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.

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 had not been any significant performance improvements around patient length of stay, readmissions following surgery and around patient discharge processes.

Theatre efficiency and performance was below trust targets. Complaints were not always resolved in the timelines specified by trust policies. Do not attempt cardiopulmonary resuscitation records were not always consistently managed across the surgical wards.

However, the service provided relevant information and made it easy for patients to give feedback about their experiences. Staff delivered patient-centred care that reflected patients’ needs and preferences.

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 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff told us they provided care based on patients’ individual needs and preferences. Patients and relatives told us staff kept them involved in decisions about their care and delivered care and treatment in a way that met their needs and preferences.

We identified a regulatory breach during our previous inspection in September 2025, where we found shortfalls in person-centred care planning. We found improvements had been made during this inspection. We observed care and looked at the care records for 6 patients with enhanced care needs, including those living with dementia or a learning disability. We saw patients received appropriate care and treatment and staff interacted with patients in a positive way. In most cases, we saw staff demonstrate a good understanding of patients’ needs and provided appropriate care and treatment.

The care records we looked at showed care plans were person-centred, complete and up to date, and daily notes entries included information about discussions with patients and their relatives or carers. Most of the generic care plan records we looked at showed additional free text sections where staff could record additional person-specific care prompts and actions were completed to a good standard. Most of the records we looked at included ‘this is me’ hospital passports which included patient’s preferences.

During June 2024 to September 2025, the surgical wards achieved overall compliance of 13% for hospital’s quality assurance (QAA) audit standard 25 (relating to use of bed board magnets, blue wristbands and completing passports of care).

QAA audit records between February 2026 and May 2026 showed improved compliance. The surgical wards achieved 63% compliance around completion of ‘this is me’ passport documents, 83% compliance for appropriate patients wearing a blue wristband and 73% compliance for patients with a cognitive impairment having the correct alert symbol ticked on their bed board.

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.

During our previous inspection in September 2025, we identified shortfalls in the way surgical services were configured and delivered. We found significant improvements had not been made during this inspection.

The average monthly bed occupancy rate across all the surgical wards at the hospital ranged between 92.7% and 96.7% between September 2025 and May 2026. This was similar to the bed occupancy rates reported during our previous inspection. We found most surgical wards were at full capacity during the inspection. 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 73.4% between September 2025 and May 2026. This was below the hospital’s target of 85%. The monthly performance trend remained stable (ranging between 72% and 74%) during this period. There had been a slight improvement in performance since our previous inspection, where we reported average theatre utilisation was 72% between October 2024 and September 2025.

There was a theatre improvement programme in place with weekly progress meetings taking place. Managers told us the programme was focussed on improving pre-operative assessment processes and theatre utilisation.

There had been 501 operations cancelled for non-clinical reasons on the day of surgery between September 2025 and May 2026. The most frequent reasons for cancellations included list overruns due to the complexity of procedures (115) and unavailable ward beds (105). There had also been 198 operations cancelled on the day of surgery for clinical reasons during this period. These included procedures deemed no longer necessary (60 cancellations), surgery or treatment was deferred (49 cancellations) and 6 cancellations due to inadequate preoperative assessments. There had not been any significant reduction in the number of operations cancelled since our previous inspection, where we reported 653 operations cancelled for non-clinical reasons and 139 cancellations for clinical reasons on the day of surgery between October 2024 and September 2025.

The electronic patient records and theatre management systems had not yet been fully aligned across the trust’s hospitals, which meant staff relied on paper records for information such as pre-operative assessments when undertaking surgery at different hospitals. Staff reported there had been instances where these records had not been made available or were incomplete, leading to delays or cancellations. An electronic pre-operative assessment record had been implemented across the trust to standardise information.

During staff focus groups, theatres and medical staff told us the electronic pre-operative assessment record did not always include all the relevant information and this had led to procedure cancellations on the day of surgery. They also told us there had been a reduction of personnel in the pre-operative assessment team and this had led to increased delays and cancellations.

Staff told us the electronic theatre management system did not currently enable patients to be booked for pre-operative assessment without being listed for surgery first. This had led to instances where procedures had been cancelled for clinical reasons on the day of surgery because listed patients had since had a pre-operative assessment and were not suitable for surgery. This had been identified as a risk by the trust and there was a system upgrade planned to resolve this issue.

During our focus group of gynaecology staff, the medical staff told us about ongoing challenges with scheduling elective procedures and last-minute cancellations of theatre lists due to staffing, inappropriate scheduling and not managing staffing rotas properly.

Theatres and medical staff told us there was a shortage of staff in the booking and scheduling teams across the surgical services. Managers told us they had trained additional administrative staff to undertake booking and scheduling tasks. They were also in the process of applying for funding to recruit additional booking staff in specialties such as gynaecology, in order to improve wait times performance and reduce procedure cancellations.

Managers told us funding had been agreed for additional administrative support to validate patients at pre-operative assessment, but further resource was required to improve booking and scheduling processes and to reduce procedure cancellations due to patients being unsuitable or inappropriately listed for surgery.

Most areas we inspected were compliant with mixed-sex accommodation guidelines. The surgical services reported 15 mixed-sex accommodation breaches between September 2025 and January 2026, of which 14 related to ward B2 (male general surgical ward). Staff told us mixed-sex accommodation guidelines were breached due to bed capacity issues and they tried to place patients in side rooms to reduce privacy and dignity risks. There had not been any significant improvements around reducing mixed-sex accommodation breaches on ward B2 since our last inspection, where 19 mixed-sex accommodation breaches had been reported between October 2024 and September 2025, including 18 related to ward B2.

The surgical wards we inspected did not include significant numbers of medical outlier patients. However, we found patients 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.

Most wards operated as mixed-specialty wards, which meant patients from a range of surgical specialties could be admitted to multiple wards. The surgical services had recently commenced ward reconfiguration activities as part of the hospital’s bed reconfiguration proposal and ‘right care, right place’ plan. This included plans to reconfigure an existing orthopaedic ward (ward B6) as a dedicated geriatric orthopaedic ward with 18 beds and plans to open a new dedicated 24-bedded trauma and orthopaedic specialty ward (ward T6). The reconfiguration proposal included plans to move ward B2M to ward B5 once refurbishment work had been completed with improved facilities for monitored patients. The services also planned to reconfigure wards B1, B2, STU and H4 as dedicated general surgical wards with clearly defined specialties. The reconfiguration proposal identified the proposed changes would lead to a 3% reduction in bed days, eliminate trauma and orthopaedic outliers across surgical wards and lead to improved flow and reduced cancelled operations.

The hospital did not have a dedicated gynaecology ward. Gynaecology patients were mainly admitted to ward H4 (general surgery) but elective gynaecology could be admitted to other surgical wards. We found gynaecology patients had been admitted to wards H4 and B1 (female general surgery) during this inspection.

We saw medical ward rounds on most wards being carried out by different teams of doctors because the wards had mixed-specialty patients. The medical staff in each surgical specialty area received daily information on the location of patients and we did not identify any instances where patients had not been reviewed by a doctor.

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 surgical same day emergency care unit (SSDEC) was located next to, and staffed by, the surgical triage unit (STU). GP referrals or patients attending A&E that required same day surgical care were referred to the SSDEC area. There had been 3 incidents reported relating to patients remaining in the SSDEC after the closure time of 11.30pm between September 2025 and May 2026. Incident records showed the patients had transferred to an inpatient ward but had remained in unstaffed areas for a short period of time before they were transferred.

There had not been any incidents reported related to patients being kept overnight in theatre recovery between September 2025 and May 2026. The service reported the hospital site capacity team managed patients to prioritise and allocate beds where patients were in theatres 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.

We received mixed feedback from service partners and stakeholders. Some service partners gave positive feedback about the way care and treatment was coordinated between services. However, other service partners and stakeholders described the significant challenges across the surgical services impacted care provision due to capacity constraints and staffing culture issues.

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 patients and their relatives or carers with relevant information and discussed this with them, so they were well informed about their care and treatment. Most patients and relatives we spoke with told us they had been given suitable information about their care and treatment and that they received regular updates about their care and treatment.

We saw notice boards across the surgical wards and theatres that included information for staff, patients and visitors. Staff used electronic and traditional information boards, which included information about patient’s care, risks, and around access and flow. These were kept up to date in most areas we inspected.

Information leaflets were readily available and could be provided in different languages or other formats, such as braille or easy read format, if required. Patients could also access information about the surgical services on the trust’s website. Patients received information verbally and in writing before and after their surgery. Staff could access interpreter and sign language services for patients who needed it when required.

Information around performance, safety incidents, audits and complaints was shared with staff during daily huddles and routine staff meetings. Performance data was routinely collated and presented in performance dashboards.

Information such as policies and guidelines were available in paper and electronic format. Paper records were held securely, and electronic 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. The staff we spoke did not identify any concerns relating to accessing information technology (IT) systems or any connectivity issues.

Most staff (92%) had completed mandatory training in information governance and data security. There had been no information commissioner’s office (ICO) reportable data breaches relating to the surgical services at this hospital between September 2025 and May 2026.

We scored the service as 2. The evidence showed some shortfalls. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. However, complaints were not always resolved in the timelines specified by trust policies.

Patients 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. The complaints policy included information on how to escalate their concerns internally within the trust or to external organisations such as the Parliamentary and Health Service Ombudsman.

There had been 240 complaints received by the surgical services at this hospital between September 2025 and May 2026. The most frequent reasons for complaints related to clinical treatment, including treatment delays and inappropriate care (51 complaints) and communication with patients (40 complaints). Records showed the time taken to resolve complaints ranged between 1 month and 6 months during this period, which meant complaints were not always resolved in the timelines specified in the trust’s complaints policy.

There had been an increase in the number of complaints received by the surgical services, with 240 complaints raised during September-May 2026, compared with 203 complaints between October 2024 and October 2025.

Staff told us they routinely engaged with patients 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 between September 2025 and May 2026 showed the average score across the surgical wards and theatres was 91%, indicating most patients were positive about their experience of the surgical services.

The surgical wards also monitored patient experience as part of the observe, listen and act (OLA) assessments. OLA assessments undertaken between September 2025 and May 2026 showed most surgical wards had been rated as green, indicating they had achieved expected compliance against the OLA assessment standards.

Feedback from complaints, compliments and feedback from surveys was routinely reviewed by managers and shared with staff to aid learning and improvement. We saw learning from feedback was shared during daily huddles and information and learning from patient feedback was also 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 September 2025. 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.

During this inspection, we found there had been some improvements made around waiting times performance for referral to treatment pathways and some cancer pathways. However, there had not been any significant improvement relating to patient length of stay, readmissions following surgery and around patient discharge processes.

The proportion of patients who had waited less than 18 weeks from referral to treatment (RTT) across the surgical services was 58.4% in April 2026. This was worse that than the national average (65%) for April 2026 and worse than the NHS operational standard of 92%.

The average monthly RTT compliance between September 2025 and April 2026 across the surgical services ranged between 53.1% and 59.4%. The data showed RTT performance had improved since our previous inspection, with sustained monthly improvement in performance during this period. The improvement trajectory followed national trends but overall compliance was still below national averages throughout this period.

Performance data for April 2026 showed there had been 23 patients waiting for treatment longer than 65 weeks. This had improved from 30 patients in September 2025. The number of patients waiting over 18 weeks had decreased from 16,364 in September 2025 to 13,426 in April 2026. The number of patients waiting over 52 weeks had also decreased from 1,563 in September 2025 to 1,286 in April 2026, indicating an improving trend in 18-week and 52-week waiting time performance.

Managers reviewed RTT performance on a weekly basis to identify and manage any impact to patients. Elective recovery plans were in place and performance was reviewed during routine meetings across the surgical specialties and clinical service groups.

The neuroscience and major trauma care group 2026/27 elective access and recovery targets plan outlined planned improvements which aimed to achieve 67% RTT compliance for patients waiting less than 18 weeks. As part of the improvement plan, there had been a targeted increase in procedures undertaken during February and March 2026, through insourcing, outsourcing and waiting list initiatives. The care group reported RTT performance improved from 52% compliance in January 2026 to 59% in March 2026.

The overall average percentage of patients readmitted following discharge from the surgical services was 7.8% between September 2025 and April 2026. The data showed patient readmission rates were highest in the general surgery (13.7%) and gynaecology (12.2%) specialties during this period. During our previous inspection we reported the overall average patient readmission rate between September 2024 and August 2025 was 6.6%, indicating a decline in performance since the previous inspection.

The overall average length of stay across all the surgical services at this hospital was 5.9 days between September 2025 and May 2026. The average length of stay was 4.9 days for elective admissions and 5.9 days for non-elective admissions.

There had not been any significant improvement in average length of stay performance since our previous inspection, where we reported the overall average length of stay across the surgical services was 5.7 days between October 2024 and September 2025.

During our previous inspection we reported 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.

During this inspection we found most specialties demonstrated good compliance against the 31-day and 62-day cancer wait time standards between September 2025 and March 2026. However, performance against the 62-day standard for the gynaecology, head and neck and lower gastrointestinal specialties remained below expected levels during this period, indicating significant improvement had not been made across these specialities since our previous inspection.

The surgical services reported there had been 361 instances where patients did not attend (DNA) inpatient procedures or appointments between September 2025 and May 2026.

The average time taken to discharge patients across all the surgical services after the decision to discharge had been made was 2.6 days between September 2025 and May 2026. The average was 6.3 days for trauma and orthopaedics and 5 days for spinal surgery.

Performance across the surgical services had declined since our previous inspection in September 2025, where we reported the overall average time to discharge patients was 1.8 days between October 2024 and September 2025 and the average was 3.5 days for trauma and orthopaedics and 2.9 days for spinal surgery.

The surgical services had reported a criteria-led discharge process was implemented during September 2025, however this had not led to significant improvements in discharge processes. Whilst most wards held daily meetings involving nursing, pharmacy staff and flow coordinators to discuss patient admission, flow and discharges, medical staff did not routinely attend these meeting across most of the wards we inspected.

Patients 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.

There had been 10,555 surgical procedures undertaken at this hospital between September 2025 and May 2026. The most frequent surgical procedures carried out were for trauma and orthopaedics (2,263) and neurosurgery (2,063). Approximately 75% of all surgery carried out during this period was for elective procedures. Records showed there had been 319 surgical procedures undertaken by the gynaecology service at this hospital between September 2025 and May 2026. Most (78%) of these were elective surgical procedures.

We did not observe any significant delays relating to the admission, transfer or discharge of people in the surgical wards and theatres. Most patients we spoke with told us they had received timely care and treatment and that staff kept informed about their surgery, including when they were likely to be discharged. The care records we looked at also showed discharge checklists were completed by staff.

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.

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 patients we spoke with told us they had been treated with equality and in a non-discriminatory way.

Most staff (96.7%) 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 patients with protected characteristics, such as those with a disability or mental health disorder, those identifying as LGBTQ+ and patients with communication or language difficulties.

The surgical services had a good understanding of the challenges faced by the communities they served due to an increased level of deprivation and health inequalities among the local population. The services had analysed a number of indicators such as referral to treatment wait times, procedure cancellations, DNA (did not attend appointment) rate and patient initiated follow up (PIFU) rates using the index of disparity tool.

The index of disparity reports from May 2026 for spinal surgery, gynaecology and spinal surgery identified disparities by age and ethnicity for 2 indicators (DNA rates and PIFU utilisation rates). The analysis showed there were no significant disparities in the other indicators relating to the surgical services at this hospital.

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 2. The evidence showed some shortfalls. 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. However, we found inconsistencies in staff practice around the management of do not attempt cardiopulmonary resuscitation records.

We identified inconsistent practices across the surgical wards in relation to the management of do not attempt cardiopulmonary resuscitation (DNACPR) records.

On ward T4 (trauma ward) we found a DNACPR form had not been fully completed to reflect who had been involved in discussion because the patient lacked capacity. This DNACPR form had been updated by a consultant to accompany the patient when they were discharged. The patient’s care records showed an existing DNACPR form was already in place from when the patient was admitted to the hospital, but some of the information in the updated DNACPR form differed from the existing form. We also looked at the records for 2 other patients on the ward. Whilst the electronic records showed a DNACPR discussion had been completed, a paper DNACPR was not present in the care records. We highlighted this to senior staff during the inspection.

We also looked at 4 DNACPR forms across the other surgical wards. These were all current, complete and showed involvement from the patient or their relatives or carers had been documented.

Data from the most recent annual trust-wide DNACPR documentation audit showed the review had sampled 2 records from the surgical services at this hospital and 100% compliance was noted for completeness of unified DNACPR forms and patient records entries.

DNACPR compliance was reviewed as part of a hospital-wide task and finish group. The hospital reported additional DNACPR e-learning training had been developed for medical staff and advanced clinical practitioners and they planned to launch this during 2026.

Patients were followed up after their discharge from the hospital and post-operative follow up care and treatment was provided through outpatient appointments. Patients told us they had discussions with staff about their treatment plans, outcomes and post-discharge arrangements and that staff kept them informed. Staff told us they planned and discussed care and treatment plans, including post-discharge arrangements, on admission to the service.

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 utilised advanced care plans for palliative and end of life care. We looked at the care records for a palliative care patient. This showed care plans had been put in place taking into account the patient’s individual needs and preferences and there had been involvement with the specialist palliative care team nurses. The care records for another patient showed a discharge to assess referral had been made to facilitate end of life care at home, in accordance with the patient’s wishes.