The Care Quality Commission
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Shrewsbury and Telford Hospital NHS Trust

This is an organisation that runs the health and social care services we inspect

Overall: Inadequate read more about inspection ratings
Important: We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

All Inspections

6 July, 7 July, 13 July, 14 July, 19 July, 20 July 2021, 17 August, 18 August and 19 August 2021

During a routine inspection

The Shrewsbury and Telford Hospital NHS Trust is the main provider of district general hospital services for nearly half a million people in Shropshire, Telford & Wrekin and mid Wales. There are two hospital sites:

  • The Royal Shrewsbury Hospital; and
  • The Princess Royal Hospital

Both hospitals provide a wide range of acute hospital services including accident & emergency, outpatients, diagnostics, inpatient medical care and critical care.

During 2012/13, the Princess Royal Hospital became the main specialist centre for inpatient head and neck surgery with the establishment of a new head and neck ward and enhanced outpatient facilities. It also became the main centre for inpatient women and children’s services following the opening of the Shropshire women and children’s centre in September 2014.

During 2012/13, the Royal Shrewsbury Hospital became the main specialist centre for acute surgery with a surgical assessment unit, surgical short stay unit and ambulatory care facilities.

Together the hospitals have just over 800 beds and assessment & treatment trolleys. The trust operates, on average, over 5,000 outpatients’ clinics per week.

The trust has over 5,800 whole time equivalent members of staff.

Alongside the services at the Princess Royal and Royal Shrewsbury, the trust also provides community and outreach services such as:

  • Consultant-led outreach clinics
  • Midwife-led unit
  • Renal dialysis outreach services
  • Community services including Midwifery, Audiology and Therapies.

The trust had experienced significant challenges over the past 18 months due to the COVID-19 pandemic. Staff were redeployed from substantive roles to care for the most acutely ill patients and support staff in critical areas. Services had to be redesigned and moved at short notice.

At the time of our inspection, the trust was part of an improvement alliance with an NHS trust based in Birmingham, which had commenced in 2020 and was still in operation. The alliance involved the sharing of resources, staff, expertise and learning to facilitate improvement across the trust.

We carried out this unannounced inspection of Shrewsbury and Telford Hospitals NHS Trust because at our last inspections in 2018 and 2019 we rated the trust overall as inadequate, and the trust was placed in special measures. We inspected to see what improvements had been made.

We carried out an unannounced inspection of the following acute services provided by the trust:

  • Urgent and emergency care at both the Royal Shrewsbury Hospital and the Princess Royal Hospital;
  • Medical care at both the Royal Shrewsbury Hospital and the Princess Royal Hospital;
  • End of life services at both the Royal Shrewsbury Hospital and the Princess Royal Hospital; and
  • Maternity services at the Princess Royal Hospital.

We also inspected the well-led key question for the trust overall.

We inspected these services because during previous inspections we had identified concerns and had taken enforcement action to check whether the trust had made improvements to the care and treatment delivered.

We did not inspect all the services previously rated as requires improvement because this inspection was focused only on services where we had concerns. We are monitoring the progress of improvements to services and will re-inspect them as appropriate. Services previously rated as requires improvement and not inspected this time include:

The Royal Shrewsbury Hospital:

  • Surgery;
  • Critical Care; and
  • Outpatients.

The Princess Royal Hospital:

  • Surgery;
  • Critical Care; and
  • Services for children and young people.

Our rating of services stayed the same. We rated them as inadequate because:

  • The trust had made improvements since our last inspection but further work was needed to improve the rating.
  • We rated safe and responsive as inadequate and caring as requires improvement. Effective and well-led had improved to requires improvement. Well-led is the overall trust-wide rating, not an aggregation of services ratings.
  • We rated four out of the seven services inspected as requires improvement and three as inadequate.
  • In rating the trust, we took into account the current ratings of the seven services not inspected this time.
  • Staff did not always assess and respond to patient risk. Records were not always of good quality, stored safely or easily available to staff to ensure that they could provide safe nursing care
  • Vacancies within nursing, medical and allied health professional staffing was still impacting on the safety and quality of patient care.
  • Practice in respect of infection prevention and control was varied in performance and the environment across many core services did not promote safe and high-quality care.
  • Practice in relation to pain relief for patients varied across core services. The availability of key services was varied with patients not being able to access them seven days a week, especially in respect of the services provided by allied health professionals.
  • Staff did not always treat patients with compassion and kindness but it is acknowledged their ability to do so was impacted by other challenges the trust faced.
  • Individual needs were not always met. People could not always access the service when they needed it and did not receive the right care promptly.
  • Leadership at trust level and across core services had improved but there was further work to do which included but was not limited to management of risk and performance, culture and governance.

However:

  • Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
  • Services had improved safeguarding practices which improved safety for service users.
  • Mental health provision for service users had improved.
  • Actions were being taken to recruit nursing, medical staff and effective leaders.
  • Medicines were generally managed well, with some exceptions in some areas. The safety culture within the trust had improved since our last inspection but learning was not always shared effectively.
  • Services generally provided care and treatment based on national guidance and evidence-based practice. Staff monitored the effectiveness of care and treatment. The service made sure staff were competent for their roles. Staff worked together as a team to benefit patients. Key services were available to support patient care. Practice in relation to Mental Capacity Act and Deprivation of Liberty Safeguards had improved across the whole of the trust.
  • The board was developing and starting to work well together.

How we carried out the inspection

We carried out this inspection on various days throughout July 2021. We visited areas relevant to each of the core services inspected and spoke with a number of patients and staff, as well as holding focus groups.

During the inspection we visited:

  • 12 wards within medical services at the Royal Shrewsbury Hospital;
  • 10 wards within medical services at the Princess Royal Hospital;
  • All areas of the emergency department within urgent and emergency care services at the Royal Shrewsbury Hospital;
  • All areas of the emergency department within urgent and emergency care services at the Princess Royal Hospital;
  • Five wards where end of life care services was delivered and the mortuary at the Royal Shrewsbury Hospital;
  • Five wards where end of life care services was delivered and the mortuary at the Princess Royal Hospital; and
  • All areas within maternity services at the Princess Royal Hospital.

We spoke with 192 staff members of various speciality and profession including, consultants, doctors, radiotherapists, midwives, nurses, healthcare support workers, allied health professionals, pharmacists, patient experience, domestic staff and administrators.

We spoke with 41 patients throughout the departments and reviewed 135 patient records.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

12 November 2019 to 10 January 2020

During a routine inspection

Our rating of the trust stayed the same. We rated it as inadequate because:

  • The safe, effective, responsive and well led key questions were all rated as inadequate.
  • The caring key question went down to requires improvement.
  • Royal Shrewsbury Hospital was rated requires improvement.
  • The Princess Royal Hospital was rated as inadequate.

21 August to 21 September 2018

During a routine inspection

Our rating of the trust went down. We rated it as inadequate because:

  • The Princess Royal Hospital, Telford and Royal Shrewsbury Hospital, Shrewsbury were rated as inadequate overall.
  • In four services, safe and well-led was rated as inadequate.
  • In many services, overall, safe, effective, responsive and well-led were rated as requires improvement.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website – www.cqc.org.uk/provider/RXW/reports.

12 – 15 December 2016

During an inspection looking at part of the service

Shrewsbury and Telford Hospital NHS Trust is the main provider of district general hospital services for nearly half a million people in Shropshire, Telford & Wrekin and mid Wales; 90% of the area covered by the trust is rural. There are two main locations, Royal Shrewsbury Hospital in Shrewsbury and Princess Royal Hospital in Telford. The trust also provides a number of services at Ludlow, Bridgnorth and Oswestry Community Hospitals.

We inspected this trust using our comprehensive methodology in October 2014. At that time we rated the trust requires improvement overall, and we had particular concerns about end of life care at Royal Shrewsbury, which was rated inadequate. Since our last inspection, we can see that the trust has made significant improvements in a number of areas, including end of life care. We also noted a positive change in culture amongst staff and leaders. The overall rating reflects the fact that the trust still have some way to go on its improvement journey but the change in ratings in a numbers of areas acknowledges what they have achieved so far.

We rated Shrewsbury and Telford Hospital NHS Trust as requires improvement overall.

  • Insufficient numbers of consultants and middle grade doctors were available.

  • Nursing staff vacancies were impacting on continuity of care and an acuity tool was not used to assess staffing requirements.

  • The trust was not achieving the Department of Health’s target to admit, transfer or discharge 95% of patients within four hours of their arrival in ED.

  • Ambulance handover times regularly fell below national standards.

  • The trust’s referral to treatment time (RTT) for admitted pathways for surgery have been lower than the England overall performance since September 2015.

  • The triage process for patients brought in by ambulance was inconsistent and unstructured.

  • Attendance levels for mandatory training were noted to be poor in most areas

  • Compliance with the trust target for completion of staff appraisals was below the trust target.

  • There were three Never Events relating to retained products following surgery,

  • Current safety thermometer information was not displayed on the wards

  • The maternity specific safety thermometer was not being used to measure compliance with safe quality care.

  • In maternity services, feedback to staff on incidents was described as inconsistent and only a few midwives told us they had received feedback.

  • Inconsistencies were identified in the staffs application of the World Health Organisation’s (WHO) ‘five steps to safer surgery’ checklist.

  • Mortuary staff decontaminated surgical instruments manually; this exposed staff to unnecessary risk and did not provide a high level of disinfection.

  • Mental capacity documentation had not been completed for defined ceiling of treatment decisions when a person had been deemed as lacking capacity.

However, we also saw that:

  • Openness and transparency about safety was encouraged. Incident reporting was embedded among all staff, and feedback was given. Staff were aware of their role in Duty of Candour.

  • In every interaction we saw between nurses, doctors and patients, the patients were treated with dignity and respect. Staff were highly motivated and passionate about the care they delivered.

  • There were clearly defined and embedded systems, processes and standard operating procedures to keep people safe and safeguarded from abuse.

  • Treatment was planned and delivered in line with national guidelines and best practice recommendations

  • Local and national audits of clinical outcomes were undertaken and quality improvements projects were implemented in order

  • It was easy for people to complain or raise a concern and they were treated compassionately when they did so.

  • There was clear statement of vision and values, driven by quality and safety. Leaders at every level prioritised safe, high quality, compassionate care.

  • The trust had made end of life care one of its priorities in 2015/2016.

We saw several areas of outstanding practice including:

  • The trust had rolled out the Swan scheme across the trust which included a Swan bereavement suite, Swan rooms, boxes, bags and resource files for staff.

  • The palliative care team had developed a fast track checklist to provide guidance to ward staff on what to consider when discharging an end of life patient.

  • Virginia Mason Institute (VMI) designed and developed its systems to become widely regarded as one of the safest hospitals in the world. The trust embraced these methodologies and in partnership with VMI, they have developed new initiatives within the hospital. They used the model to create the transforming care institute (TCI). TCI wants an effective approach to transforming healthcare by coaching teams and facilitating continuous improvement.

However, there were also areas of poor practice where the trust needs to make improvements:

  • The trust must ensure ED meets the Department of Health’s target of discharging, admitting or transferring 95% of its patients with four hours of their arrival in the department.

  • The trust must ensure all patients brought in by ambulance are promptly assessed and triaged by a registered nurse.

  • The trust must ensure a suitably qualified member of staff triages all patients, face to face, on their arrival in ED by ambulance.

  • The trust must ensure that it meets the referral to treatment time (RTT) for admitted pathways for surgery.

  • The trust must ensure there are sufficient nursing staff on duty to provide safe care for patients. A patient acuity tool should be used to assess the staffing numbers required for the dependency of the patients

  • The trust must review its medical staffing to ensure sufficient cover is provided to keep patients safe at all times.

  • The trust must ensure that all staff are up to date with mandatory training

  • The trust must ensure that all staff have an understanding of how to assess mental capacity under the Mental Capacity Act 2005 and that assessments are completed, when required.

  • The trust must ensure the application of the World Health Organisation’s (WHO) ‘five steps to safer surgery’ checklist is improved in theatres

  • The trust must ensure that up to date safety thermometer information is displayed on all wards

  • The trust must ensure they are preventing, detecting and controlling the spread of infections, associated in the mortuary department by ensuring surgical instruments are decontaminated to a high level and there are arrangements in place for regular deep cleaning.

In addition the trust should:

  • The trust should ensure all staff received an annual appraisal.

  • The trust should consider using the maternity specific safety thermometer to measure compliance with safe quality care.

Professor Sir Mike Richards

Chief Inspector of Hospitals

14-16 Oct 2014, Unannounced visit: 27 Oct 2014

During a routine inspection

The Shrewsbury and Telford Hospital NHS Trust is the main provider of district general hospital services for nearly half a million people in Shropshire, Telford & Wrekin, and mid Wales. Of the area covered by the trust, 90% is rural. There are two main locations: the Royal Shrewsbury Hospital (RSH) in Shrewsbury, and the Princess Royal Hospital (PRH) in Telford. The trust also provides a number of services at Ludlow, Bridgnorth and Oswestry Community Hospitals.

We carried out this comprehensive inspection because the trust had been flagged as a potential risk on CQC’s Intelligent Monitoring system. The inspection took place between 14 and 16 October 2014, and an unannounced inspection visit took place on 27 October.

Overall, this trust requires improvement. We rated it good for caring for patients, but it requires improvement in providing safe care, effective care, being responsive to patients’ needs, and being well-led.

Our key findings were as follows:

  • Staff were caring and compassionate, and treated patients with dignity and respect.
  • Both of the main hospitals were clean and well maintained. Infection control rates in the hospital were lower when compared to those of other trusts.
  • Patient’s experiences of care were good, and results from the NHS Friends and Family Test were in line with the national average for most inpatient wards, but were above the national average for A&E.
  • The trust had recently opened the new Shropshire Women and Children’s Centre at the Princess Royal site. This had seen all consultant-led maternity services and inpatient paediatrics move across from the Royal Shrewsbury site. We found that this had had a positive impact on these services.
  • The trust had consistently not met the national target for treating 95% of patients attending A&E within four hours. However, we saw at the Princess Royal Hospital that services were safe and effective, with adequate staffing, and the team were well-led. There were greater challenges at the Royal Shrewsbury site.
  • There was some good care delivered in the medical wards, but high staff vacancies and heavy reliance on bank staff were putting considerable pressure on the staff.
  • We were concerned about Ward 31 at the Royal Shrewsbury Hospital, which was being used for day surgery patients whilst the purpose-built day surgery unit was being used to accommodate inpatients. Ward 31 had no heating, there was no emergency call bell, and we were concerned about staffing on this ward. Although the trust addressed these issues immediately when we brought them to their attention, this arrangement does not provide day-case patients with an effective service.
  • The trust was not meeting the Core Standards for Intensive Care Units at either site. We were concerned about nurse staffing levels, and asked the trust to look at the situation immediately. During our unannounced inspection we were pleased to see that the trust had responded.
  • The trust had recognised that end of life care was an area for development for them, and had recently started to make progress; however, our inspection found that there was still much more to be done. We were concerned about the safety and effectiveness of the mortuary arrangements, particularly at the Royal Shrewsbury Hospital.

We saw several areas of outstanding practice, including:

  • The trust had outstanding safeguarding procedures in place. The safeguarding team had links in every department where children were seen, with safeguarding information shared across the trust.
  • The trust had appointed an Independent Domestic Violence Advisor (IDVA). The post had been substantiated through funding from the Police Crime Commissioner, due to excellent outcomes recorded by the trust. We were told that referrals from the trust to the Multi-Agency Risk Assessment Conference (MARAC) had been endorsed as excellent practice by the Co-ordinated Action Against Domestic Abuse (CAADA). CAADA is a national charity supporting a multi-agency and risk-led response to domestic abuse.
  • The compassionate and caring dedication for end of life care within the renal service was outstanding, especially the development and introduction of the ‘my wishes’ document at the Princess Royal Hospital, for supporting people who had been diagnosed with an ‘end stage’ decision.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly:

  • The trust must review the levels of nursing staff across A&E critical care, labour ward and end of life services to ensure they are safe and meet the requirements of the service.
  • The trust must ensure that all staff are consistently reporting incidents, and that staff receive feedback on all incidents raised, so that service development and learning can take place.
  • The trust must ensure that staff are able to access mandatory training in all areas.
  • The trust must ensure that accident and emergency and all surgical wards are able to access all the necessary equipment to provide safe and effective care.
  • The trust must review pathways of care for the patients in surgery, to ensure that they reflect current good practice guidelines and recommendations.

There were also areas of practice where the trust should take action, which are identified in the hospital reports.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Use of resources

These reports look at how NHS hospital trusts use resources, and give recommendations for improvement where needed. They are based on assessments carried out by NHS Improvement, alongside scheduled inspections led by CQC. We’re currently piloting how we work together to confirm the findings of these assessments and present the reports and ratings alongside our other inspection information. The Use of Resources reports include a ‘shadow’ (indicative) rating for the trust’s use of resources.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up. Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.