The Robert Jones & Agnes Hunt Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked those leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question as good. At this assessment, we rated this key question as good. This meant there was good service leadership across all levels. Leaders and the culture they created assured the delivery of high-quality care.

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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The service had a clear vision and values. Leaders led by example and checked practice against the values. The service values were, friendly, excellence, caring, professional and respect. Surgery services promoted these values.

There were posters displayed with the trust vision, values and corporate objectives identified for staff and patients to see.

There were copies of the trust strategy 2023-2028 available for all staff to access through the intranet and with some copies in ward areas. The strategy described its vision and goals for the trust as: Vision - Aspiring to deliver world class patient care.

There were also a set of strategic objectives: ‘Deliver high quality clinical services, develop our Veterans' Service as a nationally recognised centre, Integrate the MSK pathway across Shropshire, Telford and Wrekin, grow our services and our workforce sustainably and innovation, education and research at the heart of what we do’.

Leaders ensured any risks to delivering the strategy were understood and had an action plan to address them. They checked and reviewed progress against delivery of the strategy.

Surgeons told us the culture had improved, and morale was high. They told us the team ethos had been nurtured, and everyone aspired to be the best at what they did. Training and teaching were part of the culture at the trust.

Theatre staff told us the environment they worked in was excellent and the facilities and equipment to do their job were good. The support from managers within theatres was highlighted as being good and staff generally felt proud to be part of the team.

Almost all staff told us they felt respected and valued by their colleagues and the leadership team within the trust. There was a strong sense of teamwork, which encouraged candour, openness, and honesty.

We were told most staff had attended human factors training as part of the initiative to improve working relationships and the culture within the service.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support. They embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Managers and senior leaders had the right skills to perform their roles effectively. The leaders reported a positive working relationship with each other and were dedicated to their role and responsibilities. They understood the division’s performance, the challenges faced, and the actions needed to address those challenges. We saw leaders were enthusiastic in their approach to improving the service and they shared the same vision with all staff.

Staff told us leaders in the surgery services, regularly made themselves available and visited wards and theatres frequently.

Nursing staff said they saw the matron on the wards and would approach them with concerns.

Leaders were visible and available. They lead by example, modelling inclusive behaviours, and nurtured open and co-operative relationships. Leaders took account of their staff’s specific needs. For example, managers intervened when staff were struggling. Managers explored contributing factors to difficulties and arranged support when needed.

Managers looked at options for flexible working and helped staff as they received feedback from their work.

Leadership was sustained through suitable recruitment and succession planning. Leaders at all levels were knowledgeable about issues and priorities for the quality of services and could access support and development in their role.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff culture of speaking up was strong. Staff raised concerns and were supported without fear of consequences. Staff felt managers had been more responsive and supportive over the last few years.

Staff and leaders actively promoted staff empowerment to drive improvement. Staff encouraged each other to raise concerns and promote the value of doing so. Staff were confident that their voices would be heard.

Leaders were open to feedback. When concerns were raised, leaders investigated sensitively and confidentially, and lessons were shared and acted on.

The service valued diversity in their workforce. Leaders worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

Diversity and inclusion was valued in in the workforce. Leaders supported work towards an inclusive and fair culture by improving equality and equity for staff. The service recruitment policy showed that equality and diversity was valued in the recruitment process. Managers completed workforce race equality standard data collection monthly. Staff came from a variety of ethnic backgrounds and there was an inclusive culture.

Staff said they felt like part of a family and were recognised for their contribution by both their managers and their peers.

Leaders acted to continually review and improve the culture of the organisation in the context of equality, diversity, and inclusion. Leaders prevented and addressed bullying and harassment at all levels.

Leaders made reasonable adjustments to support disabled staff to carry out their roles well. Managers took account of their staff’s neurodiversity needs and supported staff when needed.

The service had clear responsibilities, roles, systems of accountability and good governance. Staff used these to manage and deliver good quality, sustainable care, treatment and support. Staff acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

There were structures, processes and systems of accountability to support the delivery of good quality and sustainable services.

The quality strategy was available to staff across all areas of surgery services and managers understood the priorities outlined within it. Staff had recognised the need to improve in some areas and told us improvements had been seen across their areas.

There were monthly clinical governance and quality committee meetings, which included representatives from the surgery, theatres and anaesthetics directorates.

Minutes from divisional governance meetings reported on risks, incidents, complaints and performance against national and local assessments. Meetings were well attended by members from all areas within the division.

The service maintained a divisional risk register, which defined the severity and likelihood of risks. The leadership team reviewed the risk register monthly and severe risks were escalated to the trust board, when necessary, through the corporate risk register. Risks were discussed and agreed at the divisional governance meetings before a risk was put on the register.

Managers and ward staff could describe the risks associated with their areas and we were told information was shared through regular safety huddles and staff meetings. The ward managers would email the staff with updates from staff meetings.

Risks were owned by senior staff and those we reviewed were manged effectively. However, we noted a new risk by speaking with clinical leads, where there was no consultant on site overnight, only on call. This had been already identified and was on the risk register. Various actions were in place, including recruitment into this role, which was ongoing during the time of the assessment.

The clinical governance meeting oversaw the development of the organisation’s clinical quality strategy. Managers used information from the analysis of adverse incidents, complaints and clinical data through audits to find risks and make needed improvements. This data was presented in a quality and safety report through the quality and safety committee.

Staff understood their roles and responsibilities. Staff attended department meetings monthly to ensure they received information needed for their role and responsibility. These meetings were held both in person and online to aid flexible working. Meeting minutes from different departments supported the governance structures and messaging further up the organisation. Managers accounted for the actions, behaviours, and performance of staff during these meetings.

Leaders had effective plans for business continuity in case of emergency or natural disasters, such as adverse weather events. Staff were confident about these arrangements and knew how to begin them. The plan outlined suitable plans for the sustainability of the business if external events affected the running of the hospital.

The service understood its duty to collaborate and work in partnership, so services worked seamlessly for people. Staff shared information and learning with partners and collaborated for improvement.

Leaders understood their duty to collaborate and work in partnership with other organisations so that services worked well for people. Leaders shared information and learning with partners for improvement. Leaders recognised their need to work with their neighbouring NHS trusts and integrated care systems.

Leaders were open and transparent, and they worked well with relevant external stakeholders.

The service gathered feedback from staff through discussions and scheduled meetings which were minuted and available for those that could not attend. Along with staff meetings, the service used the daily safety huddles, held in all areas including wards and theatres, as the main method to share important messages.

Patients were given the opportunity to provide feedback about their care and we saw patient feedback questionnaires that had been completed by patients. The trust had a patient engagement group that met quarterly to discuss trust policies, plans and developments.

There was some evidence that the views and experiences of patients and others were gathered and acted on to shape and improve the service. For example, the quality accreditation programme involved patient representation and independent staff in the assessment process for the ward. This awarded the area with a rating of satisfactory, good, great or outstanding.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contributed to safe, effective practice and research.

There was evidence of improved culture across the service and there was strong leadership. Divisional leaders and ward managers acted to make improvements in the running of surgery services. They had regular meetings where learning was discussed.

The trust was accredited as an elective surgical hub delivering high standards in clinical and operational practice. The scheme, which was run by NHS England’s Getting It Right First-Time programme in collaboration with the Royal College of Surgeons of England, assessed hubs against a framework of standards to help hubs deliver faster access to some of the most common surgical procedures such as cataract surgeries and hip replacements. It also sought to assure patients about the high standards of clinical care.

The trust held an event to mark the end of the ‘ASCOT Trial’ – a major clinical trial which helped to transform the lives of people suffering with damage to their knee joint or cartilage. It had been running in partnership with Keele University and supported by the Orthopaedic Institute Charity, Versus Arthritis and the Medical Research Council.

The trust received the NHS Pastoral Care Quality Award in recognition of its efforts and commitment to providing gold standard quality pastoral care to international recruits. In 2023, the organisation welcomed 22 international nurses to its workforce, from countries including Kenya, India, Saudi Arabia, Jamaica.

In April 2023, the trust launched an enhanced recovery programme for all arthroplasty patients, which aimed to get patients back to full health as quickly as possible following surgery. Research around enhanced recovery has shown that the earlier a person gets out of bed and starts walking, eating, and drinking after an operation, the shorter their recovery time will be. The programme had seen more than 1,000 patients before the end of the year.