The Princess Royal 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

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant people’s needs were not always met.

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 evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

We viewed the record of a patient with a learning disability on acute medical unit. We noted that a learning disability passport was included, as well as ReSPECT form, and a care ceiling had been established. The learning disability team had input in the patient’s care and their family, as their main carers, were involved and were potentially going to stay overnight with the patient. We saw posters with a quick response code on display for the dementia care team and saw evidence of their involvement in a patient record. We viewed a dementia care box on acute medical ward which included sensory items and communication cards, with words in both English and Welsh.

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 evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Most of the relatives we spoke with said they were regularly updated with patients’ progress. Staff we spoke with knew how to request translation services through the trust intranet. Information leaflets were available for patients, for example materials from a national stroke charity on fatigue and driving after a stroke. We viewed a booklet produced by a staff member on discharge lounge which included information on giving feedback and signposting for patient advice and liaison services. We viewed a ‘Swan pathway box’ on acute medical unit which contained information on end of life and bereavement information for patients’ loved ones.

All nursing and medical notes were paper based. They were mostly secured in locked trolleys, however we found a trolley with a broken lock on acute medical unit. This was fed back to the nurse in charge.

Leaders made notifications to external bodies as required.

The evidence showed some shortfalls. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support but did not always tell them what had changed as a result.

Patients knew how to complain or raise concerns and felt they could do so without negative consequences. There were 91 complaints made regarding medical services at the Princess Royal Hospital in the 6 months prior to the inspection. The most common themes were communication, clinical treatment, patient care, admission/discharge and staff values and behaviours. A ward manager discussed a complaint they had recently received about patient care and reflected that staff felt they could not always provide the care they wished to due to short staffing. Staff we spoke with knew how to deal with complaints. Actions taken because of complaints were presented at the Quality Operational Committee meeting, however inspectors did not see responses to feedback on display, for example ‘You Said, We Did’ boards. This was also noted by staff undertaking the 15 steps challenge walkaround on wards 9 and 11 on 2 March 2026.

In the same period, 68 compliments were received largely about support for patients, friendliness of staff and nursing care.

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.

Performance against cancer referral standards for the trust was mixed. As of 12 April 2026, 6% of suspected cancer referrals waited 62 days or more to be ruled out, confirmed or treated following urgent referral. This did not meet the national benchmark of 0% but was similar to the peer average of 7%. However, the proportion of patients with any suspected cancer where diagnosis was confirmed or ruled out within 28 days following urgent referral was 86%, above the national benchmark level of 80%.

The latest data from January 2026 identified challenges in some other referral to treatment (RTT) pathways. For example, in geriatric medicine RTT there was 88% percentage growth in patients yet to start consultant-led non-emergency treatment compared to the same month in the previous year. In cardiology there was a 51% increase in patients with a confirmed appointment requirement yet to start consultant-led non-emergency treatment, compared to the same month last year. Such increases indicate that activity is likely not keeping pace with demand for non-emergency consultant-led care. Staff in the service identified challenges including high vacancies in the service, capacity gaps and high numbers of referrals with no restrictions on demand management and produced action plans to tackle these areas. A quality improvement project was underway to improve RTT metrics in cardiology, respiratory and dermatology services by standardising outpatient clinics to increase efficiency. This was due to an external review which found inconsistencies in approach.

Stroke patients initially presenting at the trust’s sister hospital which did not have acute stroke services had to be transferred to the Princess Royal Hospital (PRH) which could cause a delay in their access and treatment pathway. We saw this was a high risk on the service’s risk register, and there was a standard operating procedure to ensure patients were urgently transferred to PRH. There were no substantive neurology services at the trust at the time of inspection. Staff told us a locum neurologist attended once or twice a week, otherwise staff used a telemedicine provider for remote advice. Patients requiring further neurology treatment were transferred to another hospital trust in the Birmingham area. Staff spoke about other inequalities facing their patient cohort. For example, staff could refer patients living in England to virtual ward services provided by a community healthcare trust but could not refer patients living in Wales.

Although staff planned for patients’ discharges, we observed long lengths of stay, including in areas intended for quick flow, such as the acute assessment unit. At the time of the inspection, a patient had been on the unit for 7 days, and staff told us that a patient had been on the unit for 12 days in the past due to a lack of onward capacity on medical wards. The service had measures in place to try to improve flow. Leaders held site safety meetings 3 times a day. We observed a meeting and noted that potential discharges were highlighted, and plans formed to expedite discharge letters to speed up the process. There was a flow manager for medicine in post at the time of the inspection, however this was a seconded role that was due to end within the month. They acted as a liaison between medical wards and clinical site managers to facilitate flow. Leaders and staff also attended weekly ‘stranded and super stranded’ meetings to ensure ward managers were sighted on patients who had been in hospital for 14 and 21 days respectively and were not medically optimised for discharge. According to trust data, the greatest delay to patients not medically optimised was awaiting diagnostic or specialist review. Around the time of the inspection, there were no stranded and super stranded patients who were medically fit for discharge from the Shropshire and Telford regions. However, there were some medically fit patients from Powys, Wales awaiting social worker review or on waiting lists for onward placements.

However, patients were able to be admitted to acute assessment unit directly from their GPs and community services, reducing pressure on the emergency department. Inspectors found the premises including bathrooms to be accessible, and patients we spoke with felt the environment and equipment were suitable for their needs.

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.

The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We saw evidence of complete and updated ReSPECT forms in patient records, and examples where care ceilings had been established. We saw evidence of responsive and thorough review of a patient nearing the end of their life by the palliative care team.