Castle Hill Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

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

There were several areas within the medical care core service where systems and processes for ensuring safe care and treatment were not fully effective. These combined issues increased the risk of avoidable harm to patients and resulted in ongoing shortfalls relating to staffing, as well as new concerns regarding governance, safe care, and treatment standards.

There was very low compliance with timely observations, sepsis screening and escalation, combined with unreliable blood culture processing, which created risks of missed organisms, inappropriate antimicrobial prescribing, delays and unreliable sample assessment. This meant patients with suspected sepsis were not reliably identified or monitored, constituting a breach of Regulation 12 (Safe Care and Treatment).

Falls training compliance was low, and there was no evidence that allied health professionals had been offered falls-related training, meaning the trust could not be assured staff had the skills required to prevent and manage falls safely. This constituted a breach of Regulation 12 (Safe Care and Treatment).

Fire safety management was inconsistent, with wedged fire doors, unresolved fire safety defects, insufficient fire warden cover, and incomplete fire training and drills. These failings meant the trust could not be assured patients could be safely evacuated in an emergency, constituting a further breach of Regulation 12 (Safe Care and Treatment).

There were continued shortfalls in staffing levels, training and professional support, meaning the service could not consistently ensure sufficient numbers of suitably qualified and competent staff. This demonstrated ongoing non-compliance with Regulation 18 (Staffing).

Duty of Candour requirements were not consistently met, with delays and omissions in written apologies and feedback following incidents. While staff understood Duty of Candour principles and communicated openly with patients and families, compliance was not reliable, resulting in a breach of Regulation 20 (Duty of Candour).

We have not awarded this service a score for Safe.

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

Learning was not consistently supported by timely and compliant Duty of Candour processes, and statutory requirements were not always enacted, with overall compliance remaining below the expected standard. However, staff demonstrated a good understanding of incident reporting and described examples of open communication with patients and families following incidents.

Trust‑wide compliance with Duty of Candour was 35% for verbal and written apologies and feedback following moderate or above harm incidents. Although up‑to‑date data was unavailable in October 2025 due to a system change, June 2025 data demonstrated significant variation across care groups.

• Compliance within specialist cancer and support services was 27%, and although performance had improved by January 2026, outstanding actions remained, including verbal and written apologies and feedback letters.
• Within cardiovascular services, compliance was 74%, with several apologies and feedback letters still outstanding in January 2026.
• The community, frailty and therapy care group reported 96% compliance; however, incidents remained open and some responses were overdue, reducing assurance of timely completion.

These failures meant that patients and families were not consistently informed in a timely way, and written apologies and feedback were not always provided, resulting in a breach of Regulation 20 (Duty of Candour). In response, from October 2025 the trust introduced a requirement for mandatory completion of verbal and written apologies and feedback before Duty of Candour forms could be submitted.

Despite these shortfalls, there were strengths in the learning culture at ward level. Staff understood which incidents to report and were confident in doing so. They shared examples of incidents relating to falls and pressure ulcers, and we saw evidence of learning leading to improvement, including measures to reduce overnight movement for patients at risk of falls.

Staff demonstrated a good understanding of Duty of Candour principles, and incidents were reviewed through established governance processes. Managers encouraged staff to review investigation reports, and learning was shared through emails, team meetings, daily safety briefings and safety huddles. Consultants shared immediate learning with nursing and medical staff to support prompt improvement.

Ward meeting minutes demonstrated a focus on learning and improvement, with examples of sustained changes to practice, including the introduction of checklists, purchase of new equipment and environmental adjustments to reduce falls risk.

The trust had transitioned to a new electronic system for managing incidents, complaints and PALS, intended to strengthen reporting, integration and consistency across care groups. However, system changes had contributed to gaps in oversight, particularly in relation to Duty of Candour assurance.

Staff consistently operated effective systems that supported safe, coordinated care and continuity across pathways and transitions. Staff worked collaboratively with patients, relatives, and healthcare partners to maintain safety during admissions, transfers, and discharges between wards, units, and hospital sites.

Staff followed clear and established protocols, including standard operating procedures (SOPs), to support safe and effective patient flow.

During periods of high operational pressure, staff implemented the continuous flow model, “Planning for Tomorrow Today,” and applied the Humber Health Partnership Temporary Escalation Space (TES) standard operating procedure to maintain safe and timely movement of patients into, through and out of the wards.

Transfers from the emergency department and assessment areas onto wards for medical patients were managed consistently with bed allocation coordinated using real time availability, ward intake profiles and full visibility of expected and confirmed admissions across the site.

Daily safety briefings, ward rounds, and board rounds were structured and reliable, giving teams oversight of bed occupancy, admissions, transfers, and discharge planning. These processes were well understood and generally worked effectively in practice to support continuity of care and maintain flow. Most staff told us these systems worked well and gave examples of effective coordination.

We observed multiple examples of well-functioning pathways with some examples below.

• Oncology teams described good patient flow, supported by multiple access routes including the patient flow team and triage. Staff expedited scans, escalated concerns and liaised with on call teams to ensure patients were directed to the correct pathway. Staff reported that paramedics and outpatient staff could refer patients directly to the unit.
• Staff from the infectious disease ward described safe admission pathways for patients with complex infections, including antimicrobial resistant infections, tuberculosis, HIV, and those returning from abroad to ensure timely and appropriate specialist review.

We observed effective and comprehensive handovers and safety checks that addressed all aspects of patients’ needs. For example.

• In the catheter lab staff used “safer nurse” handover sheets and an adapted ISOBAR framework (Identify, Situation, Observation, Background, Agreed plan, Read back), alongside the World Health Organization (WHO) checklist and safety huddles, to ensure safe and thorough communication.

Systems to support safe and timely discharge were well developed. The site team maintained clear oversight of confirmed and potential discharges, supported by twice daily reviews from the discharge management team. Ward based discharge liaison officers, therapy teams and the patient flow team worked collaboratively with community partners to promote safe and timely discharge, support rehabilitation, and continuity of care, helping to reduce the risk of readmission.

An effective discharge checklist supported safe transfers of care and medical staff also liaised with community professionals, including GPs, district nurses, and community pharmacies, to facilitate safe discharge arrangements. Patient discharge assistants (PDAs) supported timely discharge by engaging with families, ensuring equipment was in place, and confirming therapy reviews were completed. However, PDA’s were not consistently available across all wards, which limited the effectiveness of this support in some areas. Staff also made effective use of the trust’s own ambulance transport service to facilitate safe transfers of care.

Patient experience indicators reflected good performance. The 2024 trust wide adult inpatient survey scored 8.7/10 for patients reporting they did not wait long for a hospital bed, and patients we spoke with described overnight transfers as smooth and well managed. Staff reported that patients requiring urgent treatment after discharge were transferred directly back to the referring ward rather than being conveyed to the emergency department.

However, the service continued to experience sustained pressure from medical outliers, defined as medical patients cared for on non-medical wards, with specialty medical consultants maintaining oversight of treatment plans.

Staff caring for medical outliers reported difficulty contacting the on‑call specialty consultant or medical doctors via the switchboard, despite an agreed escalation process. We escalated this issue to senior leaders following the assessment, and immediate action was taken through issuing ward teams with mobile phones. Leaders confirmed staff could escalate concerns directly to the on‑call senior team where contact with the parent specialty was not possible or clinical ownership was unclear. Leaders acknowledged this would remain challenging until seven‑day senior clinician cover was in place.

The hospital site did not have a step down ward or discharge lounge, which meant patients often waited for transport or medication on clinical wards. This reduced privacy, increased ward congestion, and created additional pressures on staff delivering direct care.

The service faced significant delays linked to community capacity for home care and domiciliary care. As a result, a substantial number of inpatient beds were occupied by patients awaiting onward care, affecting patient flow, elective admissions, and the ability to accept patients from emergency and acute pathways.

There were high numbers of patients who were clinically fit for discharge with no criteria to reside (NCTR), including people aged 75 and over who were classed as stranded or super‑stranded. These pressures impacted patient flow but were system‑wide in nature and not attributable to shortcomings within the service’s internal processes. Staff continued to work proactively with system partners to reduce risks to patient safety and continuity of care and demonstrated a clear understanding of how to escalate concerns appropriately.

The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff demonstrated a good understanding of safeguarding procedures and were confident using the reporting systems to make alerts and referrals. They provided examples of when they had raised concerns.

All safeguarding related policies were clear and comprehensive. However, staff reported having to use a different computer system for recording safeguarding concerns which created additional administrative steps although this did not delay referrals or prevent concerns being raised.

Safeguarding link nurses based on wards disseminated information to other staff members and acted as a point of contact for advice and escalation.

Staff worked closely with the safeguarding team, who provided responsive advice and support and regularly visited wards to provide additional guidance, oversight, and specific training. Staff liaised regularly with the local authority safeguarding team, who provided timely advice and support for complex safeguarding cases. Clear information sharing pathways were in place, which helped ensure concerns were escalated appropriately and decisions were made in partnership with external agencies.

Care records showed appropriate documentation with clear evidence of safeguarding considerations being recorded in patient notes.

The training policy stated that safeguarding adults training was mandatory for all trust employees. Most staff received safeguarding training specific to their roles, including how to recognise and report abuse. Compliance was strongest for levels 1 and 2, with most staff meeting or exceeding the 85% target and some areas achieving 100%. Deprivation of Liberty Safeguards (DoLS) training showed high compliance, with most staff meeting or exceeding the 85% target, and some achieving 100%. We identified gaps in training records, including staff who had not completed level 1 or level 2 safeguarding adults training. Compliance with level 3 safeguarding adults training for nursing staff was also below the required level. Leaders told us that actions were underway to improve compliance. Some of the gaps had not been fully highlighted through existing governance and oversight processes. Although training compliance was monitored bi‑monthly by the safeguarding adults operational group, this had not yet supported early identification or mitigation of these gaps.

The service did not work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Routine audits were in place to monitor NEWS compliance and to assess whether patient observations were completed within required timeframes. Despite this, compliance with NEWS observations and sepsis screening remained low across all care groups. This meant patients at risk of sepsis were not consistently monitored, assessed, or escalated in a safe or timely manner and highlighted significant gaps in basic observation practice and in the early recognition and management of deterioration.

Although the trust monitored NEWS compliance through routine audits to assess whether observations were completed on time, point‑prevalence audits undertaken in November 2025 continued to show overdue observations and incomplete sepsis screening. The results demonstrated significant variation and, in several areas, extremely low compliance:

• The specialist cancer and support services care group recorded 33% compliance on oncology ward 31 and 0% compliance across oncology wards 29, 30, 32 and 33, and the infectious diseases ward.
• The cardiovascular care group, cardiology ward 26 achieved 50% compliance while cardiology ward 28 recorded 0%.
• The major trauma care group recorded 0% compliance on the complex rehabilitation ward.
• However, the community, frailty and therapy care group achieved 100% compliance on the frailty ward.

This constituted a breach of Regulation 17 (Good Governance).

Actions to address low compliance formed part of the Humber Health Partnership Sepsis Improvement Plan, which included a requirement for each specialty to develop their own sepsis screening and management improvement plan. The trust confirmed that a new audit process would be introduced to improve reliability and oversight. A new QI dashboard was being used to monitor use of the sepsis tool, supported by three monthly reports from the digital team, and quarterly audit results were reviewed by the trust’s patient, sepsis, and resus group to support sustained improvement. The trust also planned to introduce a bespoke in‑house e‑learning programme from April 2026, as funding for the external e‑learning package ended in August 2025.

The service did not ensure that diagnostic pathways for suspected sepsis were timely, reliable, or aligned with national standards. A risk recorded on the risk register identified that patients were not consistently managed in line with the National Institute for Health and Care Excellence (NICE) guideline Sepsis: recognition, diagnosis and early management (NG51), which sets out evidence‑based recommendations for the early recognition, assessment and management of sepsis. As a result, patients with suspected sepsis did not always receive timely or reliable diagnostic assessment.

Falls related training was not consistently completed across staff groups and compliance did not always meet the trust’s required standards. Although most care groups achieved over 80% compliance with the basic falls prevention module, completion of the ‘fallsafe’ module varied widely, particularly among medical staff, whose rates ranged from 33% to 80%. Compliance with the more detailed ‘carefall’ module was consistently below the trust’s 85% target and, in some care groups, fell below 50%, with medical staff achieving only 39% to 56%. Additional clinical services staff also showed low compliance with carefall, and students demonstrated similarly variable uptake. There was no evidence that allied health professionals had been offered any falls related training. These gaps meant the trust could not be assured staff had the required skills to prevent and manage falls safely, contributing to a breach of Regulation 12 (Safe Care and Treatment).

Staff reported receiving inappropriate and unsafe transfers of patients labelled as medically fit for discharge who subsequently required further treatment or experienced deterioration. In some cases, risks had not been recognised by the referring ward or were not clearly documented in handover information. Staff reported inconsistent handover quality from other wards and hospital sites, noting that SBAR (Situation, Background, Assessment, Recommendation) was not always followed and electronic documentation was sometimes incomplete. Staff gave examples including patients requiring catheter care, blood tests or extended inpatient stays involving multiple specialties due to complex comorbidities. This constituted a further breach of Regulation 12 (Safe Care and Treatment).

Despite these concerns, we observed some examples of good practice. Patients identified as being at risk of falls wore yellow wristbands, enabling staff to recognise them easily and provide appropriate support. Staff used bed bumpers, mattress alarms, and red socks to reduce the risk of falls.

The trust’s falls prevention educator worked alongside the practice development matron to deliver face to face falls prevention training for the non-registered workforce and provided education during induction for all new resident doctors and registered nurses. Bespoke training was also delivered in ward areas in response to identified needs.

In addition, the trust participated in the Falls AQUA collaboration, commissioned by the Integrated Care Board (ICB), which brought providers together to improve falls prevention through evidence based quality improvement, shared learning, and benchmarking.

We observed regular, effective handover meetings, safety huddles, and ward and board rounds. These were attended by all relevant staff, who were able to share information and escalate concerns. Staff routinely discussed key information to maintain patient safety, including falls risk, mobility, care plans, suitability for step down or discharge, dietary needs, and infection status. These meetings evidenced collaborative decision making and ensured consistent oversight.

Most staff demonstrated good practice in identifying, monitoring, and escalating other risks. Enhanced observations were carried out appropriately, although this was more challenging for patients cared for in single rooms, where staff needed to remain outside to maintain visibility.

Staff escalated risks promptly and involved patients in shared decision making. They described strong support from medical staff and specialist teams such as the tissue viability nurses. Care records showed that risk assessments were completed consistently.

Consultants reviewed patients across different specialty wards, ensuring coordinated oversight of care and treatment. Managers demonstrated a good understanding of risks on their wards, although the highest risks they identified did not always align with the care group risk register. Following the assessment care group leaders showed good awareness of risks.

In cardiac theatres, we observed a communication board adapted for the cath lab environment, clearly identifying staff roles, safety elements, procedures, and steps. On the infectious diseases ward, staff confirmed that one room was reserved as a high consequence bed for patients recently diagnosed with HIV or drug resistant TB. This room included an antechamber and negative pressure system to maintain clean and dirty zones with a one way flow.

Staff did not always detect and control potential environmental risks to maintain a consistently safe setting. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The care group did not consistently manage fire safety effectively. We identified concerns that could impact safe evacuation in an emergency. During the assessment, an internal fire evacuation door was found wedged open on the infectious diseases ward.

We reviewed the fire risk assessment for the frailty ward, completed in December 2025. Although it had passed the audit and was compliant, it identified several fire safety issues, including:

• A high risk concern where an external fire exit had been temporarily locked due to patient acuity. Immediate action was taken, with the lock removed within 24 hours and clear signage installed.
• Moderate risk issues, including fire doors wedged open, missing intumescent and cold smoke seals, lack of self-closing mechanisms on some doors, a cupboard door that did not fully close, and a missing smoke detector in a storeroom. These were logged on the trust estates system with a three‑month completion timescale.

We reviewed recent fire risk assessments within the cardiovascular care group. The January 2024 assessment for cardiology ward 26 identified the need for additional signage above fire doors and repairs to damaged door seals. The August 2024 assessment for cardiology ward 28 and the cardiac monitoring unit (CMU) identified a gap in a fire door and insufficient door glazing. These were categorised as moderate risk actions with a three month completion timeframe however senior leaders could not confirm whether actions had been completed.

The trust advised that nominated fire wardens should be on duty at all times. However, no fire warden was recorded as on duty during the frailty ward risk assessment. Care group leaders confirmed that the ward had recently been staffed by a high number of bank and agency staff, but had since recruited permanent members of staff, which they said would improve fire warden allocation.

Fire risk assessments showed inconsistent allocation of fire wardens across several areas. The infectious diseases ward listed only two fire wardens, and leaders could not confirm continuous cover. On cardiology ward 26, only one fire warden was recorded, although leaders stated additional wardens were in place records required updating. In the endoscopy suite, leaders in the digestive diseases care group were also unclear about out‑of‑hours and weekend fire warden arrangements.

In addition, not all staff had completed recent local fire training or table top exercises, highlighting gaps in fire preparedness. These gaps reduced assurance that staff would respond effectively in the event of a fire.

Despite these concerns, all fire extinguishers were in date and routinely tested, and ward level risk checks were completed weekly and monthly. Data showed high compliance for clinical and non-clinical fire safety training.

Most wards had secure entrances and exits. However, direct observation from nurses’ stations was limited on many wards due to building layout. For example, on the infectious diseases ward all beds were in side rooms, reducing direct line of sight.

All wards were observed to be clutter free, with most equipment and furniture stored appropriately and sufficient space for emergency access. However, a bedroom on the complex rehabilitation ward, had been used for equipment storage since 2021, and the frailty ward lacked rehabilitation stairs, requiring patients to be transferred to the main building for stair assessments.

Most staff reported having access to enough equipment such as resuscitation trolleys and hoists. However, staff on the complex rehabilitation ward reported limited access to wheelchairs.

Staff in cardiology reported insufficient cardiac monitors. Leaders acknowledged ongoing telemetry challenges, including delays in repair and replacement. They reported plans to trial new monitoring software, with trust wide rollout if successful.

The service generally maintained safe, clean kitchen environments. Food storage was well managed and a dedicated catering team recorded fridge temperatures daily. Staff understood escalation processes. However, on the infectious diseases ward and on the complex rehabilitation ward, fridge temperatures were repeatedly recorded out of range with no clear evidence of escalation or corrective action, indicating gaps in assurance.

Communal sitting rooms were available and encouraged patients to spend time out of bed. These areas were homely, well equipped and provided activities. Some wards had access to outdoor spaces, and most had quiet rooms.

On the complex rehabilitation ward patients had access to a gym suitable for bariatric and wheelchair‑using patients.

Staff completed daily safety checks of specialist equipment. Maintenance was timely, stock was rotated appropriately, and resuscitation trolleys were tamper‑evident, clean and regularly checked.

Electrical equipment had undergone safety testing within the previous 12 months in line, with policy.

All sharps boxes were clearly signed, dated, and stored correctly. All oxygen cylinders were in date and stored appropriately.

Across most wards, controlled substances hazardous to health (COSHH) were stored safely. However, one unsecured cleaning product was found on the frailty ward in an unlocked sluice room. This was escalated and resolved immediately.

The service did not always ensure there were enough qualified, skilled, and experienced staff. However, staff received effective support, supervision, and development opportunities and worked well together to provide safe care that met patient’s individual needs.

Ward managers held daily safety huddles to discuss staffing and escalation of concerns, and provided examples of how pressures were managed, including reallocating bay responsibilities to maintain safe cover.

Nursing staffing remained a significant risk across several wards. High turnover, sickness, reliance on temporary staffing and inconsistent deployment meant the trust could not demonstrate safe or sustainable nursing staffing arrangements. These issues affected the workforce availability and resilience and continued to impact service stability.

Fill rate data describes how many of the planned staffing hours were actually delivered, with a 100% fill rate meaning wards and units were staffed exactly as planned. Fill rate data showed most shifts were covered but some wards relied heavily on bank and agency staff.

Within the community, frailty, and therapy care group the frailty ward had 100% of registered nurse gaps filled by agency staff and experienced ongoing instability, including high turnover and 7% sickness. Leaders had appropriately recorded these risks on the care group’s risk register. Matrons kept daily records to evidence shortfalls and staff reported support from other areas. A staffing review resulted in an uplift of one registered nurse and one healthcare assistant.

Within the cardiovascular services, there were higher levels of absence to due sickness and maternity leave, alongside significant use of agency staff. Senior leaders confirmed that an establishment review had identified the need to increase registered nurse numbers.

Within the specialist cancer and support services the infectious diseases ward relied on 100% agency cover for registered nurse gaps. Oncology wards showed high turnover, with ward 29 oncology ward reporting 11% sickness rate and ward 33 heavy reliance on temporary staffing.

Within the major trauma care group, the complex rehabilitation ward had a high registered nurse turnover of 28% and 9% sickness with moderate bank use. Staff reported regular challenges when 1:1 care was required.

In digestive diseases the endoscopy unit and Ward 100 HRI operated as one service and although there were no vacancies, sickness was 7%, with moderate bank and agency use.

Despite rotas often being completed in advance, staffing levels did not always reflect patient acuity. On the frailty ward, nurses were caring for up to 13 patients each, above the national guidance of 1:8. Staffing continued to be challenging, with higher sickness, turnover and sustained reliance on temporary staff, and the trust remained in breach of Regulation 18 (Staffing).

Medical staffing had improved across specialties, supported by cross site cover. Sickness was low and turnover was minimal, with most specialties reporting a 0% turnover.

Vacancy pressures varied with the highest levels in oncology (69%), and infectious diseases (23%). Other specialties showed negative vacancy rates, reflecting over establishment or the use of cross cover arrangements.

Temporary staffing supported service delivery effectively with bank staff achieving high fill rates, including 100% in cardiology, 100% in endoscopy and 98% in oncology. Some bank shifts were filled without formal requests, indicating unplanned staffing pressures. Agency use was minimal and limited to short‑term sickness cover.

In cardiology, three qualified advanced clinical practitioners (ACPs) and trainee ACPs provided cross‑site support alongside medical staff and consultant‑led clinics.

As a result, the trust was no longer in breach of Regulation for medical staffing.

Staffing data for other staff groups, including allied health professionals, additional clinical services, administrative staff and students, showed variation in sickness, capacity, and fill rates.

Sickness was generally low, however, cardiology ward 28 and the CMU recorded 75% sickness.

Turnover was low overall, but the frailty ward reported 33% turnover, with several other wards exceeded 10%.

Vacancy rates were mixed. Some areas operated above establishment, while oncology day treatment unit reported 12% vacancies, potentially affecting capacity.

Fill rate data showed over delivery on the oncology day treatment unit (144%) and frailty ward (111%) and 81% on cardiology ward 26. However, the complex rehabilitation ward 64% and oncology ward 29 (63%) fell below expected levels, indicating reduced capacity and increased pressures on staff.

Additional data showed cardiology ward 28 and CMU delivered only 16% of planned hours, and endoscopy unit 54% indicating significant gaps in service delivery.

Mandatory training modules were standard across all care groups, however, role‑specific and locally mandatory training requirements varied between services.

Across most care groups, mandatory and role specific training largely met or exceeded the trust target of 85%, supporting safe and effective staffing. However, locally mandated training remained consistently below target, particularly for medical staff, students, and estates and ancillary staff. As a result, the service remained in breach of this Regulation 18 (Staffing).

We did not receive any training data to show that all staff had been offered or had completed for advanced life support.

The Oliver McGowan (Learning Disability and Autism) training data was limited as the trust implemented a phased roll‑out from November 2025, which meant full compliance information was not yet available.

Compliance with nationally mandated resuscitation training varied across care groups, with several services not meeting the trust target. This demonstrated inconsistent assurance and highlighted the need for further improvement to achieve sustained compliance.

The GMC results showed that resident doctors reported generally positive experiences of support and supervision. Clinical and educational supervision scores remained strong, with cardiology and oncology achieving particularly high results, including confidence in supervision during both in‑hours and out‑of‑hours working. Community therapy and frailty services also demonstrated stable supervision arrangements.

Medical staff confirmed that revalidation and peer supervision were up to date, indicating that trainees felt supported and able to access guidance despite workload pressures.

Staff described a range of professional development opportunities across roles, including RGN and therapy apprenticeships, preceptorship programmes for newly qualified staff, specialist ECG training, and access to postgraduate study. Student paramedics were supported to learn in cardiac theatres. Ward‑based training and study days were available, and rehabilitation staff attended specialist teaching sessions on brain injury.

The service effectively assessed, managed, and controlled infection risks.

Ward areas were clean, well maintained, and appropriately equipped, with consistently high standards of cleanliness. Several areas achieved five‑star cleanliness ratings. Staff cleaned equipment after use, labelled it appropriately, and stored it correctly.

Compliance with infection prevention and control and hand hygiene was consistently high, supported by regular audit activity.

Cleaning records were up to date and showed that ward areas were cleaned regularly. Equipment was stored off the floor, and sterile areas, including the cath lab, were well maintained.

Handwashing facilities and sanitising gel were readily available, and clear signage promoted effective hand hygiene. Staff followed infection prevention principles, including appropriate use of PPE, bare arms below the elbows, and compliance with the trust’s uniform policy.

Patients were screened for infectious diseases on admission, with symptomatic patients isolated in single rooms or bays. The infectious disease ward had clear signage for safe patient management. Staff received specific simulation training. Patients with infections were scheduled at the end of endoscopy procedures to allow for additional cleaning time.

The trust’s 2024 adult inpatient survey scored 9.3/10 for ward cleanliness, patients describing wards as “spotless” and “well maintained.”

Most wards were regularly deep cleaned. However, the frailty ward could not be fully deep cleaned following an infection outbreak due to limited decant space, and care group leaders were not aware of this risk at the time of the assessment.

Clinical and non-clinical waste was managed appropriately.

The service monitored Healthcare Associated Infection (HCAI) surveillance indicators, and the IPC team provided regular support, audits and oversight. During infection incidents, they ensured effective isolation and management, making effective use of single rooms to maintain safety while supporting patient flow. Senior leaders met with multidisciplinary teams following any reported infection to complete post infection reviews, identify actions and share learning to improve practice.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities, and preferences.

National Institute for Health and Care Excellence (NICE) recommends that inpatients in an acute healthcare setting have their medicines reconciled within 24 hours of admission. Medicines reconciliation (comparing the list of medicines people were taking prior to admission with what was currently prescribed) was conducted using various sources to ensure the information was correct and up to date to reduce the risk of a medicines error occurring. Trust medicines reconciliation rates showed 31% of patients having this completed during their hospital stay and only 8% of patients having this completed within the first 24 hours of their admission (on average over a 6-month period). This meant that a patient’s medicines were not always reconciled at admission or during their stay.

Nursing staff told us that pharmacy professionals were not always visible on wards but could be contacted if needed and evidence that medicines reconciliation had been completed was not always accessible.

When antimicrobials were prescribed to treat an infection, the indication was not always recorded on the prescribing system and there was not always evidence of a timely review of the medicine as per the trust guidelines. The trust was aware this required improvement.

Patients were not always given their medicines at the right time. This included time critical medicines such as those for the treatment of Parkinson’s Disease. The NICE quality statement QS164 states ‘Adults with Parkinson's disease who are in hospital or a care home take levodopa within 30 minutes of their individually prescribed administration time.’ We saw medicines being given outside the 30-minute time frame on several occasions. There was a risk that people’s Parkinson’s symptoms would not be adequately controlled. We also found that one person did not get their medicine for treatment of Parkinson’s Disease as the hospital did not stock it at the time of the inspection. However, there was no evidence that an alternative medicine was being sought in a timely manner so there was a risk that their Parkinson’s symptoms would worsen. We raised these concerns with care group leaders in the cardiovascular care group, who acknowledged staffing pressures and confirmed that work was already underway to review and strengthen staffing models within the Cath lab, supported by optimisation work and business cases to increase staffing levels.

The trust’s 2024 adult inpatient staff survey showed bottom‑five performance nationally, scoring 4.4/10 for patients being given information about medicines to take home on discharge, indicating that people were not always supported to understand their medicines.

Despite this, medicines, including controlled drugs and intravenous fluids were stored safely and securely. People’s allergy statuses were recorded on all medicine’s records. Medicines given via a syringe driver were given safely and regular checks were in place.

For people prescribed insulin for diabetes, blood glucose levels were checked and recorded at appropriate intervals.

The trust’s 2024 adult inpatient survey scored 8.4/10 for patients being able to take their own medication when required.