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 Good. At this assessment the rating has remained Good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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.

We scored the service as 2. The evidence showed some shortfalls. While the service had a clear vision and strategy, and leaders noted positive changes in staff culture, staff did not always feel engaged.

Leaders spoke about the ‘radiology roadmap’ that steered vision and strategy in the service, which included improvements to the IT infrastructure, as well as additional services such as computed tomography (CT) perfusion scanning, a useful technique in the diagnosis of stroke. They noted a change in culture since the COVID-19 pandemic with more cross-site communication, and staff pushing for changes in the department, such as the implementation of a CT post-mortem service which some staff had already completed training on. However, some staff we spoke with were unclear about how changes as part of the Hospital Transformation Programme (HTP), trust-wide works to specialise Royal Shrewsbury Hospital in emergency care, and The Princess Royal Hospital in planned care, would impact them and their department. Leaders for the service however felt they disseminated any information they received about HTP to staff. Staff rated engagement below the trust average in the 2025 staff survey.

We scored the service as 3. 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 had the skills, knowledge and experience to perform their role, having undertaken leadership training both within and external to the service. They had a good understanding of the services they managed and were mindful of being visible for staff. The lead superintendent spoke about the weekly ‘tea and toast’ sessions they held for modality superintendents to bring any issues for discussion, as well as 8-weekly job specific catchups. The clinical lead for radiology explained how they worked cross-site and operated an ‘open door’ policy. While the centre manager held more of a strategic than operational role, they also tried to visit each site once a week. All members of the management team who were registered radiographers worked a half day clinically once a quarter. Staff we spoke with said their line managers were approachable, and they would feel able to go to them with most issues.

We scored the service as 3. 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 we spoke with said they felt able to speak up without fear of negative consequences and would be able to approach their managers with any concerns. However, staff scored ‘We each have a voice that counts’, which covered themes such as being safe to speak up about concerns, and confidence that the organisation would address any concerns, below the trust average in the 2025 staff survey.

We scored the service as 3. 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.

Staff we spoke with said they were able to work flexibly to accommodate their family life and said many other colleagues also did so. Managers put reasonable adjustments in place for staff members to help them carry out their role. In the latest staff survey from 2025, staff in the service rated ‘We work flexibly’ in line with the trust average, although this had reduced slightly from the previous year. The trust undertook equality monitoring of staff, and reports on equality, diversity and inclusion and gender pay gap were available on the provider’s public website. There was a trust race equality network, PRIDE network for LGBTQIA+ staff, a multi-faith and belief network and ‘DAWN’, the Disability, Ability, and Wellness Network.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Leaders and staff met to discuss and manage risk, performance and outcomes. We viewed a sample of minutes from Radiology Events and Learning Meetings, audit, governance and learning meetings, radiation protection committee meetings and staff forums. We saw that actions on areas for improvement raised in a CQC IR(ME)R inspection of nuclear medicine were discussed at radiation protection committee. However, open forum meetings did not appear to have set agendas to discuss risk, performance and outcomes. Service performance was reported to board through the integrated performance report.

Leaders maintained a risk register across the radiology service at the trust. Top risks on the register such as the risk that images will not be reported promptly leading to a potential delay in diagnosis, and a shortage of radiologists with skills to perform ultrasound and CT guided interventional radiology procedures due to retirement matched leaders’ top concerns. The service also kept a comprehensive asset register which included details of equipment maintenance contracts and expiry dates, although the service did not have a rolling replacement contract for equipment.

The service kept and updated a business continuity plan including troubleshooting details and workarounds for system outages, including total information technology outage. Information governance systems included confidentiality of patient records.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

We saw evidence that service leaders collaborated with external partners including those from other hospital trusts and integrated care systems to ensure services worked seamlessly for people, for example when setting up a new service such as the giant cell arteritis pathway. Leaders also met every 3 months with third party providers for reporting services to discuss performance.

We scored the service as 3. 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.

We saw evidence of several innovative projects and solutions to challenges in the service. Staff told us that they had moved to using melatonin, a synthetic version of a hormone naturally produced to regulate sleep-wake cycle, instead of sedation for paediatric scanning. Leaders commented that this had been so successful that previously required recovery beds had been released. The service showed innovate thinking in response to national challenges in sonography staffing, recently employing 2 vascular scientists to undertake vascular ultrasound. The service and partners had recently introduced a new single giant cell arteritis pathway for all of Shropshire, Telford and Wrekin. The ultrasound scanning element provided by the service was 96% compliant with key performance indicators at the time of the inspection. Leaders said the introduction of CT virtual colonoscopy clinics had led to fewer patients not attending for scans, and fewer inappropriate bookings.

Leaders were keen to participate in accreditation schemes such as Quality Standards for Imaging but understood there were currently barriers, such as not using a dedicated document management system. We did not see any evidence of participation in research at the time of inspection.