CQC finds improvements at Shrewsbury and Telford hospitals but concerns remain

The Care Quality Commission (CQC) has found signs of improvement at hospitals run by Shrewsbury and Telford Hospital NHS Trust, although inspectors identified a number of areas where further action is required.

Following inspections in March, urgent and emergency care at The Princess Royal Hospital in Telford has been upgraded from inadequate to requires improvement. Urgent and emergency care at Royal Shrewsbury Hospital remains rated requires improvement.

CQC also assessed medical care at both hospitals. Princess Royal Hospital’s medical care remains rated requires improvement, while Royal Shrewsbury Hospital’s medical care has improved from requires improvement to good.

The overall rating for both hospitals remains requires improvement.

The two hospitals provide NHS services to communities across Shropshire, Telford and Wrekin and parts of Wales. The inspections were carried out without prior announcement as part of CQC’s ongoing monitoring of healthcare quality.

At Princess Royal Hospital, inspectors found three regulatory breaches within urgent and emergency care relating to lengthy waits and concerns around the premises and environment.

Medical care at the hospital had two continuing breaches relating to mandatory training and inconsistent completion of risk assessments. Inspectors also identified two new breaches concerning staffing and performance of the stroke pathway.

CQC found that the trust had performed poorly across several areas of a national stroke audit and that the number of beds available for emergency stroke admissions had reduced over time.

Staffing did not always meet planned levels, while completion of some mandatory training, including safeguarding and basic life support, was significantly below the required standard.

Inspectors also found that staff compliance with patient observations stood at 54%, significantly below the 90% target, creating a risk that changes in people’s conditions might not be identified.

Urgent and emergency care at Princess Royal Hospital continued to use corridors to care for people, presenting risks to safety, dignity and privacy. Inspectors found there was insufficient space for the number of people requiring support, with some patients spending more than 12 hours on chairs or trolleys and being cared for in areas not intended for extended stays.

However, inspectors also identified improvements. Leadership had strengthened since the previous inspection, while staff and people using services felt able to raise concerns. Teams worked with external partners to support people’s safety, and inspectors highlighted the development of a frailty assessment area designed to reduce hospital stays for older people.

At Royal Shrewsbury Hospital, two regulatory breaches were identified in urgent and emergency care, relating to staffing and safe care and treatment.

Inspectors found the department did not always have sufficient staff, with employees reporting that staffing pressures could prevent them from completing basic safety checks.

People were also not always assessed quickly enough, creating a risk that serious or deteriorating conditions could be identified late. Some people had spent hours in the department without identification wristbands, and inspectors found that clinical management of the waiting room was not consistently in place.

There were positive findings within the department, including a culture in which staff felt confident reporting safety incidents. The hospital had also introduced measures aimed at improving patient flow and supporting discharge.

Work with a local community trust through an integrated front door team was helping to prevent avoidable hospital admissions and support people to receive care closer to home.

Medical care at Royal Shrewsbury Hospital received the strongest improvement, with its rating increasing to good.

Inspectors found that incidents were thoroughly investigated and that learning was shared with staff. Teams also worked with organisations including community trusts and housing support agencies to help maintain continuity of care following discharge.

However, three regulatory breaches were identified in medical care relating to timely treatment, infection prevention and control, and the management of hazardous substances.

Inspectors found that infection control procedures were not always followed. A confirmed case of Salmonella on one ward had not been reported to the local health protection team, which inspectors said increased the risk of further spread.

Across the inspections, people and their relatives reported positive experiences of staff, including being treated with kindness, dignity and compassion and being kept informed about their care.

CQC has required the trust to provide an action plan detailing the immediate improvements it is making in response to the concerns identified. The regulator said it will continue to monitor the services and their progress.

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