Royal Shrewsbury Hospital

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question Requires Improvement.

At this assessment the rating has changed to Good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

The service was in breach of regulation. We were not assured there were enough staff to keep patients safe, the governance around ensuring COSHH products were stored safely and management of medicines was robust.

We have not awarded this service a score for Well-led.

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

The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The service had a clear vision and a set of values including quality and sustainability. There were realistic strategy for achieving the priorities and delivering good quality sustainable care. The vision, values and strategy had been developed in collaboration with staff.

Staff knew the organisation’s vision and values and understood how these were reflected in their team’s work. The 2025 NHS staff survey showed that 73% of respondents felt their team shared common objectives. However, a smaller proportion (46%) felt they were involved in decisions about changes affecting their work area. At the time of the inspection, the trust was carrying out major developments at both Princess Royal Hospital and Royal Shrewsbury Hospital under the Hospital Transformation Programme (HTP), which leaders expected to finish by 2028. While staff expressed some uncertainty about how the HTP might affect their daily roles, such as potentially working at a different site, they remained optimistic about the anticipated benefits. The service operated a zero-tolerance approach to abuse and harassment, with clear escalation processes in place, and monitored staff experiences of bullying, harassment, and discrimination through the staff survey. None of the staff we spoke with reported experiencing bullying or harassment in the workplace.

Staff consistently described ward and divisional leaders as visible, approachable and supportive. Ward managers, matrons and senior leaders were actively involved in operational management and frequently worked alongside frontline teams.

We found evidence of a positive learning culture. Staff discussed incidents, complaints, patient safety concerns and governance issues through regular meetings, safety huddles and shared-learning forums. Weekly and monthly meetings reviewed themes, trends and actions arising from incidents and patient safety incident response framework processes.

Staff spoke positively about leadership development opportunities, communication improvements and new leadership forums. They described an open culture where concerns could be raised and discussed. However, staff raised concerns regarding financial recovery initiatives, staffing processes and workforce pressures. They told us the increased requirement for ward managers and education staff to undertake clinical duties had reduced time available for leadership, supervision, education and competency development of newer staff. Staff felt these issues had affected morale and had been raised through governance channels.

Staff described a positive multidisciplinary culture and strong teamwork across acute and community services. Staff were encouraged to participate in service improvement and innovation activities.

Many staff told us they were proud to work in the department and proud of the successes of the department. Staff worked well as teams and supported one another.

The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders and managers had the skills, knowledge and experience to perform their roles. Leaders demonstrated a strong understanding of the services they were responsible for and were able to clearly explain the challenges facing those areas. They recognised the importance of maintaining visibility and took deliberate steps to remain accessible to staff. For instance, although the divisional medical director spent approximately half of their time undertaking clinical duties at the trust’s sister site, The Princess Royal Hospital, they ensured a regular presence at Royal Shrewsbury Hospital, visiting at least every one to two weeks. During these visits, they made a point of engaging with newly developed or reconfigured areas, as well as services they had not visited recently, to maintain oversight and staff engagement.

Leaders had a good understanding of the services they managed. We attended huddles, bed and flow meetings and observed the decisions made being effectively implemented through the service. Leaders demonstrated oversight of operational pressures through regular staffing meetings, board rounds and divisional reviews. Staffing shortfalls were reviewed daily and escalation arrangements were well understood by staff.

Leaders recognised staffing challenges and had implemented measures to support recruitment and retention--. However, staff consistently reported concerns regarding staff shortages, sickness absence and recruitment difficulties. Pharmacy staffing pressures were identified as having a wider impact on ward processes, including medicines reconciliation and timely discharge arrangements.

Staff spoke positively about leadership within the service and described a supportive management structure involving ward managers, matrons, specialist nurses and senior clinicians.

Leaders demonstrated good oversight of quality and safety. Governance arrangements included monthly ward manager and matron meetings, weekly medicines safety huddles, shift safety huddles and regular review of incidents, complaints and safeguarding concerns. Shared learning from incidents was discussed with staff through a range of forums.

Ward managers, matrons and senior nurses-maintained visibility within clinical areas and provided support to staff. Staff consistently reported feeling able to raise concerns and described leaders as approachable and supportive. Newly qualified nurses, overseas nurses and students all reported receiving appropriate supervision and support.

The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff could access support from a Freedom to Speak Up Guardian (FTSU). They could raise concerns without fear. A FTSU Guardian worked alongside the trust’s senior leadership team to ensure staff had the capability to speak up effectively and were supported appropriately if they had concerns regarding patient care.

There was a system and process in place to enable staff to be able to speak up about any safety concerns. There was a freedom to speak up policy and a freedom to speak up team.

Patients and carers were given the opportunity to make their views on the service known. The department positively encouraged people to give feedback on the service. They took people’s views seriously and a made change when appropriate.

Leaders valued the insights staff brought through their contributions to meetings and other forums. Staff were comfortable sharing the challenges they faced with the inspection team and did so openly and honestly.

The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Managers put reasonable adjustments in place for staff members to help them carry out their role. Staff were able to apply to work flexibly.

The service conducted equality monitoring of its workforce, with equality, diversity and inclusion reports and gender pay gap information publicly available on the provider’s website. Plans were also in place to publish an ethnicity and disability pay gap report during the 2025/2026 reporting period. Staff were supported through several inclusion networks, including a Race Equality Network, the PRIDE Network for LGBTQIA+ staff, DAWN (Disability, Ability and Wellness Network), and a Multi-Faith and Belief Network.

The 2024 Staff Survey results for Medicine and Emergency Care showed a 3% increase in staff recommending the Trust as a place to work and in confidence in the standard of care provided.

The evidence showed some shortfalls. Leaders did not always operate effective governance processes. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Several workforce pressures remained. Pharmacy provision was limited in some acute areas, practice educators were frequently diverted into clinical roles, and staffing shortages occasionally required managers to work within clinical numbers.

The service had a divisional risk register. Risks were categorised using the severity of the impact giving a red, amber, green (RAG) rating. Leaders had failed to identify and mitigate risks associated with medicines optimisation and control of substances hazardous to Health, which were subsequently identified during our inspection.

At the time of our inspection, patient records were maintained in paper format and were generally stored in locked trolleys to protect patient confidentiality. The service advised that electronic patient records were due to be implemented shortly after the inspection. Electronic patient flow boards were in use on each ward and were typically located near the main nursing station, in areas visible to the public. These boards displayed patients’ full names and ages, creating a potential risk to patient confidentiality. This concern was raised with senior leaders during the inspection.

Ward teams used discharge pathways, discharge forums and discharge coordinators to support timely discharge. However, some patients remained in hospital for prolonged periods while awaiting reablement packages, community placements or care home arrangements.

Daily multidisciplinary board rounds and operational meetings supported oversight of patient safety and flow. On Acute Assessment Unit (AAU), leaders had identified risks associated with the location of cardiac monitoring facilities. This risk had been recognised and recorded on the risk register. Staff described how deteriorating patients were stabilised and transferred appropriately when required.

The Hospital Transformation Programme outlined a range of initiatives designed to prioritise patient and public involvement. These included measures to enhance patient experience through improvements to signage, wayfinding and design features within building 60. The programme involved collaborative engagement activities, accessibility reviews and a public survey on design options, with feedback used to inform implementation. A phased rollout across the estate was planned, supported by ongoing fundraising efforts for the Telford Cancer Centre.

Leaders carried out a quality improvement project to improve the quality of discharge summaries in the acute medicine department. Staff attended weekly ‘stranded’ and ‘super stranded’ meetings to ensure ward managers were aware of patients who had been in hospital for 14 and 21 days respectively and remained not medically optimised for discharge. Trust data indicated that the main cause of delays for these patients was waiting for diagnostic tests or specialist reviews. At the time of the inspection, there were no stranded or super stranded patients in Shropshire and Telford who were medically fit for discharge. However, some medically fit patients from Powys, Wales were still awaiting social worker assessments or were on waiting lists for onward care placements.

Staff discussed pressures relating to capacity and patient flow across the acute medical pathway. During a site meeting, leaders reviewed bed capacity, internal transfers and discharges. There had been ongoing monitoring of bed availability and actions were taken to support flow through the emergency and acute medicine pathways.

Leaders demonstrated oversight through staffing meetings, board rounds, divisional review meetings, medicines safety huddles, IPC meetings and governance forums. Audit programmes reviewed deteriorating patients, medication management, infection prevention and control, falls prevention, documentation, moving and handling and patient experience. Findings were shared with staff through learning forums and governance processes.

Senior staff held daily operational meetings involving emergency department and medical teams. These meetings reviewed capacity, staffing pressures, admissions, discharges and escalation requirements.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They shared information and learning with partners and collaborate for improvement.

The service maintained strong working relationships with a range of partner organisations. Virtual ward services were delivered by a community trust, with which the trust formally entered a group partnership arrangement on 1 April 2026. Evidence of collaborative learning with partners was seen in the sample of after-action reports reviewed. Staff also described the relationship with partner organisations providing thrombectomy services as “excellent”, highlighting effective joint working and collaboration.

The virtual ward service had worked in partnership with community services and housing support agencies to facilitate safe transfers of care. Staff explained that discharge summaries and handovers were used to support continuity of care across services.

Staff worked collaboratively with patient volunteers during the annual Patient-Led Assessments of the Care Environment, with patient assessors comprising at least 50% of each assessment team.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Following analysis of falls incidents, nursing stations had been introduced throughout the short stay unit to help reduce the risk of falls. Staff reported that this had contributed to a reduction in falls and improved interactions and engagement between staff and patients.

The wards demonstrated a strong commitment to end-of-life care through use of the SWAN model, multidisciplinary palliative care involvement and personalised support for patients and families.

Dementia care arrangements were well developed, including dementia support workers, the Butterfly Scheme, specialist input and information for patients, families and staff.

Staff described being passionate about their work and committed to innovation. They told us the service had recruited a substantial number of staff over recent years and had continued to strengthen multidisciplinary working. We heard examples of collaboration with Healthwatch and other stakeholders to improve services.