Salisbury District Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question as good. At this assessment the rating has remained the same. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We have not awarded this service a score for Well-led.

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

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The trust vision was to provide an outstanding experience for their patients, their families and the people who work for and with them. The trust set out priorities through their strategic pillars which was people, population and partnership (3Ps). We spoke with staff who were aware of their visions and priorities.

The medical division had their own strategy which was to work inclusively to motivate, empower and develop teams to achieve the best possible experience for staff and patients. The division shared with us their plan for the year 2024/25 which included developing and improving the escalation for medical and nursing teams to support deteriorating patients through their NEWS2 observation compliance.

New starters received a comprehensive overview of the trust behaviour framework through their induction process. The trust also had a dedicated ‘Breakfast Club’ session where staff had the opportunity to contribute to discussions about the strategy for their service. This was open to employees at all levels across the organisation.

Further embedding of values and behaviours occurred within the targeted leadership development programmes where participants engaged in exploring the concept of organisational culture, its significance and the individuals roles in influencing and shaping it.

Staff reported the team worked effectively together, with staff across all areas respecting each other and working together to provide the best possible care and treatment to patients. We observed positive and caring interactions between staff and their patients and their relatives who used the service. We also noted good collaboration and communication between different specialities.

Whilst leaders were aware of significant challenges in the service, they did not always address these effectively.

The leadership team was not always effective at managing and improving ongoing concerns relating to patient safety in relation to the lack of compliance with local targets for NEWS2 and VTE for 50 consecutive months. Whilst this had been flagged to leaders for a significant period of time, actions taken to address these issues were not always effective, meaning issues particularly around compliance VTE assessments persisted.

The division faced staffing challenges for the nursing and medical workforce and this had been on the division risk register for a number of years. Despite ongoing recruitment and countermeasures to mitigate the risks, the medical division was reported to the highest contributor on locum spend.

However, staff told us the departments leadership team were visible and approachable, and well-integrated in the department. Staff felt supported by leaders to develop their skills and take on more senior roles.

The division of medicine was made up of a triumvirate which consisted of the divisional director of medicine and two divisional director of nursing.

The trust ran internal leadership programmes for all staff in a clinical and non-clinical roles starting from band 2s to consultant level. These were delivered with a mix of online learning and face to face sessions. Some of these included band 7 development program, manager networking clubs and management suite which was designed to support the development of all managers.

As part of development within the division’s senior management team, the clinical director for medicine had been supported to attend a shadow board opportunity which provided leadership development by exposure of high-level decision making, as well as organisational succession planning to nurture future leaders.

The trust also ran nurse in charge workshops which provided junior leaders in medicine the skills, competency and confidence to work with autonomy whilst providing safe and effective care. Staff presented sessions on different topics like emergency preparedness, human factors and patient flow and discussed learning outcomes.

In addition to this staff could also access a range of leadership tools and team development exercises through the trust intranet.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The trust had freedom to speak up (FTSU) guardians who were available should staff wanted to raise any concerns. Staff were aware of who these were and told us they felt they could raise concerns without fear of reprisal.

Staff had access to the freedom to speak up policy which provided information on how to speak up and what to expect to happen after speaking up.

The department reported 17 FTSU concerns raised across endoscopy and all medical inpatient wards in the last 12 months. Some of the themes identified included behaviours performance management and addressing poor behaviours.

Staff told us there was a culture of speaking up, they felt safe and supported in doing so, and without fear of detriment. Staff gave us examples where they had raised concerns with their managers. We were told these were treated sensitively and seriously, and managers worked with the member of staff to resolve the concern. Staff we spoke with were happy with the outcome and felt comfortable to raise concerns again.

The service strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who work for them.

A core component of the trusts strategic planning framework for 2025-26 was the long-term vision metric that all "Staff are Treated Equitably." We spoke with a number of international staff who praised the multicultural integration into their role.

The trust had an equality and diversity inclusion (EDI) steering group who met monthly to discuss a range of issues related to creating a more equitable and inclusive environment. The membership of the group had been broadened to include a wider range of stakeholders from across the trust, including the medicine team.

Additionally staff had access to seven staff networks which provided staff with a safe space for discussion of issues, helped raise awareness of issues within the whole workforce and provided individual support to colleagues who faced challenges at work. The trust also held cultural events like the south Asian heritage month and black history month which gave staff from different cultural backgrounds a sense of inclusion and belonging.

All new starters participated in a 45-minute EDI induction workshop as part of their induction. The session provided new employees with the essential guidance on inclusive behaviours, the nine protected characteristics under the equality act, and the importance of maintaining clear personal and professional boundaries.

The trust ran a leading for inclusion workshop as part of their transformational and aspiring leadership programme. The workshop encouraged leaders to develop their cultural intelligence and their capability to work and communicate effectively across diverse cultures.

Staff had access to the trust wide equality, diversity and inclusion policy which was in date. Staff also received regular updates and signposting to relevant information, advice and guidance through the trusts inclusion and well being calendar.

The trust had an inclusion and wellbeing team who ran training sessions, workshops and interventions particularly to inappropriate behaviours.

Outcomes for patients were not always positive, consistent and did not always meet expectations, such as national standards. For example, the division was 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. We reviewed the complaints received by the endoscopy unit in the last three months and found two out of four complaints received was regarding delay in treatment and appointment.

Despite programmes of audit identifying areas of improvement, for example, around infection, prevention and control, challenges persisted which demonstrated governance processes were not always effective in addressing areas of poor practice and compliance.

Although action had been taken to mitigate the risks and provide assurance around the management of VTE across the medical wards, VTE risk assessments were not being documented in patient records. This had been an ongoing problem for over 50 months at the time of our inspection that the trust had been unable to rectify. The trust were waiting for the introduction of an new electronic recording system in April 2026 which would mean all patients would have a VTE risk assessment recorded.

Information discussed within various committees and group fed into the clinical governance committee and to the trust board. The division of medicine was led by a triumvirate which consisted of a divisional director of medicine and two divisional directors of nursing.

Clinical Governance Meetings were held monthly and were open to all staff. We reviewed the medical governance meeting minutes for the month of May and June 2025. The agenda included performance, incidents, complaints, risks and patient safety reviews. Each department also held their own monthly governance meetings where they carried out morbidity and mortality reviews and area reports with learning points and themes which had been identified.

The department operated systems to ensure they shared information with external organisations effectively, in a timely way, for example, accidents and incidents were reported to the relevant authorities, including the CQC.

There were procedures to safely manage sensitive data which allowed them to maintain people’s privacy, dignity and confidentiality.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The department collaborated and worked in partnership with stakeholders to support the delivery of the service and support joined up care. They shared information and learning with partners to improve the service.

The trust had set up a patient and public voice partner group within their cancer department. The group met once every 8 weeks to progress patient initiatives and had successfully implemented a number of projects in the last 12 months. Some of this included the macmillan information hub, the fresh fruit and veg stall and the refreshment of the oncology outpatient department with artwork, working in partnership with Artcare.

Leaders engaged with external stakeholders such as the local council, health watch and health inequalities group who met monthly. We reviewed the meeting minutes of groups meeting for the month of May 2025. Topics of discussion included neighborhood collaboratives programmes and updates from public health on hypertension and obesity.

The trust provided dedicated armed forces champion training and education to staff, empowering them to identify, signpost and advocate for patients. The half day training involved local Armed Forces charities including Defence Medical Welfare Service (DMWS) and help for heroes.

The trust had recently appointed a help for heroes nursing role to support their armed forces community. The role was fully funded by the help for heroes charity and helped signpost patients and carers and provided specialist physical and clinical support across the hospital. To date the trust reported that there were over 250 armed forces champions across the hospital.

For mental health patients, the department worked closely with a local mental health trust to ensure a joint approach to the provision of mental health care and assessment for patients in the department, including ensuring timely assessment, patient advocacy and risk management.

The department also worked closely with the local police and shared key information which enabled safeguarding and consistency for service users and ensured concerns were identified and acted upon both timely and collaboratively.

Whilst the service had some areas of innovation and improvement, there were other areas which showed a lack of improvement with consistently low compliance. The trust had set up an improving together programme which provided staff with a strong and consistent framework for how the organisation approached problems, new ideas and overall improvement. Each ward held daily quality improvement huddles. We saw an improving together board in every ward which included quick wins, new improvement opportunities and celebrations.

However the division was repeatedly not meeting the trust target and the national target for a number of performance metrics which meant improvement projects and mitigations in place were not effective. Despite regular meetings where areas of concern were discussed and countermeasures were put in place; the division did not see any improvement in performance.

Leaders encouraged staff to speak up with ideas for improvement and innovation and actively invested time to listen and engage. There was a strong sense of trust between leadership and staff.

The trust reported that as of February 2025, almost 600 people had been or were currently going through the improving together training and an average of 65 improvement ideas had been implemented per board.

Post inspection, the trust provided us with details on the improvement projects which were undertaken by the department. Some of these included the setting up of their new Acute Frailty Unit (AFU) which enabled staff to deliver even better care and reduced the average length of stay of from 16 days to 6.

The trust reported that using the programme methodology, the inpatient falls reduction team had improved reduced inpatient falls by 54%, which was a whole year ahead of target.

Additionally, the cardiology team had implemented a programme through improving together and had reduced initial appointment wait times by 40%. The team had also developed a team newsletter to improve team communication and shared the progress with colleagues who couldn’t always directly participate in their improvement huddles.

Foundation doctors could undertake improvement projects through the Healthcare Improvement Programmes, also known as HIMP. We reviewed an improvement project which was presented at the HIMP meeting for the month of June which identified key issues and discussed interventions required and its significance.