Royal Shrewsbury Hospital, Shrewsbury

General Services Information

Hospital Questions

• How many single rooms are available to NHS patients at this hospital: 79

• Of these how many have an ensuite toilet: 22

• Of these how many have an ensuite toilet and shower or bath: 21

• Does this hospital operate an accident and emergency unit:

• How many specialist palliative care beds are available at this hospital: 0

• Does this hospital have a named private unit/service:

Trust Questions

• Does the Trust treat private patients:

Patient Safety

Trust Questions

• Is there a system for recording operations that resulted in a foreign body being left post surgery: Incident reporting system

• What is the reporting system for a foreign body being left post surgery: Incident Reporting System - Datix Also advised to contact Patient Safety team

• Is there a system for recording operations that were cancelled due to missing notes:

• What is the reporting system for operations that were cancelled due to missing notes: Incident Reporting System - Datix Also advised to contact Patient Safety team

• Is there a system for recording operations that resulted in wrong site surgery taking place:

• What is the reporting system for operations that resulted in wrong site surgery taking place: Incident Reporting System - Datix Also advised to contact Patient Safety team

• During the period 01 April 2010 - 31 March 2011, how many operations resulted in a foreign body being left post surgery: 1

• During the period 01 April 2010 - 31 March 2011, how many operations were cancelled due to missing notes: 0

• During the period 01 April 2010 - 31 March 2011, how many operations resulted in wrong site surgery taking place: 0

• How many incident investigations using a full Root Cause Analysis did were carried out in 2010/11: 111

• What percentage of patient safety incidents resulting in severe harm or death had a full RCA initiated/completed: 0-30%

• What percentage of acute inpatients have a track and trigger warning system in place for the duration of the admission: 100%

• What percentage of patients are risk assessed for venous thromboembolism on admission: 61-90%

• Compliant with all relevant NPSA safety alerts issues in 2010/11 (you can find a full list of alerts issued at http://www.nrls.npsa.nhs.uk/resources/?p=3). :

• Alerts where not expected to be compliant by 1st December 2011 and when expected to be compliant. : All should be complete by 1st December 2011

• Does the Trust have a policy for providing educational programmes on using and interpreting clinical indicators:

• Does the Trust have a designated member of staff who supports teams in locating and analysing safety and quality data? (support):

• Is safety and quality data available on a central platform and actively disseminated to users:

Infection Control

Trust Questions

• Does the Trust employ an antibiotic pharmacist:

• Does the Trust operate a pre-admission assessment clinic or equivalent system where patients are screened and results returned in advance of the day of admission:

• Elective patient groups screened at the pre-op assessment clinic: All elective surgical and medical Except groups not requiring screening according to DH guidelines eg cataract patients and endoscopy patients

• Are all oncology patients screened at the pre-op assessment clinic: YES

• Are all chemotherapy patients screened at the pre-op assessment clinic: YES

• Are all elective neurosurgery patients screened at the pre-op assessment clinic: Not Applicable

• Are all patients with past history of MRSA screened at the pre-op assessment clinic:

• What method of MRSA screening is used when screening at admission: Culture based in 24-48hrs except ITU/HDU where we use Molecular

• On admission, does topical suppression take place immediately:

• Does the Trust have at least one accident and emergency unit:

• Are all patients admitted through A&E screened:

• Is screening done according to individual risk assessment: Except children and maternity

• Does the Trust have a dedicated isolation ward:

• How many beds does it contain: 25

• Does the Trust have an isolation policy:

• Where medically appropriate, are patients with C Diff isolated in single rooms as a matter of priority:

• Does the Trust prescribe probiotics to any patient groups as a prophylactic measure to reduce C.difficile infections:

• Does the Trust have a policy to guide the use of metronidazole and vancomycin for C.difficile infected patients:

• Does the Trust routinely isolate all patients with diarrhoea:

Stroke Medicine

Hospital Questions

• Does the hsopital have a specialist stroke unit:

• What type of stroke unit does the hospital have: combined acute and rehabilitation stroke unit

• Number of beds in the unit: 25 This includes 20 beds and 1 assessment trolley on Ward 22S and 4 beds in ward 22R

Trust Questions

• Does the Trust have a specialist stroke unit or units:

• Is the Trust part of a stroke care network:

• Details: Shropshire and Staffordshire Heart and Stroke Network

• How many emergency admissions with a primary diagnosis of stroke (ICD10 codes I60 - I64) did the Trust receive in the financial year (period 01 April 2010 - 31 March 2011): 834

• Of these, what was the number of patients given a Computerised Tomography (CT) scan within 24 hrs of admission: 694

• Is thrombolysis for stroke patients provided 24 hours per day and 7 days a week : At both RSH & PRH. We also partake in a network-wide stroke rota with Burton and Stoke. Aiming to have telemedicine for stroke patients available from October 2011 at both RSH & PRH to support high quality delivery of thrombolysis.

• Are there any formal arrangements with neighbouring hospitals for the emergency transfer of stroke patients who would benefit from thrombolytic treatment: For patients who require Intra Arterial Thrombolysis they will transfer to University Hospital of North Staffordshire as this is the closest centre that can deliver this treatment.

Trauma & Orthopaedics

Trust Questions

• Does the Trust offer a trauma service:

• Does the Trust have a dedicated trauma list available 24 hours a day for the duration of the week, (Sunday to Sunday): 6 out of 7 days currently at RSH, 7th being planned. 5 out of 7 currently at PRH, 6th day being planned.

• Does the Trust offer an orthopaedics service:

• Do all the Trust's orthopaedic ward/team have a linked geriatric team with whom they have regular meetings at least once a week: Not at RSH - being planned

• Does the Trust run a pre-operative patient education session/class for patients to attend prior to Total Knee Replacement (TKR) and Total Hip Replacement (THR)? :

• What is the audited Percentage of all patients that attend the class prior to surgery: 100

• Does the Trust have a standardised anaesthetic protocol for Total Knee Replacement (TKR) and Total Hip Replacement (THR) patients:

• Estimated percentage compliance to this protocol: 25

• Estimated percentage of the Trusts total knee replacement (TKR) and total hip replacement (THR) patients walk within 24 hours of surgery: 25

• Does the Trust have a specialist orthopaedic physiotherapy service which is available 7 days a week:

• How many patients' discharge's delayed due to lack of physiotherapy services at weekends - estimated figure: 5 Less than 5%

• Are patients for total knee replacement (TKR) and total hip replacement (THR) admitted prior to the day of surgery:

• What is the principle reason for patients not being admitted on the day of surgery: Co-morbidity management, eg: IDDM, DVT management etc

• Are patient records routinely recorded using a specific multi-disciplinary team THR/TKR pathway document:

• Is this data used to monitor compliance with the agreed pathway:

• Is criteria-based discharge used:

• Are patients routinely phoned in the first 48 hours after discharge to check on their progress:

Paediatrics

Hospital Questions

• Does the hospital have a paediatrics service:

Trust Questions

• Is the Trust's elective paediatric surgery carried out only by designated surgeons with at least six months training in a specialist unit:

• Do the Trust's anaesthetists with responsibility for paediatric anaesthesia participate in at least one paediatric list per week:

• Is a paediatrician on site (SpR or higher) 24 hours per day, 7 days per week:

• Are at least two registered children's nurses on duty 24hours per day in each children's ward:

• Is there a designated facility on site for parents or guardians to stay overnight:

Palliative Care

Trust Questions

• Does the Trust provide a palliative care service:

• How is specialist palliative care delivered at the hospital: Adult inpatient specialist palliative care unit 3.8 wte Nurse led adult inpatient Specialist Palliative Care Service. Core Hours Mon-Friday . Weekly specialist palliative care MDT. 2Pa's visiting Consultant in palliative provided from local Hospice ( Severn Hospice).24/7 access to medical advice for health care professionals provided from local Hospice. Acute Trust referrals to local Hospice or community palliative care nursing services. Community services include palliative care ( Macmillan) Nursing team and Hospice at home

• Does the hospital's specialist palliative team includes: Other (please specify) 2Pa's visiting Consultant in palliative provided from local Hospice (Severn Hospice).

• Is the Trust's specialist palliative care team available 24 hrs a day seven days a week: 24/7 access to medical advice for health care professionals provided from local Hospice.

• Are facilities provided to support relatives and carers who wish to stay with a patient in hospital: Purpose built flat available adjacent to oncology ward

• Does the Trust routinely survey and evaluate the views of patients and bereaved relatives and carers regarding the delivery of care on the end of life programme:

Maternity Care

Maternity Sites

• Ludlow Hospital - Midwife Led

• How many women gave birth in the unit during the year? (not including home births): 81

• How many babies were born in the unit during the year? (not including home births): 81

• How many women were booked for a home birth: 4

• How many women had a home birth? (not including births at home by accident): 4

• Number of antenatal rooms: 0

• Total antenatal beds: 0

• Number of assessment area rooms (for monitoring and / or induction): 1

• Total assessment area beds: 1

• Number of delivery rooms: 1

• Total delivery beds: 1

• Number of postnatal rooms: 2

• Total postnatal beds: 7 1 x 3 and 1 x 4 bedded rooms

• Number of rooms in obstetric high dependency unit: 0

• Total obstetric high dependency beds: 0

• Number of single rooms used for both delivery and postnatal care (labour, delivery, recovery and postnatal, or LDRP, rooms): 0

• Amenity rooms; Are women able to book a single room in advance of their birth:

• If women can pay for a single room what is the average cost per night (GBP): 0 Not applicable

• Does the maternity unit have a neonatal intensive care unit:

• Does the maternity unit have a neonatal high dependency unit:

• Does the maternity unit have a special care baby unit:

• Security measures - ankle bands for the baby:

• Security measures - cot alarms:

• Security measures - CCTV:

• Security measures - restricted access:

• Pain relief available - bath or shower: Provided by unit

• Pain relief available - birthing pool: Not available

• Pain relief available - birth ball: Provided by unit

• Pain relief available - Massage: Provided by women

• Pain relief available - Aromatherapy: Provided by women

• Pain relief available - TENS: Provided by unit

• Pain relief available - Epidural: Not available

• Pain relief available - Mobile epidural: Not available

• Pain relief available - Entonox (gas and air): Provided by unit

• Pain relief available - Intramuscular injection: Provided by unit

• Total number of WTE midwives at the unit in your funded establishment, including vacant posts: 6.56

• Total number of WTE midwives at the unit as staff in post, including agency and bank staff: 7.64

• Does the unit have midwives available to provide one-to-one care available 24 hours a day, 7 days a week: On site and on-call

• Does the unit have midwives available for home births available 24 hours a day, 7 days a week: On call

• Does the unit have midwives trained and experienced in water birth available 24 hours a day, 7 days a week: On site and on-call

• Does the unit have a paediatrician available 24 hours a day, 7 days a week:

• Does the unit have an obstetrician available 24 hours a day, 7 days a week:

• Does the unit have an anaesthetist available 24 hours a day, 7 days a week:

• Does the unit have a dedicated obstetric anaesthetist available 24 hours a day, 7 days a week:

• Robert Jones & Agnes Hunt Orthopaedic Hospital - Midwife Led

• How many women gave birth in the unit during the year? (not including home births): 83

• How many babies were born in the unit during the year? (not including home births): 83

• How many women were booked for a home birth: 4

• How many women had a home birth? (not including births at home by accident): 1

• Number of antenatal rooms: 0

• Total antenatal beds: 0

• Number of assessment area rooms (for monitoring and / or induction): 1

• Total assessment area beds: 1

• Number of delivery rooms: 1

• Total delivery beds: 1

• Number of postnatal rooms: 1

• Total postnatal beds: 6 1 x 6 bed bay

• Number of rooms in obstetric high dependency unit: 0

• Total obstetric high dependency beds: 0

• Number of single rooms used for both delivery and postnatal care (labour, delivery, recovery and postnatal, or LDRP, rooms): 0

• Amenity rooms; Are women able to book a single room in advance of their birth:

• If women can pay for a single room what is the average cost per night (GBP): 0 Not applicable

• Does the maternity unit have a neonatal intensive care unit:

• Does the maternity unit have a neonatal high dependency unit:

• Does the maternity unit have a special care baby unit:

• Security measures - ankle bands for the baby:

• Security measures - cot alarms:

• Security measures - CCTV:

• Security measures - restricted access:

• Pain relief available - bath or shower: Provided by unit

• Pain relief available - birthing pool: Not available

• Pain relief available - birth ball: Provided by unit

• Pain relief available - Massage: Provided by women

• Pain relief available - Aromatherapy: Provided by women

• Pain relief available - TENS: Provided by unit

• Pain relief available - Epidural: Not available

• Pain relief available - Mobile epidural: Not available

• Pain relief available - Entonox (gas and air): Provided by unit

• Pain relief available - Intramuscular injection: Provided by unit

• Total number of WTE midwives at the unit in your funded establishment, including vacant posts: 9.41

• Total number of WTE midwives at the unit as staff in post, including agency and bank staff: 8.91

• Does the unit have midwives available to provide one-to-one care available 24 hours a day, 7 days a week: On site and on-call

• Does the unit have midwives available for home births available 24 hours a day, 7 days a week: On call

• Does the unit have midwives trained and experienced in water birth available 24 hours a day, 7 days a week: On site and on-call

• Does the unit have a paediatrician available 24 hours a day, 7 days a week:

• Does the unit have an obstetrician available 24 hours a day, 7 days a week:

• Does the unit have an anaesthetist available 24 hours a day, 7 days a week:

• Does the unit have a dedicated obstetric anaesthetist available 24 hours a day, 7 days a week:

• Bridgnorth Hospital - Midwife Led

• How many women gave birth in the unit during the year? (not including home births): 98

• How many babies were born in the unit during the year? (not including home births): 98

• How many women were booked for a home birth: 7

• How many women had a home birth? (not including births at home by accident): 5

• Number of antenatal rooms: 0

• Total antenatal beds: 0

• Number of assessment area rooms (for monitoring and / or induction): 1

• Total assessment area beds: 1

• Number of delivery rooms: 1

• Total delivery beds: 1

• Number of postnatal rooms: 2

• Total postnatal beds: 4 2 x 2 bedded rooms

• Number of rooms in obstetric high dependency unit: 0

• Total obstetric high dependency beds: 0

• Number of single rooms used for both delivery and postnatal care (labour, delivery, recovery and postnatal, or LDRP, rooms): 0

• Amenity rooms; Are women able to book a single room in advance of their birth:

• If women can pay for a single room what is the average cost per night (GBP): 0 Not applicable

• Does the maternity unit have a neonatal intensive care unit:

• Does the maternity unit have a neonatal high dependency unit:

• Does the maternity unit have a special care baby unit:

• Security measures - ankle bands for the baby:

• Security measures - cot alarms:

• Security measures - CCTV:

• Security measures - restricted access:

• Pain relief available - bath or shower: Provided by unit

• Pain relief available - birthing pool: Not available

• Pain relief available - birth ball: Provided by unit

• Pain relief available - Massage: Provided by women

• Pain relief available - Aromatherapy: Provided by women

• Pain relief available - TENS: Provided by unit

• Pain relief available - Epidural: Not available

• Pain relief available - Mobile epidural: Not available

• Pain relief available - Entonox (gas and air): Provided by unit

• Pain relief available - Intramuscular injection: Provided by unit

• Total number of WTE midwives at the unit in your funded establishment, including vacant posts: 7.16

• Total number of WTE midwives at the unit as staff in post, including agency and bank staff: 6.89

• Does the unit have midwives available to provide one-to-one care available 24 hours a day, 7 days a week: On site and on-call

• Does the unit have midwives available for home births available 24 hours a day, 7 days a week: On call

• Does the unit have midwives trained and experienced in water birth available 24 hours a day, 7 days a week: On site and on-call

• Does the unit have a paediatrician available 24 hours a day, 7 days a week:

• Does the unit have an obstetrician available 24 hours a day, 7 days a week:

• Does the unit have an anaesthetist available 24 hours a day, 7 days a week:

• Does the unit have a dedicated obstetric anaesthetist available 24 hours a day, 7 days a week:

• Royal Shrewsbury Hospital - Midwife Led

• How many women gave birth in the unit during the year? (not including home births): 550

• How many babies were born in the unit during the year? (not including home births): 550

• How many women were booked for a home birth: 82

• How many women had a home birth? (not including births at home by accident): 48

• Number of antenatal rooms: 0

• Total antenatal beds: 0

• Number of assessment area rooms (for monitoring and / or induction): 1

• Total assessment area beds: 4

• Number of delivery rooms: 3 Including water pool room

• Total delivery beds: 3

• Number of postnatal rooms: 7

• Total postnatal beds: 13 5 single and 2 x 4 bed bays

• Number of rooms in obstetric high dependency unit: 0

• Total obstetric high dependency beds: 0

• Number of single rooms used for both delivery and postnatal care (labour, delivery, recovery and postnatal, or LDRP, rooms): 0

• Amenity rooms; Are women able to book a single room in advance of their birth:

• If women can pay for a single room what is the average cost per night (GBP): 50

• Does the maternity unit have a neonatal intensive care unit:

• Does the maternity unit have a neonatal high dependency unit:

• Does the maternity unit have a special care baby unit:

• Security measures - ankle bands for the baby:

• Security measures - cot alarms:

• Security measures - CCTV:

• Security measures - restricted access:

• Other security measures: Electronic Ankle Tags

• Pain relief available - bath or shower: Provided by unit

• Pain relief available - birthing pool: Provided by unit

• Pain relief available - birth ball: Provided by unit

• Pain relief available - Massage: Provided by women

• Pain relief available - Aromatherapy: Provided by women

• Pain relief available - TENS: Provided by unit

• Pain relief available - Epidural: Not available

• Pain relief available - Mobile epidural: Not available

• Pain relief available - Entonox (gas and air): Provided by unit

• Pain relief available - Intramuscular injection: Provided by unit

• Total number of WTE midwives at the unit in your funded establishment, including vacant posts: 31.87

• Total number of WTE midwives at the unit as staff in post, including agency and bank staff: 28.73

• Does the unit have midwives available to provide one-to-one care available 24 hours a day, 7 days a week: On site and on-call

• Does the unit have midwives available for home births available 24 hours a day, 7 days a week: On call

• Does the unit have midwives trained and experienced in water birth available 24 hours a day, 7 days a week: On site and on-call

• Does the unit have a paediatrician available 24 hours a day, 7 days a week: On call

• Does the unit have an obstetrician available 24 hours a day, 7 days a week: On call

• Does the unit have an anaesthetist available 24 hours a day, 7 days a week:

• Does the unit have a dedicated obstetric anaesthetist available 24 hours a day, 7 days a week:

• Princess Royal Hospital - Midwife Led

• How many women gave birth in the unit during the year? (not including home births): 436

• How many babies were born in the unit during the year? (not including home births): 436

• How many women were booked for a home birth: 51

• How many women had a home birth? (not including births at home by accident): 38

• Number of antenatal rooms: 0

• Total antenatal beds: 0

• Number of assessment area rooms (for monitoring and / or induction): 1

• Total assessment area beds: 2

• Number of delivery rooms: 4 Including water pool room

• Total delivery beds: 4

• Number of postnatal rooms: 4

• Total postnatal beds: 13 1 single and 3 x 4 bed bays

• Number of rooms in obstetric high dependency unit: 0

• Total obstetric high dependency beds: 0

• Number of single rooms used for both delivery and postnatal care (labour, delivery, recovery and postnatal, or LDRP, rooms): 0

• Amenity rooms; Are women able to book a single room in advance of their birth:

• If women can pay for a single room what is the average cost per night (GBP): 50

• Does the maternity unit have a neonatal intensive care unit:

• Does the maternity unit have a neonatal high dependency unit:

• Does the maternity unit have a special care baby unit:

• Security measures - ankle bands for the baby:

• Security measures - cot alarms:

• Security measures - CCTV:

• Security measures - restricted access:

• Pain relief available - bath or shower: Provided by unit

• Pain relief available - birthing pool: Provided by unit

• Pain relief available - birth ball: Provided by unit

• Pain relief available - Massage: Provided by women

• Pain relief available - Aromatherapy: Provided by women

• Pain relief available - TENS: Provided by unit

• Pain relief available - Epidural: Not available

• Pain relief available - Mobile epidural: Not available

• Pain relief available - Entonox (gas and air): Provided by unit

• Pain relief available - Intramuscular injection: Provided by unit

• Total number of WTE midwives at the unit in your funded establishment, including vacant posts: 35.54

• Total number of WTE midwives at the unit as staff in post, including agency and bank staff: 36.48

• Does the unit have midwives available to provide one-to-one care available 24 hours a day, 7 days a week: On site and on-call

• Does the unit have midwives available for home births available 24 hours a day, 7 days a week: On call

• Does the unit have midwives trained and experienced in water birth available 24 hours a day, 7 days a week: On site and on-call

• Does the unit have a paediatrician available 24 hours a day, 7 days a week:

• Does the unit have an obstetrician available 24 hours a day, 7 days a week:

• Does the unit have an anaesthetist available 24 hours a day, 7 days a week:

• Does the unit have a dedicated obstetric anaesthetist available 24 hours a day, 7 days a week:

• Royal Shrewsbury Hospital - Consultant Led

• How many women gave birth in the unit during the year? (not including home births): 3778

• How many babies were born in the unit during the year? (not including home births): 3856

• How many women were booked for a home birth: 0

• How many women had a home birth? (not including births at home by accident): 0

• Number of antenatal rooms: 13

• Total antenatal beds: 22 9 single rooms, 1 family room, 3X4 bedded bays

• Number of assessment area rooms (for monitoring and / or induction): 2 Shrewsbury day assessment unit and Shrewsbury induction bay (ward 19)

• Total assessment area beds: 11

• Number of delivery rooms: 11

• Total delivery beds: 11

• Number of postnatal rooms: 5

• Total postnatal beds: 11 2 single, 1 family room and 2 x 4 bed bays

• Number of rooms in obstetric high dependency unit: 0

• Total obstetric high dependency beds: 0

• Number of single rooms used for both delivery and postnatal care (labour, delivery, recovery and postnatal, or LDRP, rooms): 0

• Amenity rooms; Are women able to book a single room in advance of their birth:

• If women can pay for a single room what is the average cost per night (GBP): 50

• Does the maternity unit have a neonatal intensive care unit:

• Does the maternity unit have a neonatal high dependency unit:

• Does the maternity unit have a special care baby unit:

• Security measures - ankle bands for the baby:

• Security measures - cot alarms:

• Security measures - CCTV:

• Security measures - restricted access:

• Other security measures: Electronic Ankle Tags

• Pain relief available - bath or shower: Provided by unit

• Pain relief available - birthing pool: Not available

• Pain relief available - birth ball: Provided by unit

• Pain relief available - Massage: Provided by women

• Pain relief available - Aromatherapy: Provided by women

• Pain relief available - TENS: Provided by women

• Pain relief available - Epidural: Provided by unit

• Pain relief available - Mobile epidural: Not available

• Pain relief available - Entonox (gas and air): Provided by unit

• Pain relief available - Intramuscular injection: Provided by unit

• Total number of WTE midwives at the unit in your funded establishment, including vacant posts: 79.30

• Total number of WTE midwives at the unit as staff in post, including agency and bank staff: 79.01

• Does the unit have midwives available to provide one-to-one care available 24 hours a day, 7 days a week: On site and on-call

• Does the unit have midwives available for home births available 24 hours a day, 7 days a week:

• Does the unit have midwives trained and experienced in water birth available 24 hours a day, 7 days a week: On site

• Does the unit have a paediatrician available 24 hours a day, 7 days a week: On site

• Does the unit have an obstetrician available 24 hours a day, 7 days a week: On site and on-call

• Does the unit have an anaesthetist available 24 hours a day, 7 days a week: On call

• Does the unit have a dedicated obstetric anaesthetist available 24 hours a day, 7 days a week: On call

Trust Questions

• Do all women have a choice about where they receive their antenatal appointments (i.e. at hospital or local health centre):

• Are NHS antenatal classes available (e.g. Parentcraft):

• Available during the daytime (until 5pm): Oswestry and Ludlow Midwife Led Units

• Available in the evenings (after 5pm): Shrewsbury (incl Whitchurch and Market Drayton), Wrekin and Bridgnorth Midwife Led Units

• Available at weekends (Saturday and/or Sunday): Shrewsbury (incl Whitchurch) and Wrekin Midwife Led Unit and Shrewsbury Consultant Unit

• Available for women only groups: Breastfeeding classess - Shrewsbury

• Available for other groups:

• Also available for: Teenagers, Twins and Multiple Pregnancies, Breatfeeding Workshops, Waterbirth Sessions, Aquanatal Exercise Classess and Relaxation for labour

• Are all women routinely offered ultrasound scans:

• Scan 1 available between: 10-14 weeks 1st Trimester screening offered

• Scan 2 available between: 20-22 weeks

Trust Statistics

Trust Questions

• You can view various measures relating to the Trust's performance by clicking the following link: The Shrewsbury and Telford Hospital NHS Trust