Care Quality Commission (CQC) inspectors have found a number of improvements at Shrewsbury and Telford Hospital NHS Trust but say more work is needed to ensure people receive the standard of care they should be able to expect.
Inspectors visited the trust’s Princess Royal Hospital, Royal Shrewsbury Hospital and its five mid-wife led maternity units, between 12 and 15 December 2016 to check on whether improvements had been made following its previous inspection in October 2014. Subsequent unannounced visits also took place on 30 December 2016 and 3 January 2017.
Progress had taken place in several areas - including end of life care, where concerns were highlighted following the regulator’s previous inspection in 2014. The trust’s rating for providing effective services had also improved and was upgraded from Requires Improvement to Good.
There was evidence of strong multidisciplinary team working on all wards and departments inspected and staff from all relevant clinical teams were involved in handover meetings to ensure patients received coordinated care.
However, inspectors found that more work is needed to ensure sure that patients receive the best possible care across all wards and departments.
The trusts two emergency departments were experiencing continued pressure and a shortage of consultants and middle grade doctors meant that some patients had to wait too long for an initial clinical assessment.
In Maternity services inspectors found that safety needed further improvement. Learning from safety incidents was not always being shared with all staff to support improvements. A lack of regular postnatal ward rounds meant that high risk postnatal women were not regularly reviewed. On the Wrekin mid-wife led unit medicines management was also a concern.
The trust’s main maternity unit at the Princess Royal Hospital was rated as requires improvement overall and requires improvement for being safe and well led.
The trust’s overall rating remains as Requires Improvement.
CQC’s Chief Inspector of Hospitals, Professor Ted Baker, said:
“Our inspectors found a number of improvements had been made at Shrewsbury and Telford Hospital NHS Trust since our last inspection, and staff are to be commended for this."
“End of life care services had made significant progress and we noted a positive change in culture among staff and leaders at the trust. The change in ratings in a number of areas acknowledges what has been achieved by the trust’s staff and leadership team and we found several examples of outstanding practice."
“However, the overall rating reflects the fact that the trust still has some way to go on its improvement journey. There were a number of areas where action was needed, particularly with regard to maintaining appropriate staffing levels in the emergency department and ensuring a strong safety and learning culture within maternity services."
“At the time of our inspection, new senior leaders had started to make positive changes in the trust’s maternity service, but more action is needed to ensure these changes are fully embedded and sustained."
“We have made it clear where we expect to see further improvement and the trust knows what it must do to address the issues we have highlighted. We will continue to monitor Shrewsbury and Telford Hospital NHS Trust and return to check on its progress.”
The trust must make a number of improvements, including:
- All patients brought in by ambulance must be promptly assessed and triaged by a registered nurse.
- The trust must ensure its emergency department meets the Department of Health’s target of discharging, admitting or transferring 95 per cent of patients within four hours of arrival in the department.
- Sufficient nursing staff must be on duty to provide safe care for patients. A patient acuity tool should be used to assess the staffing numbers required for the dependency of the patients.
- Medical staffing must be reviewed to ensure sufficient cover is provided to keep patients safe at all times.
- All staff must have up to date mandatory training.
- The trust must ensure it meets the referral to treatment time for admitted pathways for surgery.
- Staff must have an understanding of how to assess mental capacity under the Mental Capacity Act 2005 and assessments must be completed.
- The trust must ensure the application of the World Health Organisation’s (WHO) ‘five steps to safer surgery’ checklist is improved in theatres.
- The prevention, detection and control of the spread of infection, associated with the mortuary department, must be ensured through the decontamination of surgical instruments and making sure arrangements are in place for regular deep cleaning.
Inspectors found some areas of outstanding practice, including:
- The trust had introduced the ‘Swan Scheme’ which provides resources for staff and practical measures for patients at the end of their lives and their families. This including Swan boxes, bags and end of life information files for staff, as well as a Swan bereavement suite.
- The palliative care team had developed a fast track checklist to provide guidance to ward staff on what to consider when discharging an end of life patient.
- The trust is working with the Virginia Mason Institute to improve care for patients, for example those who suffered from sepsis (blood poisoning).
Shrewsbury and Telford Hospital NHS Trust provides district general hospital services for almost half a million people in Shropshire, Telford and Wrekin. There are two main locations, Royal Shrewsbury Hospital in Shrewsbury and Princess Royal Hospital in Telford. The trust also provides a number of services at Ludlow, Bridgnorth and Oswestry Community Hospitals.
Full reports from the inspection have been published on our website.
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