Two years ago, a member of theatre staff at Salford Royal raised what they believed was an urgent warning with a Freedom to Speak Up guardian. “We are going to harm someone,” they said. The staff member told the Manchester Evening News they were warning hospital bosses about a series of concerns within the surgical unit, including incidents where things had been left inside patients, wrong-site surgery and operations taking place without the correct consent form.
A year later, they said, the Trust came back with what they described as a “fabricated action plan”. Despite that, they told the MEN they had seen little change. “I'm really concerned we're going to kill somebody. It is not 'we might', it is 'we will'. It pains me to say it, but it's a matter of time,” they said. The staff member said they had now reached the point where they would not raise the same concerns again.
CQC finds 12 breaches at Salford Royal
The warning is now at the centre of a much bigger question facing the Northern Care Alliance (NCA), which runs Salford Royal, Royal Oldham Hospital, Fairfield General Hospital and Rochdale Infirmary. Staff on the picket line on Friday (October 2) said they have continued to raise concerns about staffing, patient safety and the culture around speaking up. And those concerns have since been backed by findings from the Care Quality Commission (CQC), which has repeatedly identified problems within surgical services at Salford Royal.
A fresh inspection found the service still required improvement, with inspectors finding 12 breaches of legal regulations, including in relation to safe care and treatment, governance and staffing. The CQC also found that staff remained “reluctant to raise concerns” because they feared they would be “dismissed or lead to punitive actions”.
Just 43.4 per cent of staff responding to a January pulse survey said they felt supported to raise concerns about unwanted behaviours. The survey showed 32.2 per cent of responses were neutral and 24.4 per cent responded negatively, the CQC said. Similar issues were highlighted by the CQC's September 2025 inspection, in which it found staff “did not always feel confident in raising concerns” through FTSU.
Staff describe 'culture of fear'
“We found significant improvements had not been made during this inspection,” the CQC wrote in its latest report, published on Wednesday (September 30). Some staff also reported issues around bullying and harassment to inspectors, and spoke negatively about the support they received from line managers. Anaesthetic and medical staff reported staff morale was still low and had not significantly improved.
But for staff who say they had been raising concerns for years, the question remains whether these problems were already being warned about long before they appeared in a regulatory report. The MEN has spoken to current and former staff within NCA who describe a system in which raising concerns did not lead to visible or meaningful action.
One current member of theatre staff said they believed there was a “culture of fear” within the Trust. “I think people are scared of talking,” they said. “I've worked in this unit for a really long time. I just feel there is no one you can go to with a concern that will take it seriously and it will stay confidential - or to get some genuine feedback or support.”
Concerns raised through Datix and FTSU
Staff also described concerns being raised through Datix - the NHS system used to record patient safety incidents and staff accidents - as well as through Freedom to Speak Up. One worker said: “They want us to voice our point, like a tickbox - and sweep it under the carpet again. The carpet people are sweeping problems under is getting bigger and bigger.”
Speaking outside Salford Royal during the latest period of industrial action, Unison assistant branch secretary Sally-Ann Griffiths said staff had told her they were reluctant to report incidents because they feared repercussions. She said staff would tell her: “There's no point”, or “I'm not prepared to take the repercussions” of raising a Datix. She said the result was a “vicious cycle” in which Unison would raise an issue with the Trust only to be told they couldn't look into it since: “There’s no Datix about it.”
The problems come against a wider backdrop of serious patient safety concerns across Northern Care Alliance. Reports produced by the Trust have linked lengthy delays with “28 deaths” and 56 issues of “severe harm”, while problems diagnosing illness led to ten deaths last year. There were also 10 “never events” recorded at the NCA across 2025 and 2026, which the NHS describes as patient safety incidents which were “wholly preventable,” according to the reports.
Former staff echo concerns
Theatre staff outside Salford Royal claim “never events” are happening in their unit “on a regular basis” due to short staffing and gaps in training. Some, they claim, are being “downgraded” and recorded as serious incidents instead. These concerns are echoed by former staff within NCA. Former consultant gynaecologist Dr Vanessa Lawton, who worked at the NCA for nearly 21 years, said she repeatedly raised concerns about patient safety and felt ignored.
“I did a lot of speaking up,” she told the MEN, adding the Trust would repeatedly encourage staff to voice their concerns. “I'm very vocal. It was all a complete waste of time.” One example she told the Independent involved a woman in her early 50s who attended a 15-minute weekend appointment after experiencing post-menopausal bleeding. Dr Lawton said the woman was not examined during that appointment when she should have been, and was not examined at a second appointment either. Months later, the patient returned to hospital with advanced cervical cancer and died.
Dr Lawton said she was concerned that an investigation into the woman’s death did not consider the impact of shorter appointments, which had been introduced as part of an attempt to increase the number of appointments. She also described other cases which she believed demonstrated the consequences of staff working under pressure. She told the MEN about one missed ovarian cancer and another case involving a large ovarian tumour which was not identified until it had grown substantially.
“The large ovarian tumour turned out to be benign, but that’s just luck,” she said. “She'll have had a much bigger operation, because it had grown so much between discharge, having not noticed it. The cervical cancer patient wasn’t examined, which would be normal practice. And the ovarian cancer was because they didn’t read the scan report in full - and that’s being rushed. I was seeing that kind of thing, lots of complications, all treated as though they’re single events.”
Another retired consultant Dr Glyn Smurthwaite, who worked at Salford Royal for almost 30 years, said he believed the trust's governance system had “utterly failed” and criticised the way Datix reports were handled. He said: “One of the questions when you fill the form in is if you want feedback, I always ask for feedback, I filled in hundreds and I honestly can tell you not a single one has ever resulted in anything meaningful. It’s completely ineffective. It’s not an ineffective system, it’s ineffective because the people who run it are ineffective.”
He also raised concerns about the gap between trust leadership and staff working on the frontline, describing a “disengage between the people managing the organisation and what the organisation actually does”.
Staffing pressures and cancelled operations
Staff on the picket line said the problems with speaking up cannot be separated from the pressures they face at work, with one staff member saying “people are firefighting every day” to cover staffing shortages. The CQC report also highlighted issues with staffing levels and cancelled care. Inspectors found 501 operations had been cancelled for non-clinical reasons on the day of surgery between September 2025 and May 2026. There were also more than 700 instances where staff were redeployed between areas to cover shortages between the 2025 and 2026 inspections.
The report also found 79 incidents were recorded between September 2025 and May 2026 related to staff shortages, most of which were because of cancelled non-emergency procedures. None were reported as causing significant patient harm, and nine were graded as causing moderate harm. Despite this, the CQC said nursing and support staff felt their workloads had improved and they were happier in their roles since the previous inspection. Staff also felt levels were 'safe'.
However, one theatre staff worker said staff were regularly being moved between theatres to fill gaps, despite the risks involved in moving workers between different patients. They said there was a rule within the unit that staff should be moved a maximum of twice, but added: “I have come into work and been moved three times to different theatres. That is the danger. Every patient is different. One day I was moved seven times - it’s so dangerous.”
“We're moving due to staffing gaps - there’s still not a good skill mix,” they added. “It’s just plugging a gap.” The same worker said staff were also being moved between different hospitals to cover shortages. “The skill mix is rubbish. We're just putting bums on seats and it's putting patients at risk,” they added.
Overtime pay dispute and strike action
Against this backdrop, more than 350 theatre staff within the Trust have been staging strike action in a dispute over overtime. More than 350 nurses, clinical support workers and housekeepers within NCA walked out on October 2 and again the following Monday (October 5). The dispute surrounding the strike action centres on the use of an outside agency, called NHS Professionals (NHSP), to manage additional shifts.
Unison claims changes to the way overtime is managed mean some staff can now earn less for an additional shift than they would have done previously, with some missing out on as much as £80 a shift. One staff member on the picket line in August told the MEN that changes over the past year pushed theatre workers towards NHSP, before enhanced pay rates for overtime were removed altogether in January. The result, they said, was that people were still needed to fill the same staffing gaps - but were being paid less for doing so. They added that colleagues have been working five or six shifts a week - two or three more than in their usual 37.5 contracted hours - to earn the same amount they previously made from taking just one extra shift.
The Trust said it has made a “fair and strong offer” to Unison. It said it believes the offer “addresses many of the issues raised in this dispute”. However, Ms Griffiths said striking staff are simply “demanding to be paid their already agreed terms and conditions”, adding that many members feel obliged to take overtime shifts because “there's not enough staff”. And these staffing pressures have led to exhausted workers taking time off, which leaves fewer people available to work, putting even more pressure on those who remain, one staff member said on the picket line in August.
But following the most recent round of strike action, the NCA has announced on Wednesday (October 7) a resolution package which it says is intended to address the dispute and the wider pressures affecting theatre services. Under the package, eligible theatre staff working additional voluntary shifts during what the Trust calls a “period of extraordinary pressure” will receive enhanced NHSP bank rates. The enhanced rates will be guaranteed for 12 months while the Trust works to address what it described as the “underlying causes” of pressures affecting theatre services.
The package will also establish an Improvement Taskforce involving nominated theatre staff and overseen by the Trust Board. It will examine issues including workforce and vacancy pressures, rota design, communication, management and leadership, staff experience, workplace culture and recruitment and retention - many of which staff have described to the MEN.
Union disputes Trust's claims
The union, however, says the package does not mean the dispute has been resolved. Unison North West regional organiser Kevin Dolan said members felt the Trust's claim that it was building a culture where staff felt “safe, valued and respected” did not reflect their experience. He said theatre staff were working in a “chronically understaffed” department, with morale “at rock bottom”, and accused the Trust of preferring to “spend taxpayers' money” on agency staff rather than paying its own employees under their existing terms and conditions.
Mr Dolan also disputed a claim made by the newly appointed interim chief executive Kevin McGee that he had “met with theatre colleagues and their trade union to listen and understand their concerns”. “This is simply untrue,” he said. He claimed union representatives had not yet spoken to Mr McGee and that members felt management had “actively avoided conversations with them”.
The NCA disputes that account. Gertie Nic Philib, chief people and strategy officer at the Trust, said NCA has invited Unison representatives to meet them informally. “They have advised that they are unavailable until 27 October, but our door remains open should that change,” she said. “We want the best for our theatre colleagues, patients and the communities we serve. We remain firmly committed to resolving this dispute through open, honest and direct discussions with our staff.”
NCA told the MEN there are a number of routes available for staff to speak up when something is not right or they are concerned, claiming it has invested in more FTSU guardians and it is increasing the visibility of senior leaders. It also said the Trust is supporting clinical leaders to speak openly about both problems and progress. The Trust encouraged staff who feel processes to investigate incidents and make improvements are not being followed properly to speak up and escalate their concerns.
NCA Chief Nursing Officer Juliette Cosgrove said: “We are making improvements for our patients and service users and the Care Quality Commission’s recent report following their inspection of surgical services at Salford Royal featured lots of examples of this. We’re proud of our staff and their work to improve the ‘Caring’ rating from Requires Improvement to Good. Inspectors also fed back they’d heard from patients and families on the compassionate and respectful care they’d received. We’ve also made progress in areas including staffing arrangements on wards, safeguarding, patient safety processes, surgical safety compliance and the management of deteriorating patients. We will keep building on the progress we’re making by listening to our colleagues, learning when things go wrong and sharing best practice across the NCA when we make improvements.”
For the Trust, the latest announcement marks a commitment to addressing many of the issues at the centre of this dispute. But for staff who have been sounding the alarm for years, it remains to be seen whether the changes being promised are enough to show that they are finally being heard.
