Huddersfield Royal Infirmary

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• 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 assessment we rated this key question good. At this assessment the rating has remained good.

We looked for evidence that there was an inclusive and positive culture within the service, where equality, diversity and inclusion were promoted and embedded in everyday practice. We reviewed whether staff felt able to speak up, raise concerns and contribute to improvement, and whether there were effective systems to support freedom to speak up.

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.

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff consistently described strong multidisciplinary team (MDT) working and a cohesive and supportive team, despite the operational pressures. UEC consultants were described as highly supportive, responsive to nursing escalation, and respectful of concerns raised. Nurses reported that when they escalated a patient’s deterioration or risk, medical colleagues acted promptly. We observed positive and caring interactions between staff and their patients and their relatives who used the service. We also noted good collaboration and communication between UEC staff of all grades and disciplines.

The UEC division had a strategy programme and provided examples of how improvement programmes in the service contributed and linked into the overall trust strategy, supporting a more coordinated and informed approach to driving quality improvement across the organisation. The trust’s strategy for 2023-2028 included plans to reduce health inequalities, ensuring quality and safe care and improving care for children and young people.

The vision and values are aligned with key workstreams across the trust including appraisals and Work Together Get Results (WTGR). Whilst the trust’s vision and values were displayed across the hospital, we did not see these posters, at the time of inspection, within the UEC department. This meant staff, patients and visitors had fewer visual reminders of the expected behaviours and standards.

Staff described parts of the organisational culture that affected how the service operated during busy periods. They told us that leadership presence at peak times often felt reactive, with decisions made in response to immediate pressures rather than through coordinated planning. Staff said this contributed to a culture where frontline teams were left to manage day‑to‑day challenges with limited proactive support. They felt that clearer direction, more visible planning and more consistent communication from leaders would help support a more positive and resilient culture.

Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Staff told us they worked under sustained and significant pressure. They said staffing arrangements were not planned well enough to support safe and consistent care. For example, during the night there was no on‑site Matron or Band 7 leadership presence within the UEC department, which some staff felt left them without senior clinical oversight at times when they needed it most.

Staff told us that while UEC leaders were visible, their presence did not always translate into effective support. Some staff said that although leaders were seen walking the floor, the check‑ins they provided felt brief and did not consistently address the pressures teams were facing. Staff also reported that leadership input during peak times was sometimes reactive rather than coordinated, which limited its impact on patient flow and the day‑to‑day challenges experienced by frontline teams.

The most recent NHS staff survey indicated inconsistent experiences of leadership, particularly regarding communication, development and flexible working. Line management scores were slightly below peers, and staff reported valuing stronger appraisal and development support. In response, the department implemented additional management training focused on performance management, supervision and feedback.

The UEC directorate also undertook internal staff surveys following implementation of the Urgent Same Day Emergency Care pathway (March and September 2025). Findings were used to inform local action plans.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The department had several formal and informal routes for staff to raise concerns. The divisional management team reviewed current concerns monthly and discussed ongoing actions. An action log was maintained and overseen by the Freedom to Speak Up (FTSU) team.

Staff told us they would only use the FTSU process as a last resort. This was usually when they felt they would not be listened to through normal management routes or when their concern related to senior staff. None of the staff we spoke with had previously used the FTSU process.

When we asked staff whether they felt able to raise concerns and be confident these would be listened to and acted upon, feedback was mixed. Although staff said they would speak up if needed, several did not feel assured that concerns would be taken seriously or lead to action.

The trust’s staff speaking up questionnaire showed that 84% of staff were aware of FTSU and 56% of staff knew who the FTSU guardians were. Not all staff in the urgent and emergency care service were aware of who their FTSU guardian was.

Leaders told us there were two FTSU ambassadors in the emergency department. They said FTSU guardians carried out site visits and that FTSU posters had recently been refreshed and were visible within the department.

Staff had completed a mandatory training module called “Speak Up”. Additional modules were available for managers and senior leaders. An introduction to FTSU was also included as part of the trust‑wide corporate induction for new staff.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

We saw the trust “one culture of care” calendar which included a mixture of religious festivals as well as equality, diversity and inclusion related events and key dates.

Staff had training in equality, diversity, and human rights with a compliance rate of 91% across the service, although compliance for medical staff was only 77%.

The trust had a number of staff networks, including disability, pride and armed forces networks. The trust also had a workforce inclusion strategy (2025-28) which aimed to ensure that “all colleagues felt valued, respected and enabled to make a positive change together, where everyone can succeed, regardless of background and/or circumstances”. We saw evidence of education booklets for staff “let’s talk about race” and “LGBTQ+ awareness” as well as 500 Ramadan packs distributed to staff.

We reviewed the Workforce Race Equality Standard (WRES) data from the NHS Staff Survey 2025. The results were trust-wide and were not broken down by individual departments.

The data showed a decrease, compared with previous years, in the percentage of staff from black and minority ethnic groups who reported experiencing harassment, bullying or abuse from other staff. This figure was below the national average.

The percentage of staff from black and minority ethnic groups who believed the organisation provided equal opportunities for career progression was above the national average.

The percentage of staff from black and minority ethnic groups who reported experiencing discrimination at work from a manager, team leader or other colleagues in the last 12 months had decreased by 5.23% compared with the previous year and was now below the national average.

However, the survey showed an increase over the past two years in the percentage of staff from black and minority ethnic groups experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months.

We also reviewed the Workforce Disability Equality Standard (WDES) data from the NHS Staff Survey 2025. This showed a reduction in the percentage of staff with a long-term condition or illness who reported experiencing harassment, bullying or abuse from managers or other colleagues in the last 12 months. There was also a reduction in the percentage of staff with a long-term condition or illness who felt pressure to come to work despite not feeling well enough.

The data showed an increase in the percentage of staff with a long-term condition or illness who felt satisfied with the extent to which their organisation valued their work. There was also an increase in the percentage of staff who said their employer had made reasonable adjustments to enable them to carry out their work.

The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Staff said senior leaders were visible and listened to concerns but were often unable to provide practical solutions due to limited resources and capacity. Ongoing operational pressures across the hospital affected patient flow. Although the service operated within OPEL and the Surge and Escalation Plan, staff reported that escalation rarely resulted in meaningful change, which reduced confidence in the process.

We found a slow pace of change in addressing issues highlighted at previous inspections. Concerns regarding ligature risks had been raised before, and we continued to see the same issue at this inspection. This did not give assurance that identified problems were acted on within an appropriate timeframe or that governance systems were driving improvement.

The service did not meet its own mandatory training target of 90% for medical staff. Compliance across all modules was below target. This meant the provider could not be assured that medical staff had the up‑to‑date skills and knowledge required to deliver care safely. Leaders were aware of the issue but had not taken effective action to improve compliance. This was a breach of Regulation 18.

The trust took a planned pause from participating in national audits. As a result, there was a period with no external benchmarking and limited independent assurance about outcomes.

Governance arrangements included regular safety, audit and quality meetings. Learning from incidents, complaints and mortality reviews was shared through monthly morbidity and mortality meetings. Risks were recorded on the departmental risk register and aligned with staff concerns.

Leaders recognised risks within the department and had documented mitigation plans. Risks were escalated through established governance processes to board level where required. Ten risks were recorded on the UEC risk register, each with action plans and review dates. However, entries did not include the date risks were added, limiting assurance that concerns were addressed promptly.

The most significant risk identified by staff and leaders was paediatric staffing, including insufficient numbers of paediatric nurses and Paediatric Emergency Medicine consultants.

Staff had access to major incident and emergency policies. The trust took immediate action following inspection feedback, including drafting new standard operating procedures for waiting room management, patients who left without being seen, and oncology and haematology patients receiving cancer treatment.

All staff were able to describe how they made notifications to external bodies such as the local authority for safeguarding issues and to the UK Health Security Agency for notifiable illnesses.

We heard the organisation had a Safeguarding Committee, which provided oversight of safeguarding performance at divisional level. Meetings were held bi‑monthly. We heard about the Safeguarding Operational Group which had been recently restructured to enhance its operational relevance and ensure effective frontline engagement. Meetings were held quarterly and had been operational for over 12 months. Staff reported positive feedback regarding its relevance, usefulness and focus.

The safeguarding adult’s policy was due for review in December 2025 and was scheduled for committee approval and board sign off in February 2026. The children’s safeguarding policy was due for renewal December 2027.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Staff and leaders told us how the UEC department worked closely with key partner organisations to support shared learning, joint improvement, and system-wide patient safety. For example, joint learning and debriefs were routinely undertaken following significant or complex incidents with the local NHS ambulance trust, we were told about a recent joint debrief following a trauma attendance, enabling shared reflection on pre-hospital and ED care, escalation, interface working and joint learning.

The department had recently undertaken collaborative work with a local community healthcare provider in relation to the high-intensity user cohort at the trust.

Healthwatch recently shared a report summarising feedback gathered through their community engagement work, including insights relating to ED, which were passed on to the department. This provided an opportunity to identify issues and make improvements informed by patients’ real experiences.

The trust was also progressing a wayfinding project, working with governors and key stakeholders, including members of the Visual Impairment Group, to improve how people find their way around the hospital sites, particularly routes between the UEC department and USDEC. Directions at the time of our inspection were confusing.

Staff told us there had been a reduction in private ambulance provision after 1am across West Yorkshire. This meant some people waited longer than necessary to be transferred to the right place for their ongoing care.

The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

We found the service had a repeated breach of the Health and Social Care Act. Leaders had previously been told what needed to improve, but the required change had not been implemented. Because a past issue had not been addressed, risks to people remained. This showed the service had not demonstrated the ability to learn from mistakes, sustain improvements or embed safe and effective ways of working.

Systems to check and monitor quality were not always effective. Although audits were carried out, they did not always identify all risks, or they did not lead to meaningful action. For example, hand hygiene audits showed an average compliance rate of 99% between January and December 2025. This did not reflect what we observed in practice.

Some staff told us they were encouraged to identify opportunities for quality improvement and to contribute to innovation within their departments. However, they reported that their suggestions were not always acted upon, and they did not consistently feel listened to. They also told us that limited time and competing priorities sometimes made it difficult to complete quality improvement work.

The service provided examples of improvement to systems to manage patient movement through the hospital. This included the opening of the USDEC, which had improved flow, reduced pressure on the UEC, and helped improve timely access to care.

We were told about quality improvement governance meetings which were attended by senior staff and focused on quality, patient safety, and service improvement. The department was looking to introduce a pre‑meeting to encourage wider staff engagement and increase submissions of clinical audit ideas.

A series of lead roles were being developed, including a lead for quality improvement, though this role had not yet been filled.