Royal United Hospital Bath

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.At our last assessment we rated this key question as good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

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

Description: We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

Quality Statement Score: 2

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Although staff applied specific evidence-based assessment tools to assess and meet the needs of vulnerable patient groups, these were not always completed consistently. For example, a 4-month oversight gap occurred between April and July 2025, when the service stopped all fluid balance audits to update their electronic record system. This meant the service did not have any data regarding patient hydration during this time. For people using the service, this oversight left clinical needs unmonitored and directly compromised their safety. Once the department restarted auditing in August, leaders created an action plan and used ‘Learning from Audits’ posters to change practices.

For patients at risk of skin breakdown, a tool was used to trigger the use of pressure-relieving mattresses and tissue viability nurse referrals. During our inspection, we observed most patients in the major’s area had been transferred onto beds. Staff told us this was standard practice to protect skin integrity and improve patient comfort. Staff achieved a 94% compliance rate for pressure ulcer risk assessments between 2024 and 2025. A targeted review of 45 patient records further confirmed this, showing that 89% of patients had a documented skin check. In addition, patients admitted with existing pressure damage were prioritised for transfer onto air mattresses, which were requested from the hospital’s equipment library if not immediately available. This meant there was an embedded culture of assessing skin health quickly and staff acted on their findings to keep patients safe.

However, maintaining this standard was more challenging for patients in corridors. While staff reported patients with known pressure ulcers were prioritised for movement into majors to access a more comfortable bed, this did not protect patients with pre-existing damage who waited for long periods of time on trolleys. Data from July to September 2025 identified 2 incidents of hospital-acquired pressure damage within the department, both categorised as grade 1 (the initial stage of skin damage). One of these incidents involved an elderly patient who remained in a seating area, although the duration of their stay was not recorded. While the number of incidents was low, the corridor environment was fundamentally unable to support preventative care, posing an ongoing risk to vulnerable patients.

Specialist teams used targeted assessments to reduce the time frail patients spent in the department. The frailty team used a clinical frailty scale to evaluate an older person’s overall health and functional baseline. A high score triggered an immediate referral to specialist teams which would fast-track the patient’s journey to a dedicated older person’s ward, bypassing unnecessary delays. This helped to protect vulnerable patients from deconditioning (the physical decline and loss of independence that often occurs when frail individuals stay in a hospital bed for too long). By escalating assessments in the ED, the team helped to ensure patients received care in a quieter, more appropriate environment.

Description: We plan and deliver people’s care and treatment with them, including what is important and what matters to them and in line with legislation and current evidence-based good practice and standards.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff and the systems they used were up to date with national legislation, current guidance, and required standards. Medical staff followed clinical standards set by both the Royal College of Emergency Medicine (RCEM) and the National Institute for Health and Care Excellence (NICE). Staff were aware of legislation and guidance which protected patients’ rights and knew how to apply this in practice. This included patients who were subject to mental health and mental capacity legislation or codes of practice, and people’s human rights. Staff were also trained to support patients with cognitive impairment and advocate for them.

The service maintained a formal process to review and adopt NICE guidance. A Clinical Guidance Implementation Manager sent updated standards to department leaders, who then completed assessments to check for compliance. Records showed the department achieved full compliance in several areas. This helped to ensure the department’s clinical policies remained up to date with the latest medical evidence.

Description: We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people.

The service demonstrated an effective, team-based approach to patient care by ensuring that various specialists worked together. Staff consistently used a multidisciplinary method to assess and plan treatments which meant that decisions were not made in isolation. Since teams had reliable access to the information they needed, patients benefitted from well-coordinated care that addressed their specific medical needs from the moment they arrived. This was particularly evident in the support provided to patients with learning disabilities or dementia. For instance, the trust’s lead nurse for dementia made regular visits to the department to provide expert clinical guidance. Additionally, dedicated safeguarding staff were readily available to offer advice and support whenever concerns regarding the abuse or neglect of adults or children were identified.

Staff demonstrated a clear understanding of referral pathways for specialist input. As a designated trauma unit, the hospital provided 24/7 access to surgical trauma teams, emergency diagnostics, and scanning services. Detailed standard operating procedures guided staff in directing patients to the most appropriate specialty, including surgical and medical units, same day emergency care, and the trauma assessment unit. Furthermore, clinicians had immediate access to specialist advice, both in person and via telephone, from various practitioners and allied health professionals. This meant patients received care appropriate to their needs and staff worked well together to achieve this.

Description: We support people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff recognised that patients with complex needs required tailored support to navigate the hospital environment. A specialist Learning Disability and Autism team operated Monday to Friday to support personalised reasonable adjustments for people with sensory or communication needs, enabling them to understand and manage their healthcare, maintain choice and control, and maximise independence during their admission. Staff told us they were easily contacted and responsive when needed. We observed the service used television screens in the waiting room to broadcast community health information. This meant patients had access to services within the hospital to support them, and information was shared for people to independently access health advice if they wanted to.

The emergency department (ED) used other specialist teams to focus on the root causes of ill health, such as alcohol and drug dependency. An alcohol liaison team screened patients aged over 18 years and referred them to community partners as necessary. These interventions connected patients with local pharmacies and support groups, giving them a clear pathway to recover from addiction and helping to prevent future emergency admissions.

Staff worked with external partners to support the most vulnerable members of the community, including those experiencing homelessness. They collaborated with a local ambulance service and social workers to help and support patients who attended the ED frequently for the same reasons (such as for drug and/or alcohol addiction). Staff told us about their ‘High Impact User’ group and how they initiated care plans based on information from multiple services. This joined-up work helped to ensure that patients in these circumstances did not leave the hospital returning to unsafe conditions, helping to promote long-term health.

Description: We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

Quality Statement Score: 2

We scored the service as 2. The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The trust managed patient flow with mixed success, as high bed occupancy within the hospital often affected how quickly patients received care and treatment. Data from August 2025 showed the hospital operated at a 93.62% occupancy rate. Staff reported that patients staying longer than 7 days who no longer needed medical care occupied 16.2% of these beds. These waits were particularly acute for patients experiencing mental health crisis, who waited in the department on average 7.4 hours in August 2025. This meant patients faced ongoing delays where outcomes in this area were unchanged.

However, the trust had lower numbers of patients who reattended the department when compared with the national average. From July 2023 to July 2025, the trust’s monthly unplanned reattendance rate was between 5.5% and 6.8%. This was the number of attendances recorded as reattending for an unplanned follow up for the same or related clinical condition at this department. This was consistently lower than the national (which was between 8.5% and 9.4%) and regional average (which was between 7.9% and 8.9%). One indicator of patients being given the right care first time was in the number of patients reattending the service within 7 days. This meant patients were discharged when their condition was stable, their diagnosis was likely accurate, and their treatment plan was effective.

The service took active steps to improve performance and protect vulnerable groups through clinical workstreams. For example, leaders expanded the Same Day Emergency Care (SDEC) service to offer alternatives to admission. In the children’s ED, leaders tracked 82 standards set by the Royal College of Paediatrics and Child Health. However, they only fully met 60 of these, with 6 standards not met and 16 only partially met. For older patients, the trust achieved 93% compliance for clinical frailty assessments among patients aged 65 and over. This meant specific risks were identified early and supported people’s independence.

Description: We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff ensured patients understood and agreed to their treatment before it began. We heard consent conversations taking place between staff and patients, and all were conducted as they should be. Most staff were aware of legislation when it came to a patient who could not give their consent. Staff knew if the patient was not conscious that they had a duty to act to save their life or provide the right care and treatment. Reasons for the treatment being necessary would be explained to the patient when they regained consciousness and were judged as able to understand.

Staff were aware of their role and responsibilities around patients who did not have the mental capacity to give consent to care and treatment. Most staff knew consent could not be provided by another person unless they had a lasting power of attorney for health and welfare for the patient. In those cases where the patient did not have capacity or an attorney, staff knew they needed a multidisciplinary approach to treating the patient where a decision was taken in the patient’s best interests. Most staff were aware of the legal position around consent from children or young people under the age of 18. Staff mostly recognised how a child or young person could give their consent if they were assessed as mature enough to do so regardless of age.