The Robert Jones & Agnes Hunt Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination.

At our last assessment we rated this key question as good. At this assessment we rated this key question as good. This meant people were safe and protected from avoidable harm.

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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually show and embed good practice.

Managers and staff recorded accidents, incidents and complaints. Staff knew how to report incidents and understood the process. Staff used reflective accounts to learn from incidents and lower the risk of the same incidents being repeated.

Outcomes from incident investigations were shared both internally and externally to ensure lessons learned were widely shared. This minimised the risk of reoccurrence.

The service managed patient safety incidents well.

Staff received information on incident investigation outcomes during department meetings and by email.

The service had applied the duty of candour in all applicable situations we were made aware of. Staff were aware of their responsibilities and when the duty applied. The duty of candour is a regulatory duty that relates to openness and transparency and requires providers of health and social care services to notify patients (or other relevant persons) of certain ‘notifiable safety incidents’ and provide reasonable support to that person. We saw evidence of the duty of candour being applied if appropriate when patients and/or their relatives made complaints but also when an incident occurred. The documentation we reviewed set out what went wrong, why and what was being done to reduce the risk of it occurring again. An apology and the opportunity to discuss the issue with the matron or senior nurses was offered to the patient and relatives.

Leaders could describe the duty of candour process. We were told how a specific staff member would also be allocated as the family liaison contact to support and answer any questions throughout the process.

The service worked with people and healthcare partners to keep safe systems of care, in which safety was managed or monitored. Staff made sure there was continuity of care, including when people moved between different services.

Staff from the bookings team provided information needed for the safe admission of people to the service. Information on procedures was explained and available to be reviewed at home.

People were given a pre-assessment prior to their surgery to ensure they met the safety criteria for treatment at the hospital. A pre-assessment is an appointment that looks at a person’s suitability for surgery, which looks at a full medical, social and nursing history of the patient. This was conducted in a clinic environment led by a nurse and healthcare assistants.

Most nursing staff had received their up-to-date training on how to recognise and report abuse, and they knew how to apply it in line with local and national safeguarding procedures. However, medical staff compliance with annual refresher training fell below the target of 92% with safeguarding children level 2 at 79% and adult level 2 at 84% compliance.

The trust set a target of 92% for the completion of safeguarding training.

Where this target was not met, we saw a plan to capture those staff that were not compliant. If a member of staff was not up to date with training, the plan would be discussed during supervision sessions or at annual appraisals.

The training figures showed that staff were complaint with adult safeguarding, at 92.2% and safeguarding children at 94%.

All staff required to be level 3 safeguarding trained, for example specialist paediatric nurses, were trained at the time of inspection.

The trust had link nurses with experience in safeguarding that staff could approach for advice and guidance. Link nurses were responsible for sharing learning with staff in their areas and supported the main safeguarding lead within the trust.

Staff used nationally recognised tools to assess patient’s risk of developing pressure ulcers, infections and identified nutritional risks and risks of falls. There was a hospital-wide standardised approach to detecting deteriorating patients.

The National Early Warning Score (NEWS2) was used for patients across the trust. The early warning score is a tool used to help identify when a patient might be deteriorating due to complications such as sepsis. Clinical observations like blood pressure, heart rate, and respiration's were recorded and contributed to a total score. Once a certain score was reached, a clear escalation of treatment was commenced. Patients with a raised NEWS2 score were automatically screened for sepsis.

All wards that we visited used sepsis 6. Sepsis 6 is the name given to a bundle of medical therapies designed to reduce the mortality of patients with sepsis. Nursing staff on surgical wards confidently described the signs of sepsis and what action they would take. For example, completing the sepsis 6 pathway in the patient’s notes and immediate escalation to the nurse in charge and medical staff.

If patients were identified as having pressure ulcers, the incident was reported, and a body map was completed to show the area(s) affected.

Nursing staff on the surgical wards had daily ‘safety huddles’, where staff highlighted ward issues, patients due for discharge and high-risk patients who required extra monitoring. We observed the safety huddles on 3 different wards and noted consistency across all areas.

The trust uses the ‘8 Steps for Safer surgery’ in line with the revised NatSIPSS2 standards in line with NHSE guidance and guidance from the centre of perioperative care. The theatre staff complete monthly audits to establish if the 8 steps to safer surgery are being completed in line with the recommendations.The process had been reviewed, compared with other specialist hospitals and a bespoke version developed, following the WHO principles. Managers had concentrated on developing a consistent approach to the WHO checklists.

The checklist comprised of the 5 steps to safer surgery; brief, sign in, time out, sign out and de-brief. Changes were made to the existing brief and de-brief checklist to make it flow better and be more useful to staff. This was achieved by combining the operation list and briefing form together and adding patient specific prompts.

Managers were examining the possibility of including the WHO checklist within the electronic system that currently managed patient flow to and from theatres.

There was a monthly audit done for the completion of the WHO checklists and results were compiled into a quarterly report that was reviewed at clinical audit meetings. We saw examples from monthly WHO checklist audits and found compliance to be improving since July 2024, when compliance was 78%. However, the fifth standard, ‘de-brief’, was lower than the 4 other components of the WHO checklist. An improvement made in this one component improved the overall compliance. An action plan had been created to address the non-compliance. The service also shared experiences with other surgical services across other trusts, to aid in improving the use of WHO checklists and this resulted in the development of the new version that was now being used.

Surgery services were fully engaged in the implementation of the national safety standards for invasive procedures (NatSSIPS2), which were published in September 2024 to support hospitals to provide safer surgical care. All NHS organisations are expected to develop their own local safety standards for invasive procedures (LocSSIPs) and to allocate responsibility for each clinical speciality that carried out procedures. Staff understood these processes which had been implemented across the service.

We saw noticeboards displaying information about WHO checklists, NatSSIPS2 and LocSSIPs and staff could describe the processes.

All wards were clearly signposted from main corridors, and each area was in a zone that was communicated to patients and visitors on arrival at the hospital. Reception areas had directions to each zone and a map to guide visitors.

During the inspection we checked resuscitation equipment and trolleys on every ward and in clinical areas. We found them all to be clean, correctly stocked with equipment and had tamper-evident seals. There were daily check logs for each trolley, and they were signed and dated to indicate that daily checks had been done.

Hoists were stored appropriately when not in use and maintenance logs were regularly reviewed and signed. Hoists had “I am clean” stickers indicating the time and date of cleaning.

Patient call bells were checked daily and signed for, and any malfunction was reported to the estates and facilities team for repair.

On Oswald ward there were 10 en-suite rooms, each one had a daily cleaning and maintenance checklist completed. Daily checks had been completed and signed for appropriately, for the last 12 months.

All areas visited had appropriate facilities to dispose of waste. Sharps bins were regularly monitored and were not overfull. There was a process to report when a bin needed removing and staff could request removal at any time during the day. Nurses completed daily checks and would ensure that waste was removed at the end of every shift.

Staffing levels and skill mix were managed in line with national guidance and theatres were staffed appropriately according to the type and amount of surgery planned.

Although there were some vacancies, the service maintained safe levels of staff by using bank and agency staff. Nursing staffing was planned and reviewed to ensure people received safe care and treatment, using an acuity tool to determine safe levels of staffing and appropriate skill mix.

The vacancy rate for nursing staff for April 2025 was 8.23% against a target of 8%. The reason for this was an increase in establishment following financial reconciliation for the year-end and the alignment with the new 2025/2026 trust workforce plan. The service expected to see the vacancy rate reduce as recruitment into the new posts continued.

Most staff had received an appraisal to review work performance and to provide support and monitor the effectiveness of the service. Staff told us their appraisals were effective because they helped them to identify and plan their development needs. Staff also told us they accessed regular supervision sessions with senior staff/managers which provided them with the support and feedback needed to enable them to work effectively in their roles. For April 2025 93.3% of nursing staff had had an appraisal, against a target of 92%.

There were effective systems to ensure standards of cleanliness and hygiene were maintained. We observed the wards, reception areas, and treatment areas to be visibly clean during our inspection.

Staff received training about infection prevention and control and hand hygiene training during their initial induction and annual mandatory training.

Hand hygiene gels were available for use at the entrance and exit of the wards, bays, theatres and the pre-operative assessment areas. Personal protective equipment such as gloves and disposable aprons were used in accordance with the trust’s infection control policy.

We saw staff and visitors using sanitising hand gel before entering and when leaving clinical and ward areas. There were signs in place to remind people to use the gels and to be “arms bare below the elbows”, when in contact with patients or in a specified zone.

Nurses that were administering medication wore a red apron to indicate they were performing a task that required them not to be disturbed. This system was an aid to reducing errors at a time when staff needed to concentrate and staff and patients had a visual reminder not to disturb the person.

Pharmacy staff checked (reconciled) patients’ medicines on admission to wards and worked in the pre-operation assessment clinic. This ensured patients were taking the right medicines they needed for other conditions while in hospital.

Wards had security keypads on the doors to all medication storage rooms and locked cabinets within the room. Medications were stored in cabinets and there was a process to check stock and monitor the use of medication. Two members of staff were required to sign out medication before being used and we saw that in all cases the checks had been completed.

Medication requiring to be stored in a cooler environment was kept in fridges. We saw temperatures were checked and signed for daily to ensure the correct temperature was monitored. In most cases there was an alarm fitted to the fridges which would alert staff if the temperature changed and was out of tolerance.

Medicine stock levels were checked weekly. Controlled drugs (CDs), which are controlled under the Misuse of Drugs legislation (and subsequent amendments), were disposed of appropriately by trained staff. All CD destruction was logged in an ongoing record and monitored by the pharmacy team.

We observed staff accessing CDs and they followed the correct procedure. Expiry date checks were done on fentanyl medication and guidelines were checked for diluting the medication.

There was a reminder notice attached to the CD cupboard with actions from a CD audit to aid staff. Information from audits had been shared with staff at meetings and information displayed.