The Care Quality Commission has told Salisbury NHS Foundation Trust that it must make improvements following its first full inspection, including on staffing levels and in spinal care.
Nurse staffing levels across a range of services were highlighted as a potential “risk to patient safety”, following the inspection in December.
“While some made good use of the gardens and away days, others felt lonely and bored”
The CQC warned of nursing shortages in emergency and urgent care, surgical wards, services for children and young people – including the neonatal unit, critical care, maternity and the spinal unit/ Staffing levels were not always meeting national guidelines or recommendations, it said.
Meanwhile, the trust was not meeting its target of 85% for the percentage of staff receiving mandatory training, said the regulator’s inspection report.
Following the inspection, the CQC also issued a warning notice requiring the trust as a priority to improve the quality and safety of its spinal services and to take action to minimise the risks facing patients waiting for attention.
It stated that “steps must be taken” to manage the numbers of spinal patients waiting for video uro-dynamics and outpatient appointments.
CQC chief inspector of hospitals Professor Sir Mike Richards said that the individual needs of patients “were not consistently met”.
Sir Mike Richards
“In spinal services there was disparity between the experiences of some patients – while some made good use of the gardens and away days, others felt lonely and bored.”
“Spinal patients waited too long for specialist services but there was little risk assessment of the patients who were waiting,” he added.
Overall, the organisation was rated as “requires improvement”, with improvements needed for services to be safe, responsive and well led.
As well as nurse staffing levels, the trust has been told it must make improvements in 19 main areas, including completing a review of triage arrangements in A&E must be “without delay” to ensure all patients are clinically assessed promptly by a healthcare practitioner.
The trust must also improve the observation of patients waiting to be assessed so those seriously unwell, anxious or deteriorating are identified and seen promptly.
“I am pleased to see that our patients and staff rate the care at Salisbury District Hospital highly”
Meanwhile, the trust was told it must ensure that attempts to meet surgery targets do not have an impact on individual patients, who must not be sent home if there is clearly no safe pathway for discharging them, said the CQC.
However, inspectors noted that the trust provided services that were “good” for being caring and effective and identified a number of areas of outstanding practice.
The inspectors praised the “strong culture” of reporting and learning from incidents and said there was an “outstanding level of support” given by consultant surgeons to the junior and trainee doctors and other staff, including the student nurses.
Nurse-led pathways were also being used to improve patient treatment. The CQC noted that Salisbury came top in a national audit for patients with early arthritis.
“During our inspection we found an extremely positive culture within Salisbury Hospital. Many of the staff have worked in the trust for some time, they feel respected and valued and know each other well,” said Sir Mike.
Trust chief executive Peter Hill acknowledged that use of temporary staff to ensure safe staffing levels on wards was “currently an issue” and proactive recruitment was underway locally to improve the situation.
He noted that mandatory training, some aspects of documentation and the follow up of patients discharged from the spinal unit were among other areas highlighted by the CQC for action.
Mr Hill said: “A detailed action plan is in place to continue the improvements we have already started to make in areas identified within the report.”