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

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment effective was rated as good. At this assessment, we rated this key question as good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

We looked at a sample of policies and found some were out of date and had not been reviewed on the set date. We spoke with senior leaders who knew of the issue and had already set up a programme to review all documents and instructions to staff, to ensure they were updated. Managers and staff showed us several assessment tools used in their assessment of patient needs at all stages of care. Staff recorded patient needs clearly and aligned these to care plans. Staff ensured patient needs from their pre-assessment had been included in their assessment plans.

Patients reviewed and discussed their authorised care plans to ensure they had an opportunity to contribute to their care. This included communication and wellbeing needs that patients may have needed during their stay.

Managers used an audit schedule to ensure staff were implementing and completing documentation that promoted a person-centred approach to care. These audits included personal care needs, patient repositioning, clinical needs and risk assessments. The audits completed promoted safe care which met the expected standards.

Managers completed the audit schedule every month. The audits showed good compliance with all areas.

Staff completed patient records on the ward that had up to date risk assessments for vital signs, falls, nutrition, skin integrity, and venous thromboembolism (VTE) risk. VTE is the risk of a patient developing a blood clot after surgery.

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.

Managers referenced National Institute of Health and Care and Excellence (NICE) guidelines. Medical staff and managers followed accreditation schemes that enhanced evidence-based practice. Staff showed a good understanding of evidence-based practice and understood national tools such as the malnutrition universal screening tool and how to apply it.

There were 2 main clinical pathways for patients, a major and a minor pathway and all patients would be on one of them. A clinical decision was made at the pre-operative stage to determine which pathway was appropriate. Following surgery, the patient would be monitored on a pathway and information and assessments completed in the appropriate pathway booklet. Patient information was mainly electronically stored and written notes would be scanned into the patient electronic records. Pathways were in line with evidence-based practice guidelines.

The service had enhanced recovery pathways for all patients following surgery. This enabled a standardised approach for all patients and included multidisciplinary team involvement to optimise the rehabilitation process and reduce the time patients spent in hospital. Patients were encouraged to mobilise as soon as possible or as directed by the consultant. There was an initiative in place called “eat, drink and move”, which reminded staff and patients the importance of rehabilitation.

At their pre-operative assessment, patients saw members of the multidisciplinary team including nurse, anaesthetist, and pharmacist. All patients for joint replacements were offered a ‘joint school’ following their pre-operative assessment. Joint school provided information about the procedures and included post operative advice. These sessions were held twice a week in the lecture theatre at the day unit. We were told of plans to increase the frequency of the joint school to eventually be available daily, Monday to Friday.

Medical staff followed professional guidance and recorded medical device implants using the National Joint Registry (NJR). The NJR collects information on joint replacement surgery and monitors the performance of joint implants. This helps to inform on a national level, if there were concerns raised about joint replacement.

Staff understood nutrition requirements for patients that had medical conditions such as diabetes and could refer to services such as speech and language therapy for patients who had swallowing difficulties.

Managers received and managed safety alerts efficiently. Safety alerts are notifications sent to providers that give them information they may need to consider action for. Managers explained that each alert was triaged and sent to the most suitable department head for distribution. Managers confirmed they had feedback mechanisms to show that the information had been received by tracking responses using a separate spreadsheet which highlighted any needed actions. For example, a national prompt was received for an epidural medication. The alert was sent to all medical consultants and anaesthetists.

The service worked well across teams and services to support people. Staff shared their assessment of people’s needs when people moved between different services.

Staff worked closely with hospital teams both internally and externally. Staff welcomed collaborative working with multidisciplinary teams from the neighbouring NHS trust who helped support patient recovery.

Staff who cared for patients on the ward had access to their pre-assessment information. This supported them in making informed decisions about their needs in the ward environment. Staff knew what areas of care they handled and knew how to escalate queries and concerns.

Staff handed over key information about patients at handover meetings which meant patient needs were documented and discussed between shift changes.

Staff communicated patient needs with each other through face to face and telephone communication on the ward and pre-assessment areas. These conversations were performed discreetly and ensured confidentiality was maintained.

Management teams met with local NHS trust managers to provide support for extra bed capacity. This included transferring patients that met the inclusion criteria of the hospital.

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, reduce their future needs for care and support.

Safety was prioritised at the earliest phase of care given. Staff at the pre-assessment department took an interest in patients to make sure they were healthy enough to have the surgery they needed. For example, patients could not move beyond the pre-assessment phase of their assessment if a physical concern such as high blood pressure was identified.

Staff offered post operative guidance through leaflets and discharge documentation. Medical staff arranged follow up appointments when needed where further signposting for rehabilitation occurred.

Smoking and alcohol usage were used as parameters for the clinical risk to patients and this was assessed at both the pre-assessment and admission stages of treatment.

Information was available about long term conditions, such as diabetes. Patients told us they had been given advice about their lifestyle choices that could affect health after surgery. Information was displayed in ward areas for patients and staff to access.

Patients were appropriately encouraged to mobilise, eat and get dressed, as soon as possible after surgery. This was to help with recovery and ensure the patient could return to a regular routine after surgery.

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

Managers and staff understood what positive outcomes looked like and contributed to schemes to support positive outcomes for patients.

Post general anaesthetic audits took place for every patient. The audit included standards such as pain scores, nausea, temperature, discomfort in recovery and assessed readiness for transfer to the wards. The audit also measured the confidence of the patient in the care they received. Actions from this audit included the introduction of more warming blankets, due to patient responses to temperature standard questions. Results were shared with staff at recovery team meetings and results were also discussed during consultant meetings.

The service took part in national audits, such as the elective surgery patient recorded outcomes (PROMs) programme. The hip replacement average result for the trust, was 22.3 against the England average of 14.3. However, the knee revision result was 13.5 against the England average of 14.6. All other results, the trust performed better than the England average for PROMs.

The service acted to improve services and made recommendations following analysis of the results. Managers followed performance schemes such as the National Joint Registry (NJR). Managers used these schemes to assess their performance and improve. Both registers, which included NHS and private patients, were designed to aid early reviews of patient groups for monitoring performance. This review included the implant, potential side effects and potential complications. The data also allowed patients to be contacted in case the implant was recalled for safety reasons. Data from these schemes showed that the main surgical operations conducted at the hospital were hip and knee replacement surgery. Shoulder and ligament realignment surgery were also included in this data. Medical consultants followed the National Ligament Registry (NLR) and the Breast/Cosmetic Implant Registry (BCIR) to support data capture in this area.

From June 2023 to May 2024, patients at the trust had a lower-than-expected risk of readmission for elective admissions, and similar to expected risk of readmission for non-elective admissions when compared to the England average.

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

We saw consent to treatment was obtained and checked in line with legislation and guidance.

Consultants or a member of the surgical team would gain consent before any procedure and often this was sought at pre assessment when the procedures were discussed.

Checks were completed to ensure the patient understood all aspects of the surgery and recovery.

Patients that did not have capacity to give valid informed consent were assessed following the requirements in the Mental Capacity Act 2005.

Staff understood the requirements in Mental Capacity Act 2005 and knew how to support patients who lacked the capacity to make decisions about their care. Training compliance for mental capacity and Deprivation of Liberty was just above the trust target of 92%, at 92.6%.