England’s chief inspector of hospitals says failing leadership is perpetuating poor care at Shrewsbury and Telford Hospitals NHS Trust, following a focused inspection that identified further serious concerns.
Responding to ongoing patient safety concerns, the Care Quality Commission (CQC) undertook focused inspections of the trust’s medical care and end of life care, visiting Royal Shrewsbury Hospital and The Princess Royal Hospital, Telford on 9 and 10 June.
Following the inspection, The Princess Royal Hospital remains rated as Inadequate overall and Royal Shrewsbury Hospital moves from Requires Improvement to Inadequate overall. They were both rated Inadequate for being safe, effective, responsive and well-led. Caring was not rated as the inspection team were unable to speak with patients due to the coronavirus pandemic.
CQC recognises that services have been affected by the Covid-19 pandemic, but in response to these findings the trust is entering into an improvement alliance with University Hospitals Birmingham NHS Foundation Trust. The trust recognised they were unable to make the changes necessary without further outside intervention. CQC welcomes this alliance, announced on 7 August, to develop and implement a new rapid improvement plan.
Inspectors found issues CQC previously identified through ongoing engagement, inspections and enforcement action had not been addressed. They also found new areas for concern where services had been meeting standards previously.
Risks were not well managed and patient records did not consistently reflect people’s needs and wishes. Some staff did not have the right competencies for their roles, and the trust’s policies and procedures were not always based on the most recent national guidance.
The trust’s issues have been perpetuated by its leaders’ collective failure to demonstrate that they had the skills and abilities to meet the challenges the trust has faced. They were not always visible or successful in embedding their priorities, feeding a culture that did not identify or respond to problems.
As a result of inspectors’ latest findings, the trust remains rated Inadequate overall. It is rated Inadequate for being safe, effective, responsive and well-led. These ratings are unchanged from those published in April 2020.
Professor Ted Baker, CQC chief inspector of hospitals, said: “We have repeatedly called for intervention to support improvement at Shrewsbury and Telford Hospitals NHS Trust. Despite this the trust has not resolved long-standing known issues, and poor patient care has been normalised. This situation must not continue.
“The trust has not responded satisfactorily to previous enforcement action. So I welcome their improvement alliance with University Hospitals Birmingham NHS Foundation Trust, which has been prompted following further intervention and enforcement action from CQC.
“This is the first step towards implementing the urgent changes that are required. We will continue to carefully monitor the trust to determine whether this drives the required change and will take further action if there is no progress.
“The trust’s board is fully aware of the essential improvements it must deliver. We continue to monitor the trust, including through further inspections.”
Following the inspection, CQC issued a warning notice to Shrewsbury and Telford Hospitals NHS Trust identifying the specific areas where improvements must be made with a compliance date of 30 September 2020.
The trust has been told it must make several improvements, including:
- Implementing effective risk assessments and using processes to learn from incidents
- Maintaining accurate patient records
- Ensuring its staff are competent for their roles
- Fully complying with the Mental Health Act.