Salisbury District Hospital

On this page

• 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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to a good.

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.

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.

The service based patient care around individual needs and preferences. Staff supported patients living with dementia and learning disabilities by using, ‘This is me’ documents and ‘My Health Passport’ for autistic patients which contained information about the patients’ interests, how they communicated pain and what caused them distress.

Patients presenting with mental health needs were appropriately signposted by nursing staff to the liaison team for further assessment. The liaison team were based within the main hospital and were available from 9am until 5pm seven days a week. Outside of these hours, staff could contact the local intensive support for advice and support.

The department had access to interpreters, including for British Sign Language when needed. Staff also had access to communication aids to help patients.

We saw positive interactions between staff and patients with complex needs to ensure they remained settled in the service. Staff made sure patients living with mental health problems, learning disabilities and dementia, received the necessary care to meet all their needs.

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.

We spoke with staff from the emergency department (ED) who said they had good input from the medical specialties which helped with streaming into the wards. Medical wards can significantly impact EDs by causing patient flow bottlenecks, which lead to delays, overcrowding, and poorer outcomes for all patients. For example, staff told us the stroke team visited ED to assess and pull patients into the wards.

Although there wasn’t any direct streaming to the acute frailty unit currently, the trust reported that patients were directly streamed to the acute medical unit (AMU) where there was input from the Acute Frailty team.

ED staff commented that they weren’t always included in change discussions and there was a disproportionate risk between the department and the medical wards which led to poorly coordinated care for patients.

Discharge planning was supported by discharge coordinators who liaised with external partners such as GP’s, social workers and nursing homes to enable handover of care. For the areas which did not have discharge co-ordinators, there was a trust-wide discharge team who supported all clinical areas with discharge planning, with a specific focused support for fast track and complex in and out area discharges.

The wards engaged with other healthcare providers both within and external to the hospital to ensure that patients received appropriate follow-up care. For example, patients received coronary artery bypass graft (CABG) at specialists units in neighbouring hospital trusts.

Patients admitted to the medical wards received ongoing care from a multidisciplinary team which was made up of different specialties. These included an older person assessment team which consisted of physiotherapists and occupational therapists who were based in the ward. Additionally, patients received ongoing care from the SALT team.

The provision of specific mental health care was provided by a local mental health trust team who undertook assessment, and continued care where relevant, of adult patients within the trust who required specific mental health input. Staff had access to the application of the mental health act guidance which provided them with the correct procedures to follow when a patient was detained under a section of the mental health act.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service complied with and staff had access to the Accessible Information Standard (AIS) guidance which staff could use to support people with information and communication needs. The AIS is for people who have a disability, impairment or sensory loss and need to have their information provided in a way they can access and understand.

Additionally, staff also had access to trust wide translation and interpreting policy which provided staff with a framework to support communication with patients and carers who were non-English speakers and people who may have other communication needs related to a disability or impairment.

The trust intranet had a range of resources to support providing information in accordance with individual need. These included hard of hearing resource boxes and on demand British Sign Language (BSL) services.

The trust also provided staff with guidance on communicating with a deaf or hard of hearing person and using a BSL interpreter.

We saw a wide variety of resources including leaflets, and interpreter services were available to ensure the patients understood their care and treatment, if required.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

Patients and relatives received a friends and family feedback comment card on arrival and were supported to raise their concerns with the department. In the first instance this was to escalate to staff and leadership team. If they were unable to provide a resolution, patients were signposted to Patient Advice Liaison Service (PALS).

Staff had access to the complaints and concerns handling policy which provided staff with guidance on complaint management. This document was in date and due for review in March 2026.

The division had received 21 complaints in the last 12 months. Four of these related to the endoscopy unit. We spoke with staff who told us they received feedback on the outcome of investigation of complaints and acted on the findings.

The department provided us with examples of when changes were made in response to patient feedback. A patient had complained about the change in the echocardiogram reporting schedule. Following this the deputy divisional head of nursing, the elderly care team and cardiac investigation unit (CIU) staff met to discuss how they could introduce a change and this was a simple change in how data was captured through the system which had been implemented.

Leaders also increased the uptake in communication courses after this was identified as a theme across incidents, complaints and real time feedback.

The response rate to the Friends and Family Test (FFT) in May reported the trusts highest response to date since the new digital dashboard and SMS message service went live in June 2024. The response rate was 19% with a satisfaction rate of 94% therefore met the response rate target but slightly fell short of the satisfaction rate target of 95%. The top three themes for dissatisfaction were staff attitude, environment and communication.

The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Difficulty in providing adequate inpatient bed capacity due to GP/ED attendances and discharge delays was one of the highest risk on the divisions risk register. Staff in the acute medical unit told us they aimed patients to stay at the unit for no longer than 48 hours but this did not always happen.

As a result of poor flow throughout the hospital, patients experienced delayed admission to medical wards from the emergency department. Data provided by the trust showed an increase in the number of average delayed bed days from April to May: from 1564 to 1796 days.

The trust reported that poor flow throughout the hospital was directly impacted by increased numbers of patients without criteria to reside. These were patients that were medically optimised for discharge but were waiting for health or social care support outside of the hospital setting.

Patients faced delays in receiving speech and language therapy, The unmet needs of acute ward patients referred to the Speech and Language Therapy (SALT) team was one of the risks on the SALT risk register. The trust employed a small team of SALT who covered 18 wards and were not meeting the demand for SALT assessment which led to delays in face to face assessments and some patients discharged before SALT input. The department had put current control in place to mitigate these risks and action plans developed to address these concerns.

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 completed Equality, Diversity and Inclusion (EDI) training as part of their mandatory training. The service also completed the Oliver McGowan training for Autism and Learning Disabilities which they felt was valued and encouraged reflection. Staff followed processes that supported them to deliver care and treatment that did not put patients with protected characteristics at disadvantage.

The trust board had recently partnered with a leading expert and held workshops with all staff in managing difference and facilitating courageous conversations about EDI. The trust reported that feedback from these sessions had been unanimously positive and had a transformational impact in reshaping the strategy for embedding EDI support throughout all departments and teams.

The division worked with the local authority and sought out views of patients, local people and communities across Swindon and Wiltshire about their experiences of using health and care services and to help shape improvements and outcomes. This involved working with potentially disadvantaged groups like routine and manual labours and the Gypsy, Roma, Traveller, and Boater (GRTB) community to ensure equity of access, care and treatment.

For patients living with dementia, the service used the nationally recognised “This is me” document. ‘This is me' helps health and social care professionals better understand a patient’s needs, preferences and values beyond their dementia diagnosis. This can help staff to deliver care that is tailored to the person's needs. Used effectively, it can help to reduce distress for people with dementia and their carers. It can also help to overcome problems with communication and prevent more serious conditions such as malnutrition and dehydration.

Staff worked hard to remove any barriers to access for patients. There was a strong inclusive culture which prevented discrimination and inequalities, supported by training and guidance. Staff listened to people who had concerns or complaints and sought ways to improve the service.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

People were supported to make informed choices about their care and plan their future care while they had the capacity to do so.

Staff supported patients to make decisions about their care and treatment and their future. Care plans reviewed accurately reflected patients advanced planning decisions.

Any patients being discharged without onward support for care needs had a discharge planning document completed as part of the admission documentation. This was completed by the nurse in charge.

Staff had access to the trust wide resuscitation policy and demonstrated a clear understanding of the trust do not attempt cardiopulmonary resuscitation (DNACPR) policy and ReSPECT documentation. The ReSPECT process created personalised recommendations for a person’s clinical care and treatment in a future emergency in which they are unable to make or express choices. These recommendations were created through conversations between a person, their families, and their health and care professionals to understand what mattered to them and what was realistic in terms of their care and treatment.

The trust also carried out monthly audits on DNACPR and reported a compliance of 100% for all wards and departments within the medical division.