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

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

Leaders and the culture they created generally supported the delivery of high‑quality, person‑centred care at service and operational levels. Staff described visible, approachable and supportive leaders, and inspectors observed a positive learning culture that enabled compassionate, person‑centred practice. However, the delivery of care was at times constrained by longstanding infrastructure, environmental and system‑level challenges, which leaders were aware of and had appropriately risk‑assessed and escalated.

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 evidence showed a good standard. 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 the trust visions and priorities.

The surgical division had their own strategy and this was aligned to the trust’s vision and strategy. This was articulated as: Improving the health and well being of the population served / Working through partnerships to transform and integrate services / Supporting people (staff) to make the trust the best place to work.

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 told us that their respective teams 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.

Leaders were not always effective in influencing trust leaders to support and drive improvement in known risks and issues in the service. However, the service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Divisional leaders were aware of significant challenges in the service, however they were not fully empowered with authority or the resources, to influence change despite escalating issues through numerous channels be able to address these effectively.

Divisional leaders were not always effective at managing and improving ongoing concerns relating to lack of storage within the theatre environments. This had been flagged to senior trust leaders for a significant period of time. Actions taken to address these issues were not always effective, meaning known issues such as fire safety, infection prevention and control persisted.

The Surgical Division was made up of a triumvirate which consisted of the Clinical Director of Surgery, Divisional Head of Nursing and a Divisional Director of Operations. Staff told us the leadership team were visible. Staff felt supported by leaders to develop their skills and take on more senior roles.

On the wards, theatres and departments we visited, there was strong clinical leadership from managers and lead nurses. Staff told us leaders were approachable, friendly and had an open-door policy for staff to approach them.

Staff felt comfortable raising issues and appreciated management made efforts to accommodate personal circumstances, such as adjustments for childcare needs. Regular ward meetings provided staff with opportunities to discuss concerns and collaborate on solutions, reinforcing a positive working environment.

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

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.

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 evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving 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.

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. These included networks for staff with physical disabilities, long-term health conditions, special needs and mental health challenges, for ethnically diverse staff, for LGBTQ+ and for international doctors. The trust provided reasonable adjustments for disabled staff to support them in their roles, demonstrating a proactive approach to creating an accessible and supportive working environment. For example, we saw a member of staff who had a visual impairment was able to bring their assistance dog with them to 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 equality and diversity inclusion 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. The trust had an inclusion and wellbeing team who ran training sessions and workshops for staff. They also produced regular updates and signposting to relevant information, advice and guidance through the trusts inclusion and well being calendar.

The evidence showed some shortfalls. Although the service had established governance processes and leaders had clear responsibilities and roles, governance processes were not always effective in addressing areas of poor practice and compliance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Service leaders were not empowered to influence changes or rectify issues at a more senior level.

The service had established governance structures and systems of accountability. Regular governance meetings were held, attended by appropriate personnel, including divisional directors, nursing management, and clinical leads. Meetings were documented, with minutes showing detailed discussions on current and future performance, risks, and quality management.

The service maintained a risk register, with each risk assigned a score and a responsible lead. Risks were actively reviewed and updated during governance meetings, ensuring the service had continuous oversight of issues that could have potentially affected the quality of care.

Despite programmes of audit identifying areas of improvement, for example, concerning lack of storage within the theatre environments, infection prevention and control, challenges had persisted. For example, the risk relating to electrical extension leads and fire safety hazards within theatres had both been opened on the risk register in December 2023. There were documented actions and reviews recorded on the risk register relating to these risks. However, the risks remained open with no long term plan, which demonstrated governance processes were not always effective in addressing areas of poor practice and compliance.

There has been an ongoing issue around the lack of documentation of venous thromboembolism (VTE) risk assessments across all but one ward on in the surgical department. Venous thromboembolism risk assessments were not always being documented effectively in patient records due to challenges with the electronic system. However, a review of patients records showed VTE prophylaxis had been prescribed. Action had been taken to mitigate the risks and provide assurance around the management of VTE across the surgical wards, and by the procurement of a new electronic patient record due to be implemented in April 2026. However, documentation of this risk assessment persisted across the patient records we review across the surgical service. There was a risk that prescribing VTE prophylaxis without a formal documented risk assessment meant some people may receive it even if they didn’t need it.

The surgery division had clear service performance measures, which were recorded and monitored by the service and wider hospital. Data collection was detailed. This included monitoring of referral to treatment times, monitoring of cancellation on day of surgery rates, review and learning from incidents, patient feedback and review of the risk register. Areas of good and poor performance were highlighted and used to challenge and drive forward improvements. Monthly reports were produced and discussed at the relevant governance meetings.

The trust and service reported challenges with the effective oversight and reporting of staff training data from the elearning system. This has been documented on the trust risk register, with oversight held by the trust clinical governance and people committees. At the time of the inspection the trust reported they were reviewing the trust database but this work had not been completed. Managers within the service maintained oversight on individual training compliance and ensured frontline staff were working with appropriate training and knowledge. For example, specifically safeguarding training and although managers were assured staff were trained to carry out their role and responsibilities this additional oversight processes were time-consuming.

There was effective workforce planning including for managing major incidents or emergencies.

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 evidence showed a good standard. 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 trust was a partner with other local NHS trusts and worked as a part of the wider health and care system. The system was comprised of multiple providers including NHS organisations, local authorities and voluntary sector organisations working together across the Bath, Swindon and Wiltshire Integrated Care System.

The service recognised its role within the overall partnership and leaders could describe how they were contributing to achieving better outcomes for patients. For example, providing surgical services in the community where possible.

Leaders and staff engaged openly with a range of stakeholders, including patients, equality groups, the public, and local organisations, to plan and manage services effectively. These engagements facilitated the sharing of best practices and learning, contributing to continuous improvements within the service.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The trust had set up an quality improvement programme called “improving together”. Staff described how this provided a strong and consistent framework for how the organisation approached problems, new ideas and overall improvement.

Wards and departments had “improving together” boards which included sections for; quick wins, new improvement opportunities and celebrations. Staff held daily quality improvement huddles to discuss challenges and improvements. The service provided examples of staff-led improvement opportunities. We saw examples of nurse-led projects to improve patient documentation. For example, one such project was designed to improve completion of checklists for patient’s personal belongings upon their admission. We were also given examples of resident doctor-led presentations that were focused on developing confidence in their clinical practice and processes. For example, increasing confidence in obtaining radiological investigation out of hours.

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.