Salford Royal Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

Our rating of effective stayed the same. We rated effective as requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The surgical services did not have had effective systems and processes for assessing people’s needs in the surgical wards. Staff did not always complete nursing assessments, and the management of pressure ulcer care, catheter care and bowel care was consistently worse than trust targets for people admitted to the surgical wards.

The services had made improvements to spinal multidisciplinary team meetings, but these had not yet been fully implemented and embedded.

Whilst staff followed national guidance to gain consent, the services did not have effective systems for assessing and managing people with a Deprivation of Liberty Safeguards (DoLS) authorisation in place.

The national clinical audit findings showed clinical outcomes (such as mortality rates) for most people were positive. However, the surgical services failed to meet standards relating to timely access to treatment across most national clinical audits.

However, clinical guidelines and pathways were based on national guidance. Staff worked well together for the benefit of people who used the service and advised them on how to lead healthier lives.

We have not awarded this service a score for Effective.

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

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Admission policies were in place to provide guidance for staff around the assessments required on admission to the surgical services. Most people we spoke with told us they were assessed on admission and that staff took into account their needs and preferences.

The care records we looked at showed people who used the service underwent appropriate pre-operative assessment for elective and emergency surgery.

Most of the care records we looked at in the surgical wards showed risk assessments and care plans had been completed. However, care record audits showed poor compliance around the timely completion of nursing assessments, and in relation to managing pressure ulcer care, catheter care and bowel care for people admitted to the surgical wards. This meant people’s needs were not always assessed or met in a timely manner.

The hospital’s quality assurance (QAA) audit standard 31 related to nursing admission documentation completed timely and in full as per ward area. The surgical wards only achieved overall compliance of 24% between June 2024 and September 2025. This was below the compliance target of 80% and demonstrated poor staff compliance.

The surgical wards also achieved poor overall compliance of 21% for QAA audit standard 36 (relating to pressure ulcer management) and 50% compliance for both QAA audit standard 56 (relating to catheter care) and QAA audit standard 57 (relating to bowel care) during this period.

People who used the service were assessed by medical staff and advanced clinical practitioners. Daily medical ward rounds took place to assess people’s needs. However, the services did not routinely undertake daily consultant-led ward rounds. All new admissions were reviewed by a consultant followed by daily reviews by a registrar or above. There was a major trauma consultant of the day in place during the day shift, 7 days per week.

The service had 24-hour access to mental health liaison and specialist mental health support teams. Staff understood how to seek guidance and advice to support people with mental health concerns. We saw mental health assessments were completed in the care records we reviewed.

We scored the service as 3. The evidence showed a good standard. The service had systems and processes that were in line with legislation and current evidence-based good practice and standards.

Staff followed clinical guidelines and pathways that were based on national guidance, such as from The National Institute for Health and Care Excellence (NICE) and the Royal Colleges’ standards. We reviewed a number of care pathways, including for major trauma, spinal, head or brain injuries, intestinal failure or injury, general surgery and orthopaedic surgery and found these were based on national best practice guidance.

Emergency surgery was managed in accordance with the National Confidential Enquiries into Patient Outcome and Death (NCEPOD) recommendations and the Royal College of Surgeons standards for emergency surgery.

Staff in the surgical services used enhanced care and recovery pathways for a number of surgical specialties (excluding neurosurgery). Enhanced recovery is an evidence-based approach to delivering care in a way that promotes a better surgical journey and delivers a quicker recovery. The service had enhanced recovery after surgery (ERAS) nurse specialists in place to support people’s recovery following surgery.

The surgical services had adopted Sip Til Send guidelines since May 2025 for all adult surgical service users, with the exception of some high-risk procedures, such as upper gastrointestinal or bariatric surgery.

The surgical services had developed 27 Local Safety Standards for Invasive Procedures (LocSSIPs) and implemented the principles of the National Safety Standards for Invasive Procedures (NatSSIPs). Most (23) had been harmonised across the trust and there was on-going cross-site working to harmonise the remaining 4 LocSSIPs standards.

We scored the service as 2. The evidence showed some shortfalls. Whilst the service worked well across teams and services to support people, improvements to spinal multidisciplinary team meetings had not yet been fully implemented and embedded.

There were routine weekly multidisciplinary team (MDT) meetings across the surgical specialties to review and discuss individual cases and plan appropriate care and treatment. There were 11 specialty MDT meetings held across the surgical services, including 8 within the hospital and 3 involving services across the Greater Manchester region.

The findings from the spinal safety look back review (July 2023) identified learning around the spinal MDT processes. An audit was carried out and this showed only 55% of spinal cases were discussed in MDT before surgery. The surgical services developed a local standard operating procedure (SOP) to outline the improved process for spinal surgery MDT meetings in November 2024.

A review of the revised spinal surgery MDT process was undertaken in May 2025 (covering 52 elective cases between December 2024 and February 2025). This showed only 81% of referred cases had been reviewed in the weekly spinal MDT meeting and 2 further cases had been discussed but there was no documented record of the discussion. The audit also found only 62% of consultant neurosurgeons were present in the MDT. The trust reported that complex spinal neurosurgeons had been formally part of this meeting since June 2025.

Clinical leads and consultants we spoke with told us improvements had been made following the audit, including in the number of cases reviewed, consultant attendance and in relation to administrative support. However, they told us further improvements were still being made to improve consistency, and the revised process had not yet been fully embedded. They told us consultant job plans were being revised to enable better attendance. Orthopaedic spinal cases had not yet been added to the MDT. There were plans to standardise the process for documenting MDT discussions and outcomes and to store meeting minutes in a central location.

Stakeholders also fed back that the spinal MDT process were not yet fully embedded, highlighting shortfalls in consultant attendance, administrative support, radiology input and around making sure MDT outcomes and decisions were robust and clearly documented.

We observed a combined weekly spinal and spinal neurosurgical MDT meeting during the inspection. We found the MDT meeting was well-attended and managed well. Key clinical information was discussed, with microbiology, radiology and oncology input along with a post-operative review of all instrumented spinal cases and a pre-operative review of planned admissions for the following week.

An MDT coordinator arranged the meeting and recorded meeting minutes. The MDT coordinator told us they had started to trial the use of artificial intelligence (AI) technology to support the recording of discussions and outcome reasons.

We saw there was effective daily communication between multidisciplinary teams across the service. Daily staff safety huddles and handover meetings took place to ensure all staff had up-to-date information about risks and concerns.

The ward staff told us they had a good relationship with consultants and ward-based doctors. We saw there was effective team working and communication between the theatre teams, including between surgeons and anaesthetists.

Care records showed there was routine input from nursing and medical staff as well as specialist nurses and allied health professionals in the delivery of people’s care and treatment.

People who used the service did not highlight any concerns about how their care and treatment was coordinated. Most people told us staff worked well together as a team.

Services such as diagnostic imaging, pharmacy, pathology and mental health liaison were available 7 days per week. Physiotherapy and occupational therapy support was available on weekdays and out of hours, with some onsite weekend priorities for respiratory therapist support across all wards, new admissions and discharges.

Most other specialist support services (such as tissue viability, acute pain and speech and language therapy) were available during weekdays with on-call arrangements during out of hours and on weekends.

Staff told us they regularly engaged with teams and services across the trust’s other hospitals to plan and deliver services and share good practice and learning. However, some staff told us they had experienced issues relating to theatre equipment and accessing people’s care records when they had carried out elective surgery at the trust’s other hospitals because systems and processes such as theatre equipment and electronic care records had not yet been standardised across the trust.

Service partners and stakeholders told us staff in the surgical services were responsive and professional. They spoke positively about the way care was coordinated between services and how information was shared with them.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

People who used the service told us they were provided with information around healthier living. Staff told us they routinely discussed health promotion and lifestyle choices with people who used the services.

Health promotion information was displayed on notice boards and in information leaflets that were readily available across the areas we inspected. People could be referred to specialist support with smoking cessation or alcohol or drug abuse.

People identified with weight concerns were given advice on healthy eating and were referred to dietitians or signposted to specialist support services.

We scored the service as 2. The evidence showed some shortfalls. The service did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The surgical services participated in both national and local clinical audits. The surgical specialties at the hospital had been involved in 79 local audits and 21 national clinical audits during the past 12 months. The services also reported outcomes data to databases such as the National Joint Registry (NJR) and the Spine Tango Registry. Clinical leads told us they had also recently started submitting data to the British Spine Registry (BSR).

Findings from clinical audits were reviewed during monthly directorate and divisional governance meetings and any changes to guidance and the impact that it would have on their practice was discussed.

Outcomes for most people who used the service were positive, consistent and met expectations, such as national standards. The national clinical audit findings showed clinical outcomes (such as mortality rates) were within expected ranges across most clinical audits. However, the surgical services failed to meet standards relating to timely access to treatment across most national clinical audits. Whilst we saw evidence actions plans had been put in place to improve audit compliance, these action plans included limited or no details on how the services planned to improve timely access to treatment.

Findings from the national hip fracture database audit, national emergency laparotomy audit, and national joint registry were published at hospital-level.

The 2024 national hip fracture database audit (based on 2023 data) showed the risk-adjusted 30-day mortality rate was within expected ranges when compared nationally.

The hip fracture audit showed 99.4% of people at the hospital were documented as not developing a pressure ulcer, which was within the top 25% of sites nationally, and better than the national average of 92%. However, the audit also showed the hospital was in the bottom 25% of sites nationally for the crude hospital length of stay (days), reporting an average of 29.2 days compared to the national average of 19 days. We saw there was daily ortho-geriatrician presence during weekdays along with the use of enhanced recovery pathways to improve people’s outcomes.

The 2024 national emergency laparotomy audit (NELA) (based on data for period between 2021 and 2023) showed the hospital performed better than national averages for risk adjusted mortality and for most of the audit indicators relating to pre-operative, peri-operative and post-operative care standards. The audit showed the hospital was highlighted as amber (below expected standards) for case ascertainment and for the crude proportion of cases with access to theatres within clinically appropriate time frames.

The national joint registry (2023 data) showed mortality and revision rates for hip and knee replacements at the hospital were within expected ranges. The audit identified poor compliance relating to audit standards for consent rate and time taken to enter data.

The 2023 fracture liaison service database audit (based on 2023 data) showed the hospital performed worse than national average for 7 of the 10 audit standards. Compliance was better than national average for the percentage of non-spine cases identified, spine fractures and falls risk assessment completion. Compliance was significantly worse than national averages for indicators such as assessment within 90 days (11% compared with national average of 64%), strength and balance by 16 weeks (0% compared with national average of 9%) and 16 week follow up (0% compared with national average of 29%).

The 2022 fracture liaison service database audit (based on 2020 data) had also highlighted performance was worse than expected for the proportion of people assessed by the fracture liaison service within 90 days, indicating no significant improvement had been made by the time of the 2023 audit.

Findings from the national bowel cancer audit, the national oesophago-gastric cancer audit, the national prostate cancer audit and the national pancreatic cancer audit (NPaCA) were published at trust level and included data across the trust’s other hospitals.

The trust performed in line with national averages for most audit indicators in the 2025 national bowel cancer audit (based on 2022/23 data), including for adjusted 90-day mortality after major resection.

The trust was identified as an alarm level outlier in 2025 national bowel cancer audit for the proportion of service users with an 18-month unclosed ileostomy after anterior resection. An ileostomy is a surgical procedure where the small intestine is brought through an opening in the abdomen to create a stoma, an opening on the surface of the skin. The clinical audit leads told us 14 of 23 people who had undergone the procedure at this hospital had a closed ileostomy within 18 months. They told us the 9 remaining service users included those who could not undergo further treatment due to health concerns and those who chose to wait longer to have the treatment with their preferred surgeon.

The 2025 national oesophago-gastric cancer audit (based on data for the period between 2021 and 2023) showed the trust performed better than the national average for adjusted 90-day and 1-year postoperative survival rates. However, the trust compliance was worse than national average for the percentage of people diagnosed with unknown stage (6% compared with national average of 17%) and for the percentage of those having disease-targeted treatment who were treated within 62 days of urgent GP referral (6% compared with national average of 26%).

In the national prostate cancer audit 2023 report, 89.4% of men had complete information to determine disease status, which did not meet the national standard of 100% but was better than the national average of 75.6%. The trust was not eligible for any of the other metrics reported within the audit.

The 2024 national pancreatic cancer audit (NPaCA) (based on 2021/22 data) showed the trust was in line with national averages for standards relating to people receiving disease-targeted treatment and supportive care, adjusted survival rates and for the proportion of cases discussed at multidisciplinary meetings. However, the audit showed poor compliance below national average for waiting times from referral to diagnosis or treatment and for the proportion of people seen by a clinical nurse specialist (18% compared with England average of 46%). An action plan had been put in place to improve clinical nurse specialist support.

Patient recorded outcome measures (PROMS) data during April 2023 to March 2024 showed that people receiving knee surgery at the trust were more likely to have better outcomes for their health compared to other trusts, but those receiving hip surgery may not have as favourable outcomes.

We scored the service as 2. The evidence showed some shortfalls. The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Staff followed trust policies around consent and understood how to obtain informed verbal and written consent from people before providing care or treatment. People who used the service told us staff explained what they were doing and asked for their consent before delivering care and treatment.

The consent policy provided guidance for staff on how to obtain consent for care and treatment for adults and from young people aged 16 or over who received treatment in an adult healthcare setting. Staff we spoke with understood how to seek consent from young people using the Gillick competence when required.

Care records we looked at showed that written consent had been obtained from people who used the service and planned care and treatment was delivered with their agreement. Consent records showed the risks and benefits of the specified surgical procedures were clearly documented and had been explained to people.

A consent and operation note audit was undertaken in 2024 based on 91 emergency consent procedures and 142 elective surgery procedures across the hospital. The audit showed high levels of compliance (99%) relating to documenting risks and benefits of the procedure and consent forms being signed by staff and service users. The audit also identified areas for improvement relating to staff recording their name and job title and documenting if written information had been provided. Audit findings had been shared with staff to aid learning and improvement.

Staff had policies in place and received training in the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) as part of their mandatory safeguarding training.

The nursing and medical staff were trained to carry out mental capacity assessments to determine if a person had the capacity to make their own decisions. People identified with post-operative confusion or delirium were also assessed by the medical staff.

Staff told us they could seek support and guidance around consent, mental capacity and best interest decision making processes from the hospital-wide safeguarding team.

The trust’s enhanced patient observation (EPO) policy provided guidance for staff on assessing and monitoring people identified at risk of harm. The policy stated that enhanced observation was regarded as a restriction or deprivation of liberty, a capacity assessment would be required if a person lacked the capacity to consent to stay in hospital, and a DoLS authorisation would need to be considered.

We looked at 5 enhanced observation care records, which showed capacity assessments had been completed, and multidisciplinary best interest meetings and decisions had been documented. However, two of the care records we looked at did not include DoLS authorisations or a documented rationale for why this was not required.

The hospital’s quality assurance (QAA) audit standard 26 related to the completion of EPO documentation, including mental capacity, behavioural charts, EPO risk assessments and care plans. The surgical wards only achieved overall compliance of 34% between June 2024 and September 2025. This was below the compliance target of 80% and demonstrated poor staff compliance.

The surgical wards also achieved overall compliance of 67% for QAA audit standard 27 (relating to DoLS applications being completed and reviewed) during this period.

The service reported they had developed additional training for staff in order to improve QAA audit compliance relating to mental capacity and DoLS standards as part of the 8 priority improvement workstreams (8P’s).