The Robert Jones & Agnes Hunt Hospital

On this page

• 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

The trust participated in national audits and benchmarked against similar units.

We observed critical care ward rounds, which occurred twice daily, staffing handovers and safety huddles and found them to be thorough, with an integrated approach.

Records were comprehensive and easy to follow.Patients’ physical, mental health and social needs were assessed. Staff screened patients for pressure ulcers, falls, venous thromboembolism (VTE) and delirium on admission and throughout their stay on the unit.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff kept detailed records of patient care and treatment. Within the high dependency unit, patient records were kept on an electronic patient records system and on paper, this had not changed since the last inspection. Staff told us, and we saw a new IT system had recently been implemented, and it was their second week.

Most information relating to patient care was recorded, either electronically or paper-based, from admission and updated throughout admission on the unit. Patients had individual care plans which were revised and adapted as treatment progressed.

Records were comprehensive and easy to follow. Patient record audits were carried out every month.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them.Staff did this in line with legislation and current evidence-based good practice and standards.

Patients’ physical, mental health and social needs were assessed. Staff screened patients for pressure ulcers, falls, VTE and delirium on admission and throughout their stay on the unit. April 2025 figures showed us that the unit had reported 0 falls, 0 deep vein thrombosis and 0 Pulmonary embolism.

We saw that any new guidance and best practice was discussed at some clinical governance meetings, and we observed staff providing care and treatment which was in line with best practice.

We were provided with a standard operating procedure for the transfer of adult patients. Staff told us hospitals within the critical care network, who could provide level 3 care, would be contacted to identify if a bed was available. Policy stated a transfer decision should only be made by the covering consultant anesthetist, only if there was absolutely no possibility of an internal placement for the patient, such as the requirement for level 3 care or specialist intervention. No critically ill patient would be transferred without first being appropriately assessed by the on-call consultant anesthetist for the “transferring” hospital.

Staff assessed and met patients’ needs for food and drink. There was not a designated dietitian assigned to the unit who was involved in the assessment, implementation and management of patient with specialist nutritional support; however, the unit had access to a dietician when patient's on the unit require their input.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. The high dependency unit’s participation in quality improvement initiatives had improved significantly since last inspection, such as benchmarking, accreditation schemes and peer review, which were not done at the previous inspection.

The unit audited themselves against the Guidelines for the Provision of Intensive Care Services (GPICS) however, it was felt that not all aspects of GPICS requirement fitted a level 1 and 2 unit. However, the unit continued to self-assess as part of their participation in the regional critical care network, which incorporated guidelines. The self-assessment required the unit to assess their facilities, operations, governance, staffing, additional services and relationships. The unit was due an external review by the regional critical care network this year.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff of different levels worked together as a team to benefit patients. The service accepted level 1 and 2 patients There was guidance in place when considering whether admission to the high dependency unit was required.

Elective patients were pre-booked for a bed at the unit during their pre-operative appointment with their consultant. Some staff told us they sometimes treated level 3 patients. However, the unit was not commissioned or currently able to manage level 3 patients, but this was something the unit was hoping to be able to provide in the near future. Between April 2024 and May 2025 12 patients were transferred out of the hospital to neighbouring trust for additional care, of which 4 patients were ASA 2 and ASA 3.

There was now a consistent daily ward round and handover including different specialties, this was an improvement from the last inspection. However, not all allied healthcare attended.

Access to clinical investigation was available. Services included, X-rays, magnetic resonance imaging (MRI) scans and computerised tomography (CT or CAT) scans.

There were some services on the high dependency unit which were not available seven days a week, such as the speech and language team, dietician and physiotherapist. Many staff told us they had to call for allied staff to visit the unit if needed.

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.

There was a recovery guide for patients. The guide contained advice and information on different aspects of health following a stay in critical care. It included topics such as mobility and physical activity, including exercises, nutrition and relaxation. It also contained contact details of other services and sources of support.

Patients who may have needed extra support were identified during their pre-operative appointment.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The high dependency unit routinely collected and monitored some information about the outcomes of patient’s care and treatment. The unit participated and contributed data to the Intensive Care National Audit and Research Centre (ICNARC) andGuidelines for the Provision of Intensive Care Services (GPICS).We used data from April 2025 that showed ICNARC Audits was 98.50% against 95.00% target. GPICS standards were not all met, however trust told us not all standards were easily met due to the size and complexity of their unit.

The unit was now benchmarking themselves against similar units. There had been a recent review of the high dependency unit by the external members of the regional critical care network.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes.

The trust commissioned an external review 12 months prior to our inspection. Senior leaders told us that this was extremely helpful and had supported them when reviewing their GPICS standards, which many are not within their operational scope. We reviewed this external report and found that some of the recommendations related mainly to children’s services than critical care; however, we noted anaesthetic medical cover was mentioned within the review along with simulation (SIM) recommendation for improvement, such as increasing the frequency of SIM and scenario education within the department. We had a tour of the SIM room along with taking part in some of the scenarios and found this to be educational and highly thought of. SIM training, or simulation training, a method used by the NHS to enhance healthcare professionals' skills and competencies in a safe and controlled environment.

A network adult critical care unit peer review visit was scheduled for 2026. Senior leaders told us that they did not feel as a network there was strong collaborative working. They also felt they as a trust should be taken seriously as a critical care service and be seen as being a unit that was able to support other trusts within the network. A collaborative network group meeting was arranged for June 2025. The trust looked forward to their peer review in 2026.

The 24-7 outreach and the improved communication systems had led to better patient outcomes and workflow, with early identification and management of deteriorating patients.

The service told people about their rights around consent and respected these when delivering person-centered care and treatment.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Patients said staff explained all care and procedures to them, including where written consent was required.

Staff could describe the process for completing a mental capacity assessment and took all practical steps to enable patients to make their own decisions.

For those patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately.