Royal United Hospital Bath

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question as good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

Description: We always treat people with kindness, empathy and compassion and we respect their privacy and dignity. We treat colleagues from other organisations with kindness and respect.

Quality Statement Score: 2

We scored the service as 2. The evidence showed some shortfalls. The service did not always respect people’s privacy and dignity, and in times of increased demand, it was challenging for staff to consistently deliver compassionate care.

The department did not always ensure the basic privacy and dignity of patients during periods of high pressure. We observed elderly patients on trolleys in the corridor for extended periods of time. In the ambulatory area, we saw staff performing ECGs behind short screens that allowed passers-by to see patients during this time. These shortfalls did not promote the dignity of patients using the service. Overcrowding of the department prevented staff from always being able to deliver compassionate care. This meant they did not always have the time to interact with patients or to update them on the next steps in their journey. We saw patients in the ambulatory area sitting ‘shoulder to shoulder’ without knowing how long they would wait or what the next step in their journey was.

Poor access to the children’s resuscitation room meant children and young people were not treated with dignity when requiring emergency care and treatment.

Almost all the patients we met said staff treated them well. Patients were able to maintain their dignity as much as possible, although this became less easy for them and staff when the department was crowded and patients were being held on corridors. One patient told us, “The staff have been great, although I’ve been waiting a long time and not really sure what I’m waiting for next.” Another patient said, “I can’t say it’s been a great experience, and in this area (the ambulatory assessment unit of the majors’ department) they really do appear to be run off their feet, which affects how kind they are able to be.”

However, staff tried their best to maintain a culture of kindness, empathy, and compassion. We observed nurses in the children’s area taking extra time to be playful with children and offering tea and biscuits to worried families. Friends and Family Test results, which included feedback from patients, informed that 80% of patients rated the service as “good” or “very good”, noting staff were approachable and empathetic.

Staff worked hard to prioritise dignity in a difficult environment. Reception staff told us they used alert cards to identify patients with autism or dementia early. In one instance, we observed staff protecting the dignity of a patient in mental health crisis by pulling curtains around other patients during a challenging incident.

Description: We treat people as individuals and make sure their care, support and treatment meets their needs and preferences, taking account of their strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff respected the unique identities and sensory needs of their patients. For instance, clinicians addressed a transgender patient by their preferred name, and the observation area provided fidget items for patients with a learning disability and autistic people. Similarly, a learning disability team assisted patients with complex needs and staff told us they were easily contacted.

During our inspection, we were told staff sometimes used a ‘reverse queue’ system which meant the most vulnerable patients were identified and moved to a quieter, safer space. However, we did not observe this in practice, and we continued to see vulnerable patients in suboptimal areas. After further discussion with leaders, it was not their intention to provide care in this way but at times of increased demand, it was often difficult. Staff continued to do their best for people, and we observed patients in the corridor being offered hot drinks and biscuits while they waited.

Staff used tailored approaches to meet the emotional and physical needs of different age groups. We saw staff communicate effectively with children in the children’s area, and the service utilised a therapy dog to provide emotional support.

Description: We promote people’s independence, so they know their rights and have choice and control over their own care, treatment. and wellbeing.

Quality Statement Score: 2

We scored the service as 2. The evidence showed some shortfalls. The service did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

The physical environment of the department often hindered patients’ ability to look after themselves. We identified chairs in the waiting room did not have armrests, which made it difficult for frail patients to stand up without help. In the corridors, immobile patients were dependent on staff to move them to a private room if they needed to use the commode or bedpan. These physical constraints did not help to support people’s independence.

Systemic pressures and a lack of resources often overrode a patient’s control over their personal information. In the ambulatory area, we observed staff handing over patient details in front of others. This meant patients could not control who overheard these conversations including personal information.

The service’s approach to discharge did not always support a person’s independence once they left the hospital. Instead of printing discharge summaries or providing instruction leaflets for specific medical problems, staff gave verbal advice or signposted patients toward the NHS website. This meant patients had less control over their recovery at home if they didn’t have a computer or didn’t know how to use one.

However, the service instigated a standard process of promoting patient choice by offering flexible assessment options. For example, when the Urgent Treatment Centre became overwhelmed, staff gave patients with non-life-threatening conditions the choice to book a ‘hot clinic’ appointment for the next day. This allowed patients to return at a time that suited them rather than waiting in a crowded room. By providing this option, staff helped patients to have more independence, choice and control over their care and treatment.

Description: We listen to and understand people’s needs, views and wishes. We respond to these in that moment and will act to minimise any discomfort, concern or distress.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

The staff mostly listened to and understood patients’ needs, views and wishes. Staff usually responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress. For example, staff prioritised clinical safety by using structured assessment tools to identify and treat the most unwell patients first. Upon arrival by ambulance, the Pitstop area was used to conduct immediate assessments to support critical decision making. This meant that despite a crowded environment, any life-threatening emergencies were quickly identified and prioritised first.

Staff acted with compassion to maintain the dignity and comfort of patients facing long waits or difficult circumstances. For example, during ‘comfort rounds’, team members moved long-stay patients from trolleys onto hospital beds. Although we observed patients remained on trolleys in the corridor due to capacity, the majority of those in the majors’ area had been transitioned to beds. Patients not yet moved confirmed staff were already in the process of arranging their transfer. This was a significant positive finding, as the wider mattresses provided essential support for frail and vulnerable individuals, directly improving pressure area care and overall comfort.

Staff were quick to help whenever a patient used their call bell. During a July 2025 audit relating to the use of call bells, it was found that every patient had their call bell within easy reach. Similarly, on average, staff answered calls in less than 3 minutes in the same audit. We observed patients in majors with their call bells in easy reach, which meant people could summon help when they needed it. We also observed patients in the corridor requesting help from time to time and staff were immediately responsive to their requests.

Staff were able to support patients and relatives in distressing events. They said they were enabled to have time to look after friends and relatives of a patient who had sustained serious or life-threatening injuries. They were able to keep them updated and felt they had the skills to deliver bad news when this was necessary. However, staff told us how this became harder to manage when the department was crowded and there were few available spaces to take friends and relatives aside for more privacy.

Description: We care about and promote the wellbeing of our staff, and we support and enable them to always deliver person centred care.

Quality Statement Score: 2

We scored the service as 2. The evidence showed some shortfalls. The service did not always promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff told us that delivering care became increasingly difficult during periods of extreme pressure. Operational demands often meant managers had to cancel their dedicated management days to cover clinical gaps, and nurses regularly missed their breaks during busy shifts. These persistent challenges contributed to higher sickness levels, with many staff citing stress as the primary cause. Ultimately, while support systems were available, they could not fully shield the workforce from the physical and mental exhaustion caused by a crowded and understaffed environment.

Senior staff actively promoted a culture of support, ensuring that team members felt valued and empowered to deliver person-centred care. Doctors felt well-supported by their consultants, while nursing staff described their leaders as experienced and visible on the shop floor. When asked, staff across all levels expressed confidence they would receive help if they were struggling.

Leaders tried their best to make staff feel safe and valued. Nurses told us they felt like a “united team” that “gelled well”, with one noting how colleagues supported them through a difficult time. Emergency department leads also stayed involved by helping with clinical tasks when things got busy. By holding weekly wellbeing meetings and listening sessions, leaders stayed approachable. This meant staff felt comfortable speaking up, ensuring their concerns were heard, which helped to maintain morale even when the workload was heavy.

Some of the wellbeing events and arrangements included ‘Greatex’ prizes (for when a member of staff was praised for something they had achieved); a ‘wellbeing consultant’ offering support and guidance; visits from the ‘pets as therapy’ dog; coffee mornings; cycle club; and a ‘wellbeing huddle’ every Wednesday for 20 minutes. There had also been away days for staff with visiting speakers, including the air ambulance charity team.