Hull Royal Infirmary

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to Requires Improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The current evidence showed a good standard and while improvements were made, these need to become fully embedded and sustained over time. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff survey results from 2024 showed a deteriorating picture in how senior leaders listened to staff and how they lacked confidence that their voice would be heard. During inspection we were told that the management structure at triumvirate level had changed and that all staff reported a greater confidence in raising concerns or suggestions and that they felt heard

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Senior leaders were able to articulate how their role aligned with the trust values of Purpose, Visions, Values and Strategy.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. We were given examples of how staff were given the opportunity to ask questions regarding plans for the future and the trusts overall strategy.

Staff could explain how they were working to deliver high quality care. All staff could articulate the trust values and how they fitted into delivering high levels of patient care.

Current evidence showed good standards, with improvements that need to be fully embedded and sustained. Inclusive leaders at all levels understood the care context and reflected the organisation’s culture and values. Newly appointed leaders, in post for two months, demonstrated the skills, knowledge, experience, and integrity to lead effectively.

Nursing and medical staff across the emergency department understood the key risks to patients within the department. Staff told us the emergency departmental leads and senior managers were approachable, visible, and provided them with good support.

Staff understood the reporting structures and leaders understood their key roles and responsibilities. Leaders also fully understood the key risks and challenges faced by the emergency department. Leaders were able to demonstrate how they worked as part of a multidisciplinary team within the service and how they collaborated with partners such as the local NHS ambulance trust. They told us they worked well together and there was regular engagement to review performance and identify improvements to services.

Leaders had the appropriate range of skills, knowledge, and experience to carry out their roles. There was a triumvirate leadership structure at departmental and divisional level with medical, nursing, and operational leads.

Leaders understood but did not always have resources and space to manage the priorities and issues the service faced. Capacity constraints and issues with partnership working with other specialities within the trust and across other parts of the hospital impacted on patient flow in the emergency department.

Leaders had effective support and opportunities to develop and maintain their credibility and skills. All staff had opportunities to develop including for future leadership roles. There was inclusive recruitment and succession planning. The trust had effective recruitment processes and ongoing checks to ensure all staff met the legal requirements to work in the trust.

The evidence showed a good standard and while improvements had been made, these need to become fully embedded and sustained over time. The service fostered a positive culture where people felt they could now speak up and their voice would be heard. The service was previously in breach of the legal regulation in relation to this quality statement. Improvements were found at this assessment and the service was no longer in breach of this regulation.

Staff survey results from 2024 showed a deteriorating picture in how senior leaders listened to staff and how staff lacked confidence that their voice would be heard. During inspection we were told that the management structure had at triumvirate level had changed and that all staff reported a greater confidence in raising concerns or suggestions and that they felt heard.

Leaders fostered a positive culture where people felt that they could speak up and that their voice would be heard. They were able to describe how staff reported concerns and how these were investigated, then feedback given to staff, via various forums. Leaders described an open-door policy and had an eagerness to want to help and support staff.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. We saw staff offer patients opportunities to provide feedback. We also noted that the department conducted patient surveys to provide more opportunities to seek feedback.

Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements.

The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The service promoted equality and diversity in daily work and provided opportunities for all staff to develop. Staff survey results showed that staff felt there were opportunities for career development.

Policies and processes were in place to ensure the service was inclusive and fair in the way it operated. Staff received training in equality and diversity and had a good understanding of cultural, social and religious needs of patients and demonstrated these values in their work.

Governance structures were in place but inconsistently applied and was not always used effectively. New leadership had introduced a stronger focus on governance, management and sustainability but this was yet to be fully embedded. The service was previously in breach of legal regulations in relation to governance, management and sustainability. Insufficient improvements were found at this assessment, and the service remained in breach of this regulation.

Staff had time and resources to undertake effective governance and manage risk. There was an inconsistent approach in gathering a good range of accurate and timely data which meant that information was not always available to understand and ensure that performance, quality and improvements were made as needed.

We saw a slow pace of change with issues highlighted at previous inspections such as training compliance, hand hygiene and adherence to good infection prevention and control measures. These had still not been fully addressed. We noted that changes had been introduced, and actions were ongoing, but this had not been timely.

We noted that the department held a significant amount of risk and that there was inconsistent support and escalation from other areas of the hospital.

Governance was used to learn, improve and innovate. Information held about patients was secure and protected. Staff had the strategies and guidance to respond to major incidents.

There were regular and effective meetings for safety, audit, quality, and governance. These discussed and addressed key areas of performance, risk, audit and workforce. Minutes recorded the areas of concern identified and actions were taken to learn and improve.

Monthly governance meetings were held to discuss governance, risk, and performance. Risk registers were reviewed during these meetings. The governance and reporting processes enabled leaders to understand the key risks and challenges to the service and to identify improvement actions to address key risks, such as capacity and flow issues. Processes were in place to escalate issues to the hospital leadership team, we saw evidence of effective escalation from the department to senior leaders and then to the executive team. We also noted that information was effectively disseminated from the executive level to the department.

Daily safety huddles and bed management meetings enabled sharing of information and escalation of patient risks and capacity and resource issues. Risks were discussed at safety huddles, board rounds and bed management meetings and staff and leaders were proactively managing and escalating any concerns.

Risks were captured on a divisional risk register and were rated in terms of likelihood and consequence. The trust had risk management processes which meant that risks were escalated appropriately from the emergency department up to board level when required.

Staff and leaders at all levels demonstrated a good understanding of the risks within the emergency department and the action being taken to mitigate or remove risks. We discussed the top risks for the service with the leadership team and reviewed the emergency department risk register. We saw that the main risk was that patients in department were often held in temporary escalation spaces.

Staff received feedback from incident reporting and risks during nursing huddles. We also saw examples of meeting minutes held for all grades which provided a forum for learning from incidents and risks.

There was effective workforce planning including managing major incidents or emergencies.

Good practice was recognised and celebrated.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Leaders understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. The leadership team understood how their staff felt about delivering care that met both the physical and mental health needs of patients.

Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care, such as the local NHS ambulance trust. Partners we spoke with informed us although communication between services was challenging there were no performance issues, and the teams worked well together.

The trust’s strategy aligned to local plans in the wider health and social care economy, and services were planned to meet the needs of the relevant population.

The evidence showed inconsistent standards. New leadership had introduced a stronger focus on continuous learning, innovation, and improvement but this was yet to be fully embedded. Since the changes, the service has encouraged creative approaches to promoting equality of experience, outcomes, and quality of life, and has begun to contribute more actively to safe, effective practice and research.

All senior leaders were aware of the issues that faced the department and the areas that required improvement following the previous inspection. We noted that it was only after the recent change in the triumvirate management system that the pace of change had improved.

Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery. We saw that the department had empowered staff to make changes. We saw examples of how the management of patients receiving treatment with the department had changed following the previous inspection. At the previous inspection we saw patients receiving sub-optimal care in non clinical areas with no effective oversight. At this inspection we saw designated ‘fit to sit’ areas for clinically appropriate patients to receive treatment had been introduced following staff consultation, we also noted that oversight had been remodelled and all areas had the appropriate oversight.