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The Robert Jones & Agnes Hunt Orthopaedic Hospital Foundation Trust

The Robert Jones & Agnes Hunt Orthopaedic NHS Foundation Trust is one of the UK's five specialist orthopaedic hospitals and is a leading orthopaedic centre of excellence. The hospital is a specialist hospital with a reputation for innovation, and provides a comprehensive range of musculoskeletal (bone, joint and tissue) surgical, medical and rehabilitation services; locally, regionally and nationally. The organisation is a single site hospital based in Oswestry, Shropshire, close to the border with Wales. As such, the Trust serves the people of England and Wales, as well as acting as a national healthcare provider. It also hosts some local services which support the communities in and around Oswestry. As an organisation the trust is committed to ensure that patients who are attending or admitted to the hospital who have dementia receive high quality care with equity of access to available healthcare services at the hospital and also within their area of residence.

27 April 2016
West Midlands
Hospitals and Hospital Trusts
Local Alliances:
Shropshire, Telford & Wrekin Dementia Action Alliance

1. Action Plan

1. The National Dementia Declaration lists seven outcomes that the DAA are seeking to achieve for people with dementia and their carers. How would you describe your organisation’s role in delivering better outcomes for people with dementia and their carers?

As a trust we aim to ensure and implement best practice, adopting and delivering on the dementia national guidance and quality standards within the organisation working collaboratively with the local health and social care economy, and cross boundary working. 

The RJAH is part of the local health economy group with an overall purpose to

  • To inform  review the development and implementation of local Dementia strategies
  • To develop an integrated approach to the provision of services.
  • To ensure dementia patients and their carers are consulted and given the opportunity to inform discussions about quality of care locally
  • To uphold the principles of person-centred care.
  • To demonstrate improved access to and quality of care for people with dementia and their carers.

In addition to the above the RJAH  is committed to :

  • To continually improve our services through the development of an explicit care pathway for the management and care of patients living with dementia.
  • Staff are appropriately trained in dementia care, and staff awareness & implementation of the Butterfly scheme.
  • Development of a more dementia friendly environment supporting the wellbeing and independence of people living with dementia who attends the hospital as outpatient, inpatient and/or visitor. 

2. What are the challenges to delivering these outcomes from the perspective of your organisation?

To continually improve services and to meet increasing demands for orthopaedic services which includes elderly patients with cognitive impairment or early stages of dementia.

To support staff through training and education in dementia care this is a continual cycle, and demonstrates effectiveness of this through monitoring and audit.

To work collaboratively, supported by the community services to ensure early diagnosis and the appropriate intervention by local services is delivered. To work collaboratively to ensure care is available in the community so enabling the patient’s safe discharge in a timely way, avoiding delays.

Delivery of the estates strategy plan which includes key elements of the dementia friendly environment which accommodates both patients living with or without a cognitive impairment/diagnosed dementia.

Member website


2. Actions

  • To improve the hospital environment to become more dementia friendly

    To develop a painting schedule for adult wards in line with estates maintenance programme.

    To purchase toilet seats & grab rails in areas of need which comply with dementia friendly specifications.

    To continue rolling out pictorial signage on toilets and bathrooms following its implementation of this on the Care of the Elderly Ward/Medical Ward.

    Clear face clocks or calendar clocks to be implemented within clinical areas including outpatients.

    Review dementia friendly taps within bathrooms to ensure these meet the requirement.

    To ensure dementia friendly environment is considered and incorporated in plans within all new builds. This will be including the new theatre complex, Tumour unit, HDU, and ward.

    Introduction of Memory boxes within adult wards and HDU.


    2016 - Second Quarter Update

    New member

  • Delivery of Person Centre Care which involves family and carers

    To ensure the ‘This is me passport’ is implemented and used within the clinical environment. To encourage staff when assessing patients at pre op with a diagnosed dementia is encouraged to bring the passport in with them.

    To ensure all patients with a diagnosed dementia and their family/carers are informed about the Butterfly Scheme (to opt in or out), and that the information booklet is provided.

    Staff are trained and aware of the butterfly scheme within the RJAH. To provide information for all staff at induction, and ensure there is a butterfly champion in each clinical areas.

    To monitor and audit the Butterfly scheme.

    Encourage carers/relatives of a patient living with dementia to complete the carers questionnaire in order to review feedback, and act on any issues to improve services.

    Implement the dementia/delirium bundle across the organisation.

    Deliver specific activities and celebrate this on the Care of the Elderly Ward. To use the specific ‘Poppy Lounge’ which has been developed on the Care of the Elderly Ward this mimics the home environment as much as possible to assist people requiring memory support.

    To increase volunteers to help support patients with dementia who may be able to participate in activities to support the nursing and multidisciplinary team.

    Being implemented

    2016 - Second Quarter Update

    New member

  • To ensure staff have the training and support and enough time to care

    All clinical staff including medical staff to attend dementia awareness training, and deliver on the trust set target, and training plan.

    Non clinical staff to attend Dementia Friends training as per training needs analysis. This also includes volunteers and members of the Trust board.

    Staff to be aware of the clinical dementia lead, and clinical specialists within the organisation who they can consult with for further help and advice. This will also include colleagues within the Mental Health Team, and community services for memory services and  mental health.

    To ensure staffing levels meet the staffing level template, and there is adequate skill mix to support the complex needs of patients with dementia.

    Network with other organisations and the local health economy for support, and additional training for staff.

    Meet regularly with the safeguarding/dementia links within the RJAH to provide up to date information and it is disseminated within the clinical areas.

    Being implemented

    2016 - Second Quarter Update

    New member

  • Assessment and early identification of cognitive impairment or early dementia

    To undertake a dementia screen all patients over the age of 75yrs admitted as an emergency or transfer from another hospital or community. To investigate further by following the dementia pathway, and review other possible causes. Refer on to appropriate services e.g. memory services.

    To meet CQUIN targets.

    To undertake a dementia screen all patients attending pre op assessment over the age of 75 yrs. To follow this up (if positive) back to the GP for further assessment, or monitoring.

    To implement the dementia/delirium bundle  across the trust.


    2016 - Second Quarter Update

    New member