Bradford Royal Infirmary

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

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

This meant people’s needs were met through good organisation and delivery.

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

We have not awarded this service a score for Responsive.

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

We scored the service as 2. The evidence showed some shortfalls in how person centered care was delivered. The service did not always make sure people were at the centre of their care and treatment choices although they did work in partnership with people, to decide how to respond to any relevant changes in people’s needs. We found breaches of person centred-care.

The trust experienced poor patient flow across the hospital, which affected the emergency department and contributed to delays in moving patients to wards. This also meant patients did not always see specialist teams when they needed to. Staff told us some specialties would only review patients once they had been moved to the emergency assessment unit, which contributed to delays in patients receiving timely treatment.

People who used the service and those close to them, including carers and dependents, were involved in their care and understood their condition, treatment options and care plans. The 2024 Urgent and Emergency Care Survey showed the department rated as about the same as other trusts for patients being informed by a doctor or nurse what would happen after their first assessment. The department was comparable to other trusts for waiting times for emergency department patients and worse than expected for patients waiting with an urgent care need.

Most patients we spoke with told us they had an assessment of their health needs and were consulted about their treatment plan. Many understood the challenges faced by staff and said their tests and treatment were explained to them. However, the 2024 Urgent and Emergency Care Survey showed the department scored 7.3 out of 10, rated as worse than expected, for explaining why tests were needed in a way people could understand.

Staff generally considered people’s individual needs and preferences. Patients were given blankets, pressure relieving equipment and additional pillows when needed. However, staff did not always complete risk assessments to identify needs such as falls risks, bed rail use or pressure ulcer risks. Staff understood how to complete these assessments and who to contact for support, but they told us operational pressures meant they did not always have time to complete them. This increased the risk of avoidable harm. This was a breach of person-centred care regulation.

People who regularly attended the emergency department had care and support plans in place. These were discussed by multidisciplinary teams, who made sure people were supported and that other relevant organisations were involved. This included mental health services, homelessness support services and local authority teams, ensuring people received the most appropriate support for their wider needs.

The children’s emergency department was child‑friendly, with toys available to support play and reduce anxiety. There was no dedicated play specialist in the department, but staff could request support from play specialists based on the children’s ward. Staff had completed training in distraction techniques to reduce stress and anxiety in children. The secondary waiting area and cubicles were decorated with child‑friendly designs. However, there were no areas designed for older children or young people.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff worked hard to make sure all relevant health and care professionals, and other organisations were involved in planning people’s care and treatment, including those with complex needs. Staff told us they could refer or redirect people to other services such as addiction support services, counselling organisations, charities and social care providers.

The emergency department worked with healthcare providers within the trust and external organisations to support appropriate follow‑up care. However, patients referred to specialty teams often waited many hours to be reviewed and then transferred to the right ward.

Mental health care was provided by the local mental health trust. They carried out assessments and, where relevant, provided ongoing care for adults who needed specialist mental health input. After referral from the emergency department team, people should receive an initial assessment from the liaison team and, where required, a Mental Health Act assessment. However, there were often significant delays in these assessments. People who needed ongoing care in the emergency department or the observation unit because of their mental health needs were supported by emergency department staff until specialist services were able to attend. For people who needed admission to a mental health facility—whether voluntary or under the Mental Health Act—the local mental health trust was responsible for locating a suitable bed and arranging the admission. If a person required admission outside the local area, the responsibility sat with the relevant mental health provider.

All patients attending the department were registered on the electronic patient record (EPR) system. Staff recorded hospital handover information on the same system, which meant all staff could access a patient’s information easily.

Staff highlighted the value of early consultant involvement. They said this supported quicker access to diagnostics such as X‑rays, CT scans and MRI scans. This helped identify conditions earlier, including respiratory issues, and allowed for timely treatment such as inhalers. If sufficient staff were available, nurses in triage and the waiting room could ask a consultant for advice to support early decision‑making, improve patient outcomes and prevent unnecessary delays.

We scored the service as 3. The evidence showed a good standard of information provision. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Patients could access information about their condition using QR codes. This support was also available to parents whose children attended the emergency department frequently. We saw an advice sheet with QR links to information on common conditions such as coughs and colds, headaches and tummy upsets. This helped people manage minor health needs and decide whether they needed to attend the emergency department. Patients and their families were supported to make informed decisions about whether a visit to the department was necessary.

Information for patients was accessible and available in different languages and formats to meet people’s health and communication needs. This included information about how to complain and how to access other organisations that could offer support. The department met accessible information standards.

Interpreters were available for people whose first language was not English. We spoke with a multilingual interpreter who could communicate in the most commonly spoken languages in the local area. They were based in the emergency department five days a week between 9am and 5pm and actively sought out patients who needed support. However, we still saw staff using relatives as interpreters even when an interpreter was available. Using family members or friends in this way carries risks and does not follow best practice.

Staff told patients about other support available to them and referred people to external services such as mental health support, services for young adults and support for parents and carers. The department had also worked with a charity to help parents and young people access alternative services. Although the project had ended, a review showed it had successfully engaged with families.

We scored the service as 2. The evidence showed some shortfalls in the way people were involved and listened to whilst in the ED. The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result.

Results from the 2024 Urgent and Emergency Care Survey relating to interactions with health professionals in the department compared to other trusts was somewhat worse than expected for urgent care and worse than expected for doctors and nurses in emergency care.

We asked the department how it listened to and involved people in feeding back their experience of care and treatment. The trust told us it received feedback through several routes, including surveys, compliments, complaints and the Friends and Family Test. The department told us it had received 111 formal complaints in the 12 months before our inspection. These were analysed to identify themes. The main themes included delays in diagnosis and treatment, inadequate pain relief, concerns about dignity and communication issues. The department shared patient stories with staff at meetings and in newsletters to help highlight the impact a poor experience can have on people and their families.

When we asked patients and relatives how they would give feedback or make a complaint, most said they would first speak with the person in charge. If their concern was not resolved, they said they would make a written complaint. Staff said feedback about compliments, concerns and complaints was shared in newsletters, staff updates and at safety huddles and briefings.

Staff told us they aimed to resolve complaints locally wherever possible by addressing issues at the time. If they could not resolve a concern, they escalated it to a more senior member of staff. Staff encouraged people to give feedback so managers could understand concerns and make improvements. Staff also told us they directed patients to the Patient Advice and Liaison Service (PALS) when needed. The trust website included information about how people could give feedback, including a downloadable form.

The trust gave us examples of improvements made as a result of patient feedback. These included installing vending machines so people could buy food, adding a commercial phone‑charging machine, and introducing patient information boards so people could identify staff more easily. Information about waiting times had also been added to TV screens in waiting areas.

We scored the service as 2. The evidence showed some shortfalls in equity of access. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

In the 12 months prior to the inspection the department had seen a total of almost 150,000 patients. The department saw people from a wide range of ages, ethnicities and other protected characteristics such as with poor mental health and physical and learning disabilities.

Demand on the department far exceeded its original capacity. Although expansions, reconfigurations and process changes had improved flow and reduced risk, they did not address the root causes of wider system pressures. Limited bed availability in the hospital and social care delays restricted the flow of patients out of the emergency department. This led to long waits to move people to wards, which reduced the department’s ability to assess and treat newly arrived patients and contributed to crowding. This made the environment less efficient, less effective and less safe. We reviewed information the trust sent us about the percentage of patients who were admitted as part of their attendance. Evidence showed an average of approximately 22% of adults and 15% of children were admitted across the 12 month period prior to our inspection. Data further showed that the average length of stay for admitted patients fluctuated between 6hrs 47 and 7hrs 31 from April 2025 to September 2025. During our inspections we saw patients waiting significantly longer in the department from decision to admit to admission onto a ward.

We reviewed evidence about how well the department was meeting the emergency care standards (national performance targets). Between October 2024 and September 2025 patients waited between 1hr 53 and 3hr 18 from arrival to treatment which is better than the England median.

The emergency department operated 24 hours a day, every day of the year. People faced long delays accessing care, support and treatment. Staff were not always able to make sure people received timely care because of capacity pressures and delays in access. People often waited for long periods due to overcrowding, which we observed during our inspection. We looked at evidence provided by the trust about the number of patients who waited more than 12 hours from decision to admit to being moved out of the department to a bed. This showed that between October 2024 and September 2025, between 2% and 6% of patients waited longer than 12 hours in the department before going to a ward.

Leaders and staff acknowledged that people could not always access support and treatment when they needed it because of poor patient flow and capacity issues across the hospital. The service could not consistently make sure people received timely care in line with national performance standards. At the time of our inspection, this challenge was not unique to this department.

People we spoke with, including patients and families, told us about long waits in the emergency department, including after a decision to admit had been made. Some patients chose to leave the department before being seen by a clinician. Evidence the trust sent us showed that in the 12 month period prior to our inspection, 6187 adults and 1075 children left the department without being seen. This equates to 7% of adults and 5% of children who left the department before being seen.

The service had a clearly defined patient pathway that started at the entrance to the department, where all patients arriving on foot were met by a streaming nurse. Based on an initial conversation before entering the building, patients were directed to the most appropriate area of the hospital or diverted to other services, such as their GP or the co‑located urgent care provider. Staff and managers told us this approach helped ensure only people needing emergency care entered the emergency department. When we observed this process, we saw examples of patients being taken straight for tests or for an immediate medical opinion. However, when the department was very busy, the streaming nurse sometimes had to leave their post to support elsewhere in the department meaning people who could be treated elsewhere entered the ED leading to longer waits and a busier department.

The trust had introduced several new areas within the department, including a fit‑to‑sit area and an emergency ambulatory care unit (EACU), where people could wait or receive treatment without occupying a cubicle. During our inspection, the trust was also trialing a service to reduce pressure on the emergency department. In addition to the Majors and Minors areas, a Same Day Emergency Care (SDEC) facility was available nearby for medical patients. It had dedicated staff and reduced pressure on the department. Leaders told us the SDEC was effective and they hoped it would become a permanent part of the service.

People who required a bed in a mental health facility outside the trust were often cared for in the department for several days while a suitable placement was identified. This meant cubicles remained occupied for long periods, staff were required to provide ongoing support, and managers spent considerable time working with external providers and commissioners to arrange appropriate placements. We saw that staff worked with the local mental health trust to allocate alternative care provision for these patients and escalated issues through local systems.

We reviewed ambulance handover performance validated by Yorkshire Ambulance Service (YAS). Best practice states ambulance handover should be carried out in 15 minutes or less. The average handover time to this trust was 23 minutes however, some handovers took longer. The evidence the trust provided us showed more than 50% of handovers took more than 15 minutes with some taking more than 45 minutes.

Staff were alert to discrimination and inequality that could disadvantage people in accessing care, support and treatment. The organisation had a patient equality and diversity strategy covering 2023 to 2025, and staff were committed to promoting equality, diversity and inclusion. Staff worked hard to remove barriers to access.

We scored the service as 3. The evidence showed a good standard of evidence that the department considered the needs of all patients including those with protected characteristics. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

We asked the trust about patients with protected characteristics. The trust provided information about the number of patients with a learning disability who had attended the department. Between September 2024 and August 2025, 1,594 patients had a learning disability flag on their record, which represented just over 1% of all attendances. The trust also collected information about the age and ethnicity of people using the service. For example, 46% of patients identified as White, 39% as Asian, 2% as Black and 13% as Other ethnic groups.

The trust had systems to support people at risk of experiencing inequitable care, including those with learning disabilities, autism, poor mental health or language needs. This included a liaison service, learning disability and autism champions and staff training. Discharge summaries and test results were shared electronically with people’s GPs to support continuity of care.

The service made reasonable adjustments to support diverse needs, including interpreter services for people with communication barriers. For those unable to access digital information, printed leaflets were available on request. Staff also signposted people and their carers to additional services such as community pharmacies and dentists.

The trust analysed hospital data to understand the characteristics of the population using the emergency department. They told us the local area had high levels of deprivation, a large number of young people under 18 and a high proportion of residents from ethnic minority groups. These factors influenced the type of services the hospital needed to provide. The trust also reviewed Friends and Family Test results to identify any concerns that required further investigation or improvement.

The trust analysed data to identify any variations in standards and timeliness of care for people with protected characteristics, such as age, ethnicity and learning disability. They also used this information to develop targeted interventions in line with local community needs.

Staff received training in equality, diversity and human rights. However, only 67% of administrative and clerical staff had completed this training. This created a risk that some staff may not always treat people in accordance with trust policies or be fully aware of their responsibilities.

The trust had appropriate policies and procedures in place and carried out equality impact assessments for new or revised policies. We saw that these assessments had been completed for all policies we reviewed during the inspection.

We scored the service as 3. The evidence showed a good standard of supporting people to plan for the future. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Patients, relatives and carers were supported to plan for important life changes so they could make informed decisions about their future, including at the end of their life. Staff told us that people on end of life care pathways were prioritised for admission to the most appropriate ward whenever possible. If a ward bed was not available, staff moved people to a private and suitable space within the department so they and those close to them had privacy during difficult and emotional times. Multi‑agency working helped ensure care for people nearing the end of their life was delivered sensitively and with dignity. When people wished to return home for their end of life care, staff worked with other agencies to facilitate this safely and as quickly as possible in line with the person’s preferred place of death.

Staff had access to the trust‑wide resuscitation policy and demonstrated a clear understanding of the trust’s do not attempt cardiopulmonary resuscitation (DNACPR) policy. This helped safeguard people from inappropriate application of DNACPR decisions. Where DNACPR orders were put in place, these were made through conversations between the patient (when possible), their family, and their health and care professionals to ensure decisions reflected what mattered to them and what was realistic in terms of treatment and outcomes.

Staff told us discussions with patients and carers about their wishes were recorded in electronic patient notes. When relevant, information about support services was shared with patients and relatives. Staff also ensured other healthcare professionals and organisations were involved in planning people’s onward care and treatment wherever possible. This included therapy and rehabilitation teams, social workers, mental health services and addiction support services. Staff could refer or redirect people to other services to help plan their future care. People were encouraged and supported to make informed choices about their care while they had capacity to do so.

Staff told us they reviewed and assessed people approaching discharge to determine whether they needed additional health or social care input from community services. This included considering whether they needed community nursing support, rehabilitation, domiciliary care or mental health services.