The Robert Jones & Agnes Hunt Hospital

Updated 19 September 2025

We last inspected the hospital in November and December 2019. Where it was rated good overall.

We carried out this announced inspection on the 22 and 23 May 2025. We inspected this service using our single assessment framework and looked at all the key questions.

The main service provided by the hospital was surgery for adult patients. During this inspection we also inspected critical care core service.

Updated 14 October 2025

The on-site assessment took place on the 23 May 2025. The assessment took place due to overdue inspection and out of date ratings. We have rated the service as Good overall.

The high dependency unit at The Robert Jones and Agnus Hunt Orthopaedic Hospital NHS Trust provides a service to patients who need high dependency care (described as level two). Care is provided to patients who have undergone extensive or complicated orthopaedic surgery, or who have been identified at their pre-operative assessment clinic as maybe requiring closer post-operative nursing care. The high dependency unit also provides care to patients who are being nursed on the general wards and whose condition is deteriorating clinically or are causing concern. Patients are also admitted in the event of surgical emergencies.

An outreach service is provided within the trust, which operates 24 hours a day, 7 days a week. The team follows up all patients upon discharge from the high dependency unit to one of the wards, during service hours, to ensure good clinical progress continues. They attend to deteriorating patients on the general and surgical wards. The outreach role is a dual one as they also provide nursing cover to the whole hospital at night.

As of 30 March 2025, there were 4 adult critical care beds, of which 1 was occupied. Between 25 November 2024 and 30 March 2025, the trust has had between four to six open beds with an average monthly bed occupancy rate of 58%. The trust has had a comparable number of open critical beds and bed occupancy, over the past three years. Between January 2024 and January 2025, the High Dependency Unit (HDU) Hospital had an average of 21.96 care hours per patient day.

April 2025 figures:

Weekday bed occupancy at 2pm 48.51% against target 87.00%

Weekend bed occupancy at 2pm 40.63% against target 87.00%

Weekday bed occupancy at midnight 66.67% against target 87.00%

Weekend bed occupancy at midnight 38.71% against target 87.00%.

Updated 14 October 2025

The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust has approximately 200 inpatient and critical care beds across 9 wards.

The hospital is a single site hospital based in Oswestry, Shropshire. It provides specialist and routine orthopaedic care to its local catchment area, and specialist services both regionally and nationally. The hospital is a specialist centre for the treatment of spinal injuries and disorders and provides specialist treatment for children with musculoskeletal disorders. Additionally, the trust works with partner organisations to provide specialist treatment for bone tumours and community based rheumatology services. The trust is part of the National Orthopaedic Alliance (NOA), an acute care collaboration vanguard designed to improve orthopaedic care quality across England.

The surgical services at The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust are comprised of 5 inpatient wards:

Kenyon ward – 22 beds

Powys ward – 22 beds

Clwyd ward – 22 beds

Ludlow ward – 16 beds (private patients) NOT assessed

Oswald ward - oncology ward, 10 beds en-suite. NOT assessed.

The trust’s theatre suite comprises of 12 operating theatres, including 2 day-surgery theatres located in the Menzies unit.

During the inspection we visited 3 wards, the surgical admissions and day case unit, the operating theatres and the recovery unit.

We spoke with 29 patients and visitors and 40 members of staff. These included senior managers, all grades of nursing staff, healthcare assistants, domestic staff, consultant surgeons, anaesthetists, and other grades of doctors.

We last inspected the hospital in November and December 2019. Where it was rated good overall.

We carried out this announced inspection on the 22 and 23 May 2025.

We inspected this service using our single assessment framework and looked at all the key questions and 33 quality statements. The main service provided by the hospital was surgery for adult patients.

There were effective systems to ensure that standards of cleanliness and hygiene were maintained.

The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately.

The service made sure staff were competent for their roles.

All staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

Patients told us they felt involved in their own care and treatment as staff took time to explain what was happening and why.

We saw examples where staff had gone above and beyond what was expected to support patients.

The trust planned and provided services in a way that met the needs of local people.

The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

Managers and senior leaders had the right skills to perform their roles effectively.

The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

There was evidence of improved culture across the service and there was strong leadership. Staff told us they felt supported, respected, valued and were proud to work at the trust.

The service was committed to improving services by learning from when things went well and when they went wrong, promoting training, research, and innovation.

Updated 21 February 2019

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• The service had suitable premises and equipment and looked after them well.
• Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.
• An effective early warning system was in place to identify deteriorating patients and appropriate action was taken in response to this.
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
• The service followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. Managers used this to improve the service.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.

• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other preferences.

• Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.

• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.

• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

• Arrangements were in place to ensure patients could access medical support seven days a week. The service was in the process of reviewing the provision of seven-day therapy to the medical wards.

• Patients were supported to live healthier lives and manage their own care and wellbeing needs where appropriate.
• Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed the trust policy and procedures when a patient could not give consent.

• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.

• Staff consistently exceeded the expectations of patients and family members in their passion for patient care. They were committed to patients’ progress, and were motivated and inspired to provide kind and dignified care that supported patient needs on every level.
• Staff on all the medical wards consistently focused not only on patients’ physical health and comfort, but also their emotional wellbeing. Sometimes, staff used their own time to facilitate trips to events off site to ensure patients emotional wellbeing needs were met.
• Staff worked in a creative and innovative manner to provide exceptional, strong and caring emotional support that exceeded patients’ expectations to minimise their distress.

• Staff consistently involved and empowered patients and those close to them as active partners in their care and treatment.

• The service planned and provided services in a way that met the needs of local people and the specialist needs of people within the region who were living with spinal injuries.
• The service took account of patients’ individual needs.

• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

• Managers at all levels in the trust had the right skills and abilities to run a service providing high quality sustainable care.
• The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

• The service used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.

• The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

• The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.

• The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

• The service was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

However:

• The service provided mandatory training in key skills to all staff. However, staff did not always complete mandatory training in a timely manner.
• People could not always access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with the English average. However, the service was working proactively towards addressing these delays.

Updated 21 February 2019

Our rating of this service improved. We rated it as good because:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.

• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

• The service provided care and treatment based on national guidance and evidence of its effectiveness.

• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

• Staff always cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• The trust planned and provided services in a way that met the needs of local people.

• Managers had the right skills and abilities to run a service providing high-quality sustainable care.

• The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

• The trust was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

However:

• Out of hours paediatric consultant support was only available via telephone.

• A ligature point risk assessment had been carried out however not all risks had been mitigated. We highlighted further risks during the inspection which the service took immediate action to mitigate.
• Limited printed information was available in other languages.

Updated 21 February 2019

We previously inspected diagnostics jointly with outpatients so we cannot compare our new ratings directly with previous ratings.

We rated it as good because:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.

• The service had suitable premises and equipment and looked after them well.

• Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary.

• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.

• The service mostly followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.

• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

• The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. Managers used this to improve the service.

• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.

• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other preferences.

• Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.

• The service made sure staff were competent for their roles. Managers appraised staff’s work performance to provide support and monitor the effectiveness of the service.

• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

• Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. They followed the trust policy and procedures when a patient could not give consent.

• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.

• Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. All staff had access to an electronic records system that they could all update.

• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.

• Staff provided emotional support to patients to minimise their distress.

• Staff involved patients and those close to them in decisions about their care and treatment

• The trust planned and provided services in a way that met the needs of local people.

• The service took account of patients’ individual needs.

• People could access the service when they needed it. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were in line with good practice.

• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

• Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.

• The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.

• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.

• The trust used a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.

• The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

• The trust collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.

• The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

• The trust was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

However,

• Although the service provided mandatory training in key skills to all staff and had systems in place to ensure compliance, not all staff were fully complaint.

• Not all staff were up to date with safeguarding training.
• There was an increase in patient safety incidents on Mondays and Tuesdays due to these being the busiest days of the week.

• Staff did not display radiation signs in theatre areas to alert people that radiation was in use for interventional procedures.

Updated 21 February 2019

We previously inspected outpatients jointly with diagnostics so we cannot compare our new ratings directly with previous ratings.

We rated it as good because:

• People were protected from avoidable harm and abuse. The service met legal requirements.
• People were supported, treated with dignity and respect and were involved as partners in their care.
• People’s needs were met through the way services were organised and delivered.
• The leadership, governance and culture promoted the delivery of high quality person centred care.