Royal Shrewsbury Hospital

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm. We have not previously assessed this key question for Diagnostic Imaging as a standalone service. At this assessment we rated safe as Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. There was a breach of regulation around completion of mandatory training.

We have not awarded this service a score for Safe.

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

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. We scored the service

Staff knew what incidents to report and how to report them through the electronic system. They understood the duty of candour, that is the duty to be open and transparent and give patients and families a full explanation if and when things went wrong. We viewed a sample of incident reports for non-reportable incidents such as contrast extravasations. Managers investigated incidents and identified areas for learning. We saw evidence that staff who had requested feedback from investigation of incidents received it. However, some staff we spoke with said they did not always hear about incidents that they had not been personally involved with.

Since the beginning of 2026, there had been 2 incidents that were reportable to Care Quality Commission (CQC) under Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2017. Investigation reports for CQC IR(ME)R reportable incidents were particularly thorough with associated action plans, one of which included introduction of a new vetting audit for nuclear medicine examinations.

Reporting staff discussed discrepancies at Radiology Events and Learning Meetings in line with Royal College of Radiologists guidance. Interesting cases for learning were also discussed at ultrasound audit, governance and learning meetings.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured that essential information was received to determine if the patient’s needs could safely be met. At the time of inspection, most imaging referrals were submitted on paper, though GPs could submit electronic requests. Leaders told us that electronic requesting was due to be implemented for all later this year. Clinical staff vetted referrals for urgency and to ensure examinations were clinically indicated before booking. Radiographers were provided with clear criteria to vet referrals against and told us when they had queries or the referral was for a more specialist examination, such as paediatrics, they would defer to radiologists. Radiographers in X-ray had access to a list of non-medical referrers and examinations they could request to ensure referrals were within their scope of practice. Radiologists vetted all other inpatient and emergency department referrals. Some booking processes, such as interventional radiology bookings were complex, requiring liaison with several teams. Clerical staff had produced their own checklists to ensure that all elements were complete.

Staff had clearly defined scopes of practice and adhered to them. For example, we observed an assistant practitioner undertaking an X-Ray on a paediatric patient but was supervised by a radiographer throughout.

There were processes in place for flagging and communicating unexpected and urgent findings. Radiographers were confident to approach ‘duty’ radiologists or reporting radiographers to flag findings requiring urgent reporting. For GP referred patients requiring urgent review, reporting staff contacted the medical registrar on call, and for outpatients with a malignant finding, staff contacted the acute oncology team, and the patient reviewed in same day emergency care. Radiologists and reporting radiographers used ‘macros’, key phrases to flag urgent findings on reports. Leaders told us that use of the lung cancer macro meant that such cases were picked up by lung cancer specialist nurses within 48 hours. Third parties providing reporting services called trust radiology staff to flag urgent findings. Leaders were confident that when the new electronic referral system was implemented later in the year, the ability to flag urgent reports for review would be strengthened.

Staff in ultrasound told us they had recently moved to actionable reporting, whereby sonographers can give advice to referrers regarding next steps.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate. There was between 92% and 96% compliance for training in safeguarding adults level 1 and 2 safeguarding children level 1 and 2. Safeguarding adults level 3 compliance was slightly lower at 83%. Staff we spoke with could give examples of concerns that had reporting in the past or would report and felt confident about reporting concerns to managers and safeguarding leads. All patients for ultrasound examinations were accompanied by a chaperone, and patients for other examinations could request a chaperone.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe and supportive.

Staff communicated with patients so that they understood their care and treatment. Patients we spoke with said they had received information about their scan prior to attendance, and we observed staff explaining what they were going to do and why they were doing it to patients.

Staff worked with people to understand and manage risks. All patients between 12 and 55 years old undergoing tests involving ionising radiation completed a form to exclude pregnancy. Patients for magnetic resonance imaging filled in screening questionnaires and we observed staff going through the questionnaire with patients to ensure they were safe to undergo the procedure. Staff told us they could access advice about implanted device safety from medical physics experts by telephone. Staff also completed screening forms with patients prior to administering contrast media and other drugs. Staff in computed tomography checked the latest kidney function tests for patients due to receive contrast the following day. If a patient had low kidney function, they would discuss the case with a radiologist to mitigate the risk.

Staff carried out regular observations and had systems to ensure they could communicate with the patient during their procedure.

We scored the service as 2. The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Staff undertook quality assurance (QA) checks on imaging equipment in between formal performance testing. However, in some modalities this was inconsistent meaning that opportunities for timely recognition of problems could be missed. For example, monthly QA on equipment in X-Ray room 10 had been performed in April 2026 but had not been done since December 2025 before that. Full QA testing on fluoroscopy equipment had not been performed between March and December 2025 due to the unavailability of a dosemeter tool. Leaders told us that staff were using a borrowed dosemeter while a new one was on order at the time of inspection, however, QA had been recorded as not completed on 29 April 2026 due to the lack of dosemeter. However, daily and weekly QA was consistently completed in computed tomography (CT) and magnetic resonance imaging (MRI), respectively.

Staff we spoke with were confident to report faulty equipment and said that maintenance services were responsive. Both CT scanners in the main X-Ray department were 11 years old at the time of the inspection. As per the Royal College of Radiologists, equipment older than 10 years is often technologically obsolete, may produce lower quality images, may be slower, and may deliver greater radiation doses than necessary. There were also ultrasound scanners purchased in 2020 and 2021 which were showing signs of image degradation due to wear and tear. This was on the service’s risk register. The service did not have a rolling equipment replacement scheme.

Although some areas of the estate such as the main X-Ray department were aged, the environment appeared well-maintained. Some areas such as ultrasound rooms in the main X-ray department were somewhat cluttered. Newer areas such as the Evolution suite were modern and attractive. The design of the environment supported the delivery of safe care. Warning lights were visible in areas where examinations involving ionising radiation took place, controlled areas were clearly marked, and access to them was restricted. The service had completed risk assessments for all work involving ionising radiation.

Staff we spoke we felt they had they equipment they needed to do their jobs safely. Lead personal protective equipment was readily available in the sample of X-Ray rooms viewed, and inspectors viewed logs of annual radiological testing. Staff working in modalities involving ionising radiation wore personal dosimeters to monitor their radiation exposure, and procedures were in place if exposure levels were high. Ancillary equipment such as wheelchairs, walking frames and emergency trolleys in MRI was labelled as MRI safe, conditional or unsafe in line with guidance from the Medicines & Healthcare products Regulatory Agency. Staff consistently carried out daily checks on emergency equipment on a mobile application through a quick response code. Staff told us the application informed them when a more thorough monthly check was due. Inspectors checked an emergency trolley in the main X-Ray department. All required equipment was present and in date. A spill kit was available and in date for use in the event of a radioactive spill in nuclear medicine.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure there were enough qualified, skilled and experienced staff. Staff did not always keep up to date with mandatory training.

Managers calculated and monitored the number of staff required. At the time of inspection there was an 8% vacancy rate in the service. In the 6 months before the inspection, shift fill rates varied between 59% and 66%, and on average 3-7% of shifts were covered by bank staff. The service did not use non-medical agency staff. There was a rolling staff turnover rate of 10% over the 12 months before the inspection, with the highest turnover within administrative and clerical staff. Average staff sickness levels were at 4%, although amongst estates and ancillary staff, rolling staff sickness was at 15%. This data covered staff at both the Royal Shrewsbury Hospital and Princess Royal Hospital sites. As the service did not provide speciality training in radiology, the radiology workforce comprised of consultant radiologists only. Leaders told us that while radiologist staffing was currently at budget establishment, they needed to realign the budget to increasing demand. The service had recently received funding from the lung cancer screening service and were currently onboarding radiologists in this speciality. Staff were able to access an on call-radiologist overnight.

New staff received a thorough induction. New sonographers were required to have 50 examinations reviewed by a supervising sonographer followed by 20 examinations reviewed by a consultant radiologist and a departmental checklist completed before being signed off to practice independently. Staff required additional competency sign off for areas such as soft tissue ultrasound and neonatal heads. Staff completed equipment-specific competencies in X-ray and CT. The trust had a system in place to ensure staff had up-to-date professional registrations and disclosure and barring service checks.

Staff generally received and were up to date with appropriate mandatory training and the training was appropriate for the patient group using the service. However, some training areas fell below target compliance levels. At the time of inspection, 67% of staff were up to date with adult basic life support training, and 66% were compliant with paediatric life support training. This may limit assurance that all staff had up-to-date knowledge on life support. Furthermore, only 50% of staff had up-to-date training in falls prevention, and 68% of staff were compliant with action counter-terrorism training. Radiographers and clinical assistants told us they could generally complete online mandatory training during quieter times during the working day, although radiographers who also vetted referrals felt this competed for their time. Clerical staff told us it was difficult to find time to complete mandatory training during work time.

At the time of inspection, 82% of staff had received an appraisal within the last year, although this figure was lower for consultant radiographers, assistants and healthcare assistants.

We scored the service as 2. The evidence showed some shortfalls. The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

Premises were generally well-maintained and visibly clean. Nursing staff conducted monthly cleaning audits in X-ray and ultrasound rooms in the main X-ray department and all from the last 6 months exceeded the 95% target compliance level. Environmental cleaning checklists from nuclear medicine, magnetic resonance imaging and computed tomography viewed after the onsite inspection were completed consistently. However, some cleaning records we viewed on site were not consistently filled, meaning staff could not be assured that cleaning had been completed. For example, we viewed environmental clean lists in X-Ray room 9, which included the cleaning of the patient table, door handles and emptying of bins. In January 2026 there were 12 gaps in the completion of the list, 9 in February, 11 in March and 12 in April. A disposable curtain in magnetic resonance imaging (MRI) in the Evolution suite was dated 12 October 2023. This was not in line with trust guidance which stated they should be changed every 6 months or when visibly soiled. This was fed back to the staff working in MRI.

Staff followed uniform policy and were bare below the below. Staff appropriately performed hand hygiene including before and after placing intravenous cannulas. Hand hygiene audits carried out in X-Ray and mammography department in the 6 months preceding the inspection all scored 100%. Personal protective equipment was available throughout. Staff told us that ward staff always told them when an inpatient attending radiology had an infection so that they could take the necessary precautions.

Staff in ultrasound kept detailed records of decontamination for internal probes which were attributable to patients. This meant that if, for example, a decontamination product was recalled, staff could track which patients were affected. Staff told us that they had recently taken delivery of a new ultraviolet decontamination unit which decontaminated probes in 90 seconds compared to 7 minutes using their old equipment.

Staff segregated clinical and domestic waste. Sharps boxes were correctly assembled and not overfilled.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happen.

Staff followed good practice in medicines management and did it in line with national guidance. In all areas visited, contrast media and other drugs were secured in locked medicines cabinets, and all medicines we checked were in date. The service kept emergency medicines and portable oxygen cylinders on emergency trolleys which were appropriately stocked and consistently checked. There were no controlled drugs kept in the radiology department.

Staff checked that patients did not have drug allergies or other conditions, such as impaired kidney function, before administering medicines. Staff recorded medicines used including batch numbers and expiry dates on patient records.

Leaders demonstrated learning from audits in relation to medicines. As a result of an audit on anaphylaxis, staff underwent resuscitation simulation exercises. A learning need was identified as not all staff felt comfortable drawing up adrenaline, and so further training on this was arranged.