Cumberland 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 changed to requires improvement.

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 observed staff trying to give the best care they could in an environment that did not support privacy and dignity and was overcrowded.

We witnessed staff delivering kind, calm and compassionate care in challenging circumstances and most patients provided positive feedback about the care they received.

The service was in breach of the legal regulation relating to dignity and respect, and person centered care.

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.

2. The service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity.

Patients were being cared for in temporary escalation spaces in the emergency department due to the high volume of patients requiring emergency care. These were spaces that were not normally designated clinical space and lacked privacy screens and call bells, staff told us this was a regular occurrence. We observed that sensitive conversations between staff and patients could be overheard during our assessment. Patients were also having personal care behind portable screens giving limited privacy. Staff were unable to protect patient’s privacy and dignity within the constraints of the environment and the number of patients entering the department.

The department had dedicated facilities to support patients and relatives at difficult times. A private relatives’ room was available for families requiring a quiet space for sensitive discussions, receiving difficult news or grieving. A separate viewing room was also available to support relatives following the death of a patient. These facilities helped promote privacy, dignity and compassionate care.

We saw staff sourcing privacy screens from other areas of the department, however these were often shared with other areas.

Patients we spoke with told us they felt cared for. We observed housekeeping staff supporting clinical staff to provide refreshments when needed.

The Paediatric Emergency Department (PED) was quiet during our assessment, parents of children told us they had received good care.

SDEC had single cubicles and staff were able to provide privacy and dignity for patients.

2. The service did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. Staff did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Patient records did not demonstrate consistent personalised care planning to support individual patient needs, preferences and circumstances. We observed that there were routinely no care plans for patients experiencing prolonged stays within the department. However, patients were generally involved in discussions about their care and treatment, and staff communicated verbally with patients regarding their ongoing management and care needs.

Information to support patients was not routinely available in a range of languages within the department. However, staff had access to interpreter services, including British Sign Language (BSL) interpreters, to support communication with patients whose first language was not English or who had communication needs. This helped to ensure patients could be involved in decisions about their care and treatment.

Staff advised that food and refreshments were provided in accordance with patients' individual dietary requirements, including allergies, cultural requirements and specific dietary needs. However, these considerations were not consistently documented within patient records and there were examples of incidents which highlighted not meeting individual patient needs.

3. 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

Staff demonstrated a commitment to involving patients in decisions about their care and treatment. Examples were seen where staff supported patients to participate in decision-making. For example, therapy staff worked collaboratively with patients who had limited mobility to support safe and timely discharge planning, taking account of patients’ individual circumstances and preferences.

Staff communicated with patients in a respectful and accessible manner. Information was explained in ways patients could understand, and staff avoided the unnecessary use of medical jargon or abbreviations. Communication aids were used when required to support understanding and engagement, helping patients to participate in discussions about their care and treatment.

Staff received training to support the needs of patients who required additional support. Trust data showed that 90% of staff had completed learning disability training and 88% had completed dementia training. This helped staff to recognise and respond to the needs of people with cognitive impairment, dementia, learning disabilities and other vulnerabilities, supporting more personalised and inclusive care.

2. 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.

Staff worked hard to respond to patients’ needs in a timely manner and demonstrated a commitment to providing care despite the operational challenges. However, pressures within the department, and use of temporary escalation spaces meant that timely responses were not always possible.

Audit data relating to pain management indicated that pain relief reviews were not consistently completed in line with expected standards. Results showed that approximately 50% of patients included within the audit did not receive a documented pain review within the required timescales. However, patients we spoke with during the assessment generally reported that they had received pain relief when needed.

There was limited evidence that patients’ comfort, safety and wellbeing were being monitored proactively and at regular intervals. During the follow-up visit in March 2026, patient records demonstrated improved documentation of comfort and wellbeing, indicating that steps had been taken to strengthen oversight of patients’ ongoing needs.

Despite these improvements, we observed delays in responding to some patients due to the sustained pressures within the department. Patients occasionally waited for assistance with personal care and other support needs while staff managed competing clinical priorities.

3. The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

Staff described feeling well supported by their immediate managers and reported having good access to education, training and professional development opportunities. A range of wellbeing support services was available, including an online wellbeing platform, occupational health services and access to counselling through the trust’s psychology team.

Staff spoke positively about team working within the department and described a supportive culture among colleagues. They reported strong working relationships across staff groups, with little sense of hierarchy and a culture in which team members felt valued and respected. However, some staff felt that support from the wider organisation was less evident, particularly during periods of sustained operational pressure. Staff reported that additional support was not always available when demand within the department was at its highest.

Support arrangements were in place following traumatic events and incidents. Staff working in both the emergency department and paediatric emergency department described participating in immediate ‘hot debriefs’ following incidents, with more detailed ‘cold debriefs’ taking place at a later stage to support reflection and learning. The clinical educator was trained in Trauma Risk Management (TRiM) and facilitated debrief sessions for staff. Access to psychological support services was available when required, helping to support staff wellbeing following challenging events.

The paediatric emergency department participated in safeguarding supervision arrangements and received additional support from the wider paediatric team. This provided opportunities for reflection, discussion of safeguarding concerns and ongoing professional support.

Staff provided positive feedback regarding the visibility and engagement of the interim Chief Executive Officer (CEO). They reported that the CEO had taken time to understand the challenges facing the department and listened to concerns raised by staff.

Despite the wellbeing initiatives and support available, concerns remained about the impact of sustained operational pressures on staff wellbeing. Staff described stress and fatigue associated with high demand, workforce shortages and overcrowding within the department. Staff recognised that they and their colleagues were at risk of burnout. This was consistent with findings from the 2025 NHS Staff Survey. The division scored 5 compared with 6 for the rest of the organisation for the People Promise theme “we are safe and healthy”, where a higher score is better. This reflected concerns about workload pressures and their impact on staff wellbeing.