We undertook this focused inspection to follow up the concerns identified in the warning notice served in January 2016, therefore rating of the service as a whole did not change.

We conducted a fully comprehensive inspection of Salisbury District Hospital NHS Foundation trust in December 2016 and issued a warning notice to The Duke of Cornwall Spinal Treatment Centre.

Key points from the warning notice were as follows:

• Care and treatment not being provided in a safe way for service users.

• Systems or processes not being established or being operated effectively to assess, monitor, mitigate, and improve the quality and safety of the spinal services provided.

We undertook an announced focused inspection in November 2016 to follow up on the issues.

Our key findings were as follows:

• The warning notice was fully met.

• The backlog of patients waiting for a video uro-dynamics scan or outpatient appointment had significantly reduced through an increase in consultant activity, the introduction of nurse led clinics, and the introduction of a new patient pathway and patient initiated contact appointments.

• All patients had been validated and prioritised depending on risk ensuring, as much as possible, people were able to access the right care at the right time.

• Governance and performance arrangements were rigorous, embedded, and were proactively reviewed on a regular basis.

• All leaders (at executive and directorate level) had an inspiring and shared purpose to motivate all staff. This had a positive impact on the culture of the spinal centre and had improved their wellbeing both in and out of work.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Salisbury District Hospital is the main location for Salisbury NHS Foundation Trust. We visited the hospital to review improvements the Trust told us it had made to staffing levels and information governance. On our previous inspection in February 2013, we found staffing levels across the hospital were not always at levels to safely meet the needs of patients. We also found there were a number of occasions on wards in the hospital where we found patient records left unattended.

The Trust sent us a series of action plans to outline how it was going to improve in both of these areas. We went back to the hospital to check on progress, and also to ask patients and staff about their experiences of the service. All the patients we spoke to told us they found the staff caring and professional. They told us the wards were busy, but staff would answer the call bells and deal with any queries promptly.

We found the Trust had made sufficient progress to improve the staffing levels and skill mix. This included recruiting additional staff and reviewing the workforce plans on an annual basis. We also found the Trust had also put in place effective measures to prevent confidential patient information being left in areas accessible to the general public.

Our rating of services improved. We rated it them as good because:

• Staff treated people with the kindness, dignity and respect. Individualised, person centred care was delivered by a workforce who recognised and valued their responsibilities towards people using the hospital.
• There was a strong culture of doing what was right for patients, for keeping them safe and involving them in decisions which affected their treatment and care. Patients and relatives spoke highly of staff and the standards and quality of care. They were informed of investigations and treatment plans, and how these would affect them.
• Services were planned and arranged to meet the general and specific needs of local people. Staff carried out a range of risk assessments and safely managed these in line with national and professional guidance. The trusts safeguarding arrangements assisted in keeping vulnerable people safe and protected them from avoidable harm.
• The systems and processes available to support staff in their clinical practices were well organised and structured. Professional guidance was easily accessible and used to inform decision making around patient needs.
• The arrangements for reporting, investigating and learning from incidents was supported by a positive culture of improving patient care.
• The hospital environment was generally visibly clean. Most staff followed infection prevention and control procedures and routine standards of cleanliness and hygiene were maintained.
• Leaders had the skills, knowledge, experience to oversee services. We found improvements had been made in the leadership of the accident and emergency department and critical care services since the last inspection.
• Staff had the skills, knowledge and experience to deliver effective care and treatment. Staff were encouraged and supported to access training and development opportunities.
• Departments planned and reviewed staffing levels and skill mix so people received safe care and treatment.
• The trusts vision and values were understood by staff. Local service objectives had been developed and staff committed to achieving these.
• There were effective governance arrangements within departments and information was communicated upwards through various committees to the board. Information was shared with staff in an open and transparent manner, which helped staff to feel valued and respected.