Huddersfield Royal Infirmary

Updated 29 June 2026

Huddersfield Royal Infirmary is part of Calderdale and Huddersfield NHS Foundation Trust.

It provides acute and community health services. The trust serves two populations; Greater
Huddersfield which has a population of 248,000 people and Calderdale with a population of 205,300
people. The trust operates acute services from two main hospitals; Calderdale Royal Hospital and
Huddersfield Royal Infirmary.

The trust also provides community services in the Calderdale area. The trust has approximately 800 beds and 6,000 staff.

The outpatients department (OPD) was one of the largest areas in the trust, which saw more than
500,000 yearly attendances across a wide range of specialities.

We assessed the outpatients service as part of a comprehensive trust and well led assessment from 12
January to 5 February 2026. This was in response to concerns raised to us around safe care and
treatment.

Updated 30 October 2025

We assessed the outpatients service as part of a comprehensive trust and well led assessment from 12 January to 5 February 2026. This was in response to concerns raised to us around safe care and treatment.

We spoke to 36 clinical and non-clinical staff of various grades.

The service had addressed some of the concerns from our last inspection in March 2016. For example, leads had mitigations in place to ensure clinics were not overbooked. They had added extra capacity to address long waits or delays and improve patient satisfaction.

There were no previous breaches.

At this assessment we found the following examples of good practice;

• All OPD staff we spoke to enjoyed working for the hospital and felt respected, appreciated and well supported by managers and teams to raise any suggestions or concerns.
• Did not attend (DNA) rates were reported with a health equity lens; rates were compared for patients with a learning disability, by ethnicity and those from the most deprived areas. Staff used the trust’s inequalities flag on their electronic patient records (EPR) system within some services. This aimed to ensure equity across all patient groups.
• We heard examples of how OPD staff and consultants met outpatient’s individual needs including offering emotional support and reducing anxiety.
• We heard about some encouraging service initiatives and development work to better meet the needs of people with a learning disability (LD).
• The service had improved continuity of care and outcomes for outpatients with dementia. Research projects were underway in orthopaedics, surgery and physiotherapy.

However, we found areas for improvement;

• The division had many environmental and equipment issues across clinics. Some services such as surgical outpatients had unhappy staff due to their environment, working conditions and lack of facilities. Outpatients’ privacy and confidentiality could not be protected in some clinic waiting areas. Security response times were delayed accessing the Acre Mills building from the main hospital site. This meant some staff and patients felt unsafe.
• Clinical staff did not meet the trust’s target compliance of 95% for their mandatory Oliver McGowan training on learning disability and autism tier 2. Latest compliance for the full day face to face seminar was 42.7%. However, the directorate was on target to achieve Tier 2 compliance over the next 2 years aligned to the organisational trajectory.
• We could not always ensure outpatients were safety overseen by clinical staff. We were unsure how certain clinics mitigated potential risks around safeguarding, fire safety, and medical emergencies.
• The absence of staggered reception cover left the department unsupported. This placed increased pressure on clinical staff during periods of reduced cover.
• Some nursing staff told us their access to practical statutory training, continuous professional development (CPD) and upskilling was limited by having no spare staff to cover their shifts.
• 50% of the FP10 forms we reviewed from July to December 2024 were missing or had incomplete documentation. Three pads were simultaneously in use. This meant we could not ensure staff recorded, monitored or audited these prescriptions consistently.
• We found a lack of equity in access for some cross-site services such as phlebotomy, women’s health and pharmacy provision.
• Some pre-planned, elective and drop-in clinics could not increase capacity to meet extra demand. The service’s clinics did not always run on time and could keep patients waiting. We observed some consultant clinics running late and behind schedule.

Trust and service leads took prompt actions to address all our identified concerns and issues feedback onsite.

After our completed assessment we issued the trust the following breach of regulation;

The trust must ensure all outpatient environments, equipment and staff facilities are appropriate for the delivery of safe care.

We rated this service as good because it was safe, effective, caring, responsive and well led.

Updated 30 October 2025

We conducted an on-site assessment of medical care (including elderly care) on 13, 14 & 15 January 2026 in response to concerns raised to us around safe care and treatment.

We assessed all quality statements from the safe, effective, caring, responsive and well-led key questions.

The assessment team included three CQC inspectors, two pharmacy specialist CQC inspectors and two CQC specialist advisors.

We reviewed 20 sets of patient clinical records and spoke with 70 members of staff, as well as 17 patients and family members. We attended several clinical meetings, including safety briefs, nurse handovers and ward rounds. In addition, we assessed most medical wards, the discharge lounge, and Same Day Emergency Care (SDEC) for frailty.

We rated the service as good overall which stayed the same since the last inspection. With safe rated as requires improvement, effective, caring, responsive and well rated as good.

Staff demonstrated kindness and compassion, patients felt respected and cared for, and there was a positive culture of learning. The service showed good practice in workforce well-being and had effective multidisciplinary collaboration and community engagement.

However, we found continued breaches of legal regulations in relation to regulation 12 safe care and treatment relating to safe staffing, mandatory and safeguarding training compliance and medicines management (see specific headers for summary).

We also found breaches in regulation 17 (good governance) relating to inconsistent record keeping on the electronic patient record and non-adherence to trust policy.

Updated 30 October 2025

We conducted an unannounced on-site, comprehensive assessment visit of urgent and emergency care services (UEC) on 12 to 14 January and 4 February 2026 in response to concerns raised to us around safe care and treatment.

We rated the service as Requires Improvement. We found a continued breach of regulation in relation to the management of patients presenting with mental ill health.

We also identified new breaches of regulation. These included concerns about infection prevention and control, such as poor bare‑below‑the‑elbow compliance and unsafe practice. Mandatory training compliance for medical staff was low for all modules. Bed rail risk assessments were not always completed or reviewed. Patients were treated in unsuitable and unsafe areas, with limited privacy and dignity.

This meant some aspects of the service were not always safe and there was limited assurance about safety.

However, staff provided care that was kind, compassionate and respectful. Patients and their families were involved in decisions about their care, people were supported to raise concerns, and staff took time to listen. The doctors, nurses and other healthcare professionals worked well together, demonstrating strong teamwork and a shared commitment to delivering care.

Updated 20 June 2018

Our rating of this service improved. We rated it as good because:

• Staff were caring, compassionate and respectful. Staff were positive about working in the service and there was a culture of flexibility and commitment.
• Feedback from staff, parents, children and young people had resulted in changes to aspects within the service.
• The service was well led with a clear leadership structure in place.
• The advanced paediatric nurse practitioner (APNP) role was introduced to the service. Seven APNP worked on both hospital sites. Predominantly, the APNP role supported the Huddersfield hospital site by supporting the children’s workforce from a medical and nursing perspective.
• Service monitoring and improvement was managed through governance, performance and risk management systems.
• Clinical risks were identified with ongoing monitoring in place. The service had identified guidelines and protocols to assess and monitor patient risk and react to changes in risk level.
• Staff knowledge of the incident reporting process was good and incident-reporting processes were robust.
• We checked equipment throughout the service and maintenance checks were confirmed. Monitoring records of resuscitation equipment showed regular monitoring took place.
• There was good access and flow within the children’s service. Patients received evidenced based care and treatment and good multi-disciplinary working existed between the children’s services, external providers and the child and adolescent mental health service (CAMHS).
• The trust mandatory training target was 95%; Mandatory training completion was 100% in children’s services. The majority of staff (96%) had received an annual appraisal.
• Advanced paediatric life support (APLS) trained nurses were rostered on every shift. The trust confirmed that 22 staff had completed the APLS course.

However:

• Aspects of best practice staffing guidance as identified by the Royal College of Nursing (2013) were not fully implemented. However, staffing levels were considered safe by senior management and the staff we spoke with and senior support could be accessed when needed.
• The service was not compliant against the ‘Facing the Future’ standards because of a lack of permanent consultant cover between 5pm – 10pm. However, the risk had been mitigated as Paediatric Consultant staff were contactable after 5pm and at weekends. Consultant staff told us that they would attend and oversee the child’s care and treatment when needed.
• Trust training statistics identified a shortfall in nursing attendance at paediatric life support training.

Updated 20 June 2018

Our rating of this service improved. We rated it as good because:

• We rated safe, effective, responsive, caring and well led as good.
• Mandatory training compliance was high for medical and nursing staff and the number of staff with a post registration certificate in critical care had significant improved.
• Nurse staffing levels were delivered in line with Guidelines for the Provision of Intensive Care Services 2015 (GPICS) standards and patient outcomes were in line with those of similar units.
• The systems and processes in place for management of patient records and the assessment of patient risks were reliable and followed national guidance.
• Care was evidence based and feedback from patient and relatives was positive. The privacy and dignity of patients was maintained and care was compassionate.
• There was consideration given to the individual needs of patients and there had been no complaints about the service.
• Access and flow through the unit had improved. The number of surgical patients cancelled on the day of surgery due to a critical care bed not being available had reduced. The number of patients cared for in theatre recovery when a critical care bed was unavailable had also reduced.
• There was a vision and strategy for the service. There was clear medical and nursing leadership with an understanding of the risks and challenges to the service.

However;

• There were some groups of staff with low levels of morale and a lack of designated leadership within the critical care outreach team.

Updated 15 August 2016

We rated end of life care services as good overall because:

Patients were provided with an end of life care service that was safe and caring. The mortuary was clean and well maintained.

Staff delivering end of life care understood their responsibilities with regard to reporting incidents and ensured information and lessons learnt were shared proactively with other colleagues within the hospital.

We saw clear, well documented and individualised care of the dying documents and appropriately completed DNACPR forms.

The referral process was clear and responsive and staff ensured that patient’s wishes were central to the care planning process.

Staff had access to specialist advice and support 24 hours a day from a consultant on-call team for end of life care.

However:

The end of Life Strategy / Vision was in draft form. It did not contain business objectives for the team and lacked robust definition of what the vision and outcomes would be for the team in the future.

There was a limited approach to obtaining the views of people who used the service and other stakeholders. There was no mechanism to ensure feedback was captured and actioned in a timely way.

Updated 20 June 2018

We previously inspected maternity jointly with gynaecology so we cannot compare our new ratings directly with previous ratings.

We rated it as good because:

• Audit and report data showed risk assessments and records were completed appropriately and in a timely manner. We saw systems were in place for reviewing, monitoring, and sharing lessons learned from incidents.
• Clinical outcomes for mothers and their babies at the trust had improved since our last inspection.
• There were good completion rates for maternity specific training across the trust, and all maternity staff at Huddersfield Royal Infirmary had received an appraisal.
• Procedures were in place to refer and safeguard adults and children from abuse; and staff we spoke with felt confident making referrals and escalating difficult or complex cases.
• Areas we inspected were visibly clean, and audit data showed good hygiene standards.
• The emergency equipment we reviewed was appropriately sealed, in date, and daily and weekly checklists had been completed.
• There were policies in place to manage admittance criteria, emergencies and pathways for transfer from Huddersfield Birth centre to the Calderdale site. The overall transfer time from the birth centre to the Calderdale site was in line with the national average for free-standing birth centres.
• Considerable work had been undertaken since our last inspection to collect and act on the views of people who used maternity services. The women and their relatives we spoke with gave positive feedback about staff, and felt they had been included in decision making.
• Since our last inspection, methods had been introduced to better understand and improve the culture within maternity services; these included anonymous staff surveys, workshops, and human factors masterclasses.
• We saw participation in and learning from external reviews. For example, those undertaken by the Royal College of Obstetricians and Gynaecologists (RCOG) and local Healthwatch groups.

However:

• Mandatory training and safeguarding training completion rates for midwifery and nursing staff at Huddersfield Royal Infirmary did not meet compliance targets set by the trust.
• Complaints were not completed in a timely way and in line with the trust policy timescales.
• The transfer rates of women from Huddersfield birth centre to the Calderdale site were higher than average compared to other free-standing birth centres, and only 12% of critical calls met the eight minute target for attendance at the birth centre in 2017.
• There were occasions when women gave birth with too few midwifes present in Huddersfield birth centre; this went against trust protocol.

Updated 15 August 2016

We rated the service as good overall. We rated the responsive domain as requires improvement and the safe, caring and well-led domains as good. The effective domain was inspected but not rated. This was because we are currently not confident that we are collecting sufficient evidence to rate effectiveness for outpatients & diagnostic imaging.

Patients, visitors and staff were kept safe as systems were in place to monitor risk. Staff were encouraged to report incidents and we saw evidence of learning being shared with the staff to improve services. There was a robust process in place to report ionising radiation medical exposure (IR(ME)R) incidents and the correct procedures were followed.

The environment we inspected was visibly clean and staff followed robust infection control procedures. Records were stored electronically for X-ray images and OPD had a mixture of electronic and paper records. Staff were aware of their responsibilities within adult and children safeguarding practices and good support was available within the hospital.

Outpatients and radiology nurse staffing levels were appropriate with a low number of vacancies. Radiographer vacancies were higher; a recruitment plan was in place and fifteen staff had been recruited, due to start in the summer of 2016. There were also recruitment issues with ultra-sonographers and breast radiologists. There was an ongoing recruitment and retention plan in place.

There was evidence of service planning to meet patient need such as the agreement for purchase of a third MRI scanner. Diagnostic imaging waits were within targets for the national waiting times.

Staff had good access to evidence based protocols and pathways. The OP and radiology departments were very busy during the inspection but patients received good communication and support during their time there. Staff followed consent procedures and had a good understanding of the Mental Capacity Act (2005).

We observed and were told that the staff were caring and involved patients, their carers and family members in decisions about their care. There was good support for patients living with a learning disability or dementia. Staff clearly demonstrated that they put the patient first.

The diagnostic imaging department had a local development plan in place to improve services and the environment. The plan gave a comprehensive review of the demand and capacity on the department to deliver a sustainable and high quality clinical service, taking account of seven-day working plans.

Governance processes were embedded across diagnostics and the pathology and radiology teams felt supported in the new directorate structure however governance processes in OP were less well developed.

However:

People were not always able to access OP services when they needed to. There were issues with appointment backlogs, waiting lists and appointment bookings. Patients experienced long waiting times within the departments, appointment delays and cancellations. Outpatient clinics were often overbooked and we found issues with capacity and demand in all OP clinics. Actions taken to address these issues had not always been effective.

Staff we spoke with were aware of the complaints policy and told us most complaints and concerns were resolved locally. A high proportion of the total complaints received by the outpatients department (22%) related to appointment problems.

We did not see any evidence to show current trends and themes from incidents and complaints were monitored.

Updated 15 August 2016

We rated surgical services as good because:

The service had good systems and processes in place to protect patients and maintain safety. Staff understood the process for reporting and investigating incidents and there were good reporting and feedback processes at Huddersfield Royal Infirmary. Each ward recorded and displayed individual incidences of insignificant, minor and moderate falls, catheterized urinary tract infections (C.UTIs) and pressure ulcers. Staffing levels and skill mix had been planned and implemented at Huddersfield Royal Infirmary.

All patients reported pain management needs had been met in a timely manner. Care of patients’ nutrition and hydration were being met as part of the surgical care pathway. We observed patients being cared for with dignity, compassion and respect in all the surgical wards and departments we inspected. Feedback from patients through the NHS Friends and Family Test consistently showed patients would recommend the hospital to friends and family.

The breast surgical divisional management team had developed an action plan from the National Cancer Patient Experience Survey which included an enhanced role for the breast cancer nurse to explain to patients the potential care and treatment options available.

The ‘Five Steps to Safer Surgery’ and completion of the World Health Organisation (WHO) checklist was consistently good at the hospital. Mandatory training was well attended and meeting overall training targets was in progress with action plans in place to meet year end targets.

Wards and departments were spacious, visibly clean and well organised. We saw evidence of regular audit with regard to infection control and cleanliness.

The service had introduced a seven day acute rota for general surgery resulting in significant improvement to consultant presence in theatre and improved treatment and a post-operative survival rates.

Patient care was personalised in line with patient preferences, individual and cultural needs and ensured flexibility, choice and continuity of care. Clear strategies were in place and implemented to improve the care of patients. For example, the appointment of link nurses, associate care practitioners and engagement support workers.

Senior managers had a clear vision and strategy for the division and identified actions for addressing issues, the strategy clearly identified objectives for improving patient care and safety. There was good staff morale and staff felt supported at ward level.

We observed care that was coordinated and discharge and transfer planning took account of patient’s individual needs.

However:

There was no rota for the management of patients with gastrointestinal bleeds by an endoscopy consultant. This had not been resolved at the time of our inspection and staff identified this as a risk to the safety of patients.

Daily temperatures for the storage of medications were not all within the correct limits on all wards and were recorded outside the margins for the safe storage of medicines. No action had been taken to check whether records were accurate or whether there was a fault with equipment.

Trust data showed only 45% of complaints were closed within target in the surgical division.