Salford Royal Hospital

Updated 13 February 2026

Salford General Hospital is an acute general hospital in Salford and has been a part of the Northern Care Alliance NHS Foundation Trust since October 2021 when Salford Royal Hospital NHS Foundation Trust legally acquired Pennine Acute Hospitals NHS Foundation Trust and changed its name to Northern Care Alliance NHS Foundation Trust. The hospital provides a range of acute NHS services, including medical care, urgent and emergency care and surgical services. The hospital is the regional centre for major trauma, upper gastrointestinal and bariatric care and the tertiary centre for neurosurgery, neurology and complex spinal care. It is also the quaternary centre for intestinal failure.

We commenced a responsive assessment of the surgical services at Salford Royal Hospital because we had concerns about governance and safety processes in the gynaecology, spinal and neurosurgery services, and to re-rate the surgical services following a rating of requires improvement from our previous inspection in December 2022. We carried out an unannounced inspection visit between 23 and 25 September 2025.

Our assessment only looked at surgery at Salford Royal Hospital. Our findings for the surgical services can be found in the services section of this report.

The overall location rating for Salford Royal Hospital remains unchanged following our assessment of surgery. We rated Salford Royal Hospital as requires improvement.

Updated 7 May 2025

The surgical services at Salford Royal Hospital are incorporated into 2 divisions across the hospital. The division of surgery and perioperative care includes the general surgery, gynaecology, urology, plastics, trauma and orthopaedics, theatres, anaesthetics and perioperative care specialties. The major trauma, spinal, neurosurgery, head and neck and ear, nose and throat (ENT) specialties form part of the Manchester Centre of Clinical Neurosciences (MCCN) division. The hospital is also the regional centre for major trauma and neurosurgery and the tertiary referral centre for complex spinal surgery. The hospital is the regional centre for major trauma, upper gastrointestinal and bariatric care and the tertiary centre for neurosurgery, neurology and complex spinal care. It is also the quaternary centre for intestinal failure. The surgical services had 15,400 attendances between October 2024 and September 2025.

We commenced a responsive assessment of the surgical services at Salford Royal Hospital because we had concerns about governance and safety processes in the gynaecology, spinal and neurosurgery services, and to re-rate the surgical services following a rating of requires improvement from our previous inspection in December 2022. We looked at 33 quality statements as part of the assessment.

We carried out an unannounced inspection visit between 23 and 25 September 2025. During the inspection, we spoke with 24 people who used the service and 5 relatives and carers. We looked at 29 care records. We also spoke with over 100 staff, leaders and service partners and looked at policies and other documents relating to the service.

Following the inspection, we issued a warning notice to the trust on 21 October 2025 under section 29A of the Health and Social Care Act 2008. We took this action as we believed significant improvement was required to reduce the risk of harm to people who used the service. The warning notice related to staffing levels across the surgical wards and concerns about the systems and processes used to identify and manage risks affecting quality and safety on the surgical wards.

We also identified a further 11 regulatory breaches relating to person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, staffing and duty of candour in addition to the concerns identified within the warning notice.

Our overall rating for surgery remained the same. We rated it as requires improvement.

The services did not have effective governance and quality monitoring processes. We found significant shortfalls around the safety, effectiveness and responsiveness of the surgical services. Actions taken to address key issues or reduce their impact had not resulted in effective and timely improvements in the management of risks, issues and performance across the services. The services had also failed to make any significant improvements to address most regulatory breaches identified during our previous inspection in December 2022.

However, most staff had completed mandatory training and received regular appraisals. Services had enough medical staff, and teams worked collaboratively to follow national guidelines, manage sepsis effectively, and promote healthier lifestyles. Staff considered inequalities, encouraged feedback, and demonstrated a commitment to learning and innovation. Leaders engaged with partners and the wider community to plan and improve services.

We will return to assess the service to check the trust has made significant improvements in the quality of healthcare provided.

Updated 22 December 2022

Updated 27 March 2015

Overall, we have rated this service to be good. The service was delivering care that was safe, effective, caring and responsive to the needs of children and their families. There was, however ,some disparity between the overall strategy and vision with regards to the provision of care to children at Salford Royal Hospital, and further work was necessary to strengthen this to ensure the service remained viable for the future. The disparity was in part, due to the existing clinical and operational structures of the hospital. We found that where services routinely treated children, such as the PANDA unit, which was managed by the children’s services directorate within the Salford Health Care division, the governance arrangements, risk management and the measurement of performance was suitably robust.  But this was not necessarily the case for the relatively low number of children who attended the hospital annually to undergo routine day surgery. While a senior clinician was accountable for overseeing the delivery of care to all children, this oversight was not sufficiently apparent for children requiring surgery.

The low number of children who underwent general anaesthetic at the hospital meant that anaesthetists and other staff in the operating theatres were at risk of not having the necessary regular and relevant paediatric practice sufficient to maintain their core competencies. The trust had acknowledged this as an area of concern in 2013, and had instigated a range of initiatives to reduce the potential risk to children. This included commencement of scenario-based training, as well as ensuring that two qualified anaesthetists were present for any child undergoing a general anaesthetic. The service had good incident reporting systems, which staff were able to describe in detail. Staff were aware of their responsibilities to report incidents. Lessons were learned where incidents had taken place. The department was visibly clean. There were systems in place to ensure that patients were protected from the risk of harm associated with hospital acquired infections. Staff undertook regular training to ensure they could recognise and respond to the needs of vulnerable patients.

There was evidence that staff used a range of local and national clinical guidelines to assist in delivering evidence-based care. The service was recognised as being a leader in the provision of diabetes care to children and young people. Patient outcomes and clinical practice were audited to ensure that practice was consistent. Where there had been deviations from clinical guidelines, or where auditing had identified variations in clinical practice, action plans were utilised to ensure a more standardised approach to care delivery. Within the Salford Health Care children’s services directorate, we observed strong and effective multi-disciplinary team working among those involved in providing both acute and community-based care to children and their families.

We observed children being looked after in a caring and compassionate manner. Parents and some children spoke about their care and how involved they were with planning it, and how information was shared with them so they could be fully informed about what would happen to them. Parental involvement was encouraged where children were under16 years of age, in line with national recommendations; this reduced the impact of hospitalisation on younger children.

The commissioning arrangements of children’s services at Salford Royal Hospital meant that there were no inpatient facilities. Where children required hospital care lasting more than 24 hours, there were arrangements in place to ensure that they were transferred to an appropriate facility. There were arrangements in place to ensure that when young people required hospital care or admission, this was done in line with local hospital policy and only where the requirement to provide care had been appropriately risk-assessed. Some improvements were required to ensure that there was age-appropriate information available for children scheduled to undergo surgery.

Staff reported that leadership at a local, ward-based level was good; managers were reported to be supportive of their staff and people spoke positively about working at Salford Royal Hospital. Staff visions and behaviours were aligned to the trust-wide vision of ensuring that patients received safe, clean and personal care every time. A small minority of staff who worked within the day surgery unit reported that improvements could be made to ensure that they received the necessary amount of sustained and consistent support from managers.

Updated 24 August 2018

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

• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
• Completion rates for mandatory and safeguarding training were high across the service. Staff were able to identify and knew how to report safeguarding concerns and incidents, which were appropriately investigated. There was governance oversight of incidents and complaints. Learning from these was shared with staff and teams across the service.
• The service’s environment, layout and facilities supported the delivery of good quality care and helped staff to maintain appropriate levels of cleanliness and hygiene. Hospital acquired infection risks were appropriately managed.
• Patients received comprehensive risk assessments and were closely monitored for signs of deterioration. Staff escalated care to medics appropriately and quickly.
• Care and treatment was evidence based. The was effective multidisciplinary working within the teams that took account and assessed patients’ capacity to consent to treatment.
• The service collected data across a range of patient outcome measures, and benchmarked itself against similar units.
• Staff were kind and compassionate in the care and treatment provided to their patients. Staff involved people in decisions and ensured people understood the care and treatment provided to them, and supported people emotionally when appropriate.
• The service worked with local commissioners in planning the services offered to people, and took into account individuals’ needs. People could access the service when they needed to and there were sufficient staff and resources to provide care 24 hours a day, seven days a week.
• The leaders of the service understood the challenges the service faced, and had a vision and plans for development to achieve full compliance with national and local policy and guidance.
• A positive and supportive culture was evident within the service which encouraged engagement with staff, patients and the public.

However,

• We were not assured there were sufficient staff trained in safeguarding vulnerable children level three to support those occasions when older teenagers were cared for on the unit.
• The service did not have sufficient numbers of allied health professional staff to provide dedicated dietetic or speech and language therapy support for pods A to C.
• We were not assured that staff practices in relation to recording the decision to discharge a patient to the ward only when a bed was available for imminent transfer, or the service’s mixed sex accommodation escalation policy within the unit was in line with national guidance. As such, we were not assured that single-sex breaches were being appropriately reported internally and externally.

Updated 27 March 2015

The hospital's Specialist Palliative Care(HSPC) team provided face-to-face support seven days a week, with the hospice providing out-of-hours cover. There was strong clinical leadership of the HSPC team resulting in a well-developed, strong, motivated team. A strong bereavement team was available to support carers and families following the death of their relative. The teams worked well together to ensure that end of life policies were based on individual need and that all people were fully involved in every part of the end of life pathway.

Relatives of patients receiving end of life care were provided with free car parking and open visiting hours. Families were offered ‘keepsakes’ including fingerprints, photographs and locks of hair. Families were given the choice of how their relative was moved to the mortuary. Relatives received their family member's belongings in canvas bag with a ‘swan logo’, which highlighted to staff that people carrying the bag may need extra support. There was excellent spiritual/religious awareness across the hospital and facilities were in place to support the different cultures and religions of the people of Salford.

End of life care was embedded in all the clinical areas and staff we spoke to were passionate about end of life care and the need to ensure that the wishes and preferences  of their patients and families were met as they entered the last stage of their life. Palliative care link nurses were introduced onto the wards to champion good end of life care.

There was a multidisciplinary team (MDT) approach to facilitate the rapid discharge of patients to their Preferred Place of care(PPC) or Preferred Place of Death(PPD). Patients were discharged within a six-hour window.

Patients were cared for with dignity and respect and received compassionate care.

Medicines were provided in line with guidelines for end of life care.

Updated 24 August 2018

• Environmental concerns raised at the previous inspection had been addressed at the time of this inspection.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
• The department had plans for dealing with major incidents and staff understood their roles.
• The service provided mandatory training in key skills to all staff and made sure everyone completed it.
• The service prescribed, gave, recorded and stored medicines well.
• The service provided care and treatment based on national guidance.
• Patients had access to food and drinks whilst waiting for their appointment.
• Pain was assessed and managed by staff caring for patients.
• Doctors, nurses and healthcare professionals from different specialities supported and worked together as a team to improve patient care.
• The service supported patients by promoting healthier lifestyles.
• Care was delivered in a compassionate way and staff provided emotional support to patients to minimise their distress.
• Staff involved patients and those close to them in decisions about their care and treatment.
• Feedback from patients confirmed that staff treated them well and with kindness.
• Patients could access the service in the way they needed it.
• The service had managers at all levels with the right skills and abilities to run the service, providing high-quality sustainable care. Specialist clinics were well-led, organised and responsive.
• Individual clinics used a systematic approach to continually improve the quality of its services to create a service in which clinical care would flourish.

However:

• Some staff raised concerns about bank staff being left to run clinics alone without working there before.
• All staff had received safeguarding training but some staff lacked understanding of how to escalate or follow-up safeguarding concerns.
• The main outpatient area was less responsive to meeting the needs of patients.
• Because of a management vacancy in the main outpatient’s department the leadership team needed to ensure it had the capacity to deliver the quality of its service.
• Senior managers acknowledged there were staff satisfaction issues in the main outpatient’s department. We heard some staff describe the culture in the department as an ‘us and them’ culture and felt that staff morale was low.

Updated 22 December 2022