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

At our last assessment we rated this key question good. At this assessment the rating has remained the same.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patient individual needs were assessed and managed prior to treatment. Patient safety initiatives, including consistent and accurate needs assessments were observed. For example, we saw accurate completion of surgical safety checklists with documented allergy checks, and pro-active falls prevention strategies like educational boards.

Preoperative assessment clinic staff referred high risk patients to consultant-led clinics. For example, patients with high risk of complications due to frailty were assessed by consultant anaesthetists enabling pre-surgical optimisation for a safer patient outcome.

Patient needs were checked carefully and detailed care plans were maintained. Staff monitored patients’ weight and blood pressure, checked if they were eating enough, and kept track of what they ate and drank. Patients who were fed through a tube in their nose or received all their nutrition through a drip were closely watched by dietitians.

Surgical pre-assessments involved detailed patient reviews, which included past medical history, surgical site mark verifications, and ‘fit to proceed’ forms. This helped to ensure a clear understanding of the procedure and identification of any additional needs.

All surgical wards we visited had a visual monitoring system which helped to provide real-time insight into patient status. This allowed for timely interventions and referral tracking. Wound assessments were consistently completed by nursing teams, and pain management was addressed through medicine rounds and handheld electronic device prompts.

We reviewed a sample of patient records during the onsite inspection and found up to date assessments for vital signs, falls, nutrition and skin integrity. However, there was inconsistency in completing venous thromboembolism assessment documentation on the patient record.

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

The service and staff followed up-to-date policies to plan and deliver high quality care according to evidence-based practice and national guidance. These included guidelines from National Institute of Health and Care Excellence (NICE) and Royal College of Anaesthetists.

Staff had access to guidelines on the trust’s intranet system and demonstrated knowledge of them.

The service actively participated in various national and local audits to monitor and enhance care delivery. When improvements could be made to align with national guidance, staff acted promptly to implement them. For example, the service carried out an audit of consent within spinal surgery. Whilst compliance was recorded as above target, areas for improvement had been identified and addressed. Information provided demonstrated a proactive and response approach to improving the process.

The service had implemented the National Safety Standards for Invasive Procedures (NatSSIPs) programme across all areas where invasive procedures took place. The WHO Surgical Safety checklist is a subset of NatSSIPS. The service undertook audits specific to surgical safety, including the WHO Surgical Safety Checklist and local audits of the surgical site infection protocols, to enhance patient outcomes. The audits identified potential risks and verified the application of safety protocols, ensuring alignment with national standards. Data provided by the trust confirmed audits were carried out, with actions identified. For example, identifying clinical lead roles for NatSSIPs and the implementation of a NatSSIPs steering group within the trust to ensure effective oversight.

Practice educator nurses used noticeboards to communicate best practice guidance. For example, we saw noticeboards displaying best practice guidance for pressure damage prevention.

The evidence showed a good standard. 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 throughout the service held safety huddles at regular intervals, each day and 7 days per week. Staff highlighted patient risk factors at these huddles, for example patients undergoing sepsis treatment and patients who required close monitoring due to high blood pressure. Teams also identified patients who required safeguarding referrals.

Teams within the surgical service had effective working relationships, including good handovers, with other relevant teams within the organisation. These included care co-ordinators, discharge teams, and specialist teams.

We observed all staff, including doctors, nurses, and allied health professionals, collaborated well together, ensuring comprehensive and holistic assessments of patients’ needs. This collaborative approach was particularly evident during ward rounds and handovers, where specialists from various disciplines, such as orthopaedics, urology, and trauma, participated in assessing and planning patient care. Resident doctors reported feeling well-supported within these multidisciplinary teams (MDTs), reflecting a positive culture of teamwork and communication. Although we did not see an example during the inspection, staff in theatres told us that they felt able to speak up if they had a safety concern. For example, this included during the WHO safety checklist.

Staff had access to the hospital’s electronic health record system. This enabled the sharing of patient information necessary for planning and delivering care.

The service managed patient transitions between services effectively. The assessment team observed various speciality teams, including nursing and allied health professionals, working together to assess patient readiness for discharge.

Staff ensured all necessary assessments, referrals, and care plans were communicated during handovers and ward rounds to maintain continuity of care. The multidisciplinary approach was a clear strength, ensuring patients received well-coordinated and effective care across different services.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff in pre-assessment were focused on patients and ensuring they were healthy enough to have the surgery they needed. Staff on wards encouraged post operative patients to get up, get dressed and sit out of bed where possible.

The service participated in initiatives to promote the health and wellbeing of patients attending for surgery. Patients were encouraged to be more involved in decisions regarding their care. For example, staff provided patients with information prior to attendance, published by the Royal College of Anaesthetists, to help them to prepare for surgery. We spoke with patients who were able to describe their surgical journey. This included attending surgical pre-assessment during which they told us staff had provided them with information regarding their procedure. They found this both useful and informative.

Smoking and alcohol usage were used as parameters for the clinical risk to patients and this was assessed at both the pre-assessment and admission stages of treatment. The service made timely referrals to relevant professionals, such as social prescribers or local stop-smoking services, to support people's wellbeing.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service demonstrated a commitment to monitoring and improving patient outcomes. The service held regular mortality and morbidity meetings to review patient cases, identify areas of suboptimal care, and implement lessons learned to improve future care delivery. These meetings generated detailed reports that highlighted cases requiring attention, showcased examples of good practice, and outlined specific actions for improvement. This structured approach reflected the service’s dedication to continuous improvement and enhancing patient safety and care quality.

The service participated in mandatory national initiatives such as the Patient Reported Outcome Measures (PROMS) and the National Joint Registry (NJR). The service used outcomes data to assess their performance and improve. Both registers were designed to aid early review of specific patient groups for monitoring performance. National Joint Registry information/data recorded the type of implant, potential side effects and complications. The database enabled staff to contact patients in case the implant was recalled for safety reasons.

The service provided data collected and submitted to the National Hip Fracture Database (NHFD). The NHFD collect outcome data from services treating hip fractures and compares them against a series of 8 metrics. The used this database to help monitor their own performance against both these metrics and to benchmark themselves against other providers. Data showed service outcomes were meeting or exceeding national averages. For example, metric 1. Prompt Orthogeriatric Review was reported as 98% for the service compared to 89% report as the national average. Metric 2. Prompt Surgery was reported as 77% as compared to 57% which was the national average.

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

The service had clear and structured processes for obtaining and respecting patient consent. These were aligned with national guidance. Staff consistently followed these processes and supported patients in making informed decisions about their care and treatment. They ensured consent was obtained in line with legislation.

Patients told us they were informed about their rights, and how staff took time to explain procedures thoroughly, providing all necessary information regarding the nature of the treatment and any associated risks. This approach ensured patients could make informed choices and demonstrated respect for patient autonomy.

Staff were observed using consent forms according to trust policy, clearly recording consent in patients’ records to document patients fully understood the proposed treatment. Consent forms for surgery were reviewed, showing they were completed appropriately, with associated risks clearly communicated. This allowed patients to make well-informed choices about their treatment options. The service also provided a system for patients to self-administer medication, further empowering them to manage their care.

Nursing and clinical staff received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and kept up to date with relevant legislation and policies. Staff were knowledgeable about how and when to assess a patient’s capacity to make decisions about their care, and they knew how to support patients experiencing mental ill health. When patients lacked the capacity to consent, staff followed the Mental Capacity Act 2005 guidelines, conducting capacity assessments and involving relevant parties, such as family members or advocates, in the decision-making process. This ensured decisions were made in the best interests of the patient, taking into account their wishes, culture, and traditions. We saw evidence of documented capacity assessments in patient records. For example, we saw an assessment had taken place and this had been signed by the daughter of the patient and a doctor.