The Royal United Hospital Bath NHS Foundation Trust is an acute trust, providing care and treatment to a population of around 500,000 across, Bath, North East Somerset and Wiltshire.

The trust became a foundation trust in November 2014 and in February 2015 it acquired the Royal National Hospital for Rheumatic Diseases, which was the smallest foundation trust in the country. In 2014 the trust also took over the provision of maternity services across Bath, North East Somerset and Wiltshire. This included maternity provision at the Royal United Hospital as well as a number of midwifery led birthing centres across the Wiltshire, Bath and North East Somerset and community midwifery services which were managed from Bath.

The trust has 772 beds across the main location, the Royal United Hospital in Bath, the smaller location of the Royal National Hospital for Rheumatic Diseases, and four midwifery led birthing centres in the community, at Chippenham, Frome, Trowbridge and Paulton. At the time of our inspection the Paulton Birthing Centre was temporarily closed.

According to the 2011 Census, the population of Bath and North East Somerset Unitary Authority was 94.5% white and 18.8% of the population were aged 65 and over. The population of Wiltshire Unitary Authority was 96.4% white and 19.5% were aged 65 or over.

Bath and North East Somerset Unitary Authority performed better than the England averages for 23 of the 32 indicators in the Area Health Profile 2015. There were three areas where the county performed significantly worse than average: incidence of malignant melanoma, hospital stays for self-harm and prevalence of opiate use. Wiltshire Unitary Authority performed better than the England averages for 17 of the 32 indicators in the Area Health Profile 2015. There were four areas where the county performed significantly worse than average: smoking status at time of delivery, incidence of malignant melanoma, hospital stays for self-harm and death and serious injury on roads.

In the 2015 Indices of Multiple Deprivation, Bath and North East Somerset Unitary Authority was in the best quintile for deprivation, while Wiltshire was in the second-to-best quintile.

We inspected the Royal United Hospital Bath, Royal National Hospital for Rheumatic Diseases, and the community midwifery service including Chippenham, Frome and Trowbridge birthing centres. We did not inspect Paulton birthing centre as it was closed at the time of our inspection.

We inspected eight core services at the Royal United Hospital:

• Urgent and Emergency Care
• Medicine (including older people’s care)
• Surgery
• Critical Care
• Maternity and Gynaecology
• Children and Young People’s Services
• End of Life Care
• Outpatients and Diagnostic Imaging

We inspected three core services at the Royal National Hospital for Rheumatic Diseases:

• Medicine (including older people’s care)
• Outpatients and Diagnostic Imaging
• Children and Young People’s Services

We inspected the midwifery led birthing centres as a community midwifery core service.