Salisbury NHS Foundation Trust

Updated 1 March 2019

Salisbury NHS Foundation Trust serves a population of around 225,000 people across South Wiltshire, North Dorset and West Hampshire, achieving Foundation Trust status in June 2006.

Acute services provided at Salisbury District hospital include general and acute services medicine, surgery, services for women and children, accident and emergency, diagnostic and clinical support services) with specialist services including burns, spinal, plastics, cleft lip and palate, genetics. In addition to the general population, the trust provides rehabilitation to a population over three million patients.

Salisbury’s population is evenly distributed across age groups with each five-year age bracket comprising between four and eight percent of the total up to the age of 79. Black and ethnic minority groups represent 4.3% of the population of Salisbury and 3.5% of the population of Wiltshire.

The area served covers both urban and rural communities. The health of people in Wiltshire is generally better than the England average, with few areas of high deprivation. About 12% (10,400) of children live in low income families. Life expectancy for both men and women is higher than the England average, although it is 5.8 years lower for men and 2.9 years lower for women in the most deprived areas of Wiltshire than in the least deprived areas.

The trust performs approximately 36,600 planned operations or procedures each year, with an additional 31,000 people receiving emergency treatment. Last year over 129,000 outpatients appointments took place and over 59,000 people attended the accident and emergency department.

The trust had 24,493 surgical admissions from June 2017 to May 2018. Emergency admissions accounted for 6,929 (28.3%).

The trust provides:

• 24 inpatient wards
• 511 inpatient beds
• 32 day-case beds

The trust has eight theatres within their main surgical theatre suite and six additional theatres in their day surgery unit. There is a burns and plastics theatre within the designated burns and plastics ward. Plastic outpatients have two outpatient theatres where minor ops are performed. There are also two Obstetric Theatres located in the Maternity Unit. An emergency theatre team and an obstetric theatre team is available 24 hours a day.

The trust employs more than 4,401 staff including 371 medical and dental staff, 940 NHS infrastructure, (non-medical) staff, 123 other qualified (non-medical) specialised scientific, therapeutic and technical staff (ST&T), 156 allied health professionals, 135 health care scientists, 740 nursing/midwifery staff, 406 support staff to doctors and nursing staff, and 154 staff supporting ST&T services.

A review of children services, incorporating a social care inspection, was undertaken in November 2016. CQC’s children’s team undertook a joint inspection with OFSTED looking at safeguarding procedures, which specifically focused on the multi-agency response to domestic abuse. This showed good engagement with other agencies by health providers in the area (including Salisbury District Hospital) and good training for risk assessing and thinking of the child when treating adults.

Updated 1 March 2019

Our rating of the trust improved. We rated it as good because:

• We rated effective, caring, responsive and well-led overall as good, and safe as requires improvement. We found that safety for patients had improved in urgent and emergency care, surgery and critical care. However; spinal services remained requires improvement. In rating the trust, we took into account the current ratings of the five core services not inspected this time. This meant due to our aggregation of ratings principles, the overall rating for safe remained requires improvement.
• At this inspection, the overall rating for spinal services remained rated as requires improvement. Urgent and emergency services and surgery had improved their rating from requires improvement to good. Critical care improved their rating from requires improvement to outstanding.
• We rated caring, responsive and well led in critical care as outstanding. We found significant actions had been undertaken to treat people in a safe manner. We found staff cared for patients with compassion. There was compassionate, inclusive and effective leadership at all levels. Leaders at all levels demonstrated the high levels of experience, capacity and capability needed to deliver excellent and sustainable care.

On this inspection we did not inspect medical care, maternity, outpatients, end of life care, or services for children and young people. The ratings we gave to these services on the previous inspections in November 2015 are part of the overall rating awarded to the trust this time.

• We rated well-led at the trust as good. There was effective, experienced and skilled leadership, a strong vision for the organisation and embedded values. The leadership had the capacity and capability to deliver high-quality sustainable care. Leaders understood the challenges to quality and sustainability and they were visible and approachable. There was a clear vision for the trust and strong values. Whilst we found the that Non-Executive directors were well engaged we felt they would benefit from development and support to improve the constructive challenge they provide to the executive team.
• The strategic plans fitted with local integration plans for and the strategy was aligned to the wider health and social care economy. Overwhelmingly staff felt valued and supported, positive and proud to work for the organisation. There were cooperative and supportive relationships throughout the trust. There were however some pockets where staff did not feel as well engaged and supported and the trust leadership was keen to understand this and to make improvements. There was good governance and structures to assess the care provided and give assurance around quality. There were processes for managing risk, issues and performance. Information and data was of good quality. However; we found that some IT systems were not effective in enabling the monitoring and improvement of the quality of care, although plans to resolve this were being identified. The views of people using the service were considered, as were those of staff and stakeholders. The trust was committed to quality improvement and innovations. However; it is important that improvement principles and practices are given pace and prioritisation in order to be embedded within the organisation. The arrangements for the Freedom to Speak-up Guardian did not reflect the recommendations of the National Guardian’s office. Work is needed on producing an integrated performance report that identifies where there may be variations and/or a need for change or improvement.
• Urgent and emergency services (alternatively known as accident and emergency services or A&E) were rated as good and had gone up one rating since the last inspection. We have rated safe, effective, caring and well-led key questions as good. Responsiveness remains requiring improvement. We had previously rated safe, responsive and well led as requires improvement. The service had made many improvements in response to the concerns we raised at our last inspection. For example, assurance systems had been implemented to ensure the identification and management of risks was undertaken and appropriate actions taken. We found staff had the right skills and knowledge to provide safe care and treatment for patients. Clinical education was used to support staff and patients. However, we found staffing challenges meant dedicated areas of the department designed for children and young people could not be opened. A lack of a standard operating procedure for the short stay assessment (SSAU) unit meant there was ambiguity over who should be referred to the unit. There were occasions when mixed sex accommodation breaches occurred within the short stay assessment unit, but these were not always recognised by staff and therefore not always reported.
• Surgical services were rated as good and had gone up one rating since the last inspection. We have rated all five key questions as good. We had previously rated safe and responsive as requires improvement at the last inspection. The service had made a number of improvements in response to the concerns we raised at our last inspection, we found that the service had improved compliance with The World Health Organisation (WHO) surgical safety checklist. Recent audits demonstrated that compliance for the general theatres was running at 100%. Staffing levels had improved following several initiatives which had been introduced to help aid recruitment of registered nurses across all wards. Staff were competent in meeting the assessed needs of patients. Staff took the time to interact with patients, and those close to them, in a respectful, compassionate and considerate way. Patients and their relatives/carers, where required, were actively involved in their treatment and care. We found patients could access care and treatment in a timely way.
• Critical care services were rated as outstanding and had gone up two ratings since the last inspection. We have rated the safe and effective key questions as good and responsive, caring and well-led as outstanding. The service had made many improvements in response to the concerns we raised at our last inspection, these included; there were now comprehensive systems to keep patients safe which took account of best practice. Rates of compliance with mandatory training now exceeded the trust target. The team had improved practices around infection prevention and control. There were now more effective systems for cleaning equipment and staff now used personal protective equipment consistently. Staff consistently checked safety equipment and recorded this had been completed. The service had improved patient records and nursing staffing numbers now met recommended staffing ratios. Mortality and morbidity reviews had embedded and were well attended. Governance arrangements had been recently reviewed. These now reflected best practice and mirrored the trust wide reporting protocols. The risk register was updated and now included all evident risks. There was compassionate, inclusive and effective leadership at all levels. Staff at all levels were empowered and encouraged to be leaders.
• Spinal services were previously rated as requires improvement. There has been no change in the overall rating, however; there have been some significant improvements. Safe and effective care remain requires improvement, caring remains good, responsive is now rated as good, this is an improvement from the previous rating of inadequate. Well led is rated as good which is an improvement from our previous rating of requires improvement. The service had made improvements in response to the concerns we raised at our last inspection, these included; systems, processes and practices were used to keep patients safe and these were understood by staff. Mandatory training targets were met by nursing and therapy staff and the service to control any risks of infection. Staff completed a holistic assessment of patients. Risk assessments were carried out and nursing and therapy care plans were completed to meet each identified area of need. There was a strong incident reporting culture in the spinal treatment centre. Staff had the right skills and knowledge to provide safe care and treatment for patients. However; concerns were identified at this inspection, included; staffing levels for medical, nursing, therapy and psychology staff. The spinal treatment centre had contributed to any databases for data collection and analysis purposes but not for measuring service quality.

Updated 1 March 2019

Updated 1 March 2019