Hull Royal Infirmary

On this page

• 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

At our last inspection we rated this key question as Requires Improvement and remained the same at this assessment.

We found new breaches of regulation relating to complaints, Duty of Candour, and good governance, reflecting concerns about the timeliness and quality of complaint handling, and how effectively waiting times and access to care were overseen.

However, staff within medical care core service (the service) continued to provide person centred care, respond to individual needs, and work collaboratively across teams. Patients were generally positive about the support they received once admitted. These strengths demonstrated that, despite the regulatory shortfalls, frontline staff remained committed to delivering compassionate and responsive care.

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

The service ensured patients were at the centre of their care and treatment decisions, working in partnership with patients and their families to respond to changes in individual needs and preferences.

Staff understood what mattered to people and provided care that met physical, emotional, and social needs. We observed staff consistently delivering person centred care and meeting fundamental care needs.

The service could access a learning disability nurse who supported patients and provided advice and visits to clinical areas to help ensure care was tailored to individual needs. Staff used the vulnerabilities assessment tool to guide assessments, identify behaviours, and inform pathway decisions such as DoLS and supervision. A wellness questionnaire and decision matrix helped patients express how they felt each day, ensuring care remained responsive to changes in wellbeing.

Patient records were individualised and holistic, with clear recording of nutritional requirements displayed on charts. Menus met national dietary guidance and catered for medical, cultural and lifestyle needs, including diabetic and halal diets. Food and fluid intake was accurately monitored, and patients gave positive feedback about food availability and staff support.

The 2024 adult inpatient survey showed strong performance above the national average for meeting individual nutritional needs, access to food outside mealtimes, and support with eating, drinking and personal care.

Compliance with commencing VTE prophylaxis at 14 and 24 hours was variable and below the 95% target. Overall performance was generally good, and this did not detract from the person centred approach to care.

The service did not always understand the diverse health and care needs of people and their local communities, so care was not always joined up, flexible or supportive of choice and continuity.

There were areas where the service did not consistently ensure continuity and oversight of care, particularly when responsibility transferred to external providers. Staff reported challenges in coordinating care for patients living outside the local area, where differing referral criteria, documentation requirements and community capacity affected the timeliness of onward care.

However, there were examples of effective partnership working that supported more integrated care. The community frailty and therapy care group adopted a whole system approach in response to limited community capacity, working with partners to reduce avoidable admissions. The cardiovascular care group described work to improve early community intervention for patients with chronic cardiac and vascular disease to reduce avoidable readmissions.

The complex discharge team worked closely with partner organisations, including co located social workers from two ICB areas and community health services, which supported improved communication and coordination for patients with complex needs. Staff described positive examples of joint working to arrange social care packages, secure rehabilitation beds and support safe discharge for people with additional vulnerabilities, including homelessness, substance misuse and alcohol dependence.

Quality improvement discussions in December 2025 highlighted system wide actions to reduce avoidable emergency department conveyance for frail patients and care home residents. This included targeted work with care homes, frailty team reviews of care plans and ReSPECT documentation, and rollout of the “Safe to Move” assessment tool. These initiatives demonstrated emerging improvements in integrated working, although they were not yet embedded or consistent across all pathways.

The service ensured that patients and staff had access to clear, accurate and current information provided in formats that met individual needs

The trust’s 2024 inpatient survey scored 8.6/10 for patients receiving information about their condition and treatment. However, a few patients reported they had not been kept updated on timings or immediate plans.

Safety boards displayed key information, and posters with QR codes at bedsides provided access to condition specific, treatment and self-care information in multiple languages. Leaflets supported health related education, and available in multiple languages.

Staff had access to clinical guidance and standard operating procedures to support safe and consistent care delivery.

We observed dementia friendly information displayed, along with noticeboards providing guidance on pain assessment, infection control and tissue viability. Posters promoting falls prevention were visible to support the development of a “no falls” culture. Ward posters also outlined patient pathways, such as stroke care, and highlighted assessment tools and proformas to be completed, including pain assessments.

Portering services supported patient transfers to help maintain safety and continuity of care.

The service did not always keep people informed or involved when they raised complaints, and they were not consistently updated about any actions or changes made as a result. However, we did make it easy for people to raise complaints.

As of October 2025, there were 186 open complaints, including 46 overdue, and only 18% were closed within the 60 day target, resulting in a continued breach of Regulation 16 (Receiving and Acting on Complaints). Leaders acknowledged that improvement was required and reported that delays often occurred during internal quality assurance processes. Several key documents, including the complaints policy and guidance for managing correspondence, remained in draft, and a training needs analysis was underway. This meant the trust was in breach of Regulation 16 - Receiving and Acting on Complaints.

Despite these shortfalls, the service made it easy for people to share feedback and raise concerns. Patients could provide feedback through multiple routes including through the Friends and Family Test (FFT) using QR codes or paper surveys. The trust’s 2024 inpatient survey scored 8.2/10 for patients feeling able to talk to staff about worries and fears.

Wards displayed “You said, we did” noticeboards to demonstrate how feedback had been listened to and acted upon. One ward had introduced twice weekly senior nurse or sister clinics to improve communication, and some wards also offered drop in clinics to provide patients with opportunities to raise concerns or ask questions.

Feedback results were shared at governance meetings, and leaders planned improvements through targeted communication training, co‑produced action plans and real time feedback mechanisms. Wards shared positive examples of learning from complaints, supported by ward level action plans and quality improvement workstreams. Posters explained how to contact the trust’s Patient Advice and Liaison Service (PALS).

Waiting times from referral to treatment, and arrangements to admit, treat and discharge patients, were not consistently in line with national standards and showed limited improvement. However, once admitted, patients generally received appropriate care.

The trust was in the lowest performing national segment (Segment 4) for Tier 1 cancer delivery. Only 54% of urgent cancer referrals received a definitive diagnosis within 28 days, ranking the trust 118 out of 118 providers.

Seventy four percent of patients received first treatment within 31 days, and only 51% within 62 days, ranking the trust 116 out of 118. None of the cancer standards met the 75% target, and performance continued to deteriorate. NHS England undertook a national support visit to review cancer pathways, including diagnostics and endoscopy capacity.

The trust continued to fall short of the national Referral to Treatment (RTT) standard of 92%, with only 57% of patients treated within 18 weeks, ranking 106 out of 131 trusts. Four percent of patients waited more than 52 weeks, ranking 118th nationally. Performance declined across both measures, and the trust ranked 107th for the gap between planned and actual 18 week delivery. The medicine care group had completed sprint programmes to support waiting list validation.

This constituted a breach of regulatory requirements of Regulation 17 – Good Governance, as further work was needed to achieve consistent, equitable and timely access to care.

The trust’s six week diagnostic performance was 26% in June 2025, remaining well below the national standard.

Bed occupancy levels at HRI were consistently over 95% over the last few months, and on a number of occasions were in excess of 98%, both well over the recommended levels of ~85%. This reflected sustained flow constraints, significant cohort of long stay patients, reducing the availability of beds for new admissions and contributing to inequitable access to timely care.

The endoscopy ward 10 and endoscopy unit at Castle Hill Hospital operated as a single service. Weekly capacity meetings ensured available slots were used, with unused capacity offered to bowel screening.

The 30 day readmission rate to medical wards was 12%, which is higher than the national average of around 6 to 7%. The trust reported work with the GIRFT team across five flow workstreams, including one focused on understanding readmission reasons and identifying improvements. While this work was ongoing, care groups were progressing actions through the wider trust flow programme to improve patient flow, reduce delays and support timely, equitable access to care.

Staff and leaders actively listened to feedback and information from people at risk of inequality and tailored care and support accordingly.

The clinical strategy recognised that a significant proportion of the local population lived in areas of high deprivation, with poorer health outcomes and barriers to accessing care. These included rural and coastal geography, digital poverty, low health literacy, and increasing acuity and complexity. Leaders demonstrated a clear understanding of how these factors contributed to health inequity.

The strategy set out a whole system, equity focussed approach, aligned with national policy, with a focus on early intervention, prevention, self-management and delivering more care closer to home to improve population health and reduce avoidable admissions.

Future plans focused on expanding community and home based care, developing new models of delivery and supporting effective delivery of “Neighbourhood Health provisions”. Leaders recognised and responded to barriers such as digital exclusion, low literacy, and social isolation, ensuring care was accessible, personalised and compassionate.

Compliance with equality, diversity, inclusion and human rights training was strong overall, with most care groups meeting or exceeding the 85% target. Two care groups fell slightly below the threshold, but performance remained close to target, demonstrating a broadly positive organisational commitment to inclusive and equitable care.

The service supported patients to plan for important life changes, so they have time, information and support to make informed decisions, including at end of life.

Relevant healthcare professionals and partner services were actively involved in care planning, particularly for patients with complex needs. The executive team commended staff for their effective joint working in managing a complex patient case.

Palliative care and discharge liaison teams supported personalised planning, and staff reported easy access to specialist support, including Macmillan nurses, cancer support workers and specialist palliative care teams.

Staff had access to bereavement packs, and the Haven services provided pastoral and spiritual care support to patients, families, and staff and organised a walking meditation workshop in October 2025.

End of life care was delivered sensitively and with dignity, with access to practical support such as refreshments for families.

ReSPECT training compliance was strong across care groups, with most meeting or exceeding the 85% trust target. Overall, the data reflected a positive organisational commitment to ensuring staff were trained to support personalised emergency care planning. However, locally mandated ReSPECT training had not been offered consistently across all nursing staff groups. Leaders explained the local context for this variation and confirmed they would review the need to extend training to these staff groups.