Bradford Royal Infirmary

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant people felt well-supported and cared for.

We looked for evidence that people were always treated with kindness, empathy and compassion. We checked that people’s privacy and dignity was respected, that they understood that they and their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

We scored the service as 3. The evidence showed a good standard. The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

The department was very crowded, and patients were waiting and receiving care in several different areas depending on their condition. However, patients were not waiting or receiving care in corridors, which helped maintain their privacy and dignity.

We reviewed the 2025 Patient Led Assessment of the Care Environment (PLACE) results which were for the whole of the hospital. For the Privacy, Dignity and Well being domain, the department scored 96%, which was above the national average.

Staff attempted to preserve privacy and dignity in line with cultural norms, and we observed examples of this. However, we also saw situations where this was not possible due to the limited space available in certain patient waiting areas.

The department took part in the 2024 NHS Urgent and Emergency Care Survey and received 188 responses, a response rate of around 20%, which was lower than the national average. One of the survey questions asked whether patients felt they were treated with privacy and dignity. The department scored 7.5 for the emergency department and 8.6 for urgent care which was about the same as other trusts. An action plan was developed to address this and other survey results. Improvements included redesigning one of the patient zones to increase privacy and providing spare clothing for patients, so they did not need to sit in soiled clothes.

We observed staff treating patients with compassion and kindness in the various treatment areas. Patients were moved to a cubicle for triage to support privacy during conversations, although some conversations could still be overheard and staff were aware of this. When patients were seen by doctors, this usually took place in a cubicle or treatment room. In open ward areas, such as resuscitation and majors, cubicles were separated by curtains, meaning conversations were not always private. This was consistent with the layout of an emergency department. Private rooms were available when sensitive or confidential conversations were needed, and portable screens were used to maintain dignity when required. We saw staff using these screens in the resuscitation area.

The trust’s Interpreting Services Team supported patients on over 51,008 occasions across more than 50 languages, with access to face-to-face, telephone and video interpreting available 24 hours a day, seven days a week. The ED had a multilingual interpreter available daily between 9am and 5pm. However, some patients chose to use family members to interpret and risked breaching confidentiality and reducing the accuracy of communication between staff and patients.

Although privacy and dignity could be difficult to maintain in communal spaces such as the “fit to sit” area and ambulance handover area, the patients we spoke with did not raise concerns. They acknowledged the pressures the department was facing and told us that staff mostly listened and communicated with them in a way they understood. Patients described staff as kind and compassionate.

Chaplaincy staff and facilities were available to support patients, families and staff with cultural, religious or unexpected needs, including following a death. A private room was also available for confidential conversations.

We scored the service as 3. The evidence showed a good standard of treating people as individuals. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Whenever possible, people living with dementia or people who were neurodivergent could be offered quieter areas, including cubicles, if it was safe to do so. The staff we spoke with demonstrated knowledge, skills and experience in supporting people with a wide range of needs, including cultural and religious needs, mental and physical health conditions, and language requirements.

People could access food that met their cultural and religious customs, as well as any dietary or allergy needs. Patients also had access to appropriate spiritual support. The service had a chaplaincy and spiritual care team that supported patients and relatives of all faiths and those without a religious affiliation. Patients and families could also access specific religious support if they wished.

We scored the service as 3. The evidence showed a good standard of supporting independent, choice and control. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

The service treated people as individuals and made sure their care, support and treatment met their needs and preferences. Staff considered people’s abilities, aspirations, culture, protected characteristics and unique backgrounds.

We observed staff interacting sensitively with patients and relatives who were anxious. They explained what they were going to do and what the patient journey involved. Staff spoke with patients in a way they could understand, used communication aids when needed and avoided jargon and abbreviations. Patients and families were given time to ask questions, and staff explained treatment options clearly.

In the paediatric emergency department, staff supported children, young people and their families and explained information in a child-friendly way. They allowed time for questions and reassured families by making sure they understood the next steps in the care and treatment journey.

However, the hospital scored worse than other trusts in the 2024 Urgent and Emergency Care Survey for involving people in decisions about their care and for explaining why tests were needed. It also scored worse than expected for listening to people and for giving clear explanations about their condition and treatment.

We scored the service as 2. The evidence showed some shortfalls in responding to people’s immediate needs. The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Patients experienced long waits to see doctors and to start treatment. This increased the risk of long‑term harm. We also spoke with a patient who had been waiting for more than 7 hours and had not been prescribed time‑sensitive medicine they needed. This delay increased the risk of their condition worsening.

We saw staff working hard under pressure to meet patients’ needs. This was challenging because of the number of staff on duty and how busy the department was. Staff could not always respond to people’s needs straight away or act to reduce discomfort, concern or distress. This included delays in giving time‑sensitive medicines, pain relief and creating care plans to support people’s mental health needs. Staff were also not always able to support people quickly with personal hygiene needs because of the workload in the department. This was a breach of the regulation person-centered care.

There were delays for people when they first arrived because of the volume of patients, the number of staff and the size of the department. This meant staff could not always respond to people’s immediate needs. Although patients had an initial triage within an average of under 20 minutes, they then experienced long waits to see a doctor or an advanced care practitioner (ACP) who decided what treatment they needed.

Patients, relatives and carers told us they could see how busy staff were and how hard they were working. Some said staff were attentive, but others said staff did not always communicate with them or respond quickly when they needed support. Some people were frustrated by long waits for pain relief or help to use the toilet, but recognised staff were doing as much as they could with the number of staff they had available.

We spoke with ambulance crews they told us the hospital had some delays but was one of the better emergency departments to hand over patients to. The department had a dedicated ambulance handover area staffed by nurses and healthcare assistants (HCAs). Ambulance crews told us staff responded to patients’ needs in a timely way in this area.

Patients had access to trolleys with water jugs and cups in the department. We also saw these trolleys. During our time in the department over 5 days, we did not see food being offered to people. Patients who had been waiting for long periods told us they had not been offered anything to eat. A parent in the paediatric emergency department asked us if food was available for their young child as no one had told them. When we asked staff, they provided food for the family.

We were concerned that although staff worked hard to meet people’s needs in a timely way, this was not always possible because of how busy the department was.

We scored the service as 2. The evidence showed shortfalls in the standard of support for the wellbeing of staff. The service did not always care about and promote the wellbeing of their staff or supported and enabled staff to always deliver person-centred care.

We spoke with staff across the department from a range of roles and grades. Staff told us they were proud to work in the department and said colleagues worked well together to support patients and each other. Staff also said managers and leaders within the department were approachable and listened to their concerns. However, staff told us leaders and managers outside the clinical support unit were not always visible, and they often felt their concerns were not acknowledged, listened to or acted on when escalated beyond the department.

The trust introduced a staff outcomes survey to help understand how valued and supported staff felt and how often they felt overwhelmed at work. The trust shared the results with us but said staff engagement with the survey was low. The findings showed staff did not always feel valued and often felt overwhelmed. The information sent to us did not show how the department planned to respond to these specific results however, evidence was provided of actions the trust was taking to improve engagement and staff experience.

Most staff told us they felt respected by their colleagues, who recognised their individual skills and contributions. However, a small number of staff said a minority of colleagues did not always show them respect because of their gender. We raised this with senior leaders, who told us they had not been made aware of these concerns before. They said they would look into the concerns and discuss them with all teams at the regular staff meetings.

We asked staff about support for their physical and emotional well being. Staff told us there were ‘hot’ debriefs shortly after difficult or distressing incidents so they could discuss what happened, what went well, what could be improved and how the incident made them feel. Some staff told us they were not always included in these debriefs even when they had been involved in the incident, which left them feeling excluded. Staff also said the department did not always recognise when staff from other areas had been involved in incidents and might also need support. Staff told us that ‘cold’ debriefs, which usually take place several weeks after an incident, did not always happen. Despite this, staff knew they could access mental health support services and the trust’s occupational health team. Staff could also speak with their line manager to ask for a referral for physical or mental health support.

A dedicated safe space for staff known as the ‘Wobble Room’ provided staff with a quiet space away from the department if they needed time to pause and regroup. Staff said they were encouraged to use this space to support their needs. Staff also showed us wellbeing noticeboards with information about available support and details of social events. Staff told us about a recent social event outside the department attended by staff from a range of roles and grades. They said these events happened regularly, were well attended and helped staff to build relationships informally. The trust also told us about wellbeing initiatives, including outdoor walks to encourage fresh air, physical activity and peer support.

The trust told us they had introduced Professional Nursing Advocates within the emergency department. Two staff had completed training and one was in training. There were also regular weekly drop‑in sessions where staff could share their experiences, concerns or ideas. Staff could also access the trust’s Freedom to Speak Up guardian if they did not feel able to raise concerns within their usual line management structure.

We spoke with staff about career progression, training and promotion. Staff told us there were opportunities to progress within the department, and we saw evidence of jobs being advertised and internal promotions taking place.