Updated
18 November 2021
The Royal Shrewsbury Hospital is part of Shrewsbury and Telford Hospitals NHS Trust and provides acute services to those living in Shrewsbury and surrounding areas.
Services at the Royal Shrewsbury Hospital include urgent and emergency care services, emergency medicine and surgery and end of life care services. Along with diagnostic and screening, critical care and outpatient services.
The urgent and emergency care service provides services 24 hours a day, seven days a week. The service consists of a booking reception area, a main waiting area, a children’s waiting area, two adult triage rooms, four bedded resuscitation bay, 12 majors’ cubicles, ‘pit stop’ with four trolleys, four bedded clinical decisions unit (CDU), one children’s cubicle and one children’s triage room.
The hospital’s medical care services comprised of cardiology, renal, respiratory and dermatology, stroke, care of the elderly and neurology, diabetes and endocrine, clinical support services, oncology and haematology.
The end of life care service comprised of two service lines, a specialist palliative care team and an end of life care team. The palliative care team at Shrewsbury and Telford Hospitals NHS Trust works across both hospitals. They provide specialist advice and support to people living with a serious, life-limiting illness who are currently staying in either the Royal Shrewsbury Hospital, or the Princess Royal Hospital in Telford. In-patients who might benefit from the service can be referred to the hospital palliative care team by any healthcare professional, carer or community team.
During our inspection we visited all areas within urgent and emergency care, ward 22 (short stay), 22 (respiratory), 23, 28 (frailty and gen med), 27 (general med), 23 (oncology), 24c (cardiology), 24E (endocrinology), 32 (respiratory), 35 (nephrology), 36, acute medical unit, surgical assessment unit and endoscopy.
We spoke with 86 members of staff, including doctors, nursing staff of various grades, healthcare support workers, physiotherapists and managers. We spoke with 21 patients and we looked at 79 sets of patient records.
Updated
29 November 2018
Our rating of this service stayed the same. We rated it as requires improvement because:
- The critical care unit did not meet current standards and there were not timely plans in place to address this.
- Although there had been improvements to nursing and medical staffing which now meet core intensive care standards, staffing of allied health professionals continued not to meet the required standards.
- Arrangements to ensure the availability of the hospital at night team were not robust and meant that sufficient staff were not always available to assess and treat deteriorating ward patients.
- The number and availability of allied healthcare professionals to provide care and treatment for critical care patients did not meet the required standards.
- Most staff were competent to undertake their roles. However, appropriate arrangements were needed to ensure the continuing development of critical care staff to meet intensive care standards.
- Multidisciplinary team (MDT) working was not always joined up across critical care. Health professionals (doctors, nurses and allied health professionals) had separate handovers which meant there was not discussion amongst all critical care health professionals for a full and rounded review of patients.
- Staff compliance with Mental Capacity Act (MCA) and Deprivation of Liberty training was extremely low.
- Consent to care and treatment was not always sought in line with legislation and guidance. Staff did not have sufficient knowledge or understanding of mental capacity act and deprivation of liberty safeguards. Because of this regulation had been breached and we were aware that one patient had been restrained, sedated and ventilated without the required safeguards in place.
- Although patient’s admission to critical care was mostly timely patient’s discharge from critical care was frequently delayed which also resulted in mix sex accommodation breaches.
- The trust planned to provide a modern critical care unit however the identified timescale was not realistic and meant that the needs of local people were not fully or appropriately met.
- Managers within critical care had the right skills and abilities to provide the service. However, there was lack of overarching managerial arrangements to ensure a coordinated critical care service for doctors across both the trust’s hospitals to provide safe, high-quality and sustainable care.
- Managers within the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. However, there was a need to ensure this was consistently displayed by other managers outside critical care.
- There was an inconsistent approach to service delivery and improvement. Managers, who worked within critical care identified where risks were and where improvements were needed to meet required standards. However, the response from more senior managers was slow and failed to recognize the needs of a critical care service and its patients.
- Although the service provided mandatory training in key skills for all staff most medical staff had not completed it.
However:
- Patients were treated with kindness and compassion and they and their loved ones were involved in decisions about their care and treatment.
- There were sufficient nurses and doctors available with the right skills, training and experience to provide the right care and treatment within critical care.
- Most nursing and ancillary staff had received required mandatory training including safeguarding training. Compliance with mandatory training had improved as staff were able to access to mandatory training and had resulted in critical care unit achieving the diamond exemplar award (the trusts highest quality award).
- Arrangements for the prescribing, administration and storage of medicines were appropriate.
- There were appropriate systems in place to report incidents and staff were mostly confident to do so.
- The service treated concerns and complaints seriously, investigated them and when needed lessons were identified and learnt.
Updated
8 April 2020
We rated it as requires improvement because:
- The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and usually managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
- Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
- Most people could access the service when they needed it and did not wait too long for treatment. The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
- Leaders ran services well and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
However:
- There were not enough clinic rooms in some areas and this resulted in patients not being seen.
- In one area assessment rooms were too cramped or poorly lit for safety
- Staff did not have the training they needed to support patients who lacked capacity to make their own decisions.
- Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not consistently in line with national standards for some cancer specialities.
- Information system were not integrated with one another relying on duplication of data entry and many systems were paper based.
Updated
8 April 2020
Our rating of this service stayed the same. We rated it as requires improvement because:
- The service did not make sure all staff completed mandatory training in key skills. The number of staff who completed mandatory training did not meet trust targets.
- The service did not make sure all staff completed mandatory safeguarding training. The number of staff who completed it did not meet trust targets. Clinical staff working with children and young people under 18 in theatres, did not have the correct level of safeguarding training.
- Infection prevention and control measures were not consistently followed by staff entering and leaving isolation rooms.
- The maintenance and use of facilities, premises and equipment did not always keep people safe. Staff did not always manage clinical waste well. Staff did not always carry out daily safety checks of specialist equipment.
- Staff did not always complete and update risk assessments for each patient and remove or minimise risks. Staff identified and acted upon patients at risk of deterioration, however, this was not always within timescales outlined in trust policy.
- The service did not always have enough nursing and support staff to keep patients safe from avoidable harm and to provide the right care and treatment.
- Records were not always clear and up-to-date and were not always stored securely.
However:
- Staff understood how to protect adult patients from abuse and the service worked well with other agencies to do so.
- The service mostly controlled infection risk well. Staff used equipment to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
- Nursing staff in post had the right qualifications, skills, training and experience. Managers regularly reviewed and adjusted staffing levels and skill mix, using a trust wide approach to ensure safe staffing levels across the trust by prioritising areas of greatest need. Bank and agency staff received a full induction.
- The service had enough medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix and gave locum staff a full induction.
- Staff kept detailed records of patients’ care and treatment. Records were easily available to staff providing care.
- The service used systems and processes to safely prescribe, administer, record and store medicines.
- The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured actions from patient safety alerts were implemented and monitored.
- The service used monitoring results well to improve safety. Staff collected safety information and shared it with staff, patients and visitors.