The Princess Royal 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 there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

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 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 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The trust had a clear vision and a set of values, with ‘Putting Patients First’, ‘To provide excellent care for the community we serve’, and values; Partnering; Ambitious; Caring; Trusted, was underpinned by an ambitious 5-year strategy. The trust was focusing on 6 strategic themes to deliver their vision, these were continually reassessed to check that the trust was continuing to respond to challenges in the local community, reducing health inequalities and improving population health and well-being. The trust engaged both externally and publicly around the trust vision and strategy.

The service vision and strategy aligned to the overarching aims and objectives of the trust, which staff understood and could relate to their individual roles. Staff were focused on meeting the needs of patients and were aware of how their work contributed to achieving service targets. The service promoted equality and diversity and supported staff development, alongside fostering an open and inclusive culture where patients, families and staff could raise concerns without fear.

Staff reported feeling respected, supported and valued, with positive working relationships across all staff groups that encouraged strong teamwork and collaboration. Staff were generally motivated and positive about future changes; however; at the time of inspection, the trust was undertaking significant

work at both the Princess Royal Hospital and Royal Shrewsbury Hospital as part of the Hospital Transformation Programme (HTP) which leaders aimed to be completed by 2028. Staff reported some uncertainty around the potential impacts of the HTP on their day-to-day work, such as working at a different site, but were hopeful about intended benefits, with concerns raised that diagnostic imaging services were not sufficiently considered in future planning despite their integral role in supporting most patient pathways.

The department was often busy, with periods where demand exceeded available staffing, impacting the ability to complete all required tasks in a timely manner. Senior staff reported that some staff were experiencing fatigue and burnout, which contributed to sickness absence and further staffing pressures. Despite these challenges, frontline staff felt supported and listened to by their leaders. Staff recognised the ongoing workforce pressures but described strong teamwork and collaboration, with teams working effectively together to manage demand during challenging periods.

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.

The service had a clear management structure with defined responsibilities and accountability. Staff reported that they felt able to approach both immediate and senior managers with any concerns or queries, and overall described feeling supported, respected and valued within their roles. However, some staff reported feeling demoralised at times when they were expected to maintain seeing the same levels of patients on daily basis, despite reduced staffing.

Leaders had the necessary experience, skills and capability to run the service effectively, demonstrating a clear understanding of the priorities and challenges faced. They were visible and approachable, supporting staff development and progression, and responded appropriately to incidents and concerns, which helped to promote a positive culture. Leaders also maintained a presence within the service to monitor performance directly, and leadership development opportunities were available to support both current and future leaders.

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 were aware of the Freedom to Speak Up Guardian and knew who their guardian was at the trust. Patients and staff could meet with members of the provider’s senior leadership team and governors to give feedback. Staff we asked said they knew about whistleblowing and how they might approach organisations beyond the trust, if they felt this was needed. Concerns, including whistleblowing, were managed sensitively and escalated appropriately, with oversight through risk registers and management reporting.

Staff and leaders demonstrated a culture of openness, honesty and transparency, where staff were encouraged to raise concerns and contribute ideas with confidence they would be heard and supported without fear of detriment.

Patients, families and carers were provided with clear information on how to raise concerns, and staff were encouraged to resolve issues promptly, supported by formal policies. Feedback from patients, carers and staff was routinely shared and used to drive service improvements.

We scored the service as 2. The evidence showed some shortfalls. The service did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Leaders acted to improve where any disparities in the experience of staff with protected equality characteristics. Leaders took steps to remove bias from practices to ensure equality of opportunity and experience for the workforce within their place of work, and throughout their employment.Staff told us they had opportunities to apply for project work, new roles and to undertake external studies through an open application process.

The service acted to prevent and address bullying and harassment at all levels and for all staff, with a clear focus on those with protected characteristics under the Equality Act and those from excluded and marginalised groups. Staff felt everyone was treated fairly and that they would be able to report behaviour or attitudes which were negative in style.

Staff with disabilities were offered reasonable adjustments to support them to carry out their roles well. 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.

The 2025 staff survey for radiology and imaging showed a mixed position, with a response rate of 37%, demonstrating improvements in areas such as staff wellbeing, fatigue, and appraisal rates, and some indicators performing above the trust average. However, a greater number of questions showed decline, with key concerns relating to access to equipment, staffing capacity, and the reporting of bullying, harassment or abuse. While strengths were seen in compassionate culture, team working and flexible working, lower scores in morale, learning culture, and recognition, alongside a decrease in staff recommending the organisation as a place to work, indicated the need for focused action to address workforce, resource and cultural challenges.

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 demonstrated an effective and proportionate approach to risk management that supported innovation, underpinned by clear governance processes to monitor risks, outcomes and drive improvement. The diagnostic imaging risk register identified key risks with defined actions, mitigations and strategic considerations, with red, amber, green (RAG) ratings and clear ownership in place. Reporting mechanisms ensured oversight of short-, medium- and long-term challenges, and staff concerns aligned with those recorded, indicating good visibility and understanding of risks.

There was a good range of accurate and timely data and information available to understand performance and quality, there were structures, processes, and systems of accountability to support the delivery of the service. The service had a meeting structure which gave senior leaders and managers regular opportunities to discuss operational issues. Leaders were clear on the links to trust-wide groups and committees to escalate risks and issues.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients.

The service operated effective governance processes through various committees and on-site activities. There was a range of information collected, monitored and communicated at the relevant committee meetings and was fed to the trust board. Performance data was analysed and compared with other organisations and where improvements were needed, action plans were developed to make this happen.

The service had plans to cope with unexpected events and had a business continuity plan, which included major incident plans.

Staff reported that they did not always have access to the equipment and information technology needed to carry out their roles, with concerns raised about multiple systems and platforms that were difficult to navigate. Despite this, information governance processes were in place to maintain the confidentiality of patient records, and managers had access to service performance, staffing and patient care information to support effective oversight and management.

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.

The service understood the duty to collaborate and work in partnership, so services worked seamlessly for people. Staff shared information and learning with partners and collaborated for improvement. We saw evidence that service leaders collaborated with external partners including partners 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.

Some senior leaders were part of regional networks to understand the needs of the community and the provider ambitions. Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services.

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.

Staff were committed to continually learning and improving services.

There were established processes to support learning from incidents and good practice at both local and national levels, and staff demonstrated a good understanding of quality improvement methods. Overall, the service demonstrated a strong commitment to delivering high-quality, patient-centred care, with clearly identified opportunities for further improvement.

The service strived for continuous learning, improvement and innovation which was encouraged by the leadership team. The service had a robust audit process, and part of this process was to identify actions for improvement. The service shared information effectively and used it to make improvements. The service supported development and improvement opportunities for staff. For example, some imaging assistants were being supported to become radiographers. Staff were supported to have the time to develop their skills around improvement and innovation and to pursue areas of interest in the service.

Leaders promoted innovation and research, with examples including the use of melatonin for children undergoing scans as an alternative to sedation, helping to improve patient outcomes and reduces the need for an inpatient bed.