Hull Royal Infirmary

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• 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 inspection we rated this key question as requires improvement and this rating improved to good at this assessment. This meant care was effective, evidence based and consistently delivered to a good standard.

Staff within the medical care core service (the service) assessed, monitored, and reviewed patients’ needs reliably, worked collaboratively across disciplines, and used national guidance and recognised clinical tools to support safe and effective decision making. Patients received care and treatment that promoted recovery, independence, and a good quality of life.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

Staff ensured patients received effective care and treatment through assessment and regular review of their health, wellbeing, and communication needs.

Care records and personalised treatment plans were clearly documented following admission and kept up to date to reflect identified needs.

Patients and relatives reported feeling involved in decisions about their care and were aware of their treatment plan.

Records showed venous thromboembolism (VTE) risk assessments were completed consistently. However, audit compliance with VTE prophylaxis at 14 and 24 hours was variable and below the 95% target for some areas. Data quality concerns were addressed through a revised dashboard, and a group wide VTE improvement programme launched in February 2025 indicated some improvement.

Patient needs were clearly displayed on visual boards, including indicators for falls risk, skin integrity, dementia, and nutrition, supporting safe and individualised care. Staff used recognised symbols, such as the butterfly symbol for dementia.

Staff consistently used risk assessment tools effectively, with clinical risk assessments typically completed within six hours of admission. Daily nursing handovers included discussion of risks, and care plans were adjusted as needs changed and onward referrals completed where required. Managers were able to implement enhanced observations to maintain patient safety.

Patient records demonstrated that nutritional needs were accurately assessed and monitored using detailed food and fluid charts.

Staff planned and delivered care and treatment in line with current legislation, evidence based practice, and national standards ensuring safe, effective, and person centred care.

Staff had access to up to date clinical pathways aligned with national guidance, and key clinical documentation, risk assessment templates and visual prompts were displayed across wards to support consistent practice.

Staff had access to recognised assessment and screening tools, including the National Early Warning Score (NEWS2) to identify and respond to deterioration, the Malnutrition Universal Screening Tool (MUST), venous thromboembolism (VTE) risk assessments, falls risk assessments and pain assessment tools to support safe clinical decision making. However, we found compliance with risk assessments varied within the service.

NICE actions were complete, and policies were within review dates, providing assurance that care was informed by current evidence; for example, the recognition and response to the deteriorating patient policy was updated in November 2025.

Care records consistently demonstrated clear documentation of assessment, evaluation and care planning. Staff assessed and managed pain appropriately in line with national guidance and individual need. A clear escalation policy for deteriorating patients was in place, and managers could deploy enhanced one to one observation in line with risk management policies. Environmental risk assessments were completed.

Staff upheld the rights of patients subject to the Mental Health Act and made timely referrals to the Mental Health Liaison Team when required.

A multidisciplinary audit approach supported national audit submissions, identified good practice and informed learning responses and improvement action plans.

Staff worked well across teams and services to support patients and shared information effectively when patients moved between services.

We observed effective multidisciplinary collaboration across all areas we visited.

Communication and coordination between staff of all roles and grades were strong, and patient information was shared promptly to support continuity of care. Staff spoke positively about the culture of teamwork and collaborative working.

Managers held regular multidisciplinary team meetings, promoting shared learning and joint decision making. Attendance at handovers, nurse safety huddles and ward rounds varied appropriately by speciality, ensuring the right staff were present. Multidisciplinary input included medical staff, therapists, advanced clinical practitioners, students, pharmacists and healthcare assistants, with additional input from both community and ward based stroke specialists on the hyper acute stroke unit.

Staff in the endoscopy service within the digestive diseases care group worked across both Hull Royal Infirmary and Castle Hill Hospital, attending multidisciplinary meetings at each site as part of their rotation.

Staff supported patients effectively to manage their health and wellbeing promoting healthy lifestyles and providing practical advice to encourage recovery and independence.

Specialist nurses visited wards regularly, offering condition specific guidance and tailored support, including education on disease management, safe medication use and lifestyle changes to promote long term wellbeing.

The Haven provided pastoral and spiritual care for staff and patients and hosted wellbeing activities such as walking meditation workshops. An alcohol care team worked to improve care for patients with alcohol use disorders and delivered staff training on screening and managing alcohol withdrawal.

During our inspection, flu vaccinations were being offered by two nurses visiting wards, supported by ‘Stay strong, get vaccinated’ messaging displayed throughout the hospital.

A weight management programme (Fit4Life) was available through the hospital, offering personalised support, group motivation and education on healthy eating and physical activity to prevent long term health complications. People were also given opportunities to discuss wellbeing with hospital staff, including smoking cessation, lifestyle choices, prevention of serious illness and cancer screening.

A wide range of patient information materials was available on the trust website, including multi language options. Leaflets, posters and display boards across wards promoted healthy living and signposted patients to local and national support services and charities.

The service routinely monitored patient care and treatment to ensure outcomes were positive, consistent and aligned with clinical standards and patient expectations, despite some variation in audit performance. Staff used audit results, incident data and patient feedback to identify areas for development and drive continuous improvement.

Staff participated in national clinical audits, with performance benchmarked through the Healthcare Quality Improvement Partnership (HQIP).

The 2024 Chronic Obstructive Pulmonary Disease Audit showed good performance in key safety and access measures. A high proportion of patients were reviewed by the respiratory team within 24 hours, and compliance with oxygen prescribing standards exceeded national averages. However, performance was weaker in preventive and diagnostic elements, with low rates of smoking cessation pharmacotherapy and limited documentation of spirometry confirmation compared with national benchmarks.

Findings from the National Audit for Dementia indicated low performance across patient and carer experience and core assessment measures, with all indicators falling within the bottom 25% nationally. Carer satisfaction with overall care was particularly low, suggesting carers did not feel sufficiently supported or involved. Compliance with initial delirium and pain assessments remained below national averages, although pain assessment had improved compared with the previous year.

In the 2024 National Respiratory Audit Programme Adult Asthma audit, 67% of patients admitted with an asthma attack were reviewed by a respiratory specialist within 24 hours. This placed the service in the top 25% nationally and above the national average of 48%, demonstrating timely access to specialist expertise.

The trust also participated in the quarterly Sentinel Stroke National Audit Programme (SSNAP). Hull Royal Infirmary, as a routinely admitting team, performed favourably in the first three domains relating to early treatment and assessment for April to June 2025. This included high proportions of patients assessed by a stroke skilled clinician (73% team centred, 74% patient centred) and by a nurse trained in stroke management (86%). Performance was less favourable in discharge related domains, particularly team centred measures, with lower percentages of patients receiving assessments from psychologists, orthoptists and vision services.

The Commitment to Excellence (ACE) programme, introduced in March 2025 to standardise ward based quality assurance, had only included several medical wards at the time of the assessment. All audited wards demonstrated moderate to high compliance with infection prevention and control and environmental standards. However, the programme was paused after six months, providing limited assurance across all wards. To maintain oversight, the trust introduced interim point prevalence audits, which demonstrated high compliance with routine assurance processes, alongside monthly resuscitation equipment checks, infection prevention audits and hand hygiene audits.

Managers undertook regular clinical and environmental audits with clear oversight of actions, named leads and progress monitoring. However, matron audits were not always consistently completed.

Staff supported patients to make informed decisions and followed national guidance to gain consent. They demonstrated a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), acting in patients’ best interests where capacity was lacking, and taking into account the person’s wishes, feelings, culture, and history.

Consent was clearly documented in care records. MCA assessments, DoLS applications, and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were completed accurately and reviewed in line with national guidance.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. We observed staff respectfully asking for verbal consent prior to providing patient care and observed positive shared decision making with patients usually providing verbal consent before examinations, treatments, or personal care.

The hospital used IMCA (Independent Mental Capacity Advocate) when additional support was needed for patients to make their own decisions about onward care.

Training compliance for the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) was generally high for nursing staff, who met or exceeded the trust’s 85% target. However, compliance among medical staff was moderate and did not meet the target. Compliance for allied health professionals across some care groups was also unclear due to incomplete data or training gaps, meaning the trust could not fully demonstrate that all relevant staff had received the required training.

Compliance with the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms was generally high across staff groups.