Hull Royal Infirmary

On this page

• 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

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

We identified a breach of Regulation 20 relating to good governance, reflecting ongoing weaknesses in the consistency and maturity of governance arrangements. Key systems and processes were not yet fully embedded, and leaders did not always have reliable oversight of risks, incidents, performance, complaints, or data quality. These gaps limited the trust’s ability to provide assurance and to respond effectively to emerging risks.

Despite these shortfalls, we found evidence of an inclusive and compassionate culture, with many leaders demonstrating strong values, supporting staff, and promoting learning and improvement. Staff within the medical care core service (the service) described positive teamwork, a shared commitment to patient care, and increasing collaboration across the wider health and care system.

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

There was a shared vision, clear strategy, and positive culture. This was underpinned by a clinical strategy and framework that promoted equity, equality and human rights, diversity and inclusion, and staff engagement. Senior and care group leaders demonstrated a good understanding of patient needs and local community challenges.

The group strategic framework was values led and patient focused, supporting population health, safe and high quality care, and a positive patient experience.

Leaders supported and developed staff so they felt valued and proud to work in the service, while targeting services to reduce health inequalities. Innovation, partnership working and responsible resource use supported sustainable care.

A complementary group clinical strategy set out a clear five year vision, enabling services to respond to changing population needs, policy requirements and technology advances. It provided a framework for sustainable care models, digital and estate investment, workforce planning and efficient use of resources demonstrating strong leadership and forward planning.

Each care group had developed a one page clinical service strategy aligned to the group framework.

Examples included.

• Specialist Medicine’s focus on new technologies and innovation such as remote monitoring and the expansion of virtual wards beyond respiratory services, alongside strengthening care for people with long term conditions in primary care and streamlining outpatient pathways.
• Neurosciences priorities included improving outcomes through advanced technologies, enhancing stroke and long term neurological care, streamlining pathways, and developing research and collaborative working across the ICS and regional networks.
• Cardiology priorities included managing referrals through Advice and Refer/Connected Health Networks, increasing community based outpatient care, reinstating the academic cardiology department, developing vascular wound healing research, and expanding minimally invasive cardiac surgery.

There had been significant senior leadership changes over the previous 18 months, with several leaders new in post. As a result, leadership approaches, expectations, and behaviours were still embedding and consistent, inclusive, and values based leadership was not yet fully established.

This was supported by evidence from meeting minutes, staff interviews, and governance documents. Quality improvement group minutes highlighted multiple executive and senior care group changes, reflecting a prolonged period of operational transition.

Staff across several wards described confusion associated with interim leadership arrangements, frequent leadership changes and a lack of clarity around roles and responsibilities.

Ward managers and matrons were consistently visible and approachable. Staff reported feeling well supported by their immediate line managers, who were accessible and responsive to day to day concerns. However, many staff reported limited visibility of leaders at Band 8a and above, and some were unclear about the composition of the senior leadership team, which they felt made communication and engagement more difficult.

Leaders acknowledged that physical visibility was challenging due to limited senior leadership capacity across a large geographical area, although they stated that active communication channels with ward teams were in place. Care group leaders described actions to improve leadership visibility, including regular ward visits, ‘back to the floor’ sessions, ward walkabouts, staff engagement forums and coordinated leadership presence across sites. Service leads confirmed they had a presence across all sites and visited ward areas to support escalation.

Despite these challenges, there was evidence of positive leadership practice. The trust’s 2024 staff survey reported a generally positive score for compassionate leadership, indicating a supportive culture.

Staff had a clear understanding of their roles, responsibilities and reporting arrangements within their wards. The community, frailty and therapy care group actively invited staff to attend senior leadership meetings to present patient stories, ensuring frontline experiences directly informed senior decision making and improvement work. Leadership photo boards were used on some wards to improve staff awareness.

There was also evidence of leadership support for workforce development, including succession planning such as supporting medical staff into consultant roles, leadership study days, specialist training pathways and educator led development programmes.

Staff did not always feel confident to raise concerns because they did not always receive feedback or responses when they did speak up.

Some staff told us they felt fearful about challenging decisions, particularly relating to the use of the discharge lounge particularly overnight, where it was perceived to be used to manage emergency department pressures.

Staff reported that uncertainty about the long term future of areas they worked in, alongside recent leadership changes, and frequent redeployment to backfill staff shortages had negatively affected morale and wellbeing.

However, there were some positive aspects of the freedom to speak up culture. Staff had access to the trust’s Freedom to Speak Up (FTSU) Guardian and local champions.

The trust reported a range of communication methods were used to promote the FTSU offer, including social media, emails, posters, drop ins and tea trolley events. Staff provided good feedback and resolutions on concerns raised. Quarterly FTSU reports were provided to the board, with relevant data, themes and trends disseminated to care groups and the human resources team. The FTSU team received the trust’s “Golden Stars award”.

Additional support was available including Trauma Risk Management (TRiM) providing peer support following potentially traumatic events. This service was accessible via telephone, email or QR code, supporting staff wellbeing and timely access to support.

The trust encouraged staff to share their views through multiple feedback routes, including the annual staff survey and quarterly pulse check surveys. The 2024 staff survey scores for feeling able to speak up and being listened to were in line with national averages, although some measures were lower, indicating areas for improvement.

Senior leaders had implemented a targeted engagement campaign to improve staff survey participation to at least 60% ahead of the next survey, and services worked with HR business partners to address identified themes and strengthen staff engagement.

Staff actively promoted equality, diversity, and inclusion in daily operations, ensuring all staff had fair opportunities to develop and progress. Policies and processes supported an inclusive, respectful, and safe working environment.

Staff were able to access flexible working arrangements, including flexible hours and job sharing, to support personal circumstances such as caring responsibilities and health needs.

Managers consistently implemented reasonable adjustments, including modified shift patterns and occupational health support. The trust’s “Reach” initiative enabled staff to request workplace adjustments easily.

The trust’s 2024 staff survey recorded a high trust wide score for diversity and equality (8.1/10) and a positive score for inclusion (6.6/10).

The trust had active staff networks, including BAME, Disability and LGBTQIA+ groups, which provided peer support and raised awareness of diverse needs. Equality and diversity champions supported inclusive practice across clinical areas and visible signage across the hospital reinforced zero tolerance to racism, with QR codes enabling staff to report concerns.

The trust also recognised cultural and religious diversity by acknowledging events such as Black History Month, supporting a diverse international workforce, and sharing bulletins to mark key festive holidays.

Governance and accountability arrangements were poorly embedded, resulting in variable oversight, unclear leadership responsibility and inconsistent management of risks and performance across care groups. Leaders did not routinely use reliable information on risk, performance and outcomes to provide assurance or drive improvement. These failings represented continued and significant breaches of Regulation 17 (Good governance).

The service operated across multiple care groups within the Humber Health Partnership group model with a shared executive team, shared non-executive director (NED)’s which met as a joint board for the two statutory organisations. Fourteen care groups had been established. The medicine wards we assessed sat across several care groups.

While formal governance structures existed, they were not operating effectively, and oversight was variable and fragmented across care groups. The group governance model had not been sufficiently embedded, resulting in inconsistent processes, unclear leadership accountability and variation in how risks and performance were managed.

A 2025 governance audit provided limited assurance, identifying inconsistent processes, unclear roles and variable engagement. Not all care groups had a designated clinical governance lead. Support services and enabling systems also operated differently across the two trusts, further increasing inconsistency and risk.

Staff described confusion about governance structures, inconsistent meetings and limited clinical effectiveness oversight. Some governance forums were newly established and not yet effective, limiting their ability to identify or address risks.

There were ongoing risks to safe systems and patient flow, with inappropriate patient placement, prolonged stays in short stay and discharge areas, and variable safety in escalation spaces. Flow pressures were worsened by high numbers of patients with no criteria to reside, reduced community capacity and internal pressures from ward closures. SDEC beds were used overnight for AMU patients, reducing next day capacity and delaying assessment in the emergency department, with no clear evidence of timely action.

Governance processes for staffing and training were not effective, with unreliable escalation of staffing risks, frequent redeployment and poor consideration of acuity and boarded patients. Workforce pressures, including high sickness, turnover and reliance on temporary staff. Significant gaps in mandatory and role specific training meant staff were not consistently equipped for safe care. Recruitment challenges in acute medicine reduced senior cover and affected flow and performance, while therapy staffing shortfalls in stroke and neurology led to delayed assessments, reduced rehabilitation and prolonged stays.

Policies and procedures were not consistently current or applied, with key complaints and concerns policies still awaiting approval. Oversight of complaints remained ineffective, with a sustained backlog and poor compliance with response timeframes, representing continued non-compliance with Regulation 16. Duty of Candour oversight was also weak, with variable compliance and missed statutory requirements, resulting in continued non-compliance with Regulation 20.

Risk management arrangements were ineffective. The transition to a new risk system resulted in overdue reviews, missing target dates and inaccurate registers, limiting assurance. Significant risks included lack of piped oxygen on a digestive diseases ward, a backlog of untyped cardiology clinic letters, insufficient haemodialysis capacity, unreliable neurology call bell systems and increased acuity without aligned staffing. Moderate risks included the potential loss of the seven day inpatient DSN service.

Provision for patients with learning disabilities and autism was insufficient, with only one adult LD nurse covering Hull and no provision for East Riding or children, creating safety and safeguarding risks and reduced compliance with national standards.

Leaders acknowledged significant infrastructure and digital weaknesses, including ageing estates, outdated equipment and poor interoperability, leading to duplication and ineffective information sharing. Performance dashboards were available but data accuracy and reliability were inconsistent, limiting effective oversight. Staff raised concerns about the reliability of performance data, including VTE and NEWS reporting. While dashboards had been revised, these improvements had not yet translated into consistent, effective oversight.

Audit processes did not consistently lead to improvement, with some wards failing to identify or implement required actions.

Oversight of referral to treatment times and patient flow was ineffective, with performance not consistently meeting national standards.

Although some governance processes were in place, including standardised minute templates, business continuity planning in some areas and the introduction of PSIRF, these were not consistently embedded or effective. Overall, governance systems did not provide sufficient assurance or mitigate the widespread failures identified. Further work was required to ensure these systems were fully embedded into routine practice.

Leaders and staff demonstrated a clear understanding of their responsibility to work collaboratively across the local health and care system and actively engaged with community stakeholders, commissioners and partner organisations to improve patient pathways.

Staff promoted coordinated care and effective communication with local authorities, social services, integrated neighbourhood teams and ambulance services. The complex discharge team worked closely with partner organisations, co‑locating with social workers from two different ICB areas and community health services, which supported strong working relationships and effective networking across a wider geographical area.

Staff described positive examples of joint working with specialist services such as the alcohol care team and homeless teams, and provided training to ward staff on discharge processes, including differing documentation and referral criteria across ICBs.

Care group strategies focused on strengthening partnerships with community, health, social care and voluntary sector organisations. Leaders aimed to learn from community practice and develop better joint approaches for early intervention, prevention and improved pathways in the acute setting. Quality improvement group discussions in December 2025 highlighted system wide actions to reduce avoidable emergency department conveyance for care home residents and frail patients, demonstrating collaborative planning across the system.

The care group reported strong partnership working with Hull University to support continuing professional development (CPD), including co‑development of a non-medical prescribing course. Safeguarding staff maintained strong partnerships with local authorities and police and were supported by Humber Foundation Trust for mental health expertise.

Staff and leaders focused on continuous learning, innovation and improvement, and were committed to developing new and creative ways to improve patient experience, outcomes and quality of life.

Several wards and services participated in national audits, and there were multiple examples of innovation and quality improvement across care groups. Within specialist medicine, the service secured external NHSE funding to implement a COPD specific quality improvement programme and was recognised nationally for its work in this area. The care group also engaged in the HHP Flow Programme and worked with UEC GIRFT to lead improvement across urgent and emergency care pathways.

Within cardiovascular services, quality improvement projects strengthened VTE prevention and the recognition of deteriorating patients, with plans for wider roll out. The Abdominal Aortic Aneurysm (AAA) screening programme had undergone a successful turnaround and was now meeting national quality and performance standards following service review and investment.

The community, frailty and therapy care group demonstrated active learning and improvement, including projects informed by PALS and complaints, and continued in reach work to the emergency department to reduce avoidable admissions. Following the assessment, leaders in the specialist medicine care group introduced a monthly newsletter to provide staff with feedback on governance issues and improvement activity.