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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question good. At this assessment the rating has stayed the same. However, the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

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 service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The service did not regularly take part in national audits, for example the Royal College of Emergency Medicine audits. National audits help drive quality improvement, ensure patient safety, and set standards in EDs by benchmarking performance. Benchmarking helps clinicians see how their department performs against others and where they need to implement changes for better patient outcomes.

Staff participated in local clinical audits, benchmarking and quality improvement initiatives. The outcome of these demonstrated staff did not consistently deliver evidence-based care and treatment. For example, staff told us a quality assurance tool was used to monitor care in the department. The tool had 119 questions and gave an overall percentage score. The quality metrics were presented to the emergency medicine divisional leaders once a month and shared with the whole staff team. Monthly data from 2025 showed fluctuation in all metrics recorded and lower than expected performance in skin integrity checks, completion of comfort rounding (which was as low as 79.2% in September and as high as 96.1% in December), and completion of fluid balance charts.

A study was undertaken to check staff compliance with clinical observations by patient acuity between May and November 2025. The study showed the highest acuity patients were most likely to have delays in their observations being recorded although the majority of observations were delayed for all patients. Low acuity patients (those with a National Early Warning Score (NEWS2) of between 0 and 3) typically had 11 to 30 minute delays. A significant proportion of high acuity patients (NEWS2 5 and above) experienced a delay of 60 plus minutes.

We saw staff using nationally recognised tools to help monitor risk. For example, they used NEWS2 for adult patients in the ED, the Paediatric Early Warning Score (PEWS) for children and young people. These were completed within expected timeframes while we were on site however, the information above demonstrated early warning scores were not consistently completed in line with policy.

When staff suspected a patient had sepsis they contacted the doctor with the sepsis bleep. A bleep is a pager system used by hospital staff for urgent communication using a radio frequency rather than less reliable cellular data. Staff told us the sepsis bleep holders were always responsive to their call. The sepsis six bundle is a set of six time-critical interventions designed to be started within one hour of recognising sepsis to reduce mortality. Response times to the sepsis bundle were audited. Staff told us the audit included reviewing the treatment of 6 patients with suspected sepsis in the hospital each day. The audit of records for patients at high risk of developing sepsis for December 2025 showed only 41% of sickest patients had their clinical observations recorded on time, and only 72% of patients received antibiotics within the hour if they were flagged for sepsis. The number of patients assessed for sepsis at point of presentation was 80.3%, and evidence of NEWS2 scores being escalated was 88.7%, with only 85.2% of patients being review by the appropriate grade doctor.

Patients who presented in mental health crisis received a full bio-psychosocial assessments from the psychiatric liaison team.

Staff used a recognised tool, the situation, background, assessment, recommendation (SBAR), to ensure critical patient information was shared clearly, concisely and efficiently with other teams when people were transferred out of the department. The SBAR is a widely adopted healthcare communication tool.

The service did not always work well across teams and services to support people.

Some ambulance crews told us emergency department (ED) staff were welcoming and treated them with respect. However, others said they were not always treated in a friendly or supportive manner. Paramedics told us ED staff did not consistently follow the same processes, which could result in friction between ambulance crews and ED staff. One paramedic described an occasion when a pre-alerted patient was prevented from being taken directly to the resuscitation area and had to remain in the ambulance until a doctor became available to assess them. In contrast, they told us other staff would ensure that pre-alerted patients were transferred directly to the resuscitation area without delay.

The hospital had an internal professional standards (IPS) document that had been agreed by the different specialisms to ensure their patients were not left in the ED longer than necessary. However, we saw patients with a long length of stay in the department waiting for beds. This gap highlighted the specialisms could not accept ED patients because their wards were full and blocked by long stay patients awaiting discharge back into the community.

Staff held regular and effective multidisciplinary meetings. Staff shared information about patients at handover meetings within the team, for example, at the start of shift change. Regular site meetings were held throughout the day to assess safety across the hospital. The meetings were attended by managers from across the hospital and senior hospital leaders. The emergency physician in charge (EPIC) and nurse in charge (NIC) had been invited to join these meetings from the week before our inspection. The NIC felt some of the information shared about the ED at these meetings was not completely correct as it did not reflect the most up to date situation in the ED. However, they saw the meeting as an effective way of being able to escalate capacity issues within the department. The NIC anticipated their continued attendance at these meetings would help staff from other departments recognise the demand on the ED.

The ED team had a designated doctor to respond to suspected sepsis and a designated doctor to see people on the back of ambulances when there was no room to bring patients into the department.

In healthcare, operational risk is measured and communicated through an operational pressures escalation levels (OPEL) score. OPEL is the framework used by hospital departments, trusts, and local healthcare systems to measure and communicate demand, capacity, and overall strain. It has 4 levels. Level 4 indicates a risk to patient safety. The department calculated its OPEL level 4 times each day. In the 2 weeks before our inspection the department was consistently operating at levels 3 and 4. Band 6 nurses told us they had recently become aware of the OPEL system because the ED had recently become involved in the hospital wide capacity meetings where system pressure and the impact on the hospital was discussed. They considered their participation in the meeting to be essential in helping other hospital departments understand the level of pressure being experienced within the ED. They believed that their contribution could support discussions aimed at improving patient flow across the hospital.

The flow coordinator rang ARA to let them know when there was space elsewhere in the department to move patients to. The flow coordinator was in regular contact with the hospital’s clinical site team, so transfers to wards could be carried out quickly once a bed space was available.

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 service routinely monitored people’s care and treatment, and staff worked to try to ensure that outcomes were positive and consistent. However, this did not always lead to improvements in care being made.

Outcome data showed that patients waited longer than the national standards to access treatment when attending the adult ED. The time that patients waited for triage, waited on ambulances, waited to be seen by a doctor and the total time patients spent in the department delayed patients moving out of the department.

Information about activity in the department was recorded by the NIC on the shift log. The log typically showed high levels of patients in the department who were waiting for a bed on a ward and lower than planned nursing staff to meet their care needs. The logs reflected this caused crowding and meant the patients’ pathway through ED was delayed. For example, on 26 February 2026 the patient with the longest length of stay in fit to sit was 41 hours. There were 17 patients who had been nursed in that area for over 8 hours longer than stipulated in the fit to sit standard operating procedure (SOP). On 27 February the patient with the longest length of stay was 43 hours, and 8 other patients had been in that area for 8 hours longer than stipulated in the fit to sit SOP. On 28 February there were waits of up to 8 hours for patients to be assessed by a doctor. The day before our inspection, 2 March 2026, the log recorded the NIC escalated concerns about long waits for high acuity patients who were inappropriate for fit to sit being nursed there for up to 46 hours.

The logs completed overnight consistently painted a picture that included patients being held in the corridor, patients in fit to sit that could not be bedded overnight due to a shortage of beds, patients being held outside on the backs of ambulances, and crowding in all areas apart from majors, which was consistently full. The logs also reflected lower than planned staffing levels and a poor skill mix. The logs also showed staff from the previous shift commonly being asked to work longer hours to support the department.

Staff used technology to support patients effectively. For example, for prompt access to blood test results.

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

Staff understood the importance of good communication to enable patients, and their relatives and carers, when necessary, to give informed consent to treatment. Staff in the PED communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with children and young people with communication difficulties. Staff in the ED told us their tools to help them communicate with patients had been misplaced. However, they said they would borrow the communication tools from staff in the PED to help patients understand their care and treatment when necessary.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

There was a clear process for staff to follow when patients declined treatment or wanted to leave the department against the advice of staff. The process included assessing the capacity of the patient to make decisions about their health and care needs.

Staff enabled patients to make advance decisions about their care. Some patients had advance care plans that included not wanting to be resuscitated. We saw staff check these plans to make sure they were up to date and contained all the information required for staff to act accordingly with the patient’s wishes.