Royal Shrewsbury Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that people’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 Requires Improvement. At this assessment the rating has changed to Good. This meant people’s needs were mostly met through good organisation and delivery.

We have not awarded this service a score for Responsive.

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

The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Patients were routinely involved in planning and shared decision-making. Relatives and carers were involved with the patients consent. When patients were assessed as lacking mental capacity, capacity assessments were done and best interest decisions made. Staff were able to describe what arrangements they could make to accommodate the specialised needs of patients with a learning disability. In all areas we visited, patients with a learning disability were able to have families, visitors/ carers with them at all times.

The service took account of patients’ individual needs and circumstances and where possible made reasonable adjustments. There were policies that covered equality, diversity and inclusion and staff operated within them.

Assessments included patient’s social circumstances, mental health needs and vulnerabilities including any protected characteristics.

Staff spoke positively about providing person-centred care and ensuring patients were transferred to the most appropriate area for treatment. Patients requiring ongoing treatment, such as intravenous antibiotics, were reviewed through multiple pathways to determine the most suitable setting for care.

Care plans were personalised and holistic. The service used recognised assessment tools and documentation to support care planning, including MCA assessments, DoLS processes and best-interest meetings where appropriate. Staff demonstrated understanding of capacity assessments and dementia pathways.

Patients attending the same day emergency care services were prioritised according to clinical need. Information displayed for patients explained expected waiting times and the need for staff to prioritise care based on acuity rather than order of arrival.

Dementia care arrangements were well established. Staff had completed dementia training and had access to specialist advice. The butterfly scheme was used to support communication and patient-centred care. A learning disability liaison team was available 8 hours a day, 5 days a week, and mental health liaison teams were available 24 hours a day, 7 days a week. These teams supported patients with complex behavioural, mental health and communication needs. Enhanced care requirements were reviewed daily and decisions regarding one-to-one observations were supported by risk assessments.

Staff ensured older patients were actively involved in their care wherever possible. The service promoted accessibility through provision of information in different formats and languages. Staff had access to interpreter services, easy-read information and specialist resources for people living with dementia, learning disabilities, communication needs and sensory impairments.

Ward leaders described effective working relationships with frailty services, learning disability teams, mental health teams, discharge coordinators and therapy services. Frailty pathways were consultant-led and supported by advanced clinical practitioners, therapists and junior doctors.

Mental health support was available across the service. Staff told us a dedicated mental health lead was employed directly by the trust and worked collaboratively with Midlands Partnership Foundation Trust. Learning disability and mental health teams provided support 24 hours a day, seven days a week. Staff were involved in reviews relating to restrictive interventions and monitored compliance through audits and governance arrangements.

The service worked proactively with discharge coordinators and specialist pathway teams to support complex discharges. Dedicated discharge support staff helped patients requiring care packages placement.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff encouraged patients to ask questions or express concerns if they had any. They ensured patients could obtain information on treatments, local services and patients’ rights such as how to complain. Staff ensured carers and families were regularly updated about the patient’s progress. They encouraged patients to ask questions or express concerns if they had any.

The service complied with the Accessible Information Standard. The Accessible Information Standard ensures that patients with additional communication needs get information in a way they can understand and the support they need to communicate when using health and care services.

Staff communicated with patients in a way that supported their understanding of their care and treatment, including those with communication difficulties. For example, staff utilised telephone interpreting services for patients whose first language was not English, enabling them to fully understand the care and treatment options being provided.

The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

There was clear information for patients and relatives on how to make complaints. This was through material displayed in various areas and on the trust’s website.

There was a Patient Advice and Liaison Service which supported patients to make complaints but also tried to address issues early on to get problems corrected for the patient’s benefit. Staff knew how to support patients to make complaints but would also try to fix the issue causing the concern.

Patients knew how to complain or raise concerns. When patients complained or raised concerns, they received feedback. From September 2025 to February 2026, the hospital received 73 complaints, most commonly relating to communication, patient care, and admission and discharge processes. In the same reporting period, the service received 43 compliments, most commonly highlighting the friendliness of staff and the quality of nursing care.

We observed that information regarding complaints, feedback and patient involvement was displayed publicly on wards. Staff described collaborative working with patients and families when making decisions regarding care and discharge planning.

The service had a complaints policy and staff knew how to escalate concerns appropriately. Information leaflets were available on wards explaining how to make a complaint.

The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Performance against cancer referral standards for the trust was mixed. The most recent data from January 2026 highlighted challenges across several referral to treatment (RTT) pathways. For instance, in geriatric medicine, there was an 88% increase in the number of patients waiting to begin consultant-led non-emergency treatment compared to the same month the previous year. Similarly, cardiology saw a 51% rise in patients who had a confirmed appointment requirement but had not yet started consultant-led non-emergency treatment, compared with the previous year. These increases suggest that service activity was not keeping pace with the growing demand for non-emergency consultant-led care. Staff within the service identified key challenges, including high vacancy rates, capacity gaps, and a large volume of referrals without restrictions on demand management. Action plans were developed to address these issues. In addition, a quality improvement project was in progress to enhance RTT performance in cardiology, respiratory, and dermatology services by standardising outpatient clinics to improve efficiency. This initiative followed an external review which had identified inconsistencies in service delivery approaches.

Staff reported significant system pressures affecting flow. Escalation beds and SDEC areas were occasionally used overnight due to demand. Delays were reported in relation to community placements, care packages, mental health placements and access to specialist cardiology beds. Staff also reported delays associated with cross-border commissioning and discharge arrangements involving Powys (county in Wales) services.

Leaders described ongoing challenges associated with patients from Powys and wider cross-border pathways. Differences between health and social care arrangements across England and Wales contributed to delays in discharge planning, community services and package-of-care provision.

The hospital did not provide stroke services, meaning that patients presenting with stroke symptoms were required to be transferred to Princess Royal Hospital (PRH) for specialist care, potentially resulting in delays to their treatment pathway. There was a process in place to ensure that patients presenting with stroke symptoms were transferred to PRH by land or air ambulance for thrombolysis, a time-critical treatment that uses medication to dissolve blood clots and restore blood flow to the brain. This risk was recognised and recorded on the service’s risk register, with a standard operating procedure in place to facilitate the prompt transfer of patients to PRH. At the time of the inspection, the trust did not have a substantive neurology service. Staff informed us that a locum neurologist was available once or twice each week, while specialist advice was otherwise obtained through a telemedicine service. Patients requiring ongoing neurological care were transferred to another hospital trust within the Birmingham area.

Staff prioritised care for those with urgent needs. The SDEC accepted referrals from emergency departments, ambulance services, community services and primary care. Coordinators and navigators triaged referrals and directed patients to appropriate services.

The service had established systems to manage patient flow through AMU, AAU, SDEC, SSU, frailty pathways, discharge lounges and virtual ward services. Daily operational meetings reviewed admissions, discharges, delayed transfers of care, staffing pressures and bed capacity.

AAU accepted referrals from a range of sources including GPs, emergency departments, outpatient clinics and community hospitals. Suitability assessments were undertaken by staff holding referral bleeps, and standard operating procedures supported decision-making.

Dedicated frailty pathways and referral criteria were in place for older patients. The service promoted comprehensive geriatric assessment and virtual ward services, including medication reviews, monitoring, physiotherapy and community-based support where appropriate. Consultant-led frailty services worked alongside ACPs, therapists and nursing teams to support assessment and patient flow.

The virtual ward service was established and supported patients through frailty, respiratory and renal pathways. Patients received care at home including blood testing, medication reviews, intravenous antibiotic administration, monitoring and multidisciplinary support. Weekly MDT reviews ensured ongoing clinical oversight.

The discharge lounge had been relocated in December and operated extended opening hours to support patient flow. The service tracked patients through a live electronic system and monitored whether discharge letters, medication and transport arrangements were completed before transfer. Staff worked with ambulance services, families, social care providers and community teams to facilitate discharge.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff support patients to make decisions about their care and treatment and their future. Patients and their relatives participated in discussions about their treatment plans and their future. This included when further treatment was no longer in the patient’s best interest. When we looked at patient records, we saw that any Do Not Attempt Cardiopulmonary Resuscitation decisions were discussed and recorded.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. Operational leaders described regular touch point meetings throughout the day to identify potential discharges and maximise capacity. These meetings aimed to support patient flow and ensure patients were discharged as early as possible when clinically appropriate.

Ward leaders described regular reviews of discharges, delayed transfers of care and medically fit patients awaiting packages of care. We heard examples of patients waiting prolonged periods for community support and care packages. Staff worked closely with social services, local authorities and the care transfer hub to support discharge planning.

The ward used transfer hubs, multidisciplinary meetings and discharge liaison processes to coordinate discharges and reduce delays wherever possible. Staff described processes to track transport home and community arrangements following discharge.

AMU and SDEC maintained patient flow processes supported by safety boards, staffing reviews and operational meetings. Staff had access to at-a-glance boards and escalation systems which supported clinical decision-making and discharge planning.

Discharge planning started early and formed part of daily MDT reviews and board rounds. Dedicated discharge teams, discharge coordinators and transfer hubs supported patients throughout their discharge journey.

Discharge planning was embedded within daily processes. Discharge areas were available for patients’ awaiting medication, transport or final investigations. Staff described examples of patients attending the service for scheduled treatments, including intravenous antibiotics, while remaining safely supported within community settings.

The discharge lounge supported patient flow through live tracking systems and monitoring of discharge letters, transport requirements and medications. Staff worked closely with community services, social care teams and families to facilitate safe discharge.

The discharge lounge team maintained regular communication with patients, relatives, carers and care providers. Staff ensured that next of kin were informed of discharge arrangements and liaised with community services to support safe transfer home. Volunteer services, including transport support schemes, were available to assist patients returning home.

Patients and those closest to them were involved when care priorities needed to be refocussed. End-of-life care was delivered in line with the SWAN model. We reviewed records where palliative care teams had been involved and saw evidence of clear care planning and family communication. Documentation included palliative care reviews and end-of-life plans.