Foreword from the Chair and Chief Executive

Dr Catriona McMahon Louise Barnett

We welcome the opportunity to reflect on the period 2021/22 and share with our patients, staff, and volunteers some of the key features of the Trust’s performance and activities throughout the period.

As you might expect, we begin with the reflection that the operational pressures described in last year’s Annual Report have not abated. The NHS has continued to face the greatest public health and operational challenge in its history due to the COVID-19 pandemic.

For the Trust, the year has been marked by a series of very challenging operational pressures. At periods throughout the year, with the continuing prevalence of COVID-19 and its variants in the community, the Trust responded to increased admissions of patients with the virus and the impact of staff absences. In December 2021, for example, a level 4 national incident was declared, requiring the Trust to mobilise its control centre, and to step down non-essential activities to enable us to focus on dealing with the challenges of the Omicron variant wave of the pandemic.

During this period, the Trust has experienced difficulties in achieving timely discharge of patients with care pathways into the community often compromised as a result of the impact of the pandemic, as well as some very significant surges in emergency department attendances requiring admission. Such were these pressures that the Trust declared two internal critical incidents requiring support from our partners across the system to manage the higher levels of demand.

All these operational pressures have, of course, taken place against the backdrop of the imperative to recover and restore our pre-pandemic elective waiting time performance. We have continued to work to ensure that our most clinically urgent patients can access our services, and to contain both the overall number of patients waiting, and the length of wait for patients.

While we continue to have a number of patients who have waited over 104 weeks, we are seeing

the number of patients waiting over 78 and 52 weeks reducing. We still have some way to go to recover our elective waiting times to pre-COVID 19 levels and are preparing plans for 2022/23 to further address these waits.

Despite these unprecedented pressures, the staff have remained tireless in their commitment in providing safe and compassionate patient care to patients during this period. In recognition of this, we have continued to actively support staff to improve their health and well-being as well as promoting the highly successful vaccination programmes for staff for both COVID-19 and influenza. We have continued to recognise the hard work and dedication of our staff. For example, during the year almost 800 staff nominated by colleagues, received COVID-19 Heroes awards. We were also able to hold our annual awards ceremony virtually at the beginning of July.

Again, this year, we need to acknowledge the contribution and value that our partners have brought to our work, including the Robert Jones and Agnes Hunt NHS Foundation Trust, Nuffield Health, Shropshire Community Health NHS Trust, Midlands Partnership NHS Foundation Trust, and our councils and commissioners.

We are also grateful for the massive support that we have continued to receive from many volunteers, members of the public and patients and their families. We have also continued to benefit as a Trust during the year through our improvement alliance with University Hospitals Birmingham NHS Foundation Trust and from our improvement partnership with Sherwood Forest Hospitals NHS Foundation Trust in relation to our maternity services improvement work.

The Trust has continued to implement ‘Getting to Good’, which is the programme of work focussed on our improvement journey. The transformation of maternity services continues to be a high priority in this programme.

Last year, we explained that a key event for the Trust had been the publication of the first Ockenden1 Report in December 2020 which set out the emerging findings and recommendations following a review of 250 maternity cases at the Trust. We confirmed our commitment to implementing all of the actions within this report. We also set out our aim to be

1 1 London UK: Crown Copyright; 10 December 2020, Emerging Findings and Recommendations from the Independent Review of Maternity Services at the Shrewsbury and Telford Hospital NHS Trust, ISBN 978-1-52862304-9

transparent in how we intended to hold ourselves to account and to monitor our progress in implementing the recommendations. To this end, we have held ten meetings of the Ockenden Report Assurance Committee which has been independently chaired, live streamed and its work regularly reported to monthly Board meetings. At the end of 2021/22, 45 (86%) of the actions from the first report have been delivered, 35 (67%) of actions that have been ‘evidenced and assured’ and 10 (19%) that have been delivered and not yet evidenced. Only seven (14%) actions were ‘not yet delivered’ of which six were Immediate and Essential Actions and one a Local Action for Learning, with all ‘on track’ but reliant for final delivery upon external dependencies.

The final report of ‘The Review of Maternity Services at The Shrewsbury and Telford Hospital NHS Trust’ chaired by Mrs Donna Ockenden, was published on 30 March 2022. The review examined cases involving 1,486 families between 2000 and 2019 and reviewed 1,592 clinical incidents where medical records and family consent was gained. The review found repeated failures in the quality of care and governance at the Trust throughout the last two decades. The review finds that these failures result from there not being enough staff, a lack of ongoing training, a lack of investigation and governance at the Trust and a culture of not listening to the families involved. The final report provides for more than 60 specific Local Actions for Learning for the Trust covering nine areas, and 15 Immediate and Essential Actions for all maternity services in England covering ten key areas.

The reports make harrowing reading and set out significant and major failings in maternity care services at the Trust. On the day of publication of the final report, on behalf of the Trust, we offered an unreserved apology and gave a continued commitment to implement all of the actions arising from the first and final reports of the review. Both the unreserved apology and this commitment were re-iterated at a meeting of the Board of Directors in April 2022, when the Board accepted the findings of the report and considered the actions that now need to be fully implemented.

We will approach this task with the same commitment and dedication that we have shown to implementing the required actions from the first report. We owe it to those families we failed and those we care for today and in the future to continue to make improvements, and through the pursuit of our improvement work, our aim is to achieve excellent care for our communities

Building on the Trust’s values that we refreshed last year and the need to listen, engage and

build trust with the communities which we serve, during the year we approved our Public Participation Plan which we have now started to actively implement. The Plan outlines how the Trust will support its clinical teams in engaging and involving the public and increasing the involvement of our communities in all aspects of service planning and delivery. We look forward to progressing and seeing the benefits of this approach.

We should also not under-estimate the role that capital expenditure has played in enabling us to deal with service pressures in year and, importantly, the impact that capital expenditure can have on transforming services.

In-year, we have seen the opening of the new CT and MRI pod and improvements made to the endoscopy unit to help us further increase our capacity. Importantly, as part of the strategic Hospitals’ Transformation Programme, we have seen the development of the revised Strategic Outline Case (supported by commissioners and stakeholders) which seeks final approval to move forward in implementing the Future Fit consultation decision to reconfigure services across the Royal Shrewsbury Hospital and the Princess Royal Hospital.

The task for the Trust now, as we look ahead, is to recover and restore, as far as possible, the service delivery and activity performance of the organisation that had been achieved prior to the very significant impact of the pandemic, and to deliver the service improvements, to which we are committed, to ensure that we deliver high quality care for our community.

To this end we will need to remain mindful of the significant role that our staff will, continue to play in enabling this recovery and in making these service improvements, and the paramount importance of their continued health and wellbeing. We recognise the significant support we receive from patients and families across the communities we serve and our partner organisations and stakeholders. We are grateful to everyone who has taken time to share their experiences with us, which help us learn and grow to ultimately provide the best care for the communities we serve.

Dr Catriona McMahon Trust Chair Mrs Louise Barnett Chief Executive