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Provider: Salford Royal NHS Foundation Trust Outstanding

On 24 August 2018, we published a report on how well Salford Royal NHS Foundation Trust uses its resources. The ratings from this report are:

  • Use of resources: Outstanding  
  • Combined rating: Outstanding  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Outstanding

Updated 24 August 2018

Our rating of the trust stayed the same. We rated it as outstanding because:

  • For the services we rated safe and effective as good. We rated caring and responsive as outstanding. We rated well-led as good. We rated six of the trust’s 12 services as good. In rating the trust, we took into account the ratings of the six services not inspected this time.
  • We rated well-led for the trust overall as outstanding.
Inspection areas

Safe

Good

Updated 24 August 2018

Our rating of safe stayed the same. We rated it as good because:

  • Staffing levels and skill mix were planned, implemented and reviewed to keep patients safe. Any staff shortages were responded to adequately.
  • Staff within the hospital, kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.
  • There were processes and systems to mitigate risks to patients identified to be at risk of deterioration. The use of the surgical safety checklist had improved since the last inspection.
  • The trust prescribed, gave and recorded medicines well. Patients received the right medication, at the right dose, at the right time.
  • Patient safety incidents were managed well. Staff recognised incidents and reported them appropriately. The trust collected safety information and shared it with staff, patients and visitors.
  • There are effective handovers and shift changes to ensure that staff managed patient risks.
  • There were clearly defined systems, processes and standard operating procedures to keep people safe and safeguarded from abuse, using local safeguarding procedures whenever necessary.

However:

  • There were staffing challenges particularly on medical wards. Staff said they did not always have the time to give the care they would want because of staffing levels.
  • The storage of medicines was not always consistent in urgent and emergency care, surgery, medicine and critical care.
  • There were gaps in recording of equipment checks in urgent and emergency care and surgery.
  • There was inconsistency in record keeping on some of the medical wards.

Effective

Good

Updated 24 August 2018

Our rating of effective stayed the same. We rated it as good because:

  • The trust monitored the effectiveness of care and treatment in most areas and used the findings to improve them.
  • Staff gave patients enough food and drink to meet their needs and improve their health.
  • Staff worked together as a team for the benefit of patients. Doctors, nurses and other healthcare professionals supported each other to provide care.
  • There was participation in relevant local and national clinical audits and other monitoring activities such as reviews of services, benchmarking and peer review and approved service accreditation schemes.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.

However:

  • In urgent and emergency care and medicine the programme of re-audit was not always timely to ensure the services measured the impact of changes made to systems or practice.

Caring

Outstanding

Updated 24 August 2018

Our rating of caring stayed the same. We rated it as outstanding because:

  • Staff were kind, caring and respectful of patients’ privacy.
  • Staff involved patients and those close to them in their care.
  • Staff provided emotional support to patients to minimise their distress.
  • In critical care, we saw outstanding practice that demonstrated staff consistently treated patients in a compassionate, dignified, and respectful way.

However:

There were some instances where patient’s privacy and dignity were not always respected in urgent and emergency care.

Responsive

Outstanding

Updated 24 August 2018

Our rating of responsive stayed the same. We rated it as outstanding because:

  • The trust planned and provided services in a way that met the needs of local people.
  • People’s individual needs and preferences were central to the delivery of tailored services.
  • The trust used innovative approaches to providing integrated person-centred pathways of care that involved other service providers.
  • There were systems to support admission avoidance to the hospital and to discharge patients into a more appropriate care setting to meet their needs.
  • People could access the service when they needed it. Most services were meeting NHS standards.

  • The trust had an innovative approach to using technology.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.

However:

  • Access to information, communication tools and training to enable staff to provide person centred care for patients with a learning disability, mental health and dementia could be strengthened.
  • Complaints were not always responded to in a timely way in surgery.
  • The recording and management of mixed sex breaches in critical care was not in line with national guidance.

Well-led

Outstanding

Updated 24 August 2018

Our rating of well-led stayed the same. We rated it as good because:

  • The trust had an experienced leadership team with the skills, abilities, and commitment to provide high-quality services.
  • Managers across most services promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
  • There were examples where services engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and worked with partner organisations effectively.
  • The trust used a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
  • Managers took action to improve services by learning from when things go well and when they go wrong.
  • The trust collected, analysed, managed and used information well to support all of its activities, using secure electronic systems with security safeguards. Staff had access to up-to-date, accurate and comprehensive information on patients’ care and treatment, though an electronic records system that they could all update.
  • The trust had a clear, systematic and proactive approach to seeking out and embedding new and more sustainable models of care. There was a strong record of sharing work locally, nationally and internationally.

However:

  • Not all medical wards had staff meetings and nurse managers were not always able to attend governance meetings because of staffing shortages.
  • There were some cultural and staff morale issues in outpatients. The management team had taken several actions to try and improve the culture and morale. Some staff still had concerns about the culture within theatres.
  • We found some gaps in the governance and risk management processes in outpatients. Not all risks had been identified, monitored or addressed.
Assessment of the use of resources

Use of resources summary

Outstanding

Updated 24 August 2018

Combined rating
Checks on specific services

Community dental services

Good

Updated 24 August 2018

This service has not been inspected before. We rated it as good because:

  • Infection control procedures were in line with nationally recognised guidance. Premises and equipment were well maintained. Staff had the right qualifications, skills and experience to keep people safe. Processes had been put in place to prevent avoidable harm. Staff were knowledgeable about issues relating to safeguarding and there were systems in place to refer children and vulnerable adults.
  • Staff provided care and treatment based on nationally recognised guidance. Staff worked together as a team and with other healthcare professionals in the best interest of patients. Staff understood their responsibilities under the Mental Capacity Act 2005 and with regards to Gillick competence.
  • Staff cared for patients with compassion and kindness. We observed staff treating patient with dignity and respect. Patients and their families were involved in decisions about treatment.
  • The service took into account patients’ individual needs. The service reached out to vulnerable people including those with medical, physical or social issues. Clinics had been adjusted to enable persons with disabilities to access care and treatment.
  • The service was currently undergoing a period of change as the clinical lead and head dental nurse had recently left. There was resilience in the service to ensure the safety and quality of care and treatment was not compromised. There were systems and processes in place for identifying risks and planning to reduce them. Staff engaged with patients and other healthcare professionals in order to continually improve the service.