Case study: Shrewsbury and Telford Hospital NHS Trust
Shrewsbury and Telford NHS Trust (SaTH) is an acute trust in the West Midlands, offering acute services across two main hospital sites: the Royal Shrewsbury Hospital and the Princess Royal Hospital in Telford. The trust serves a population of roughly 500,000 people, providing care to residents of Shropshire, Telford and Wrekin, and Mid Wales. With over 7,000 staff, SaTH is one of the largest employers in the county.
The trust’s patient population consists of groups that face significant health inequalities. Rural and semi-rural communities within the trust’s area often experience poor access to healthcare services (Shrewsbury and Telford Hospital NHS Trust, 2023). The region also has higher rates of deprivation compared to the national average, with pockets of poverty in both urban and rural areas, contributing to disparities in health outcomes (Shrewsbury and Telford Hospital NHS Trust, 2025). The trust has recognised these disparities and is working to address them by improving access to services and supporting initiatives aimed at reducing inequality. The trust has embedded its work on health literacy within its strategic approach to health inequalities, which aims to tackle the root causes of health inequalities and ensure that all patients have access to high-quality care.
In Shropshire and Telford and Wrekin, around 40-45% of adults have low health literacy (Geodata, 2025), which is comparable to the national average of 43% of adults.
SaTH has taken steps to address these issues, with a focus on improving health literacy as part of its broader strategy to reduce health inequalities. This strategy includes initiatives designed to improve communication with patients, provide support for those with lower health literacy, and reduce barriers to accessing services.
Initiative
SaTH has taken a proactive approach to embedding health literacy into its organisational culture. The trust has implemented a range of approaches to streamline patient communication, engage both staff and patients, and foster a lasting cultural shift towards health literacy.
One of the key early steps in this initiative was a collaborative effort with the trust’s digital team to refine patient correspondence. With over 7,000 different patient letters in circulation, the system had become unwieldy, inconsistent, and often confusing for recipients. The trust undertook a rigorous review process to remove unnecessary variation and complexity, ultimately reducing the number of patient letters to just 150 (Shrewsbury and Telford Hospital NHS Trust, 2024). This work significantly improved clarity and consistency in communication, making it easier for patients to understand their care instructions and next steps.
Staff training has been a cornerstone of the initiative, with the trust implementing study days focused on health literacy across different professional groups, including nurses and midwives. To avoid the opportunity cost of taking front-line staff away from care delivery,
the trust has, where possible, integrated health literacy training into existing training days and exercises. This approach minimises disruption to frontline services while ensuring widespread staff engagement. Furthermore, operational staff have been a primary focus group, avoiding burden on clinical teams and allowing frontline staff to remain focused on patient care. In the last 18 months, the patient experience team and library service has delivered a total of 43 health literacy training sessions which were attended by 562 people. Health literacy awareness sessions have been delivered to diverse teams and events, including communications, nursing, orthoptics, and junior doctors’ training. These sessions also featured at key conferences such as the trust’s ‘Nurses Day’, with 250 attendees. Additionally, they were extended to the letters task and finish group and colleagues supporting the electronic patient record (EPR) programme. The focus is to equip participants with tools to create health information that is understandable, empowering informed health decisions.
Importantly, the trust has prioritised integrating the patient voice within its health literacy programme. The health literacy panel, which includes a patient representative, ensures that the patient perspective remains central to all decisions and processes. This commitment to co-production extends to staff training, where patient representatives are consistently involved in study days and training sessions. More specifically, a task and finish group was set up, meeting fortnightly to evaluate letter content and associated information. Patient partners attended each meeting to offer valuable insights and guidance in all decision making, helping to shape the task and finish groups’ understanding of patient perspectives. This group developed a standard operating procedure to outline the process for amending letters, which included mandatory review by the patient information panel. The panel focused on ensuring clarity and relevance in the content, with the goal of informing patients effectively about their upcoming appointments.
Patient partners recruited from the local community remained central to both the task and finish group and the patient information panel. Some of these partners were active members of other groups, such as ‘Telford Patients First’, and facilitated information-sharing to gather broader community input. Additional feedback was collected from patients in outpatient clinics, highlighting the details they wished to receive ahead of their appointments.
Despite these efforts, embedding a cultural shift in health literacy has not been without challenges. While some staff have embraced the initiative enthusiastically, ongoing engagement and encouragement was needed to reach all areas and build support for the programme. The trust has recognised the importance of clear internal communication about the project’s objectives, significance, and expected outcomes to maintain staff buy-in. Ensuring that all staff understand the broader value of health literacy, beyond individual interventions, has been critical in sustaining momentum.
The trust’s commitment to collaboration has also extended beyond the organisation. The initiative has gained traction with local system partners, with SaTH sharing its learning at the local council’s co-production conference. This engagement has helped spread best practices and align health literacy efforts with wider public health and community strategies. Additionally, the public health team at Shropshire, Telford and Wrekin ICS has expressed interest in working closer with the trust, opening the door for a system-wide approach to health literacy.
At a leadership level, securing board buy-in has been a priority. The involvement of the trust’s chief communications officer has been instrumental in achieving this. By attending patient meetings, listening to feedback first-hand, and maintaining an ongoing dialogue with stakeholders, she has helped ensure that health literacy remains a priority for SaTH’s communications strategy.
A particularly important aspect of the trust’s initiative has been its focus to future-proof its work on health literacy. By engaging medical students and nurses in health literacy education, the trust is working to embed these principles in the next generation of clinical professionals. This forward-thinking approach ensures that health literacy becomes an ingrained part of daily practice rather than a temporary initiative.
Evaluation and impact
The trust is taking stock of its work in health literacy and continuing to look forward in its approach, recognising that there is still work to be done. SaTH has received good qualitative feedback from both staff and patients. One patient partner noted, “It was great to be a part of this particular piece of work and to see the final agreed templates. As a patient I am very proud to be working with staff who are committed to improving the patient experience through patient information”.
There is an ongoing need to gather more feedback and quantifiable statistics to both demonstrate impact and refine and improve the programme further. Nevertheless, in 2024/25 the patient information panel reviewed 177 leaflets to date, in addition to the trust’s Communication Strategy, Experience of Care Strategy, posters, website extracts and feedback surveys from a range of services. Additionally, there are plans to explore health literacy’s role in reducing DNA rates, which can significantly impact both patient outcomes and service efficiency.
The trust’s view is that improving accessibility and clarity in patient information is a meaningful step towards better health outcomes. They remain committed to continuous improvement and system-wide collaboration, reinforcing their role as a leader in health literacy within the NHS.