Salisbury District Hospital

On this page

• 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

There was a defined management structure with clear lines of accountability within the maternity service. Senior leaders had worked hard to improve safety and the culture within maternity services. 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. Managers monitored the effectiveness of the service and made sure staff were competent. Staff felt respected, supported, and valued.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us there had been a huge change of the culture within the maternity service. Staff were positive about the department and its leadership team and felt able to speak to leaders about difficult issues and when things went wrong. Staff told us the culture within the service had greatly improved and teams were encouraged to value each staff members role. For example, staff told us the communication between staff and senior leadership had improved. Leaders were clear they were building a culture of support to increase staff morale. Senior leaders had carried out culture feedback sessions following score culture survey results. A flexible working, working group was introduced in 2023 and closed in 2024 following completion of all actions.

There was a good safety culture where events were investigated, and learning was embedded to promote good practice. There had been an increased focus in culture with the development of The Behaviour Charter. There was a clear theme for all staff to feel inclusive, ensuring staff feel that all positions within the team were important and for staff to listen as well as speak.

Staff felt respected, supported, and valued. We found staff were focused on the needs of women and were happy working for the trust. The director of midwifery had been in post for 15 months and the Head of Midwifery in post for 4 months and were well respected by all staff we spoke to. Staff told us senior leads were visible and approachable. Staff told us the culture within the service had greatly improved and teams were encouraged to value each staff members role. For example, staff told us the communication between staff and senior leadership had improved. Senior leaders had carried out culture feedback sessions following score culture survey results. A flexible working, working group was introduced in 2023 and closed in 2024 following completion of all actions.

The maternity service had a clear developed leadership structure, with the director of midwifery and neonatal services (DOM) under the chief nursing officer. The director of midwifery worked alongside the clinical director of women and newborn services and managed the head of midwifery. All operational matrons and lead midwives were overseen by the head of midwifery. Quality and safety, assurance, digital and safeguarding matrons and lead midwives were overseen by the director of midwifery. The previous inspection identified the maternity service did not have clear plans for maternity leadership. There was poor maternity staffing and a lack of effective systems and processes to assess, monitor and improve the quality and safety of maternity services. The service had been supported by the Maternity Safety Support Programme from 2022. During our inspection we found there had been significant developments since the previous inspection with a clearly defined management and leadership structure. The service promoted equality and diversity in daily work and provided opportunities for career development with the development of senior midwifery roles. The service had an open culture where women, their families and staff could raise concerns without fear.

Staff and leaders actively promoted staff empowerment to drive improvement. Staff completed speak up training as part of their mandatory training and induction and line managers were required to complete listen up training. The service told us the perinatal team had sent out a local staff survey as part of their ongoing culture work. The results of the survey were due in October 2024, but it was felt that the survey would show a significant improvement within the culture of the service. Staff felt confident to raise concerns without fear and women knew how to make a complaint or raise concerns. From July 2024 to September 2024 the service had received 3 formal complaints.

The Director of Midwifery and Divisional Director of Operations met bi-monthly with the Trust Freedom to Speak up Guardian and monthly with the Professional Midwifery Advocates. There were no reported concerns reported by the Freedom to Speak up Guardian over the last 3 months. Managers investigated complaints, identified themes and shared feedback with staff. Learning from these was used to improve the service. Information from the trust showed above 85% of complaints were closed within the required timescale. The service clearly displayed information about how to raise a complaint. Staff understood the policy on complaints and knew how to handle them. The Director of Midwifery held monthly Band 7 and 8 leadership meetings to support senior midwives with the need to develop, learn and collaborate as a senior leadership team. The Trust’s Freedom to Speak Up Guardian was leading on Civility and Respect as the place for starting the future delivery of a Restorative Just and Learning Culture (RJCL). There was a pilot scheme running within the trust and the pilot will form the basis of Civility and Respect training being rolled out to teams across the organisation.

Staff and leaders told us the service promoted equality and diversity within their daily work. The service had an equality, diversity and inclusion policy and a family experience and inclusion lead midwife. The service had an electronic device for women to receive a British sign language interpreter. The inclusion midwife worked closely with the Maternity Neonatal Voice Partnership to access antenatal clinics to improve the experience and care of women from different cultures.

The service monitored equality, diversity and inclusivity. There was a focus on increasing staff awareness to improve quality data in relation to health inequalities and to reduce the differences in access to services between women in white and black ethnic groups. Patient safety incidents recognised diverse needs to support inclusivity during investigation or review of incidents.

Staff understood their role and responsibilities and the maternity team had regular opportunities to meet, discuss and learn from the performance of the service. Staff were encouraged to report incidents. Staff knew how to raise and report an incident. Staff received feedback on an incident if they had requested for further information. The service leads were part of the monthly maternity improvement group to review risks and governance reporting. Maternity leads had direct access to the trust board. The trust board listened and there was a clear drive in the improvement to maternity services. Leaders identified and escalated relevant risks and issues and identified actions to reduce their impact. Risks were identified through Quality and Safety within the monthly risk and governance meetings. The leadership team took action to make changes where risks were identified. There were 10 risks identified on the maternity and neonatal risk register, all were identified as either moderate, minor or no risk.

Since our last inspection the service had improved systems and processes to assess, monitor and improve the quality and safety of maternity services. Maternity services had been on an improvement journey since 2021 and under the Maternity Safety Support Programme since 2022. The service had worked alongside the Maternity Improvement Advisor from NHS England, the Local maternity and neonatal systems and regional midwife and obstetric team during this improvement journey. The service completed a review and reset of governance structures to provide ward to board oversight. Maternity leaders attended the trust board to present all maternity and neonatal papers. Maternity safety champions met monthly. All meetings were attended by the operational safety champions team and the safety and quality lead. The service had a working group for Clinical Negligence Scheme for Trusts (CNST) with a defined term of reference. The day assessment unit had introduced core staff and ward manager and there had been an improvement in the waiting times for women being seen by a midwife. Women were risk assessed on arrival to the day assessment unit, using a nationally recognised tool. Women were seen by a midwife within 15 minutes of arrival to the day assessment unit. However, there was a delay of women having a medical review. The Maternity Early Observation Warning Score (MEOWS) and Fluid balance was completed by maternity staff for monitoring of deterioration in health which showed there had been improvement in compliance and escalation. There were actions in place to improve compliance such as MEOWS spot checks and for band 7 leads to remind staff to complete.

Women did not provide feedback on how the service worked with local communities. However, the service worked closely with the maternity and neonatal voice partnership (MNVP) to gain feedback from women.

The service was supported by maternity safety champions and a non-executive director. The non-executive director (NED) was there to provide an objective and external challenge. Their remit was to understand the current outcomes of the service, review services, current maternity risks, and report to board. The maternity safety board champions visited the maternity unit and liaised with outside representatives such as the maternity neonatal voices partnership (MNVP) group to review services, monitor risk and provide the board with a report of maternity services.

The service had been under the Maternity Safety Support Programme (MSSP) since 2022 and had been working alongside the Maternity Improvement advisor from NHS England for the last 2 years. The service worked closely with the Local Maternity and Neonatal Systems (LMNS) and in July 2024 had submitted an exit plan from the Maternity Safety and Support Programme following significant improvements within the maternity service. Leaders told the inspection team that the stakeholder criteria for leaving the Maternity Safety and Support Programme (MSSP) had been met. Oversight of the maternity service would be transferred over to the integrated care board, local maternity and neonatal systems and regional maternity teams. Following approval and gaining full assurance that all areas had been met the trust would receive a formal letter outlining the successful exit from the MSSP.

All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. There was an increase in professional midwifery advocates within the service with an increase in number of midwives trained.

Between March 2024 to June 2024 the service did not meet the compliance for fetal monitoring. The service provided an increase in awareness of fetal monitoring, with learning shared on the labour ward. The service had widened the responsibilities of band 5 preceptees with 6 months experience to be supported to be the first reviewer for fetal monitoring and supported by a band 6 midwife who would be the second reviewer. There had also been improvements made in accessing fetal monitoring training. Labour ward had recently implemented a white board for each birthing room as a gentle reminder for staff to complete hourly fresh eyes. However, training compliance for CTG training did not meet the trust compliance of 90%. Midwives were 78.5% compliant and medical staff were 70.6%. The service had predicted all staff would be complaint by December 2024. The service had introduced extra fetal monitoring training days to mitigate low compliance and there was a focus by the obstetric team to focus on obstetric attendance. CTG compliance was discussed within risk and governance meetings. The service offered a leadership, coaching and development programme maternity leads. Managers investigated complaints, identified themes and shared feedback with staff. Learning from these was used to improve the service. Staff could give examples of how they used women and birthing people's feedback to improve daily practice.