Surgery patients have left been unprotected against ‘abuse’, and others are so used to delays that they have stopped asking for help at one of the country’s biggest NHS trusts, shocking inspection findings have revealed. Helena Vesty reports.
Patients have been left in pain, while others stopped asking for help after facing delays to their care amid shocking staffing shortages at one of Greater Manchester’s major hospitals.
Surgical services at Salford Royal Hospital have been served with a warning notice by health inspectors after they found patients were at risk of abuse and that bottles and bed pans of urine were left to accumulate in ward bathrooms, with staff short on time to clear them.
Surgical services have now been rated as ‘requires improvement’ by health watchdog the Care Quality Commission (CQC). It follows an inspection from September 23 to 25. The visit was carried out ‘due to concerns regarding how gynaecology, spinal and neurosurgery services are managed, as well as to look at their safety processes’.
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The latest review came after the CQC found regulatory breaches at a previous inspection. ‘Most of these remained a concern at this latest inspection’, inspectors said.
In shocking findings, inspectors discovered that ‘some aspects of the service were not always safe’, and ‘there was an increased risk that people could be harmed’.
Inspectors said staff didn’t always make sure patients weren’t protected ‘from abuse or improper treatment’; patients weren’t told about their rights around consent didn’t have their rights respected during care and treatment; and that ‘staff didn’t always complete risk assessments or appropriately manage people’s deteriorating health to keep people safe’.
There were also concerns that patients were left waiting for pain relief and support with their personal care. During the inspection, four people on one ward told the watchdog that they ‘experienced extended pain symptoms and had experienced delays in receiving pain relief medicines’. Staff told the CQC that multiple patients had experienced delays in receiving post-operative pain relief.
Staff told inspectors patients ‘would leave their individually-labelled bed pans or bottles in the bathroom for staff to collect when they had time’. That leads to a ‘risk this could lead to inaccurate recording of fluids as the bed pans and bottles absorbed some of the liquid’, the watchdog said.
Results published today (Friday, February 13) show the CQC has issued a warning notice to the Northern Care Alliance NHS Foundation Trust (NCA), which runs Salford Royal. The warning notice highlights the areas where ‘rapid and significant improvements’ are needed.
The official warning means the CQC can take further action if improvements aren’t made within a short period of time, including recommending that the services be taken over by another body, called ‘special administration’.
Major improvements being urged in the warning notice include ‘staffing levels, as well as systems and processes used to identify and manage risks, which were affecting quality and safety on the wards’, the watchdog said.
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Inspectors found wards did not have enough staff with the right qualifications to deal with patients. Patients ‘felt staffing shortages had impacted their emotional well-being and they didn’t always feel comfortable asking for help when they needed it, due to experiencing previous delays, especially during the night’, the CQC has said.
The report reads: “Most people told us the surgical wards did not have enough nursing and support staff… We spoke with people on some surgical wards who experienced delays in receiving pain relief and support with their personal care needs.
“People who used the service were not always safeguarded in the surgical wards. Formal duty of candour was not always undertaken in a timely way in accordance with trust policies.”
In addition to the concerns in the warning notice, inspectors found some 11 regulatory breaches relating to safeguarding people from abuse and improper treatment, as well as duty of candour.
These breaches were also regarding ‘person-centred care, safe care and treatment, good management of the service and staffing’, which had already been identified as problems at the last inspection in December 2022.
Inspectors found that surgical staff are supposed to formally identify a patient’s loved one if and when things go wrong within 27 hours, but no later than 10 days after the incident. Records showed that staff only told the relevant contact within 10 days just over two-thirds (68 per cent) of the time in one division of the surgical services.
The report continues: “The general environment in some surgical wards was aged and worn…
“Staff were not always trained to provide safe care. The surgical services reported that only 18.3 per cent of eligible staff had completed dementia awareness training during the past three years. The proportion of staff that had completed life support training was below trust targets.
“The services did not always manage infection prevention and control risks well. Staff compliance with hand hygiene standards and admission screening processes was consistently below trust standards. The services did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.”
The trust responded to the report saying improvements are now underway, including increasing staffing across surgical wards, with nine additional working-time equivalent registered nurses in post between September and January, and strengthened senior nursing presence during late, weekend and twilight shifts.
NCA chief nursing officer, Juliette Cosgrove said: “We know we haven’t always got things right and still have work to do to improve. We have been working closely with the CQC since their inspection in September 2025, alongside NHS England and our partner organisations to make improvements as quickly and openly as possible.
“Our colleagues are crucial to this process, and we’ve spent time listening and making sure they have the chance to share their views on what we can do to make things better.”
Inspectors identified that there were plans to improve equipment servicing and maintenance, and that staff understood how to identify and manage sepsis.
The watchdog also found that leaders engaged with partners and the wider community to plan and improve services, and that the service supported people to live healthier lives and where possible, reduced their future needs for care and support.
Northern Care Alliance Foundation Trust covers a population of one million across its four hospitals – Salford Royal, The Royal Oldham Hospital, Fairfield General Hospital in Bury, and Rochdale Infirmary.
The hospital is also the regional centre for major trauma, neurosurgery, and upper gastrointestinal and bariatric care. It is also a centre for complex spinal care and intestinal failure. The surgical services had 15,400 attendances between October 2024 and September 2025.
After the latest inspection, the CQC has again rated how safe, effective, responsive and well-led the surgery services are as requiring improvement. How caring the service is has declined from good to requires improvement. The overall rating for Salford Royal Hospital and the NCA has not changed, and stands at requires improvement.
