Salisbury District Hospital

On this page

• 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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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.

The service did not always make sure people’s care and treatment were effective.

Completion of nursing assessments was not always consistent. For example we did not see any completed Visual Infusion Phlebitis (VIP) scores in the Acute Medical Unit (AMU) and Redlynch ward. We also found that intentional rounding was not up to date for patients who required this. Intentional rounding is a structured hospital process where nurses make regular, timed checks with patients to address fundamental needs such as positioning, pain relief, personal needs (like toileting), and the placement of essential items.

Staff effectively communicated with patients to meet their needs. For example, we observed a member of staff communicating patiently, kindly and compassionately with a patient presenting with mental health condition.

Staff discussed people’s needs with them, and they were involved in how care and treatment was planned. Patients were offered pain relief when required.

Staff used the numerical rating scale for adults and Pain Assessment in Advanced Dementia Scale (PAINAD) for adults with cognitive impairment. We spoke with members of staff who told us they used a visual pain scale to assess pain for all patients with communication needs. In addition to this, staff had access to the pain assessment tools through the trust policies and guidelines platform.

Staff assessed and acted on risks to patients of avoidable harm and worked with other specially trained professionals to support people with additional needs. We reviewed patient records and saw evidence of input from the therapy team and stroke nurses.

Staff could add flags to patient records to identify patients with additional needs or who might require additional support. This included alert flags for patients with allergies, mental health needs, learning disability needs, autism or living with dementia.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

The department undertook clinical audits and analysed the trends and shared this with all staff. Additionally the department took part in national benchmarking audits for medicine specialities. Some of these included adult asthma secondary care 2024 and Myocardial Ischaemia National Audit Project (MINAP) 2023.

The trust also took part in the national audit of dementia as part of the national clinical audit and patient outcomes programme (NCAPOP).

Staff followed up-to-date policies to plan and deliver quality care according to evidence-based practice and national guidance. We reviewed a sample of the service’s policies and guidelines and noted that all were in date with a set review date.

The team had access to the full range of specialists required to meet the needs of patients in the service. We reviewed 20 patient records and found input from the therapy and SALT team.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff reported good input from specialist teams. There were good working relationships between staff in the department and the team worked well together given the high demands and pressures in the department. We saw a flat hierarchy where staff at all levels were able to speak up and challenge colleagues in a supportive way.

Staff held regular and effective multidisciplinary meetings to discuss patients and highlighted issues and outstanding tasks.

Staff throughout the division held daily huddles where they discussed risk factors and patients who required close monitoring. The teams also identified patients who required safeguarding referrals. Staff told us they found the huddles very useful and enabled shared decision making when there were concerns about a patient’s observations or condition.

We observed a huddle which was well attended, and information was shared between different teams.

We observed good collaboration and communication between all grades and professions within the department itself. Staff told us of cooperative, supportive and appreciative relationships across the department and other parts of the hospital.

Staff referred patients for mental health assessments when they showed signs of mental ill health or depression. We reviewed patients records and found this had been completed.

The hospital had a discharge team who supported early discharges and community and house visits. We spoke with a member of the team who told us they used the No criteria to reside (NCTR) for daily reviews of patients and what they were waiting for. NCTR patients are those who no longer have a medical reason to be in an acute hospital bed but remain there due to delays in discharge pathways, often waiting for onward care, social care support, or other complex arrangements.

The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

The service had relevant information promoting healthy lifestyles and support at the department. Staff assessed each patient’s health when admitted and provided support for any individual needs to live a healthier lifestyle.

The service participated in projects to promote the health and wellbeing of patients within the medical division. The Breamore re-design project aimed to work with different specialties so that No criteria to reside patients (NCTR) received regular therapy and multidisciplinary team (MDT) review to ensure a timely and safe discharge.

Cardiac rehabilitation patients received diet and nutrition leaflets which advised and guided patients on a well-balanced diet and calorie consumption. The trust had a fruit and vegetable stall near the entrance of the hospital which sold fresh fruits and vegetables every day. Patients, families and staff were able to access this.

Patients who expressed an interest in stopping smoking received support and guidance from the treating tobacco dependence team. Support involved nicotine replacement therapy, positive behaviour change coaching and onward referral for post discharge continued support. Data provided by the trust showed that the tobacco team had made a total referral of 139 for the month of April 2025.

The service was not meeting the clinical expectations and the expectations of people themselves. Outcomes were not positive and consistent which led to delays in timely care and treatment.

The department was not meeting the trust target of 70% for the cancer 62 day standard which meant patients could not always access services when needed or receive treatment within agreed timeframes and national targets. The department had countermeasure actions and risks in mitigations to address these concerns.

Additionally, the division was also not meeting the trust target of 95% for the diagnostic waiting times. This meant patients were waiting longer than the six week standard for a diagnostic test. The trust reported 318 breaches within the endoscopy unit with breaches across procedures, and performance at around 57%. Following this a recovery trajectory for endoscopy was being completed with increases in utilisation to provide additional capacity from quarter 2.

The SALT team also carried out audits which looked at the met and unmet needs of stroke and Parkinson’s patients. The results of which showed that there were more patients whose needs were not met, with 59% of patients whose meets were not met compared to 41% whose needs were met. Following this action plans and recommendations were put in place to improve the compliance. For example the number of patients with unmet needs had decreased from 131 to 97 from March 2024 to May 2024.

The SALT team measured processes of care provided to stroke patients through the Sentinel Stroke national audit programme (SSNAP). Following changes in the national SSNAP data set which came into place in Oct 2024, the key performance indicators (KPI's) for the department had seen a dip in overall performance. The service had identified two key areas of non-compliance; percentage of patients not admitted to a stroke unit within 4 hours and therapy frequency. Following the audit the service outlined an improvement plan, which included a dedicated nurse stroke bleep holder to ensure more timely assessment and treatment.

The department had an ongoing programme of auditing, which ran audits included sepsis audit, infection control, falls risk assessment and medicines management.

Additionally, the trust carried out the fundamentals of care audit which included fluid charts, stool chart and catheter bundle.

We reviewed the pain management audit results for all the wards within the medicine division which showed spire ward performing the worst with 51% in the first inspection and Pembroke ward in the latter for the month of April 2025 with 25%. As a result a recap inspection was launched in May 2025 to cover these low scoring questions.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

The trust had robust policies and procedures in place that aligned with the Mental Capacity Act (MCA) and the Health and Social Care Act. These policies outlined the trusts commitment to gaining valid consent and ensuring that all individuals understood the nature, purpose, and implications of the care or treatment proposed.

Staff had access to a range of communication tools and techniques to ensure understanding, including: the SALT team resource to support decision making for care and treatment, elective procedures and discharge planning.

Patient records clearly highlighted when a patient had a ‘Do not attempt cardiopulmonary resuscitation (DNACPR)’ flag on the system, and staff could access this information easily.

Staff had a good understanding of Deprivation of Liberty Safeguards (DoLS), and could clearly articulate how they would assess patients, and ensure their rights were safeguarded.

Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005 (MCA). They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care. The MCA 2005 provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We saw mental capacity assessments which had been completed thoroughly.

All staff had received training in relation to the MCA 2005 and understood the importance of giving people choice in the support they received. We observed staff always sought people's consent verbally before providing any support.