Doncaster Royal Infirmary

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We saw an inconsistent standard of assessing needs and completing risk assessments.

We have not awarded this service a score for Effective.

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

Evidence shows some shortfalls. The service did not always make sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs.
We reviewed 10 sets of patient notes and found that eight contained an omission or error. We saw examples of risk assessments not being fully completed or patient specific information being omitted. We saw examples such as incomplete skin integrity risk assessments, diet and hydration recording and the assessment of pain.
Following inspection, we requested any completed audits regarding risk assessments, but none were provided.
Staff developed care plans that met the needs identified during assessment. Whilst we saw omissions in the documentation, we also saw good examples of care plans being utilised.
Care plans, when completed, were personalised and holistic. We observed some staff completing care plans with patients and their families.

Evidence shows some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Staff did not consistently assess patients’ needs for food, drink, and specialist nutrition or hydration. We observed variation in how diet and hydration needs were recorded in patient notes. We requested any completed audits regarding this issue. Whilst we were provided with a harm review of those patients waiting the longest time in the department, there was no reference to diet and hydration.

Staff were aware of sepsis management, but we saw 5 examples during inspection of patients with suspected sepsis who were delayed in treatment due to issues with the prescription and administration of antibiotics.

We observed gaps in training compliance across all job roles. Staff told us that they could not complete online training or attend training if the department was busy. We also noted training being cancelled due to no staff availability.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, we spoke with specialist staff who would work collaboratively within the department, for example the frailty team consisted of specialist therapists.

Managers provided staff with supervision (meetings to discuss care management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. All nursing staff reported that they were supported by both their line and service managers.

Managers ensured that staff had access to regular team meetings. If staff were not available to attend, then senior leaders would ensure that all staff received meeting minutes by email.

Managers identified the learning needs of staff and senior staff would regularly work with staff to help them develop and improve.

Managers dealt with poor staff performance promptly and effectively. We were given examples of how poor staff performance was identified and the steps taken to support that member of staff and help them improve.

Evidence shows significant shortfalls. The service did not work well across teams to support people.

We did not observe any staff huddles that included medical and nursing staff throughout the day when patients would be discussed, and any concerns raised.

We were told by staff across all grades and roles that medical and nursing staff failed to consistently work well together. We saw very limited communication between these job roles which meant we were not assured that they supported each other to provide safe care.

Staff told us that patients who were waiting for speciality reviews following referral could experience long waits and which impacted on patient flow and delays in patients who arrived later being delayed in initial assessment.

We reviewed staff surveys for both medical and nursing staff which showed a worsening response to teamwork within the department. We saw that 78% of nursing staff and 57% of medical staff felt that working relationships were strained. We reviewed the action plan following these results and found no reference to improving teamwork and working relationships.

We only observed effective formal communication between medical staff when handing over patient care at the beginning and end of shifts. We also noted the use of a flow navigator who linked all areas of the department effectively.

Evidence shows some shortfalls. The service aspired to support people to manage their health and wellbeing to maximise their independence, choice, and control.

Staff supported patients to live healthier lives, we saw multiple posters and patient information leaflets throughout the department. Staff told us that they would discuss health promotion with patients if there was opportunity, but this wasn’t consistently available due to pressures within the department.

We did see members of the frailty team in reach into the department to provide support to those patients that had been identified as appropriate for their input.

Evidence shows some shortfalls. The service did not always consistently monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We were provided with a comprehensive local audit schedule for the next 12 months that detailed a wide range of audit topics. We reviewed audit results following inspection but were not assured of the quality due to low sample sizes and the limited information provided which did not include actions from negative results. The audits did not provide assurance that care was being consistently monitored, and the information was being used to drive improvements. We requested any ongoing or completed national level audits and whilst we were provided with audit reports we were not provided with the actual audit.

We reviewed a harm review from November 2025 that examined the care provided to the longest‑waiting patients in the department. The review confirmed that all appropriate risk assessments had been completed. However, while the assessments were marked as completed, no time of completion was recorded. This gap meant we could not be assured that the assessments were carried out at the correct and required intervals.

Staff used recognised tools to improve the detection and response to clinical deterioration in patients as a key element of patient safety and improving patient outcomes. We saw staff using a nationally recognised early warning system, but we did not see any documented action that had been undertaken following audit to ensure that all patients were monitored appropriately.

Staff used technology to support patients effectively (for example, for prompt access to blood test results).

Evidence shows an inconsistent standard. The service did not ensure all staff completed the training required, nor did it review the recording of consent within local audits.

Information provided following the inspection did not include specific compliance figures for completed Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act (MCA) training. We did see that there was a training module that referenced MCA and DOLS, but information provided showed compliance of 53% for medical staff and 64% for nursing staff.

It was not demonstrated that staff consistently gained consent from patients for their care and treatment. We observed consent being obtained but when we reviewed local audits, we found no reference to consent being audited which did not provide assurance that there was consistent compliance.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. However, due to a lack of training compliance, we could not be assured that all staff would be able to achieve this.