Salford Royal Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

Our rating of caring changed from good to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

We found instances of poor care and received negative feedback from people in some surgical wards relating to delays in receiving assistance, personal care and pain relief.

Whilst we found staff demonstrated kindness and compassion, poor staffing levels and workload pressures across the surgical wards impacted their ability to consistently provide support and maintain people’s privacy and dignity.

Staff could access employee support programmes. However, some ward staff told us the available support was not sufficient and had not led to improvements in staff sickness, morale or well-being due to the staffing capacity and workload challenges they regularly experienced.

However, staff treated people as individuals and supported their independence and choices.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

We scored the service as 2. The evidence showed some shortfalls. The service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity.

The staff we spoke with were caring and compassionate. They told us they treated people with respect. Most people who used the service told us staff were kind, caring and treated them with kindness.

We observed staff speaking with people discreetly to maintain confidentiality. Privacy curtains were available, and people could be placed in side rooms to provide privacy and to respect their dignity. People transferred between the ward and theatre areas were given dressing gowns to maintain their dignity. The surgical wards had protected mealtimes in place.

Whilst we found staff demonstrated kindness and compassion, poor staffing levels and workload pressures across the surgical wards impacted their ability to consistently maintain people’s privacy and dignity.

We found instances of poor care and received negative feedback from people in some surgical wards relating to delays in receiving personal care. This included two instances where people had been left in soiled beds for extended periods of time, impacting their dignity. On wards B1 and B2 (general surgical wards), we also found several unused bedpans had been indiscreetly stacked next to people’s beds for them to use when needed.

Stakeholders and partners told us their interactions with staff across the surgical services had been positive. They told us they felt staff were helpful, supportive and acted professionally.

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and took into account people’s needs and preferences.

Staff told us people’s needs and preferences were assessed on admission to the surgical wards and before surgery and they respected people’s wishes where possible.

Most people we spoke with were positive about the way staff treated them. They told us staff treated them as individuals and took their needs and preferences into account when providing care and treatment. They told us staff respected their cultural needs.

We saw staff were respectful and supportive when they spoke with people and their relatives.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Staff told us they listened to people and promoted independence as much as possible. They respected people’s rights to make choices about their care.

People who used the service told us the nursing and medical staff explained the care and treatment options to them and allowed them to make informed decisions. We observed staff speaking with people clearly in a way they could understand.

People were given menu choices during mealtimes, with options available for people with specific requirements, such as vegetarian, halal and kosher meals. We saw that refreshment trollies with hot and cold beverages were available in some surgical wards and people who used the service and their relatives could access these when needed.

We scored the service as 2. The evidence showed some shortfalls. The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Staff told us they routinely assessed and monitored people in order to provide them with support when they needed it.

Staff ability to provide support for people who used the service was impacted by poor staffing levels and workload pressures in the surgical wards.

We found instances of poor care and received negative feedback from people in some surgical wards. We found people had experienced delays in receiving pain relief medicines, including patient-controlled analgesia (PCA). We saw people did not always receive assistance during mealtimes.

Some people who used the service told us they did not always feel comfortable asking for help when they needed it, because they had experienced delays in support from staff, especially during the night.

We observed delays in staff answering call bells on 3 surgical wards. We observed a person had requested support for toileting needs 4 times before staff attended to them on ward H4 (general surgical ward). Another service user on ward B2 (general surgical ward) told us they had requested support with toileting needs and staff had told them to use a commode or a bed pan because they were too busy.

Some people and their relatives told us they were supported with their emotional needs and were able to voice any concerns or anxieties relating to their surgical procedure. However, 3 people told us staffing shortfalls on the surgical wards had impacted their emotional well-being.

We scored the service as 2. The evidence showed some shortfalls. The service did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Most of the nursing and support staff we spoke with in the ward areas and in focus groups told us ward staffing was a challenge, and shifts were frequently understaffed. They told us staffing shortfalls increased their workload and staff were often redeployed to other surgical wards to address shortfalls. They told us increased workload pressures and being moved around to other wards made them feel ill, exhausted and feel like not wanting to come into work.

Staff could access employee support programmes for organisational development, counselling, health and wellbeing. Staff could access the SCARF (support, care, assist, recognise and family) programme for support. Staff participated in supervision and debriefs to support their emotional well-being. They could access occupational health and psychologist support, and a number of mental health first aiders were in place to provide support and advice for staff. Staff with prolonged sickness absence were supported through meetings with their line managers and human resources (HR) teams. The service had initiatives to support flexible shift adjustments.

Most ward nursing staff told us they understood how to access employee support programmes and that their line managers were supportive, but they felt the available support was not sufficient and had not led to improvements in staff sickness, morale or well-being due to the staffing capacity and workload challenges they regularly experienced.