The Robert Jones & Agnes Hunt Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The premises were accessible, with services located on one level. People could access the service when they needed it.

Leaders audited ReSPECT forms, and we saw evidence of audit completion.

Leaders organised learning disability and mental health training; 90% of staff had completed Tier 1 Oliver McGowan learning. However, only 37.5% had completed Oliver McGowan Tier 2.

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 were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Patient bays were situated along the same side of the unit and none of the bays looked into each other. If there were any concerns, the isolation rooms on the unit could be used. Although the high dependency unit was not able to accommodate patients in single sex areas, the facilities were designed to ensure patient dignity and respect were always protected.

The high dependency unit was accessible to people who had mobility difficulties. The unit was situated on the first floor but there were lifts to the unit, the doors were wide enough to admit a wheelchair and there was flat access to the unit and patient areas.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

High dependency unit beds were booked for most patients at pre-operative assessments when they were identified as requiring them. This meant patients who required the beds were usually identified at the earliest opportunity, and patients knew when they were to have their procedure, this enabled them to make personal arrangements around their elective procedure.

The admission criteria stated that bookings for beds for elective cases must be made as far in advance as possible and booking on the morning of a procedure for an elective case was not acceptable.

The bed occupation was at 5.3, but the unit typically had 6 patients, reflecting the need for better definition of bed requirements through pre-operative risk scoring and intervention data collection.Of the 6 beds, 5 were booked for elective patients and the 6th were kept free in the event of an emergency.

The unit was located next to the operating theatres, which was recognised as good practice. There were facilities for relatives or carers to stay on the hospital premises overnight if needed. Services within the high dependency unit were coordinated and delivered to ensure they were accessible and responsive to patients with complex needs.

The ReSPECT form and frailty assessment were in use for patient documentation. The medical team and leaders of the unit were responsible for implementing policies, including DNACPR decisions and frailty documentation decisions.

The ReSPECT process was initiated to “improve the quality and consistency of emergency care planning by promoting shared decision-making and ensuring that patients' preferences were clearly documented and respected across all healthcare settings”. We reviewed the trust ReSPECT process audit summary for 2024; we found that ReSPECT forms (97%) were completed and correctly scanned to the electronic patient record.Validation of historical ReSPECT forms accompanying patients on transfer from other healthcare settings had improved, rising from 10% from 0% in 2023 to 88% in 2024. This reflected a significant progress in recognising, reviewing, and appropriately integrating existing advance care plans into local clinical practice.

HDU had improved significantly since the last inspection, transitioning from managing routine, low-risk patients to handling more complex ASA 3 cases, due to changing patient demographics and NHS operational demands. (ASA 3 patients have conditions that impact on their overall health, such as poorly controlled diabetes, hypertension, or COPD).

The unit operated as an enhanced care area, primarily managing ASA 1 (patientswho had no underlying medical conditions, are not taking any medications, and do not have any functional limitations)and ASA-2 patients (Mild systemic disease) but the unit were increasingly receiving sicker ASA 3 patients.

An external review by a former professor of intensive care was conducted 12 months before the inspection, guiding improvements in line with GPICS standards and leading to significant operational improvements.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff had access to information. Staff had their own trust email account and received regular updates on training courses they could attend, and they could view whether their mandatory training was due or had expired.

Staff had access to an electronic personal development page on the trust’s intranet, where they could access training and review their personal performance records. They could also access policies, practices and guidance using the intranet.

Staff made information leaflets available in languages spoken by patients.

Translation services were available to patients whose first language was not English. Staff were aware of how to access the service and confirmed the service had been used in all applicable circumstances. If interpreters were required, this was identified during pre-operative assessments.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

HDU as of April 2025 had received 0 complaints. People who used the service were aware of how to make a complaint or raise concerns and were encouraged to do so. There were posters on the high dependency unit, waiting area and around the hospital publicising the complaints process.

The service treated concerns and complaints seriously, investigated them and learned lessons from the results. Complaints received by the high dependency unit were handled confidentially, with complainants provided with regular updates.

We saw leaflets in the waiting area, providing information on how to make a complaint and details of patient advice and liaison service.

The service made sure that people could access the care, support and treatment they needed when they needed it.

Patients with communication challenges could access the services of interpreters and advocates to enable them to understand the care and treatment being offered and provided.

This service provides specialist treatment and is known as a specialist orthopaedic hospital, which gives access to services for patients referred from across the country.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

Systems ensured there was no discrimination, including on the grounds of protected characteristics under the Equality Act, when making care and treatment decisions. All staff (100%) underwent equality and diversity training as part of the mandatory training programme.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Resuscitation trolleys and defibrillators were accessible to all staff. This was in line with Resuscitation (UK) guidance which states ‘All clinical service providers must ensure that their staff have immediate access to appropriate resuscitation equipment and drugs to facilitate rapid resuscitation of the patient in cardiorespiratory arrest’.

Patients could bring items from home to help make their stay more comfortable as the staff recognised the need for home comforts as being important for people’s rehabilitation.

The service had enhanced recovery pathways in place for all patients as standard, following surgery. This enabled a standardised approach for all patients and included the multi-disciplinary team involvement to optimise the rehabilitation process and reduce the time patients spent in hospital.