The Princess Royal Hospital

On this page

• 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 is the first assessment for this service since the combined inspection with outpatient’s department in 2014. This key question has been rated as requires improvement.

This means we looked for evidence that patients were protected from abuse and avoidable harm. We have not previously assessed this key question for Diagnostic Imaging as a standalone service. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that patients 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.

All staff knew what incidents to report, how to report them, and did so in line with trust policy. The service had an incident management policy.

Staff sometimes received feedback from investigation of incidents, both internal and external to the service. Staff had effective systems to raise concerns both formally and informally. Reports were analysed and urgent actions taken by leaders to manage or remove risks. The trust’s formal reporting system was easy to use. Staff saw incidents as an opportunity to learn and improve. Staff gave examples of incidents they had reported, confirming this. This included patient falls and safeguarding concerns. Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if and when things went wrong.

The service reported over 300 incidents between May 2025–April 2026 across all sites within the trust. Most incidents were low or no harm but highlighted recurring system issues rather than one-off mistakes. Key themes we noted were poor handovers between wards and radiology, administration teams incorrect or incomplete referrals, misunderstanding of processes for example booking, vetting, transport or protocols and issues with interpreter services leading to delays or cancellations.

There was 1 IR(ME)R reportable incidents in 2026 at this site. Staff met to discuss any feedback and looked at improvements to patient care, examples given was around improving environment for those with learning disability. Incidents were discussed during monthly imaging department team meetings. Learning from both imaging incidents and hospital wide incidents were discussed as a team and actions developed to implement learning. Actions were followed up at the next team meeting.

The service looked at patient safety incident investigations in line with the Patient Safety Incident Response Framework. We reviewed examples of after-action review reports and found them to be robust with details and action. Serious incident investigations showed multidisciplinary staff involvement and how learning, change and improvement resulted from the investigation.

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 about the patient was received to determine if the patient’s needs could safely be met.Safety and continuity of care was a priority throughout patients care pathway. Patients were assessed prior to the diagnostic imaging, and all imaging was based on a formal request from a member of the medical team.

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 was 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 involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge.

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

Staff knew about and dealt with any specific risk issues. The service had an established process to ensure the correct person was receiving the correct scan. Staff went through a ‘pause and check’ checklist with each patient to confirm the patient’s name, address and body part for the scan. This is in line with legal requirements of Ionising Radiation (Medical Exposure) Regulations 2017 (IR(ME)R), to prevent radiation exposure to the wrong patient. Pause and check consisted of the 3-point demographic checks to correctly identify the patient, as well as checking with the patient the site to be imaged, the existence of previous imaging and for the operator to ensure the correct imaging modality was used. We observed staff always used the 3-point demographic checks in line with the correct procedure.

There were effective systems and processes in place to ensure the correct patient was identified and received the intended procedure. We traced the patient pathway from admission through to discharge and observed that appropriate controls were consistently applied. Staff demonstrated a clear understanding of the required actions to take if concerns were identified. Patients were supported across all stages of their pathway by suitably skilled and qualified staff, who ensured that diagnostic procedures were carried out safely and appropriately.

Patient records were a mixture of electronic, and paper based and were kept securely. The IT connectivity was not always consistently available across the service to meet the needs of staff completing the records. Some staff told us that IT was not always as effective as it could be and was not always fit for purpose.

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 concentrate 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 understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff received adult and children’s safeguarding training. Staff had generally good compliance with safeguarding training requirements, but this was not consistently achieved across all levels and staff groups. Safeguarding Children Levels 1 and 2 compliance was high, around 94–96% respectively, indicating most staff had completed essential training to recognise and respond to risks for children. Safeguarding Adults Levels 1–3 training was also largely compliant at 83–93%), although some variation existed, particularly at higher levels. Prevent / Preventing Radicalisation training was well completed at around 93–96%, supporting staff awareness of wider safeguarding risks.

There were current safeguarding policies, and these reflected the national guidance for adults and children, including where children were visitors.

Staff knew how to make a safeguarding referral and who to inform if they had concerns. Expert safeguarding advice was available to support staff from Monday to Friday through the trust and staff knew how to contact them. Safeguarding concerns were considered when an incident occurred and a referral or further advice required when necessary. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff followed safe procedures for visitors, including children, attending the departments. The service had an up to date chaperone policy, which all patients were informed of when they attended the service.

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, supportive and enabled people to do the things that mattered to them.

All patients were required to complete magnetic resonance imaging (MRI) safety questionnaires. The safety questionnaires included asking patients if they had cardiac pacemaker, defibrillators or other devices in their chest and patients of childbearing age/ aged 12-55 were asked if they were pregnant. We saw these were completed. Family members who wanted to accompany patients for their scan were asked to complete a visitor’s safety questionnaire prior to the scan. All referrals included patient identification, contact details, clinical history and examination requested, and details of the referring clinician/practitioner.

Staff communicated effectively with patients to ensure they understood their care and treatment. This included adapting communication approaches to meet individual needs, particularly for patients with communication difficulties, ensuring information was accessible and understood throughout the patient journey. The service worked with patients to understand and manage risks. The treatment and care met patients' needs in a way which was safe and supportive. We spoke to various of patients during our assessment who told us they felt listened to, risks had been explained, and they were involved in decisions about their care and treatment.

The service had an established pregnancy checking process, whereby patients completed a consent-based pregnancy check form in collaboration with staff prior to exposure to radiation. These forms were designed using gender‑neutral language, aligning with Society of Radiographers guidance and demonstrating a commitment to equality, diversity and inclusion. In addition, clear pregnancy check signage was displayed in waiting areas and clinical rooms to prompt individuals who are, or may be, pregnant to inform staff before undergoing imaging, supporting safe practice and risk mitigation.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The design, maintenance and use of facilities, premises and equipment supported patient safety. Staff were appropriately trained in the use of equipment and in the safe management of different types of waste. The environment was designed in line with national guidance for the built environment, and where required, areas were secure to protect patients. Access to restricted areas was effectively controlled through measures such as keypads, swipe cards and door entry systems.

The service provided community diagnostic centre (CDC) facilities at Hollinswood House alongside services at the acute hospital. Both the CDC and hospital sites were equipped with internal scanners and externally located mobile scanners, all of which were in active use during the inspection. Mobile scanner units were owned and operated by an external provider. In addition, a mobile mammography service operated across multiple trust locations, including Whitchurch, Ludlow and Bridgnorth. Staff and patients spoke positively about this provision, highlighting that it improved access for patients living in rural areas by enabling care closer to home, while also helping to reduce pressure on the main acute site. The MRI mobile unit with no contrast facilities was located permanently outside the CDC car park.

Each department on the acute site and CDC had a preparation area, changing cubicle, appropriate scanning equipment, examination rooms and control room with a post processing and reporting area. We checked consumable equipment and found that single-use items were within their expiry dates. Staff were observed to be following established protocols for accessing scanners. Arrangements were in place to ensure safe working practices, and staff confirmed that they did not undertake lone working, which supported patient and staff safety.

We observed staff and patients walking into the controlled area when permitted to do only. Local safety rules were in place and reflected best practice. There was signage for both X-ray and MRI, which detailed the magnet strength and safety rules. MRI scanners were fitted with emergency buttons which stopped scanning and switched off power to the magnet.

The service had sufficient suitable equipment to support the safe care and treatment of patients. All equipment used within the scanning environments met Medicines and Healthcare products Regulatory Agency. Safety guidelines for MRI equipment. The service was equipped with x-ray, ultrasound, computed tomography (CT) and MRI machines, and equipment was routinely tested, with clear service date stickers indicating maintenance status. There was an established agreement with an external provider for the maintenance of imaging equipment, including the mobile MRI and CT scanner units, and all equipment was within its annual maintenance schedule. In addition, all portable electrical equipment had undergone appropriate safety testing. Clinical staff had received training in the safe and effective use of equipment, ensuring they were competent to carry out their roles. There were handover forms used when equipment was handed to engineers and physicists for servicing and testing in line with guidance and best practice.

Suitable equipment was provided and used correctly for patients who needed assistance with their mobility or to transfer onto equipment. Staff carried out daily safety checks of specialist equipment. There was ready access to resuscitation equipment in the departments, that was checked using a QR code, that trust health officer could monitor closely. The environment used for patient care reduced the risk of patient harm, and included safe flooring, handrails and window restrictors. Fire safety equipment was available and had been serviced. Fire exits were clear and free from obstruction.

Leaders maintained effective oversight of quality assurance (QA) processes, and staff consistently carried out routine checks to ensure equipment and the environment were safe and fit for use. Staff reported that sufficient equipment was available to support the delivery of safe care and to meet patients’ needs. Robust systems were in place for the timely repair or replacement of faulty or missing equipment, which supported continuity of service delivery and minimised risks to patient safety. Staff disposed of clinical waste safely, both inside and outside the building. Waste was segregated and labelled in accordance with the trust policy. Hazardous substances were stored safely and information about products was available to staff.

The service had established diagnostic reference levels (DRLs) in place for staff use, providing a standardised benchmark for patient radiation doses in line with the Ionising Radiation (Medical Exposure) Regulations 2017. The Radiation Protection Adviser’s annual report demonstrated that staff radiation exposure levels across the trust remained low and within statutory limits.

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. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

The service had 28 whole-time equivalent (WTE) vacancies across both sites and multiple staff groups. Leaders had put mitigation measures in place to manage workforce pressures, including outsourced sonography services, mobile imaging units staffed by third-party providers, and outsourced reporting to increase radiologist capacity. These measures supported service continuity while recruitment efforts continued. Leaders had taken action to address these workforce pressures through ongoing recruitment activity, particularly at Band 6 level to support the cauda equina service. Recruitment was progressing, with new starters entering induction, which leaders anticipated would help reduce workforce gaps. There was evidence of improving stability within radiography services following successful recruitment linked to the Year 2 Workforce Plan, with some additional activity lists converted into substantive roles, reducing reliance on temporary staff. Further workforce strengthening was underway, including the authorisation of a Deputy Centre Manager role, although overall staffing levels remained below plan and continued to present challenges for the service.

There remained an overall shortfall against planned staffing levels, with worked WTE below plan. Whilst leaders had taken action to mitigate this through deploying additional hours and temporary staffing, this did not fully address underlying workforce gaps. There was insufficient substantive consultant staff in post compared to planned levels. The service relied on locum consultants to support delivery; however, these arrangements did not fully mitigate the shortfall.

There were significant staffing gaps within radiography, particularly at Band 6, which was critical for service capacity and patient flow. Shortfalls were also seen across allied health professional support roles, especially lower bands, reducing the availability of support to clinical teams. Within healthcare science roles, there was variation between staff groups, with some areas significantly under‑resourced and others over‑established, indicating potential issues with workforce planning and skill mix. There were ongoing shortfalls in administrative and clerical staff, particularly at Bands 3 and 4, which may impact service coordination and efficiency.

Leaders used bank across a range of roles to maintain service delivery. However, this reflected a continued reliance on temporary staffing to fill substantive vacancies rather than a sustainable staffing model. Planned vacancy factors were not realised, suggesting that workforce assumptions did not align with actual staffing levels. This contributed to both operational pressure and potential financial risk.

Managers accurately calculated and reviewed the number of staff needed for each shift in accordance with national guidance. The manager could adjust staffing levels daily according to the needs of patients. The manager reviewed the clinics planned staffing levels for each week and adjusted the number of staff based on the number of clinics and the demand from theatres and the ward areas of the hospital. This service considered the risk to patients in each modality. The service ensured staffing levels meant there is no lone working.

The service had an on-call rota during evenings and weekends. This was to provide cover if inpatients required an urgent scan.

The rolling 12-month staff turnover rate was approximately 11.4%, with slight variation over the year and a gradual upward trend towards the latter months. Turnover varied across staff groups, with higher rates observed among healthcare scientists and nursing staff, while some groups had consistently lower turnover. This variation indicated ongoing workforce stability challenges in certain areas, which may impact service continuity and capacity.

Sickness absence across the service was 4.22% over a rolling 12-month period, with anxiety, stress and depression identified as the most common cause. Variation was seen across staff groups and departments, with higher absence rates in estates and ancillary staff and specific areas such as ultrasound. While most sickness episodes were short-term, there was a proportion of longer-term absence, indicating ongoing workforce health and wellbeing pressures.

Patients reported their needs were met in a timely manner, and we observed staff engaging with patients in a kind, supportive, and approachable way, with patients appearing comfortable and involved in conversations. However, staff described ongoing workforce pressures, including short staffing due to sickness, delays in recruitment, and challenges with retention. These pressures were further compounded by a lack of dedicated porter support, resulting in clinical staff frequently transporting patients, which reduced time available for scanning; staff noted this was inconsistent with other sites where dedicated departmental porters were in place.

The service supported the learning and development needs of staff and made sure staff received any specialist training for their role. Managers identified any training needs their staff had and gave them the time and opportunity to develop their skills and knowledge. Leaders had oversight of mandatory training levels however, staff did not consistently complete all required training to ensure they had the skills and knowledge to deliver safe and effective care. Overall compliance with core mandatory training was 89.9%, which just was below the expected standard. Whilst most mandatory subjects such as infection prevention, safeguarding, and health and safety had high levels of completion, above 90%, some areas, including resuscitation training, were notably lower.

Role-specific training compliance was significantly lower at 68.5%, indicating that staff in specialist roles did not always have up-to-date training aligned to their responsibilities. Performance had also fluctuated over the previous months, with some declines in compliance seen during the period. There was variation across staff groups, with some groups achieving high compliance, while others, including estates and healthcare science staff, had lower completion rates, particularly in role-specific training.

Training compliance for resuscitation within radiology and imaging services was below expected standards. Overall compliance across the service was 67% for paediatric basic life support (BLS) and 66% for adult BLS, indicating that a significant proportion of staff had not completed mandatory training. While some teams, including elements of X-ray and senior medical staff, remained below typical organisational targets. More concerning were areas of low compliance within clinically patient-facing teams. For example, ultrasound services at one site had compliance as low as 33% for paediatric BLS and 43% for adult BLS, and advanced practice teams reported adult BLS compliance between 50% and 57%. In addition, one medical staffing group recorded 0% compliance in adult BLS, which represents a significant potential risk to patient safety. Several non-clinical or administrative teams had no recorded data, and it was not clear whether training was not required or whether data was incomplete. Overall, the findings demonstrate inconsistent training uptake across the service and highlighted gaps in assurance that staff were appropriately trained to respond to medical emergencies.

Managers supported staff through regular clinical supervision and annual appraisals that included constructive feedback and discussions about career development. Where performance concerns were identified, these were managed in a supportive manner to encourage improvement. However, appraisal rates were 81.7%, meaning not all staff had received a recent review, limiting opportunities for structured development, feedback, and oversight of training needs.

Diagnostic imaging procedures were carried out by professionals with appropriate seniority and speciality training. Managers made sure staff attended team meetings or had access to the information shared when they could not attend. We saw notes from team meetings and other general information was shared on notice boards.

The service had recently received funding from the lung cancer screening service and were currently onboarding radiologists in this speciality.

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 or share concerns with appropriate agencies promptly.

The service had an infection prevention and control (IPC) policy and supporting guidance accessible to staff, and radiology indicators for 2025/26 confirmed hospital-acquired infections were not applicable. However, assurance over IPC standards was limited by consistently low routine hand hygiene audit performance, which declined from 66.6% to 61.65% across the year, indicating sustained non-compliance with expected standards. While the annual hand hygiene technique assessment improved significantly to 100%, and a diagnostics audit in March 2026 demonstrated full compliance across submitted areas, gaps in routine audit consistency remained, including absence of X-ray data resulting in a recorded 0% compliance due to lack of audit activity rather than performance.

Mandatory IPC training compliance was variable, with nursing staff fluctuating around target and medical staff generally stronger but not consistently meeting expectations. In addition, FFP3 mask fit testing compliance remained notably low (15.8%–18.8%), and PPE training was below optimal levels at 73%–77%. Overall, although some improvements were evident, particularly in technique assessment and targeted audit results, sustained weaknesses in routine audit performance, training compliance, mask fit testing, and incomplete data submission reduced assurance that IPC standards were consistently embedded across the radiology and wider diagnostic service. However, during the inspection staff were following infection control principles including compliant handwashing and the use of PPE as outlined in the service’s PPE standard operating procedure.

The service managed infection risks well. Staff used equipment and control measures to protect patients, themselves, and others from infection. They kept equipment and the premises visibly clean. The department was visibly clean, free from clutter and had suitable furnishings which were clean and well-maintained. Staff cleaned equipment after patient contact and labelled equipment to show when it was last cleaned. There were processes to enable staff to respond to infection prevention and control risks such as transmittable infections

Staff understood the process for managing spillage of body fluids in the department.

Staff supported infection prevention and control measures by following trust uniform policy. Nail varnish and jewellery was not worn, and staff in clinical areas were bare below their elbows to allow for full hand decontamination.

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 involve people in planning, including when changes happen.

Staff had access to required medicines and contrast media which were securely stored. Emergency medicines were kept in an accessible container. Medical oxygen cylinders were correctly stored. Staff told us medicines were administered under patient group directions (PGDs). PGDs is written legal frameworks that allow qualified healthcare professionals such as radiographers or pharmacists to supply or administer specific medicines directly to patients without a prescription and standard operating procedure. The service used systems and processes to safely prescribe, administer, record and store medicines. Staff administered contrast media for specific scans. The name, batch number and expiry date of contrast media used were recorded in patient notes.

Staff completed medicines records accurately and kept them up to date. There was effective governance of medicines, for example, medicines management incidents and learning were discussed during the clinical governance committee meeting.

The trust chief pharmacist and pharmacy manager received medicine safety alerts and shared these with staff when relevant to their practice. Pharmacy staff took the required actions from medicine safety alerts including checking medicines stored across the hospital for specific batch numbered medicines.

Staff learned from safety alerts and incidents to improve practice. There was a review of medicines errors and steps to prevent recurrence.