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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

At our last inspection we rated this key question inadequate. The service was in breach of legal regulation in relation to safe care and treatment. At this assessment the rating has changed to requires improvement. This meant services were not always planned or delivered in ways that consistently met people’s needs.

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 service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Staff reported they had completed training to support patients with a learning disability and autistic patients. However, patient feedback indicated this was not consistently reflected in practice.

Of the 30 patients spoken with in the Emergency Department (ED) waiting room, only three said staff had asked whether they had any additional needs.

We spoke with a patient who had autism and a learning disability, together with their relative. They told us that no member of staff had asked about the patient’s additional needs. The patient had remained in the waiting room overnight and had not been provided with any resources or adjustments to support them during this time. The relative described the experience as very difficult. When we discussed this with day-shift staff, they said it would not usually be expected for a patient with autism to remain in the waiting room overnight.

We also spoke with another patient who reported having autism, attention deficit hyperactivity disorder (ADHD), bipolar disorder and anxiety. They had been waiting in the ED for more than five hours and said staff had not asked about their additional needs. The patient also told us they had not been kept informed about what would happen next in their care.

These findings indicate that processes for identifying and responding to the needs of patients with learning disabilities, autism and other neurodiverse conditions were not applied consistently.

Out of 30 patients only 6 had been asked what name they wanted to be called by. Although patients told us most staff introduced themselves to the patient and their relatives. Patients in majors told us staff introduced themselves at the start of every shift change.

Most but not all patients we spoke with were given information about what would happen next. For example, one patient told us they did not know staff were going to put a cannula in because no one had mentioned this.

Patients in ARA, majors, and ambulatory majors (fit to sit) had call bells. One patient in ARA told us they could not reach their bell so had not been able to call a nurse. Another patient in fit to sit told us they had not been given a call bell.

Most of the patients we spoke to told us they had been asked about their pain levels including those who had recently arrived in the waiting room. However, one patient told us they had asked for pain relief over 4 hours ago and was still waiting for this to be given.

One patient in ARA who had previously had a stroke and had multiple care needs told us they had asked for help on several occasions but kept being told, “there are no staff,” and, “we are too busy.” However, other patients told us they felt staff were responsive to their needs.

There were posters in the ED to let people know the hospital was veteran friendly, and to empower veterans and serving members of the armed forces to discuss their health in relation to their service without fear of negative impact.

There were posters in patient areas to explain how to request a chaperone.

To recognise the individual needs and preferences of young people, children aged 16 and 17 could choose to receive their care in the PED or ED.

We asked about resources for patients in the ED waiting room and were told there was a trolley of resources for people with dementia. We were unable to look at this as staff told us it had been misplaced during the restructuring of the department in December.

There was a mental health link team who provided education and support to the team. This included mental health triage, and rapid tranquilisation.

There was a dementia team who visited the department each morning to assess and support patients who may benefit from their support.

There was a significantly higher level of person-centred care within the PED. Staff used child-friendly pain assessment charts and provided a range of resources designed to reduce children’s and young people’s anxiety about treatment and what to expect during their care. For example, a play specialist had developed an information booklet to help children understand magnetic resonance imaging (MRI) scans. The booklet included a link that enabled children and their families to listen to the sounds made by the MRI scanner in advance of their appointment. In addition, staff had created a toy MRI scanner, allowing children to become familiar with the equipment through play, helping to reduce fear and increase understanding of the procedure.

There were 2 play specialists in the PED. The play specialists had created a range of resources that enabled them to support children of all ages as well as people with additional needs. For example, they had Makaton cards to support children with a learning disability, and cards containing symbols to support any child with extra communication needs. They had ‘all about me’ work sheets that they could help children complete, so staff had a greater understanding of the specific needs of individual patients. The play therapists could also help children complete or update their hospital passport if one was required.

The therapists had toys they could give to children to help occupy them and reduce their anxiety about their care. These included sensory toys, toy doctor kits, and teddy bears. There were also a range of DVDs, games, and activities that could help children of all ages to pass the time.

There was a quiet room in the PED that could be used by children and young people that benefited from a quiet space to help them manage their anxiety and mood. The room could also be used for breast feeding mothers.

Staff in the PED worked with local and national charities to support the parents and carers of children who died in the department. Through this work they had a range of pyjamas and other clothes to dress the infant or child in. They had memory boxes they could give parents. The play therapists had resources to create keepsake infants’ hand and footprints.

We saw staff responding to people’s individual needs. For example, we saw staff make a referral to the mental health team and the bereavement team as soon as they identified patients with these needs. Nurses in the PED received training to help them manage the sudden and unexpected death of a child. The training prepared them to care for families with empathy and compassion, and to equip them to clearly communicate with parents and carers about the processes and procedures that would need to take place so the cause of death could be investigated. The trust had a cross-site lead for the sudden unexpected death of an infant or child (SUDIC). Staff told us the SUDIC lead was easy to access. Staff had created a SUDIC file so all the information they needed to support families was contained in one place.

The PED did not have a relative’s room, but staff could use the relative’s room in the ED to break bad news to parents and carers.

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 service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

We saw electronic and paper records were stored securely and only accessible by authorised staff. Paper records were stored in a lockable trolley.

Information leaflets about the management of a range of conditions could be accessed electronically through a quick response (QR) code. The electronic leaflets could be accessed in a range of languages. The service had easy read leaflets for people that needed them. Staff in the MIU had a range of leaflets to give to patients to take home so they had information to refer to about their condition. The leaflets included information about managing symptoms and when symptoms might require input from healthcare professionals.

We saw posters in patient areas in the ED and PED asking patients who use British Sign Language (BSL) to point to the poster. The sign also had an image depicting signing. There were posters with phrases written in multiple languages so people could point to the language they wanted to speak in. The service used a telephone interpretation system to translate for people whose first language was not English. Other staff told us the reception team arranged for telephone interpretation services for patients.

We saw a poster advertising the patient advice and liaison service (PALS). Information on the poster was written in 4 different languages.

The service did not comply with the Accessible Information Standard. Reception and administrative staff told us there was not a loop system for patients who were hard of hearing or deaf.

The trust website had a recite function so people with a sight impairment, or people who could not read English could listen to the information on the website. Text size could be altered, and the screen could be magnified to make browsing easier for people with sight impairments. The website could also be viewed as text only. The trust was still working towards making its website fully accessible in accordance with the Public Sector Bodies Accessibility Regulations (2018). However, most of the information, videos and documents aligned with the regulations.

Waiting times were displayed on television screen in waiting areas. However, staff told us the waiting times displayed were not always accurate.

Patients could request a paper copy of their discharge letter if they did not want it sent to them electronically. There was a doctor tasked with giving patients discharge advice and information, this included signposting patients to leaflets to help manage their symptoms and advice about when they might need to see their GP or return to the ED.

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.

The trust’s website provided clear information about how to make an online, written, or verbal complaint and how quickly people could expect a response. However, less than 60% of responses were sent within the timeframes the trust set for itself.

Information about complaints and concerns were collected and reviewed so action could be taken, including feeding back to staff to ensure changes could be made to improve the service. When patients complained or raised concerns, they received feedback.

Patients and families were involved in the investigation of the complaints. For example, we saw a complaint where the family had been invited to attend a meeting to talk about their complaint and find out what changes had been made a result.

There was a work stream to improve the patient voice in the department. Leaders told us this was being achieved through the friends and family team visiting the ED and PED weekly. At each visit they spoke to 5 patients. They fed their positive and negative findings back to staff. The matron completed a quality walk around each day, this included speaking to 3 patients and feeding back the patient experience to staff.

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.

Under the NHS England Plan there are 2 targets that trusts must work to achieve. 78% of patients should not wait for more than 4 hours in the emergency department from arrival to admission, transfer or discharge. Secondly, 10% of patients should not wait for more than 12 hours in the emergency department from arrival to admission, transfer or discharge. The trust did not meet these targets in 2025 and their performance remained much lower (worse) than the national average.

The trust used benchmarking to understand their performance metrics. Data for December 2025 showed they ranked 114 out of 120 trusts on achieving the 12-hour target. In January 2026 they ranked 120 out of 122 trusts for achieving the 4-hour target, and 135 out of 140 trusts for ambulance handover times.

In December 2025 107,64 patients were seen across the trust’s 2 EDs (type 1 attendances). Of these 2,369 (22%) breached the 12-hour target, 1365 (12.6%) breached 24 hours, and 166 (1.5%) patients breached 48 hours.

The patient with the longest length of stay in the department was 48 hours. There were 10 patients who had been in the department for over 38 hours.

Discharge was frequently delayed for other than clinical reasons. For example, at 8pm on our first day on site there were 93 patients receiving urgent and emergency care. Over half, 52, could not be discharged because they were waiting for a bed on a ward or other alternative placement. This included all the patients in majors. Fit to sit had 19 patients, 11 of these were waiting for a bed on a ward or other alternative placement. Eight of the 11 patients in ARA, and 3 of the 4 patients in resus were also waiting for a bed on a ward or other alternative placement. Twenty-five of the 52 patients had been in the department for over 12 hours, and 1 patient had been in the department for 46 hours.

Staff reported that around 80% of patients were triaged within 15 minutes. However, they told us that waits could occasionally exceed this timeframe because staff, typically the triage nurse, needed to collect patients from the PED entrance to ensure only authorised individuals could access the department.

The PED was small and had 2 majors trolleys. Staff told us both trolleys were sometimes taken up by children requiring a bed on a ward, typically a trauma ward. They gave the following example from February 2026. Two children who had sustained sports injuries had been immobilised because of suspected spinal injuries. Both children were waiting over 24 hours for a bed. This significantly impacted on the ability of the PED to function as a fully operational emergency department. Staff told us children in the age range 16 to 17 were more likely to require a bed on an adult ward, so most likely to have a long length of stay in the PED if admission was required.

Staff in the UTC told us they sometimes had patients on a trolley for several hours if they were waiting for a bed on a ward. Staff told us on they had a patient with a tibial fracture who waited 25 hours for a bed on a ward.

Nationally available data showed the average time to treat patients in the ED was challenged across the day and increased after hours. The average number of patients in the department is collected at midnight and midday. Data from August 2024 to March 2025 showed the number of patients in the department was similar at both times, suggesting a high degree of admitted patients in the department throughout the day. Seventy-one percent of all admissions happened after 12 hours and 80% of all admissions arriving by ambulance happened after 12 hours.

Data showed steady improvements in outcome for patients throughout 2025. The 4-hour performance in the ED improved from 48.7% in January to 53% in December. Outcomes for patients in the PED was significantly better. In January 2025 they saw 83.1% of patients within 4 hours and by December this had improved to 86.8%, however activity peaked in September with 90.6% of PEDs patients being seen in this timeframe. However, performance continued to be low when benchmarked nationally.

The trust collected and interrogated data to understand if people's age, sex, ethnicity or level of deprivation impacted the likelihood of having a longer stay in the department. Age was a significant factor in breaching the 4-hour and 12-hour targets. Data showed that deprivation did not appear to play a significant factor when it came to breaching 12-hour targets.

To improve flow through the ED the trust had increased the number of inpatient beds in the hospital by 38 at the start of winter. They also increased the opening hours of the discharge lounge. They worked with their partners to introduce an integrated front door to divert patients who could be treated elsewhere away from the ED and expanded other community-based treatment options to divert patients or support shorter stays in hospital.

To improve access to treatment a new process was created in September 2025 to allow clinically appropriate patients attending ED overnight the opportunity to be seen at a set time the following day in the UTC, rather than face a long wait in the waiting room. Seven appointments a day were created in the UTC 7 days a week. However, uptake of these appointments was low and inconsistent, as people frequently opted to wait to be seen in the ED rather than return to the UTC later.

The trust was actively engaged in implementing other ways to improve performance. For example, work was underway to explore reasons underpinning 4-hour breaches including scrutinising the discharge processes. There were workstreams to look at how utilisation of the UTC could be increased and how the productivity of minors could be improved. Shift pattern management was underway to explore how waits to be seen by a doctor in the late evening and early morning could be reduced.

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.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.