Updated 18 November 2021
The Shrewsbury and Telford Hospital NHS Trust is the main provider of district general hospital services for nearly half a million people in Shropshire, Telford & Wrekin and mid Wales. There are two hospital sites:
- The Royal Shrewsbury Hospital; and
- The Princess Royal Hospital
Both hospitals provide a wide range of acute hospital services including accident & emergency, outpatients, diagnostics, inpatient medical care and critical care.
During 2012/13, the Princess Royal Hospital became the main specialist centre for inpatient head and neck surgery with the establishment of a new head and neck ward and enhanced outpatient facilities. It also became the main centre for inpatient women and children’s services following the opening of the Shropshire women and children’s centre in September 2014.
During 2012/13, the Royal Shrewsbury Hospital became the main specialist centre for acute surgery with a surgical assessment unit, surgical short stay unit and ambulatory care facilities.
Together the hospitals have just over 800 beds and assessment & treatment trolleys. The trust operates, on average, over 5,000 outpatients’ clinics per week.
The trust has over 5,800 whole time equivalent members of staff.
Alongside the services at the Princess Royal and Royal Shrewsbury, the trust also provides community and outreach services such as:
- Consultant-led outreach clinics
- Midwife-led unit
- Renal dialysis outreach services
- Community services including Midwifery, Audiology and Therapies.
The trust had experienced significant challenges over the past 18 months due to the COVID-19 pandemic. Staff were redeployed from substantive roles to care for the most acutely ill patients and support staff in critical areas. Services had to be redesigned and moved at short notice.
At the time of our inspection, the trust was part of an improvement alliance with an NHS trust based in Birmingham, which had commenced in 2020 and was still in operation. The alliance involved the sharing of resources, staff, expertise and learning to facilitate improvement across the trust.
We carried out this unannounced inspection of Shrewsbury and Telford Hospitals NHS Trust because at our last inspections in 2018 and 2019 we rated the trust overall as inadequate, and the trust was placed in special measures. We inspected to see what improvements had been made.
We carried out an unannounced inspection of the following acute services provided by the trust:
- Urgent and emergency care at both the Royal Shrewsbury Hospital and the Princess Royal Hospital;
- Medical care at both the Royal Shrewsbury Hospital and the Princess Royal Hospital;
- End of life services at both the Royal Shrewsbury Hospital and the Princess Royal Hospital; and
- Maternity services at the Princess Royal Hospital.
We also inspected the well-led key question for the trust overall.
We inspected these services because during previous inspections we had identified concerns and had taken enforcement action to check whether the trust had made improvements to the care and treatment delivered.
We did not inspect all the services previously rated as requires improvement because this inspection was focused only on services where we had concerns. We are monitoring the progress of improvements to services and will re-inspect them as appropriate. Services previously rated as requires improvement and not inspected this time include:
The Royal Shrewsbury Hospital:
- Surgery;
- Critical Care; and
- Outpatients.
The Princess Royal Hospital:
- Surgery;
- Critical Care; and
- Services for children and young people.
Our rating of services stayed the same. We rated them as inadequate because:
- The trust had made improvements since our last inspection but further work was needed to improve the rating.
- We rated safe and responsive as inadequate and caring as requires improvement. Effective and well-led had improved to requires improvement. Well-led is the overall trust-wide rating, not an aggregation of services ratings.
- We rated four out of the seven services inspected as requires improvement and three as inadequate.
- In rating the trust, we took into account the current ratings of the seven services not inspected this time.
- Staff did not always assess and respond to patient risk. Records were not always of good quality, stored safely or easily available to staff to ensure that they could provide safe nursing care
- Vacancies within nursing, medical and allied health professional staffing was still impacting on the safety and quality of patient care.
- Practice in respect of infection prevention and control was varied in performance and the environment across many core services did not promote safe and high-quality care.
- Practice in relation to pain relief for patients varied across core services. The availability of key services was varied with patients not being able to access them seven days a week, especially in respect of the services provided by allied health professionals.
- Staff did not always treat patients with compassion and kindness but it is acknowledged their ability to do so was impacted by other challenges the trust faced.
- Individual needs were not always met. People could not always access the service when they needed it and did not receive the right care promptly.
- Leadership at trust level and across core services had improved but there was further work to do which included but was not limited to management of risk and performance, culture and governance.
However:
- Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.
- Services had improved safeguarding practices which improved safety for service users.
- Mental health provision for service users had improved.
- Actions were being taken to recruit nursing, medical staff and effective leaders.
- Medicines were generally managed well, with some exceptions in some areas. The safety culture within the trust had improved since our last inspection but learning was not always shared effectively.
- Services generally provided care and treatment based on national guidance and evidence-based practice. Staff monitored the effectiveness of care and treatment. The service made sure staff were competent for their roles. Staff worked together as a team to benefit patients. Key services were available to support patient care. Practice in relation to Mental Capacity Act and Deprivation of Liberty Safeguards had improved across the whole of the trust.
- The board was developing and starting to work well together.
How we carried out the inspection
We carried out this inspection on various days throughout July 2021. We visited areas relevant to each of the core services inspected and spoke with a number of patients and staff, as well as holding focus groups.
During the inspection we visited:
- 12 wards within medical services at the Royal Shrewsbury Hospital;
- 10 wards within medical services at the Princess Royal Hospital;
- All areas of the emergency department within urgent and emergency care services at the Royal Shrewsbury Hospital;
- All areas of the emergency department within urgent and emergency care services at the Princess Royal Hospital;
- Five wards where end of life care services was delivered and the mortuary at the Royal Shrewsbury Hospital;
- Five wards where end of life care services was delivered and the mortuary at the Princess Royal Hospital; and
- All areas within maternity services at the Princess Royal Hospital.
We spoke with 192 staff members of various speciality and profession including, consultants, doctors, radiotherapists, midwives, nurses, healthcare support workers, allied health professionals, pharmacists, patient experience, domestic staff and administrators.
We spoke with 41 patients throughout the departments and reviewed 135 patient records.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.