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

This meant the effectiveness of people’s care, treatment and support achieved good outcomes and was consistent.

At our last inspection we rated this key question requires improvement. At this inspection the rating has changed to good. This meant people’s care, treatment and support achieved good outcomes and promoted a good quality of life.

Care was delivered in line with evidence based and national standards and was routinely monitored, with effective multidisciplinary collaboration to benefit patients.

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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Staff ensured patients received effective care and treatment through assessment and regular review of their health, wellbeing, and communication needs.

We reviewed 20 patient electronic records. Care records and personalised treatment plans were clearly documented following admission and kept up to date to reflect identified needs.

Observations of multidisciplinary ward rounds showed staff reviewed results collaboratively and discussed treatment options before engaging with patients.

Staff used risk assessment tools effectively to assess and monitor patients’ needs and took prompt action to escalate concerns about deteriorating patients. Patient records showed early assessment of clinical risks. Daily nursing handovers included discussion of risk, and care plans were adjusted to reflect changing needs, with risk assessments and onward referrals completed where required.

Patient records showed that nutritional needs were accurately assessed and met, with food and fluid charts in place.

Staff recorded the National Early Warning Score (NEWS) accurately, appropriately, and up to date, supporting early recognition and escalation of patient deterioration.

Care records reviewed were correctly scored and documented electronically.

Care records across medical wards showed that venous thromboembolism (VTE) risk assessments were consistently completed.

The service provided evidence that VTE was last audited in November 2025. The audit reviewed compliance with VTE risk assessment and prophylaxis requirements across the organisation.

Findings showed that 92% of patients had a completed VTE assessment and 93% of prescribing decisions were appropriate; However, of those prescribed prophylaxis, only 25% received the first dose within 14 hours and 30% waited above 24 hours. This demonstrated delays in timely administration of VTE prophylaxis.

Patient needs were mostly displayed on visual boards, including magnetic signage highlighting risks such as falls, skin integrity, dementia, or nutritional requirements, supporting safe and personalised care. Visual boards were used at each patient’s bedside to support communication and person‑centred care. A review of the existing visual boards was undertaken in response to feedback from patients and carers, who reported that the boards were not sufficiently person‑centred or inclusive.

A multidisciplinary working group was formed, comprising of clinical staff, patients, and carers to co‑produce improvements.

The group worked collaboratively to review the purpose, content, and accessibility of the boards, ensuring that patient and carer voices were central to the process.

Several wards trialled alternative board designs, with structured feedback gathered from patients, carers and staff. Feedback highlighted the value of boards that patients and carers could complete themselves, enabling them to share what mattered to them and communicate directly with the multidisciplinary team.

Following this feedback, several companies were approached to explore whether bespoke boards could be designed to meet these requirements. A key requirement was that the boards could be removed from the bedside, enabling patients and carers to complete them in their own time and in a way that felt comfortable and meaningful.

As a result, bespoke removable boards were developed so patients and carers could complete them in their own time. The boards were tailored for adult, paediatric and maternity services and co‑designed with relevant staff, patients and carers. Leaders told us the new boards were scheduled for delivery in February 2026.

Within the period 2025/2026 the trust has participated in 35 local audits, 12 of which were completed.

The service provided evidence of local audits undertaken. The data reflected what audits had been completed and when. We requested data to evidence local audit completion and associated action plans. We received 3 completed audits with action plans which evidenced compliance, action and who was responsible for completion.

The trust participates in a range of audits within the National Clinical Audit and Outcomes Programme and NHS England’s Quality Accounts, where these apply to services. Oversight of case ascertainment, reporting, and action plans was coordinated centrally through the Clinical Effectiveness and Audit Group.

Staff planned and delivered care and treatment in line with current legislation, evidence-based practice, and national standards ensuring safe, effective, and person centred care.

Staff had access to the full range of specialists required to meet the needs of patients. This included doctors and nurses, as well as occupational therapists, physiotherapists, speech and language therapists (SALT), dieticians and pharmacy staff. Additional support staff including housekeeping, portering and discharge teams, were also available to support care delivery.

Staff used a range of nationally recognised assessment and screening tools to support safe and effective clinical decision-making, including the National Early Warning Score (NEWS2) to identify and respond to patient deterioration, the Malnutrition Universal Screening Tool (MUST), venous thromboembolism (VTE) risk assessments, falls risk assessments, and recognised pain assessment tools.

There was a clear escalation policy in place for the management of deteriorating patients, with staff taking timely and appropriate action. Managers were able to deploy enhanced one to one staff to provide patients requiring additional support. Staff upheld the rights of patients subject to the Mental Health Act 1983 and made appropriate referrals to the Mental Health Liaison Team when and if specialist input was required.

The service provided onsite endoscopy services. The site had Joint Advisory Group (JAG) accreditation from the Royal College of Physicians. JAG accreditation was awarded in February 2024 for 5 years subject to annual review. In February 2025 an annual review was undertaken, and JAG accreditation was awarded for a further year. The endoscopy unit sits under the surgical services within the trust.

Managers provided staff with supervision meetings to discuss care management, to reflect on and learn from practice, and for personal support and professional development and appraisal of their work performance.

Managers ensured that staff had access to regular team meetings, staff confirmed this during the inspection. The appraisal system was overseen by corporate workforce and organisational development. At the time of the inspection, 92% of staff had received an appraisal in the last 12 months meeting the trust target of 90%.

The organisational development team used appraisal outcomes to inform training, talent management and succession planning.

Staff worked well across teams and services to support patients and shared information effectively when patients moved between services.

We observed good communication and coordination between staff of all roles and grades. Patient information was shared promptly and effectively ensuring continuity of care.

Staff across medicine wards spoke positively about the strong culture of teamwork and collaborate working at local level.

Managers held regular multidisciplinary team meetings that promoted cohesive working, shared learning, and collaborative decision making

Attendance at handovers, nurse safety huddles and ward rounds varied across medical specialties to ensure the right staff were present for each area.

Multidisciplinary attendance included registered nurses, consultants, junior doctor’s physician associates, therapists, advanced clinical practitioners, students, pharmacists, and healthcare assistants.

We observed positive, open communication during daily board rounds, safety huddles, and handovers. This proactive approach supported timely escalation of issues, effective risk management, and smooth coordination of care.

Staff supported patients effectively to manage their health and wellbeing.

They promoted healthy lifestyles and provided practical advice and support to encourage recovery and independence. Specialist nurses visited wards regularly to offer expert guidance on specific conditions, ensuring patients received tailored and targeted support. This included education on disease management, safe medication use, and lifestyle changes to promote long term wellbeing.

Oncology patients received coordinated support across multiple services, including outpatients, emergency department, Macmillan staff, paramedics, GPs, and other hospital trusts. Physiotherapy staff focused on preventing deconditioning by promoting mobility, exercise and independence throughout patient hospital stays, supporting faster recovery and improved outcomes.

We observed a range of patient information materials supporting patient discharge. These resources promoted healthy living, discharge planning, and signposted patients to relevant local and national support services and charities.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Patient outcomes were measured using standardised tools, enabling national benchmarking and ongoing monitoring to inform service improvement and enhance rehabilitation outcomes.

There was effective oversight of pressure ulcer management across medical specialties, with weekly and monthly thematic review meetings led by the medical division tissue viability teams. Reviews identified themes and trends, leading to targeted actions such as staff training Learning was shared across teams to strengthen clinical oversight, improve practice, and reduce the incidence and severity of hospital acquired pressure ulcers.

The frailty and respiratory virtual wards were renamed in December 2025 to align with national guidance. The service portfolio comprised of frailty, hospital at home and respiratory hospital at home. The renaming reflected the national position on virtual ward and home‑based acute care models, strengthening consistency and recognisability across system pathways.

The community respiratory team workforce model included clinicians providing services across several respiratory pathways including supporting a community caseload and a home oxygen service.

The frailty hospital at home team was a dedicated service focused solely on providing hospital at home care seven days a week. Consultants provided clinical oversight and team worked collaboratively across divisions, ensuring coordinated, high-quality care for frail patients at home.

The service had a pharmacy virtual ward workforce model which included pharmacists providing services across several community pathways including the urgent community response service.

Within the hospital at home model, pharmacists worked as part of the integrated clinical team to deliver safe, effective, hospital‑level medicines management in the patient's home.

The Well Organised Ward (WOW) is a quality driven philosophy and was launched at trust level in August 2023. The program was launched to help transform process and practice at ward level. It is underpinned by four core principles: planning for every patient (P4EP), discharge ready date (DRD), the nurse‑in‑charge role, and the use of electronic whiteboards to support board rounds and handovers.

The programme aimed to improve patient experience and quality, reduce length of stay and support efficient discharge, embed a culture of continuous improvement, and support the professional development of staff.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood their responsibilities of the mental capacity act 2005, however practice was not always consistent.

Staff obtained consent before providing care & treatment. During the onsite inspection we observed staff explaining procedures in a way that supported patients understanding and decision making.

Where patients lacked capacity to make specific decisions, staff completed some capacity assessments and best interest’s assessments: however, the quality of the documentation varied. We found examples where best interests decision had been made appropriately but these were not recorded in the correct section of the EPR. This meant staff could not always be assured that decisions were clearly documented or easily accessible when required.

ReSPECT forms were in place for patients who were not recommended for resuscitation, however, we found inconsistencies in where these were uploaded in the EPR. This posed a risk to staff not being able to access information promptly.

We reviewed the electronic patient record (EPR) system with digital clinical facilitators at the time of inspection who confirmed that all documents uploaded to the EPR via the documents section, automatically saves information within the media section. Senior leaders told us they planned additional staff training surrounding the upload of documents onto the EPR system.