they were happy with the care they received but felt at times more staff were needed to ensure that everyone received the individual care that they required. During our visit, we observed that, on one occasion, a patients' dignity was being compromised.

Patients were very complimentary about their experiences of mealtimes. They commented that the staff made an effort to make it a pleasant experience. Patients also commented that they were well supported to eat and drink. Patients said that there was a good choice of food, including meal options that met different cultural requirements. These findings are supported by the trust's inpatient survey (2010) results, which showed that:

' 5.4 out of 10 on how patients would rate hospital food

' 8.5 out of 10 on amount of choice of food

' 7.9 out of 10 on whether patients received enough help with eating

These results are about the same when compared to other similar trusts'.

Salford Royal Hospital

All Inspections

Other CQC inspections of services

8 August 2022 to 11 August 2022

During a routine inspection

24 April 2018

During a routine inspection

13, 14, 15 and 27 January 2015

During a routine inspection

Action the hospital MUST take to improve

Action the hospital SHOULD take to improve

23-24 and 29 October 2013

During a routine inspection

11 December 2012

During a routine inspection

21 March 2012

During a themed inspection looking at Termination of Pregnancy Services

5 April 2011

During a themed inspection looking at Dignity and Nutrition