Castle Hill Hospital

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.

We have not awarded this service a score for Well-led.

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

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.

• Community, frailty and therapy, focusing on compassionate, person‑centred care through integrated pathways such as virtual wards, hospital at home and therapy‑led community hubs, supported by digital systems and partnership working to reduce health inequalities.
• Specialist cancer and support services, emphasising staff engagement, leadership visibility, workforce development and a “You said, we did” approach.
• Cardiovascular services, outlining regional tertiary cardiology provision and plans to transform acute and elective pathways through revised chest pain pathways, seven‑day cath lab working, virtual wards, expanded specialist roles and increased community‑based care, supported by collaboration across the Humber.

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 linked to interim leadership roles and unclear leadership structures. Some staff reported that leaders were not always visible, which led to uncertainty about decision‑making, accountability and escalation routes.

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. Leadership stability was reported within digestive diseases and specialist cancer care groups, where introductions to roles were clearly communicated.

Most matrons were visible and approachable, and ward managers demonstrated a strong commitment to compassionate and inclusive leadership, fostering supportive team environments. However, some staff reported limited access to senior support at weekends, particularly on the frailty ward.

Most staff had a clear understanding of their roles, responsibilities and reporting arrangements within their wards.

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. 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, leadership study days, specialist training pathways and educator‑led development programmes.

Staff generally described a positive and open culture, where they felt confident to raise concerns and speak up without fear of negative consequences. Most staff told us they understood how to escalate concerns and felt their views were taken seriously.

Staff had access to the trust’s Freedom to Speak Up (FTSU) Guardian and local champions and most were aware of these roles and how to contact them

We observed FTSU information displayed on wards, including in the catheter laboratories and infectious diseases ward, although some posters had not been updated with recent drop‑in session dates.

Additional support was available in some areas, including Trauma Risk Management (TRiM) on the cardiac monitoring unit and cardiology ward 28, providing peer support following potentially traumatic events.

In the catheter laboratories, staff used an incivility reporting tool, which staff said had contributed to improvements in team culture.

Most staff described senior leaders, matrons and ward managers as visible and approachable and said they felt supported when raising concerns. However, staff on the frailty ward reported challenges with communication and feedback during a period of change and said they would welcome clearer updates and reassurance from senior leaders.

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 spoke positively about the workplace culture and did not report discrimination or negative behaviours, indicating that respect and inclusion were embedded in practice.

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.

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).

Governance structures and accountability

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, including cardiovascular, digestive diseases, specialist cancer and support services (managed by north teams), and community, frailty and therapy and neurosciences (managed by south teams).

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 governance audit completed in summer 2025 provided limited assurance, identifying inconsistent governance processes, unclear roles and responsibilities, and variable engagement from care groups. Not all care groups had a designated clinical governance lead. We identified a lack of alignment between care groups, including variation in referral routes, triage processes, waiting‑list management, operating procedures, staff training and support. Support services and enabling systems also operated differently across the two trusts, further increasing inconsistency and risk.

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

Policies and procedures

There was insufficient assurance that policies and procedures relating to the service were current or consistently applied. Some group policies had not been fully merged, and key policies relating to complaints and concerns were still awaiting approval, further weakening governance and accountability.

Staffing and training (Regulation 18)

Staffing pressures were poorly managed and insufficiently mitigated, with high sickness, turnover and reliance on bank and agency staff. These issues contributed to continued non‑compliance with this Regulation and demonstrated a lack of effective workforce planning and oversight.

There were also significant gaps in mandatory and role‑specific training, including falls‑related training. This meant staff were not consistently supported with the skills and development required to carry out their roles safely, contributing to continued breaches of Regulation.

Complaints and Duty of Candour (Regulations 16 and 20)

Leaders did not have effective oversight of complaints management, resulting in a sustained backlog of open and overdue complaints and poor compliance with response timeframes, representing continued non‑compliance with Regulation 16 (Receiving and Acting on Complaints).

Similarly, oversight of Duty of Candour was ineffective, with variable compliance, missed statutory requirements for timely notification and written apologies, and continued non‑compliance with Regulation 20 (Duty of Candour). Governance arrangements did not ensure legal requirements were met or monitored effectively.

Risk management (Regulation 17) (Good Governance)

Risk management arrangements were ineffective. Although risks were reviewed monthly at governance meetings, there was no clear evidence of timely action, mitigation or escalation. Risks on the care group’s risk register were not consistently managed, monitored or resolved, demonstrating a failure to use risk information to drive improvement.

Significant unmanaged risks included:

• Radiotherapy capacity and staffing, resulting in delays to treatment, failure to meet cancer waiting time standards and increased safety risk. Ageing equipment increased the risk of downtime and potential service interruption.
• A backlog of untyped clinic letters, particularly in specialist cancer services, creating risks of missed information, incorrect treatment decisions and delayed GP communication.
• Fire safety risks, including insufficient fire warden cover and unresolved defects, contributing to continued non‑compliance with Regulation 12 (Safe Care and Treatment).

Infrastructure, digital systems, and information management

Leaders acknowledged significant infrastructure and digital system weaknesses, including ageing estates, outdated equipment and poor system interoperability. Staff reported duplication of work and ineffective information sharing, particularly with GP and community systems. These weaknesses were reflected on the risk register and not effectively mitigated.

Performance dashboards

Although performance dashboards were available, there was limited assurance that data was accurate or used effectively. 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.

Waiting times

Oversight of referral‑to‑treatment times and patient flow was ineffective, with performance not consistently meeting national standards. Systems for monitoring and improving performance were weak, contributing to further breaches of Regulation 17 (Good Governance).

Limited positive practice

Although some governance processes were in place, including the use of a standardised group minute structure, evidence of business continuity planning within community frailty and therapies, secure information governance arrangements, and the introduction of the Patient Safety Incident Response Framework (PSIRF), these arrangements were not consistently embedded or effective across the service. They did not provide sufficient assurance or mitigate the widespread governance failures identified, and further work was required to embed these systems 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. Positive examples included securing rehabilitation beds for patients with complex social needs and working with drug and alcohol charities to support safe discharge and continuity of care.

Staff were able to refer patients to the specialist alcohol care team (ACT) and worked with rough sleeper and homeless teams, although staff reported some gaps in coverage across localities.

The complex rehabilitation service maintained a single point of contact for community referrals, provided follow‑up in the community, and offered in‑reach nursing support to regional hospitals for patients with spinal injuries. Staff demonstrated the ability to track referrals and coordinate with social workers, supporting timely discharge planning.

Quality improvement group discussions in December 2025 highlighted system‑wide actions to reduce avoidable emergency department conveyance, particularly for care‑home residents and frail patients. This included targeted work with care homes, frailty‑team reviews of care plans and ReSPECT documentation, staff training, outcome monitoring, and rollout of the “Safe to Move” assessment tool.

The care group also collaborated with neighbouring NHS trusts, including York and Scarborough, to share learning and support continuous improvement across the region.

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.

Staff were given time and support to contribute to improvement activity, resulting in changes to care delivery.

Staff used recognised quality‑improvement (QI) methods and understood how to apply these in practice. Several wards and services participated in national audits and accreditation schemes, with learning used to inform service development.

Staff also had opportunities to participate in research activity. For example, a member of staff on the complex rehabilitation ward received a high commendation for a long‑term retrospective study using UK Rehabilitation Outcomes Collaborative (UKROC) data, contributing to improved understanding of rehabilitation outcomes.

There were multiple examples of innovation and improvement across care groups.
Within cardiovascular services, QI projects improved VTE prevention and recognition of deteriorating patients, with plans for wider roll‑out. The Abdominal Aortic Aneurysm (AAA) screening programme achieved a successful turnaround, now meeting national quality and performance standards following service review and investment.

The Immunology and Allergy Unit achieved national accreditation, reflecting strong governance and sustained improvement. Leaders also described a QI project that significantly increased awareness and uptake of the ReSPECT process, with plans to extend learning to inpatient wards.

The community, frailty and therapy care group demonstrated active learning and improvement, including projects informed by PALs and complaints, improvements in hypotension management, enhanced falls prevention measures, and continued in‑reach work to the emergency department to reduce avoidable admissions. Frailty teams were recognised in the Star Awards as Team of the Year, reflecting their sustained commitment to improving care.

Trust‑wide improvement activity included analysis of Friends and Family Test feedback, patient surveys and experience reports. Care groups were working to integrate compliance measures into performance dashboards, supporting continuous improvement cycles, with leaders reporting reductions in complaints and improvements in patient experience in some areas.