Huddersfield Royal Infirmary

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

We looked for evidence that people’s needs were assessed and that care, support and treatment reflected those needs, including any protected equality characteristics. This was not always the case. Care was not consistently person‑centred and did not always demonstrate how individual needs and outcomes were considered.

We also looked for evidence that leaders promoted a culture of continuous improvement. Systems to understand outcomes and learn from best practice were in place but were not used effectively or consistently as part of everyday work.

We identified a breach of regulation; bed rail risk assessments were not always completed or reviewed.

We have not awarded this service a score for Effective.

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

The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Risks were not always identified or managed consistently at triage. Although staff told us safeguarding, cognitive impairment, pressure damage and falls risks were routinely assessed, this was not always reflected in practice. This increased the risk that safeguarding or clinical concerns were missed, and patients did not receive timely oversight.

We reviewed patient records and saw not all patients had documentation of pain scores, nutrition and hydration, mental capacity or falls risks assessments completed.

The service aimed to triage all patients within 15 minutes of attending the department. We saw patients waiting beyond 15 minutes throughout our inspection, increasing the risk that deteriorating patients were not identified promptly and that delays in initial clinical oversight could compromise their safety.

However, data we reviewed showed the median time to initial assessment was consistently below the England average from October 2023 to August 2025.

Pain was not consistently assessed, of 10 records reviewed, 3 had no documented pain score. 5 patients reported pain, but none received analgesia despite policies to support pain relief being in place. In response to the concerns raised, a departmental review of PGD compliance was completed to ensure all triage nurses were able to administer analgesia when a patient reported pain. In addition, the standard operating procedure (SOP) was amended to include clearer guidance on the assessment, management and reassessment of pain.

Pressure risk assessments were not consistently completed; 6 of 10 records contained no evidence of assessment. Some patients identified as high risk of falls were seated in the general waiting area. There was no documented evidence of bed rail risk assessments.

We were told that compliance with physiological observations and escalation was monitored through daily retrospective audit. This had been previously identified as an area that needed improvement by senior leaders within the department. We saw no completed audits regarding this and therefore, we were not assured that there was sufficient oversight which meant patients could be at risk. However, we were told by leaders, after the inspection, that audits had demonstrated that observations were completed in 81% of cases.

Staff could add flags to patient records to identify patients with additional needs or who might require additional support. This included alert flags for patients with allergies, mental health needs, people with learning disability, autism or dementia and we saw evidence of these being used.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Staff did not always assess and meet patients’ needs for food and drink. This meant patients were at risk of not receiving adequate nutrition or hydration, which could lead to discomfort, deterioration, and unmet essential care needs.

During our review of 10 records, we found only 2 patients had nutrition and hydration documented. Inspectors saw little evidence of food and drink being offered in the department.

We spoke to several patients, some who had been waiting over 12 hours, and they told us they had not been offered any food or drink during their wait in the UEC department.

Staff told us patients who had a long wait would get hot meals, but that the service was “hit and miss”, inconsistent and arranged on an “as needed” basis.

Clinical guidelines and policies used in the department were developed and reviewed in line with National Institute for Health and Care Excellence (NICE), the Royal College of Emergency Medicine (RCEM) and other relevant bodies.

The service had governance processes to ensure national legislation, evidence-based best practice and required standards were reviewed. If needed, local guidance/working practices were updated and communicated, with training, to the UEC department staff.

UEC specific policies, protocols and pathways were accessible on a dedicated clinical guidance platform. This system had a governance framework that supported version control, named authorship, documented review dates, and rapid updating, providing assurance that guidance remained current and evidence based.

When we undertook a second inspection visit, we observed staff being proactive in supporting patients’ comfort and basic care needs. A nurse was seen asking patients in the assessment bays whether they would like any food. Within the majors area, 6 patients were observed eating at the time of inspection. The remaining four patients were either asleep or actively receiving care from the medical team.

There were options for patients and their families to purchase refreshments, including a vending machine in the department and several retail outlets, there were also multiple water fountains within the department, which were always stocked with cups.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Doctors, nurses, and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide safe care. Staff held regular multidisciplinary meetings to review patients and improve their care, such as structured nurse-in-charge and emergency physician in charge huddles every 2 hours. We saw multidisciplinary working with other services, for example link nurses who worked with speciality nurses from across the trust in roles such as dementia, falls, IPC and diabetes to identify the most appropriate care and treatment for patients.

The trust used an electronic patient record (EPR) throughout the hospital. Therefore, hospital teams completed the same record for each patient. This meant patient information was accessible for all, easy to find and helped facilitate better communication between healthcare professionals.

The UEC team worked closely with the BLOSM ( Bridging the gap, Leading a change in culture, Overcoming adversity, Supporting vulnerable people, Motivating independence and confidence) team to provide mental health assessments for patients within the UEC environment and support for the UEC team. The team were based at the hospital which made contacting them straightforward. Staff gave positive feedback about these and other supporting agencies they worked closely with.

The service had a dedicated acute frailty team comprising of physiotherapists, occupational therapists, geriatricians and registered nurses. This multidisciplinary team operated within the emergency care pathway and was proactive in identifying patients living with frailty at the point of arrival to the UEC department.

Where clinically appropriate, the team aimed to support patients to return home the same day, avoiding unnecessary hospital admission.

Data reviewed during inspection showed that on the previous day 13 patients were referred through the acute frailty pathway, with 7 patients discharged home directly from SDEC. This demonstrated effective use of same‑day assessment and treatment to improve patient flow and reduce avoidable admissions.

All staff we spoke to reported that they felt part of the wider team, and that the team worked well together to support patients and their families.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Patient information leaflets were available on the trust’s UEC clinical guidance platform. A dedicated patient information section offered a range of information including self-care, recovery and health advice covering common conditions in both adults and children. The information was easy to read, informative, and aimed to support patients better understand their condition and treatment, manage symptoms safely at home, recognise deterioration and seek help appropriately and reduce avoidable re-attendance to the UEC department. However, we saw no evidence this were printed and given to patients.

The department had posters with digital codes on for people to scan with their phones to access health information, although we did not see evidence of how patients who may not be digitally literate, may have a learning disability or may not have the means to access digital information could access these resources in a comparable way, we did not see printed information leaflets in patient areas.

Staff told us that they would discuss health promotion with patients if there was opportunity, but said this was not consistently available due to pressures within the department.

Leaders told us about how the local Integrated Care Board lead many healthy living initiatives which focused on improving population health and reducing inequalities. These fed through to the trust, such as in the trust’s five-year plan.

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The department had recognised limitations in how national audit participation was being used to monitor outcomes and support improvement. Reviews and discussions with network leads identified concerns about the audit platform, the quality and usefulness of data outputs, and a lack of clarity about how participation translated into improved outcomes for people using the service.

A planned pause in participation of national audits was taken by the trust; however, this meant there was a gap in external benchmarking and limited assurance about outcomes over this period. Local systems for monitoring outcomes were not consistently robust, and the use of audit data to inform learning, track improvement or demonstrate impact on patient outcomes was variable.

The service had re registered to participate in national audits in 2026 which included Time Critical Medications, Adolescent Mental Health and Care of Older People audits for 2025-26.

The service participated in Getting it Right First Time (GIRFT) a national initiative by NHS England to help UEC departments in England improve their performance. UEC services at the trust were reviewed as part of the GIRFT visit in May 2025. Recommendations made by GIRFT, including addressing inequity in frailty provision between sites, strengthening inter-hospital transfer arrangements, and enhancing mental health support in the emergency setting. Key strengths included the integrated UEC model, effective use of urgent SDEC run by UEC staff and strong frailty pathways.

Staff told us regular audits were conducted such as for IPC, sepsis and staffing and that the department had audit leads as well as a quality improvement lead. We were also told that clinical and nursing teams worked together on audits. We reviewed a number of the audits. The trust told us that any issues identified were overseen through the Patient Safety and Quality Board.

The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Nurses and other healthcare staff we spoke with said they did not feel confident in assessing capacity, and many were unable to articulate the principles underpinning capacity assessments, including how capacity is determined or how best‑interest decisions should be made. Staff were also unable to describe the legal implications of failing to assess capacity appropriately, either for patients or for themselves as practitioners.

Training compliance for dementia awareness remained below the trust target, with medical staff achieving 80%. Compliance for autism awareness training was also low. Part 1 stood at 76% for medical staff and compliance for part 2 was low, with nursing staff at 5% and medical staff at 8% compliance.

Medical staff compliance with deprivation of liberty safeguards training was 46% for level 2 and 73% for level 3, both below expected levels. Nursing staff exceeded the trust target of 90% for both levels.

This meant patients were at increased risk of receiving care from staff who did not have the necessary skills and awareness to recognise and respond to dementia‑related needs, autism‑specific requirements, or legal safeguards such as deprivation of liberty, potentially compromising safe and effective care.

Staff could not confirm whether a bed rails risk assessment existed, and during the inspection we saw almost all patients had bed rails raised with no documented justification or evidence staff had discussed the rails with the patients. This meant patients were not given the opportunity to discuss the risks and benefits, limiting their ability to make choices about their safety. Improper use of bed rails placed some patients at an increased risk of harm. This was a breach of regulation 12.

Staff were supported by the trust safeguarding team for guidance around consent, mental capacity and best interest decisions making processes.

We reviewed the trust’s consent policy and found that it was in date at the time of our inspection and due for review in February 2026. The trust also had a Mental Capacity Act and Deprivation of Liberty Safeguards policy. This policy was also in date and due for review in March 2026.