The Care Quality Commission (CQC) has upgraded the rating of urgent and emergency care at The Princess Royal Hospital in Telford from inadequate to requires improvement, and has rated urgent and emergency care at Royal Shrewsbury Hospital as requires improvement again following inspections in March.
CQC also inspected medical care at Princess Royal Hospital and re-rated it as requires improvement, and at Royal Shrewsbury Hospital upgraded the medical care rating from requires improvement to good.
The hospitals, run by Shrewsbury and Telford Hospital NHS Trust, provide a wide range of NHS services for people in Shropshire, Telford and Wrekin, and parts of Wales. CQC carried out the unannounced inspections as part of continual checks on the quality of healthcare.
At Princess Royal Hospital in urgent and emergency care, inspectors identified three breaches of regulation related to long delays, premises and environment. They also identified two continued breaches of regulation in medical care related to mandatory training and inconsistent risk assessment completion, and two new breaches related to stroke pathway performance and staffing.
At Royal Shrewsbury Hospital, inspectors identified two breaches of regulation in urgent and emergency care related to safe care and treatment and staffing. In medical care, they identified three breaches of regulation related to failing to provide timely treatment, infection prevention and control, and management of hazardous substances.
CQC told the trust to submit a plan showing what action it is taking to make immediate improvements in response to these concerns.
The overall rating for both hospitals remains requires improvement.
Carolyn Jenkinson, CQC’s deputy director of hospitals in the west midlands, said:
“When we visited Princess Royal Hospital, we found improvements in leadership, with staff feeling supported and able to speak up. The culture around safety and learning was strong in both services, and we saw real commitment from teams to improve, which is a good foundation to build on. People said staff were kind, friendly and responsive, and we saw staff treating people with dignity and compassion throughout our time there.
“However, there were still areas of concern that leaders needed to address. In urgent and emergency care, people were sometimes waiting far too long. Some spent more than 12 hours in chairs or on trolleys, and we saw people waiting in areas not designed for longer stays. We know staff were doing their best in difficult circumstances and faced high levels of demand, but people deserve timely, appropriate care.
“At Royal Shrewsbury Hospital, we heard from people and their relatives that staff treated them with compassion and kindness, kept them informed, and supported them through some difficult moments.
“In the hospital’s urgent and emergency care services, there was a good safety culture and staff reported incidents confidently, and the department had implemented initiatives to improve flow and support hospital discharges. However, some longstanding concerns hadn’t been fully resolved. We found people who had been in the department for hours without an ID wristband, which is essential for ensuring people get the right medicines and treatment. There also wasn’t consistent clinical management of the waiting room, which we had previously raised as an issue.
“Our report highlights where improvements are needed and the positive areas leaders now need to build on. We’ll continue to monitor the services and look forward to seeing their progress.”
Inspectors found in Princess Royal Hospital’s urgent and emergency care:
- The service routinely used corridor care, which risked people’s safety, privacy and dignity.
- The department didn’t have enough space for the number of people staff were supporting.
- The department worked closely together and with external partners to keep people safe. The development of a frailty assessment area to reduce the length of stay for older people was a particular success.
Inspectors found in Princess Royal Hospital’s medical care:
- The trust scored poorly in multiple areas of a national stroke audit, and the number of beds for emergency stroke admissions had reduced over time.
- Leaders didn’t always ensure staffing met planned levels, and some mandatory training completion levels, including safeguarding and basic life support, were significantly below the required standard.
- Staff’s observation compliance for people was significantly below the 90% target at 54%, risking undetected changes in people’s conditions.
- Leadership had improved since the last inspection. Staff and people felt able to speak up, and leaders had the skills and experience to carry out their roles.
Inspectors found in Royal Shrewsbury Hospital’s urgent and emergency care:
- The department didn’t always have enough staff, and staff told inspectors this left them unable to carry out basic safety checks.
- People weren’t consistently assessed quickly enough, risking delays in identifying people whose conditions were serious or deteriorating.
- The hospital worked with a local community trust to reduce avoidable admissions through an integrated front door team, helping people access care closer to home instead.
Inspectors found in Royal Shrewsbury Hospital’s medical care:
- Leaders investigated incidents thoroughly, involving external parties where needed, and shared learning with staff to drive improvements.
- Staff worked well with partner organisations, including community trusts and housing support agencies, to make sure people's care continued seamlessly after leaving hospital.
- Staff didn’t always follow infection control procedures, as a confirmed Salmonella case on one ward wasn't reported to the local health protection team, raising the risk of further spread.