Two Salisbury hospital services 'require improvement' says CQC

Following an unannounced, focussed inspection of these areas back in March, the Care Quality Commission (CQC) has told Salisbury NHS Foundation Trust that improvements need to be made, in particular how well the services and staff are managed.

Brief report summary

In the CQC report, published July 9, inspectors raised concerns that governance and performance management were not clear and did not operate effectively in the maternity department, as well as safety concerns not being addressed quickly enough by staff.

The Duke of Cornwall Spinal Treatment Centre, which already had an overall rating of 'requires improvement' following a previous inspection, was criticised for staffing levels, in particular a lack in leadership.

Inspectors found the service did not always have enough nursing staff or health professionals with the right qualifications, skills, training and experience to keep patients safe and provide the right care and treatment.

Insufficient staffing levels sometimes impacted on the responsiveness of the service to meet individual needs.

The report added that staff did not always keep detailed records of patients’ care and treatment. Some records were "incomplete and inconsistent", although they were stored securely and available to all staff providing care.

Covid-19 signage at Salisbury District Hospital

Concerns about service leadership

Amanda Williams, CQC’s head of hospital inspection, said: “Following our recent inspection of Salisbury District Hospital’s maternity services, we found that women and babies using the service received effective care and treatment which met their needs most of the time. But most of the time is not good enough.

“We have told the trust it must ensure there are effective systems in place to improve the quality and safety of the maternity service, and that risks are regularly assessed, monitored and mitigated to keep people safe."

'Still work to be done'

Speaking about previous concerns CQC had regarding the maternity service, Amanda said "there was still more work to be done", focussing particularly on leadership, as well as blame culture and the reporting of incidents.

She said: “We were concerned about the leadership of the service, and the lack of systems in place to ensure that people were receiving good care.

"We also wanted to follow up on previous concerns we had about the overall culture of the maternity service which meant that staff were worried about being blamed for incidents that occurred.

"Because of this, there had been a reluctance to speak out, when staff should be encouraged to report incidents and share learnings, so that improvements can be made.

"This in turn had an impact on the safety of the service for patients. Although the trust had taken steps to address this, there was still more work to be done."

Inspectors will check for improvements

Amanda added: “In the Duke of Cornwall Spinal Treatment Centre, we told the trust that it needed to review governance arrangements, including regular audits, to make sure improvements were consistently being made at the service.

"We also told the trust that risk assessments, with supporting documentation, must be completed for each patient in order to keep them safe.

“We will keep both services under review and will reinspect to check that improvements have been made.”

'Our maternity services remain safe'

Responding to the report into maternity services, Stacey Hunter, chief executive of the trust, said action has already been taken to strengthen leadership in the maternity department, including a £500,000 investment in additional midwifery roles and establishing a director of midwifery.

She also wants to "reassure women that maternity services remain safe".

Salisbury NHS Foundation Trust CEO Stacey Hunter

'We are sorry'

She said: "Salisbury Foundation Trust welcomes the CQC review of our maternity services and we recognise that improvements in leadership and some of the day-to-day systems and processes are needed.

"Following the inspection, I am able to reassure women that our maternity services remain safe. Providing high quality compassionate care is the team’s top priority. We continue to be encouraged by the regular positive feedback we get from families that have used the service.

"We are sorry that some of our processes failed to live up to the high standards rightly expected of us and pledge to do everything we can to ensure the maternity department is well run, has a happy and supportive culture and continues to deliver high quality and compassionate care."

An 'especially hard year' and an action plan

Describing the last year as "especially hard" for the spinal unit, Stacey said the team has "worked tirelessly to keep patients safe under very difficult circumstances".

She added: "The report makes clear that the unit provides a safe and caring service, but there are elements of the management processes and skills mix of staff that need improving.

"An action plan has been developed with the team and I am confident that the service will emerge even better following this CQC review.”

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