Royal Shrewsbury Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that patient’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question as Good. At this assessment the rating has remained the same. This meant people’s outcomes were consistently good, and patient’s feedback confirmed this.

The service planned and delivered patient’s care and treatment with them, in line with legislation. Patient’s rights around consent was respected when delivering person-centred care and treatment. However, staff did not always complete malnutrition universal screening tool within 6 hours of admission.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them.

Staff did not always assess patients’ needs around food and drink. The latest nursing quality assurance audit identified poor compliance with completion of the Malnutrition Universal Screening Tool (MUST) within 6 hours of admission and for weekly reassessment or following a change in patient condition. From January to February 2026, ward 24 (respiratory ward) and ward 25 (general medicine) both received a ‘red’ rating for MUST completion. Compliance within 6 hours of admission was 57.2% on ward 24 and 27% on ward 25, while reassessment rates were 35% and 0%, respectively. However, a review of patient records found that fluid balance and food charts were being completed, suggesting that nutritional monitoring was taking place despite deficiencies in the completion and documentation of MUST assessments.

An evidence-based pathway was in place to support the identification and treatment of sepsis. However, adherence to the pathway was inconsistent among various ward areas. Findings from the deteriorating patient audits conducted between December 2025 and February 2026 showed that sepsis assessments were not consistently completed on wards 25, 26, 27, 28 and 35. Compliance with the initial sepsis assessment was rated as ‘red’, with scores ranging from 33.3% to 80%, significantly below the Trust target of 100%. In addition, several wards received ‘red’ ratings for the documentation of escalation, initial response, and medical review. Furthermore, none of the audited patients who presented with suspected infection and high-risk indicators of sepsis received intravenous antibiotics within 60 minutes of the trigger concern, as required. However, ward 24 consistently demonstrated full compliance, achieving 100% across all audited measures. To address these concerns, improvement initiatives had been introduced, including the implementation of a digital observation dashboard to support the timely recognition of deteriorating patients and the development of a staff training programme, which was scheduled to be rolled out by August 2026.

Patients underwent comprehensive assessment on admission. Documentation included nutritional assessments, falls assessments, tissue viability assessments, bedrail assessments, mental capacity assessments and specialist care plans where required. Care planning processes included review of deteriorating patients, frailty assessments and specialist treatment pathways.

The service had established standards for the Acute Medical Unit that set expectations for timely triage, early warning score completion, consultant review and ongoing assessment. Clear discharge planning pathways promoted early planning from admission through to discharge.

Virtual ward staff followed the same evidence-based standards. The virtual ward service had been established for more than two years and operated within a clear framework. The service included frailty, respiratory and renal pathways and was led by an experienced multidisciplinary team comprising of consultants, advanced clinical practitioners (ACPs), therapists, pharmacists and nursing staff.

Staff told us the virtual ward delivered care in patients' homes, including blood testing, medication reviews, catheter care and intravenous antibiotic treatment. Weekly multidisciplinary team meetings were held to review patients and coordinate care.

Consultant-led board rounds, ward rounds and multidisciplinary reviews supported ongoing assessment and treatment planning. Staff described structured review systems supported by board rounds, safety meetings and escalation processes.

The service accepted referrals from acute services, general practice and ambulance services. Staff described working across organisational boundaries with community partners to support patients with complex needs. Examples included the management of patients requiring intravenous therapies and support for patients with fluid overload.

The team monitored activity and had seen increased demand. Staff described systems for identifying and escalating deteriorating patients, including regular medical oversight and review.

The evidence showed a good standard. The service worked well across teams and services to support people.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. For example, we saw evidence of coordinated working between medical, nursing, therapy and specialist teams. Referral pathways were available for occupational therapy, physiotherapy, speech and language therapy, dietetics and other specialist services to support holistic patient care.

We observed effective multidisciplinary discussions during board rounds. Medical, nursing and discharge teams collaboratively reviewed discharge arrangements, transport requirements and community support needs for individual patients.

The acute medical pathway was supported by clear patient flow processes. Same Day Emergency Care (SDEC) accepted referrals from GPs, ambulance services, emergency departments and community services. Dedicated coordinators and navigators triaged referrals and directed patients to the most appropriate pathway.

We saw good examples of how the SDEC team ensured patients were seen and administered intravenous medication as prescribed. They worked well with virtual wards and system partners to prevent hospital admissions.

The service had developed alternative models of care to support demand. This included virtual ward arrangements, acute medical outpatient clinics and enhanced phlebotomy services. Consultants maintained oversight of these pathways and staff described positive working relationships with community partners. The virtual ward service was delivered by a neighbouring Trust. The two Trusts worked closely together, which was to be further enhanced by the Group Model that was due to commence on 1st April 2026.

We observed evidence of strong multidisciplinary working. Medical staff, nurses, therapists, pharmacists, discharge coordinators, social workers and specialist teams worked collaboratively to coordinate patient care. Multidisciplinary meetings were used to review deteriorating patients, complex discharges and ongoing treatment plans.

Daily consultant-led board rounds were held, with patients reviewed by multidisciplinary teams throughout the day. Staff described a well-structured approach to monitoring patient progress, coordinating discharge plans, and escalating complex cases when necessary. Regular ward rounds and safety meetings supported effective decision-making, continuity of care, and the management of operational pressures across the service.

Referral pathways were available for occupational therapy, physiotherapy, speech and language therapy, respiratory services and dietetics. Staff described positive relationships between acute, community and specialist services.

Discharge was coordinated with all relevant teams and services. The service had developed a range of processes to support patient flow through emergency, acute medical and virtual ward pathways. Discharge planning was initiated early, with expected discharge dates established and multidisciplinary input used to facilitate timely discharge. Clear patient flow processes and escalation plans were available to support capacity management.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The department participated in audit and quality improvement programmes. The National Cancer Patient Experience Report (2025) showed the Trust performed above expectations (in 13 questions with 90% positive responses in 7 areas, 80% in 22 areas and 70% in 13 areas), with high positive response rates achieved across multiple areas. Strong performance was demonstrated in primary care, post-treatment support, and key MDTs, which were noted as scoring above the national average.

There were audits that assessed the department’s compliance with the guidance that was used to deliver care. Feedback received in 2025 was mixed, with positive experiences of treatment highlighted, while concerns were raised regarding waiting times, particularly within radiology. An action plan was implemented in 2025, with investment allocated to reduce diagnostic delays, communication training enhanced for staff, and research opportunities strengthened.

Nursing quality audit results for the question on whether the hospital did everything possible to help control patients’ pain were monitored across December 2025, January 2026 and February 2026, with findings reviewed as part of ongoing quality assurance processes. Compliance was between 85.7% and 100% with majority of the months scoring 100%. Data collected during this period were used to assess patient experience and identify any areas for improvement. Ongoing monitoring supported actions to maintain and enhance pain management practices across services.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

There were suitable procedures and guidelines which were reflective of best practice and legislation. These covered situations where patients were unconscious or unable to consent for other reasons.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. Mental Capacity Act assessments (MCA), best-interest decisions and Deprivation of Liberty safeguards (DoLS) documentation were routinely completed where required. Staff were able to demonstrate understanding of these processes and records reviewed showed appropriate documentation.

Patients we spoke to said consent had been obtained from them prior to care and treatment and procedures had been explained to them. Patient files we reviewed showed that consent had been obtained, discussed, and reviewed.

Staff ensured patients understood care/treatment before consenting, with appropriate information, support, and time. Staff demonstrated understanding of MCA, DoLS and best-interest decision-making processes.

Staff supported patients with fluctuating capacity and reviewed consent decisions over time. Specialist teams-maintained oversight of DoLS authorisations, MCA assessments and learning disability support requirements.

Staff were able to explain the consent process to us and explain the trust policy. When patients could not give consent, staff made decisions in their best interest, considering patients' wishes, culture and traditions.