Salford Royal Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

Our rating of responsive stayed the same. We rated responsive as requires improvement. This meant people’s needs were not always met.

Care plans for people living with dementia or a learning disability were not always person-centred or reflected their needs and preferences.

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 people were not in line with national standards. There was a deteriorating trend in service performance relating to average length of stay, readmission rates and referral to treatment waiting times. Theatre efficiency and performance was consistently below trust targets.

However, the services took account of inequalities and people’s future care plans and made it easy for people to give feedback about their experiences.

We have not awarded this service a score for Responsive.

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

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Staff told us they assessed people’s clinical and personal needs with their involvement and developed care plans based on their individual needs and preferences.

The electronic records included standardised care plan templates for staff to select and complete when required. This included 17 core care plans, including for pain, mobility, falls, bed rails, pressure care, nutrition and hydration and enhanced patient observations (EPO’s). Staff could also access 12 additional care plans specific for surgical services, including for pre and post-operative management, seizures, post-surgical patient-controlled analgesia and surgical wound healing.

The care plan templates included pre-populated generic prompts for staff to follow as part of a person’s plan of care. For example, the EPO care plan provided prompts for staff around frequency of observations, completion of behaviour charts and intentional rounding and around completing traffic light passports. Hospital passports are designed to help service users and their families communicate their needs to doctors, nurses and other healthcare professionals.

The electronic record system did not include standalone care plan templates specifically relating to people living with dementia or a learning disability or for reasonable adjustments. We found some aspects of care planning for these had been incorporated into the EPO care plan and some generic dementia care prompts (such as use of blue wristbands) had been incorporated into the falls prevention care plan.

The care records we looked at showed evidence of person-centred care planning in areas such as personal hygiene, oral care, pressure care, mobility, epilepsy (seizures) and nutrition and hydration (including for nasogastric feeding). However, we also found shortfalls in care planning records relating to people living with dementia or a learning disability.

We looked at the care records for 3 people living with dementia or a learning disability. We found EPO care plans had been put in place and this included generic prompts for staff to complete hospital passports and involve relatives or carers in discussions about their care. However, the care records and daily notes entries had limited information about discussions with relatives or carers, and we found hospital passports had only been completed in 2 of the 3 records we looked at.

Staff were able to verbally articulate how they provided person-centred for these service users, including reasonable adjustments that had been put in place to support them. However, this information had not been clearly documented in the records we looked at.

The care plan records included additional free text sections where staff could record additional person-specific care prompts and actions. However, we found limited instances where staff had recorded additional information in addition to the generic pre-populated prompts.

The hospital’s quality assurance (QAA) audit standard 25 related to evidence of bed board magnet, blue wristband, orientation and distraction aids in place. Abbey pain score in use and completed 4 times daily, passport of care completed within 48 hours of admission and care plan also activated. The surgical wards achieved overall compliance of 13% between June 2024 and September 2025. This was below the compliance target of 80% and demonstrated significantly poor compliance against this audit standard.

The surgical wards also achieved poor overall compliance of 45% for QAA audit standard 74 (relating to evidence of ‘what matters to me’ discussions taking place and staff acting on this information) during this period.

We found some of the surgical wards had dementia-friendly signage and dementia clocks in place. We also saw trauma activity trollies and dementia activity boxes were in place to provide distraction if people with cognitive impairment or confusion became agitated.

We scored the service as 2. The evidence showed some shortfalls. There were some shortfalls in how the service understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Staff were aware of how to escalate key risks that could affect the delivery of care and treatment. Daily bed management meetings took place to monitor and maintain access and flow and to identify and resolve any issues relating to admissions or discharges. Most people we spoke told us their care was well coordinated.

There was a full capacity protocol in place that provided guidance on escalation during busy periods. Ward H7 (neurosurgery ward) had 4 additional escalation beds for admitting people when existing bed capacity had been exceeded.

The average monthly bed occupancy rate across all the surgical wards at the hospital ranged between 92% and 96% between October 2024 and September 2025. This was reflected in our inspection as we found most surgical wards were at full capacity. National guidelines state bed occupancy levels above 85% can impact negatively on the delivery of safe care and treatment.

The average theatre utilisation (efficiency) across all surgical specialties at this hospital was 72% between October 2024 and September 2025. This was below the hospital’s target of 85%. The monthly performance trend remained stable (ranging between 70% and 74%), which showed there had not been any significant improvements made in overall theatre efficiency during this 12 month period.

There had been 653 operations cancelled for non-clinical reasons on the day of surgery between October 2024 and September 2025. The most frequent reasons for cancellations included list overruns due to the complexity of procedures, administrative / booking errors and unavailability of clinical staff. There had also been 139 operations cancelled on the day of surgery for clinical reasons, such as changes in people’s acute medical condition or the procedure deemed no longer necessary, during this period.

The proportion of people not treated within 28 days of a non-clinical cancellation across the trust was similar to other trusts during the period between April 2025 and September 2025.

Actions taken to reduce the impact of cancelled operations included sending appointment reminders to service users, utilising the golden patient initiative (pre-selecting and pre-preparing the first person on the theatre list) and identifying a backup (standby) person on theatre lists. The hospital reported weekly planning meetings were undertaken to review theatre efficiency and reduce cancelled operations. Monthly trust-wide cancellation meetings also took place to identify themes and share best practice learning across the trust’s hospitals.

A trust-wide review of theatre session delivery and standardisation was also underway which aimed to improve theatre efficiency and reduce cancelled operations.

Most areas we inspected were compliant with mixed-sex accommodation guidelines. However, we found a female service user admitted to ward B2 (male general surgical ward). Whilst they had been placed in a side room, we saw some male service users on the ward were mobile. Staff told us there had been occasions where they were unable to comply with mixed-sex accommodation guidelines on the ward due to bed capacity issues. The surgical services reported 19 mixed-sex accommodation breaches between October 2024 and September 2025, of which 18 related to ward B2.

The surgical wards we visited did not include significant numbers of medical outliers. However, we found people from some surgical specialties (such as general surgery, urology and trauma and orthopaedics) had been placed across a number of surgical wards, mainly due to bed capacity constraints.

The medical staff in each surgical specialty area received daily information on the location of service users and we did not identify any instances where service users had not had a medical review. We saw medical ward rounds on some wards being carried out by different teams of doctors because the wards had mixed-specialty service users. The services planned to reconfigure some of the surgical wards as part of the hospitals flow improvement programme. This included proposals for dedicated wards for specialties, such as gynaecology and urology.

There was a dedicated emergency 24 hour surgery theatre in the main theatres and 4 emergency trauma theatres in the Greater Manchester Major Trauma Hospital (T block) facility. The emergency trauma theatres could be accessed by lift, and the facility also had a helipad on the roof.

The neuro short stay unit (NSSU) was an 18 bedded male and female elective spinal / neurosurgery ward, which included a 2 bedded spinal and neurosurgical ambulatory care unit (SNACU). The SNACU was overseen by advanced care practitioners and consultant physios and was used to avoid accident and emergency admissions. The unit mainly admitted post-operative spinal and neurosurgery service users within 30 days of their discharge for minor complications, wound care and antimicrobial treatment.

The surgical triage unit (STU) had been relocated to the Greater Manchester Major Trauma Hospital (T block). The surgical same day emergency care unit (SSDEC) was located next to, and staffed by, the STU staff. GP referrals or people attending A&E that required same day surgical care were referred to the SSDEC area. We saw people in SSDEC area had been seen in a timely manner during our inspection. However, STU staff told us there had been instances where service users had waited in the SSDEC area all day and had not been seen, which meant they needed admission overnight.

The surgical services had an in-sourcing contractual arrangement with an external service provider to carry out surgical procedures, as part of the trust measures to reduce waiting times. The arrangement covered specified surgical procedures relating to the ENT, urology, gynaecology and orthopaedics specialties.

Service partners told us service users with increasing complex health and social needs impacted on discharge pathways and that discharge summaries from the surgical services varied in the level of information they included. They told us discharge planning was generally good but there had been some instances of errors or issues when people had been transferred from hospital to community services.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff told us they provided people with relevant information and discussed this with them, so they were well informed about their care and treatment. Most people we spoke with told us staff provided them with the necessary information about their surgery and that staff answered any questions they had.

We saw notice boards across the surgical wards and theatres that included information for staff and people who used the service. Information leaflets were readily available. Information leaflets could be provided in different languages or other formats, such as braille or easy read format, if required. People could also access information about the surgical services on the trust’s website.

People who used the service received information verbally and in writing before and after their surgery. Staff could access interpreter and sign language services for people who needed it when required.

Information around performance, safety incidents, audits and complaints was shared with staff during daily huddles and routine staff meetings.

Information such as policies and guidelines were available in paper and electronic format. Paper records were held securely, and electronic care records were easily accessible by staff and kept secure with password-protected access. Staff told us they could easily access information such as care records, policies and guidance relevant to their role.

Most staff (92%) had completed mandatory training, information governance and data security. There had been no information commissioner’s office (ICO) reportable data breaches relating to the surgical services in the past 12 months.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

People who used the service told us they knew how to raise a complaint or concern. Staff understood the policy on complaints and knew how to handle them. They told us information about complaints was discussed and learning shared through daily huddles, handovers and routine staff meetings.

The complaints policy stated that routine formal complaints would be investigated and responded to within 25 working days, where this was not possible (such as for complex complaint investigations), staff could agree a longer time period with the complainant.

People who used the service were given information on how to escalate their concerns internally in the trust or to external organisations such as the Parliamentary and Health Service Ombudsman.

There had been 203 complaints received by the surgical services at this hospital between October 2024 and October 2025. The most frequent reasons for complaints related to clinical treatment, including treatment delays and inappropriate care (75 complaints), communication with people (31 complaints) and complaints about waiting times (20 complaints).

Staff across the surgical services told us they routinely engaged with people who used the service and families to gain their feedback. This was done informally through daily engagement and formally through participation in surveys, such as the NHS friends and family test.

Friends and family test survey data between April 2025 and September 2025 showed most wards achieved compliance above the 91% trust compliance standard, indicating most people were positive about their experience of the surgical services.

The surgical wards also monitored people’s experiences as part of the observe, listen and act (OLA) assessments. Most surgical wards were scored as green, indicating they had achieved expected compliance against the OLA assessment standards.

Managers told us they reviewed complaints, compliments and feedback from surveys to aid learning and improvement. Staff were able to give examples of improvements made following people’s feedback, such as improving communication with people. We also saw learning from people’s feedback was displayed on ‘you said, we did’ notice boards in the areas we inspected.

We scored the service as 1. The evidence showed significant shortfalls. The service did not make sure that people could access the care, support and treatment they needed when they needed it.

We identified a regulatory breach around timely access to services during our previous inspection in December 2022. We reported the service must continue to monitor and take appropriate actions to improve average length of stay, readmission rates and referral to treatment waiting time performance in line with national standards.

The proportion of people who had waited less than 18 weeks from referral to treatment (RTT) across the surgical services was 53.1% in September 2025. This was worse that than the national average (61.8%) for September 2025 and worse than the NHS operational standard of 92%. The average monthly RTT compliance between October 2024 and September 2025 across the surgical services ranged between 51.7% and 55.6%.

Data for September 2025 showed there were 30 people who had waited for treatment longer than 65 weeks. The number of people waiting over 18 weeks had increased from 14,741 in October 2024 to 16,364 in September 2025. The number of people waiting over 52 weeks had increased from 1,409 in October 2024 to 1,781 in September 2025, indicating a worsening trend in 18-week and 52-week waiting time performance.

Managers told us RTT performance was reviewed weekly to identify any impact to service users. Each surgical specialty had recovery plans in place to improve RTT performance. Recovery plans included actions such as improving access, improving booking and scheduling processes and utilising patient-initiated follow up (PIFU) initiatives. The recovery plans we looked at showed most surgical specialties had consistently failed to meet monthly recovery plan trajectories during April to September 2025.

The overall average percentage of people readmitted following discharge from the surgical services was 6.6% between September 2024 and August 2025.

The monthly trend data showed readmission rates across the surgical services had increased (worsened) over time during this 12 month period, from an overall average of 5.9% in September 2024 to an average of 7.1% in August 2025. This worsening trend was also reflected in the readmission data across most of the surgical specialties.

The overall average length of stay across all the surgical services at the hospital was 5.7 days between October 2024 and September 2025.

The monthly data trend showed average length of stay across the surgical services had gradually decreased (improved) over the 12 month period for most of the surgical specialties, except for the urology, upper gastrointestinal and ear, nose and throat (ENT) specialities, for which average length of stay had increased during this period.

The hospital reported 122 super stranded service users (those who had stayed in hospital for 21 days or longer) in July 2025, compared with 108 in July 2024 in the Manchester Centre of Clinical Neurosciences (MCCN) division. This was due to people with complex needs such as those with tracheostomy care and those awaiting repatriation back to their local hospital.

There had also been 54 super stranded service users in the division of surgery in July 2025, compared with 39 in July 2024. The hospital reported this had been the highest number of super stranded people in the division of surgery compared to every month for the previous year up to July 2025.

The surgical services aimed to reduce the average length of stay compared to 2023/24 as part of the hospital-wide planned and acute care enhancement programme (PACE).

The surgical services did not consistently achieve compliance against national standards across most cancer types for 31-day and 62-day cancer treatments between September 2024 and August 2025. This included poor compliance in specialties such as gynaecology, head and neck and lower gastrointestinal specialties against the 62-day standard. However, the trust reported 31-day cancer treatment performance was better than national average in 9 of the 12 months between September 2024 and August 2025 and 61-day cancer treatment performance was better than national average all 12 months during this period. An action plan was in place to monitor and improve compliance.

The average time taken to discharge people across all the surgical services after the decision to discharge had been made was 1.8 days between October 2024 and September 2025. The average was 3.5 days for trauma and orthopaedics and 2.9 days for spinal surgery. The month to month trend showed there had not been any significant improvement or deterioration in the time taken to discharge people during this period.

The surgical services planned to roll out a criteria-led discharge process during September 2025 to improve discharge processes across a number of specialties, including neurosurgery, orthopaedics, gynaecology, urology and plastics.

Care records showed discharge planning took place at an early stage. Complex discharges included involvement from community teams and social workers to ensure continuity of care.

An audit of discharge summary documentation in the orthopaedics specialty was undertaken in May 2025 to assess compliance against NICE guideline NG27 (transition between inpatient hospital settings and community or care home settings for adults with social care needs).

The audit identified poor compliance in all 9 audit standards relating to the completeness of discharge summary documentation. Compliance ranged between 0% to 44% compared with the 95% standard. An action plan had been put in place to increase education of guidelines regarding discharge documentation by making a poster and emailing information directly to individuals.

The services reported there had been 538 instances where people did not attend (DNA) inpatient appointments between October 2024 and September 2025. The surgical specialty recovery plans included actions relating to improving DNA rates.

People who used the service could be admitted for surgical treatments through a number of routes, such as pre-planned day surgery, through accident and emergency or through GP referral. The surgical services also admitted referrals from other healthcare providers for major trauma, neurosurgery and complex spinal surgery.

Most people we spoke with told us they were kept informed about their surgery, including when they were likely to be discharged. Some people on the surgical wards told us they had waited over a year for admission for surgery since their initial referral. We did not observe any significant delays relating to the admission, transfer or discharge of people in the surgical wards and theatres.

Staff told us the provision of specialist major trauma, spinal and neurosurgery services meant they routinely admitted a higher proportion of people with more complex needs that required a longer hospital stay. Where people had experienced delays or had an extended length of hospital stay, staff were able to clearly explain the reason for the delay and the actions they had taken to resolve this.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff followed the trust’s equality policy, which outlined a commitment to recognise diversity, promote equal opportunities and support human rights in the provision of health services. New and existing policies and procedures included equality impact assessments.

Staff were able to describe the processes for embedding equity including how they ensured they did not discriminate, including on the grounds of protected characteristics under the Equality Act, when making care and treatment decisions. Most people we spoke with told us their needs and preferences were assessed, and they had been treated with equality and in a non-discriminatory way.

Most staff (97.5%) across the surgical services had completed mandatory training in equality, diversity and human rights. Staff were able to give examples of how they respected the individual wishes of people with protected characteristics, such as those with a disability or mental health disorder, those identifying as LGBTQ+ and people with communication or language difficulties.

The surgical services had a good understanding of the challenges faced by the services due to an increased level of deprivation and health inequalities among the local population. The services had been involved in clinical studies that concluded ethnicity and socio-economic factors impacted length of stay for cervical decompression and cranial meningioma resection procedures.

We looked at data around incidents, feedback from people who used the service and complaints, and this did not identify any disparity in care experiences, adverse outcomes or inequalities for people with protected characteristics.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People who used the service told us the staff discussed their care and treatment plans, expectations and outcomes with them and their preferences were taken into account. Staff told us they planned and discussed care and treatment plans, including discharge arrangements, on admission to the service.

People who used the service were followed up after their discharge from the hospital and post-operative follow up care and treatment was provided through outpatient appointments. People discharged following neurosurgery could also referred to acute and intermediate neuro rehabilitation services.

Staff told us they could seek advice and guidance from the hospital’s specialist palliative care team, including for bereavement and counselling support. A multi-faith chaplaincy service was available for spiritual or religious support to people of all faiths and beliefs.

Staff were able to describe how they could utilise advanced care plans for palliative and end of life care. We looked at the care records for a person receiving palliative care. This included a detailed assessment involving the service user and their relatives, ward staff and specialist palliative care team nurses. Care plans had been put in place taking into account the person’s individual needs and preferences, including preferred place of death and spiritual needs.

We looked at 3 care records for people where do not attempt cardiopulmonary resuscitation (DNACPR) decisions had been made. These were all current, complete and showed involvement from the person or their relatives or carers had been documented.

Data from a trust-wide DNACPR documentation review showed audit results for 61 service user records for people with a DNACPR in place within Salford Care Organisation in September 2024. The results showed Salford Care Organisation was rated green (over 95% compliance) for 10 out of 19 metrics, 8 metrics were rated amber (60-94.9%). The final metric related to the provision of a DNACPR leaflet, the Salford Care Organisation’s compliance for this metric was 10%.