Huddersfield Royal Infirmary

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At our last inspection we rated this key question as good. At this inspection, this rating stayed the same This meant people’s needs were met through good organisation and delivery.

We found that patients care plans were planned and coordinated to deliver person centred care and ensure patients felt involved and supported in their care.

There were delays in discharge for elderly frail patients due to system pressures surrounding availability of community beds and care packages. However, cancer treatment wait times, referral to treatment and diagnostic testing performance were higher (more favourable) when compared to the national rate.

Senior leaders were taking action to achieve consistent and timely access to care across all specialties and had already made measurable progress in reducing overall waiting times.

We have not awarded this service a score for Responsive.

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

Staff understood what mattered to people and provided care that met their physical, emotional, and social needs. We observed staff delivering person centred care and meeting fundamental care needs.

Staff gave multiple examples of making reasonable adjustments for patients. For example, staff on the medical acute floor supported a patient with complex needs through flexible visiting and access to friends and family. Staff on the frailty ward (frailty, and therapy) offered choice about where patients ate meals. Patients were encouraged to sit out of bed and use tables and chairs as part of their rehabilitation. Staff on the acute floor supported relatives/carers to remain with patients at end-of-life offering support and comfort

Patient records were individualised and demonstrated a holistic approach.

We observed clear recording of nutritional requirements on food charts and bed boards. Menus met national dietary guidance and catered for a range of needs, including diabetic and halal diets. Food and fluid intake was monitored, and patients reported positive experiences regarding the availability of food and drinks, and the person-centred support provided by staff.

Patient visiting hours were from 10am-8pm. Staff encouraged relatives, carers to visit. We saw examples where staff and relatives worked together to ensure a patient with dementia was comfortable and understood what was asked of them for example taking medications on time and additional fluids.

We saw evidence of the impact of the trust’s dementia strategy. There was a clear strategic direction and delivery plan to prepare and equip the workforce to provide outstanding, high‑quality care for people living with dementia, as well as their families and carers. The trusts overall ambition was to ensure that every individual receives compassionate, person‑centred care that supports them to live well with dementia. The trust had dedicated lead nurse for dementia.

The Trust was committed to leading the development and delivery of an integrated, high‑quality and equitable dementia care model, working in partnership with people with lived experience, families, carers and system partners to deliver consistent, person‑centred care that improved outcomes, supported people to live well with dementia and reduced health inequalities, while reflecting local needs and ensuring safe, compassionate and sustainable care across all settings.

The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The medical division demonstrated an understanding of the diverse health and care needs of people and their local communities, and there were examples of joined up and flexible care. There was a dedicated discharge service in place to support effective discharge into the community.

The service was working towards a dementia strategy co-produced with partners and key stakeholders aligned to local and national policy and priorities. The development of the strategy was supported by patients and their families who shared their experiences. Third sector organisations such as charity organisations had contributed to the strategy. The dementia strategy was in draft format, leaders told us it was awaiting sign off at the quality assurance group in February 2026.

The service ensured person-centred care by embedding experts by experience in the dementia operational group and quality improvement work, codesigning the dementia strategy to ensure care was shaped by lived experience and focused on what mattered most to patients.

Dementia tier two training was open to all staff and uses digital stories and empathy simulation to better understand the lived experience of dementia and to provide more empathetic, person-centred care.

The trust had agreed to use the Butterfly Scheme. The Butterfly Scheme is a system of hospital care designed to support patients with dementia or memory impairment. It aims to reduce distress during hospitalisation by ensuring that staff are aware of the patient's condition and can provide appropriate care.

“See Who I Am” care plans helped staff understand what matters to each patient supporting shared decision-making. Engagement support workers enabled patients to express their needs, maintain independence and remain meaningfully engaged whilst in hospital.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The service complied with the Accessible Information Standard (AIS). Staff ensured that patients could obtain information on treatments, local services, patient’s rights and how to complain.

Information was provided in accessible formats, including easy‑read materials. Staff kept carers and families updated, and patients confirmed they were kept informed about their care and treatment.

The medical service was aligned to the trusts commitment to promoting population health and reducing health inequalities, as reflected in the five-year strategic plan (2023–28). In November 2022, the trust board approved the first Population Health and Inequalities Strategy. The Strategy outlined the trusts vision for population health and inequalities.

In November 2025, the board approved the new Health Equity Strategy (2025-28), focused on promoting equity for all and embedding this as business as usual. The Strategy contains information about local population demographics and health challenges, as well as the importance of inclusion health and trauma informed care as part of providing compassionate high-quality health care and addressing health inequalities. It provides a framework for staff to understand different patient needs and outcomes across the patient pathway, and for thinking about how to respond to these.

The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The medical service management team were responsible for the oversight and management of complaint responses. The service aimed to proactively prevent complaints through visible and responsive leadership. Matron’s portfolios had been reconfigured to support visibility across wards and departments.

All formal complaints were received through the Patient Advice and Liaison Service (PALs), and each complaint is formally acknowledged within 3 days, aligned to NHSE complaint standards.

The service had periods of fluctuating performance in relation to complaint response times.

Improvement actions had been put in place which included weekly meetings with the head of complaints and the associate director of nursing to closely track responses.

At the time of our inspection all complaints remained within expected timeframes, with no current delays reported. Staff confirmed they received feedback on the outcome of investigation of complaints and acted on the findings.

The evidence showed some shortfalls. Cancer treatment times, referral to treatment and diagnostic testing performance were all better than the national rate. However, there were delays in discharge for elderly frail patients due to system pressures surrounding availability of community beds and care packages.

The trust was in the highest quartile nationally as of 30 November 2025 for the proportion of bed occupancy classed as clinically ready for discharge, with 33% compared to the national average of 26%. The trust also saw a notable increase between October 2025 and November 2025, indicating that the trust had faced increased difficulties with delayed transfers of care.

From November 2024 to October 2025, the most common reason for delayed discharge of patients with a length of stay of 14 days or more was ‘waiting for confirmation of immediate care needs and pathway. This accounted for over a third of all delays and had remained the predominant cause over time, demonstrating a long standing and unresolved issue.

Older patients (aged 75+ years) were more likely to experience long stays compared with national figures. As of June 2025, over a quarter classed as stranded (length of stay over 7 days) and 10% super stranded (over 21 days). The trust provided data on the first day of inspection which evidenced they had 93 patients residing on medical wards at Huddersfield site over 21 days.

We met with the discharge team leads to discuss the pathway, processes in place and the reasoning behind delayed discharges. The discharge pathway was structured from admission (emergency required from admission) and (elective prior to admission) through to discharge. Staff told us there was an increase locally/regionally in the frail elderly population which had placed additional pressure on acute frailty and elderly care beds.

The discharge model operated thorough an integrated flow hub. Patients requiring clinical care were initially screened in urgent and emergency care. Those admitted were reviewed in medical SDEC and transferred to acute medical wards for ongoing treatment if required. Frail patients are admitted into frailty SDEC, reviewed, treatment initiated then transferred to the frailty care of the elderly ward. Ward staff and the frailty team worked jointly together to support early discharge pathways and identify patients suitable for transfer. Frailty advanced clinical practitioners provided medical input.

The service had strong links with system partners. A senior nurse, commissioned by the Integrated Care Board (ICB) acted as a system flow coordinator across the trust, local authority and the ICB to resolve issues predominantly relating to care homes and community pathways.

End of Life care in Kirklees was supported by a senior nurse based in Huddersfield Royal Infirmary, aligned to the local hospice to facilitate t fast track discharges. Staff told us they had a positive working relationship with external partners in Kirklees and Calderdale, particularly for complex cases requiring multi-agency involvement.

Staff in the discharge team told us they followed a clear admission and discharge criteria, and the discharge lounge supported safe and timely transfers, particularly for patients awaiting transport or community placements.

The trust used the Home First Pathway, which supported individuals to return home from hospital when they required assessment for care, support, rehabilitation, or recovery. This approach promoted independence and reduced the risks associated with prolonged hospital stays, such as deconditioning and infection. The pathway required a collaborative working between healthcare, social care, and community services. Home First Pathway formed part of the Discharge to Assess Model (D2A), which provided short-term funded support for patients who were clinically optimised but still require care services.

The discharge team held daily planning meetings to review every patient on the daily plan of care. Meetings included the integrated transfer of care team (ITOC), community health care provider and local authorities. Local authority teams were co-located across both sites ensuring quick access and support.

Ward discharge coordinators communicated with patients to make sure the discharge process was planned and not rushed.

Medical notes were updated to confirm patients were medically fit for discharge. Patients on pathway 0 were discharged by ward teams: all other pathways were supported by the discharge team.

The discharge checklist was completed on the electronic patient record and included medications reconciliation, therapy rehabilitation requirements. Discharge letters were completed at ward level; paper copies were given to the patient and a copy sent electronically to the patient’s general practitioner (GP).

Staff told us the discharge process was part of the Well Organised Ward (WOW) initiative. We saw evidence that reflected the governance structure surrounding this. The service held weekly tri meetings. Medicine wards were divided into 7 differing speciality areas each with a designated lead. On week 8, a bimonthly acute directorate meeting took place alongside monthly business performance meetings. Leaders described ongoing work to meet key performance indicators (KPI’s).

The team were working towards streamlining the service. They had introduced a number of initiatives for example they had instigated a discharge quality group. The group had identified themes and trends following feedback from patients and external partners. They met monthly reviewing medications on discharge, timely discharge, equipment and unsafe discharge.

The discharge team had established a dedicated carers discharge quality group. The group was formed to support and enhance the discharge pathway with carers in mind. The team were able to demonstrate operational improvement initiatives put in place. For example, long stay reviews implemented to support timely discharge and well organised wards initiative launched to educate staff and promote early discharge

Despite these challenges, measurable progress had been made in a number of national indicators. Referral to Treatment (RTT) performance within 18 Weeks had been consistently higher than the national rate from November 2022 onwards. In September 2025, 75% of patients waiting up to 18 weeks compared to 65% nationally, suggesting fewer long waiters in medical specialties.

For medical specialty inpatients, the trust treated a higher proportion of patients within 18 weeks compared to the England average every month from February 2022 onwards. In September 2025 91% were treated within 18 weeks compared to 70% nationally.

From March 2025, the Faster Diagnosis standard required 77% of patients to receive a definitive diagnosis within 28 days of urgent GP referral Between September 2024 and August 2025, trust performance was similar to or more favourable than national and regional comparators. In August 2025, 78% of patients were diagnosed within 28 days of referral compared to 75% nationally. As of October 2025, the lowest performing cancer pathway was ‘Suspected cancer – non-specific symptoms’ with 52% (12 out of 23 cases) diagnosed within 28 days.

The NHS England combined treatment standard states that 96% of patients to receive first definitive cancer treatment within 31 days of a decision to treat. From September 2024 to August 2025, the trust consistently met or exceeded this standard and outperformed regional and national comparators. In August 2025, 98% of patients were treated within 31 days compared with 92% nationally.

The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff across the service and wider organisation promoted a culture in which the people using the service felt empowered to share their views and experience. During the inspection we reviewed eight medical patients who were residing on non-medical wards as medical outliers. The service was given further investment in 2025/26 to open ‘additional capacity’ areas as substantive wards both at Huddersfield Royal Infirmary and Calderdale Royal Hospital sites to support high quality, safe and person-centred care.

In response to the increased capacity the service had strengthened its medical workforce. The number of consultants, middle-grades and resident doctors had increased to ensure continuity of care and reduce reliance on bank shifts and agency staffing.

Staffing plans included dedicated support for reviewing medical patients in outlying areas, which had significantly reduced following the establishment of the new substantive wards.

The service had clear exclusion criteria for identifying medical outliers. Decision to outlie patients were made through site meetings as part of OPEL escalation processes, with senior doctors identifying clinically appropriate patients. The site and service team maintained oversight of all medical outliers, with daily reviews available through the knowledge portal.

Across the medical care groups, compliance with equality, diversity, inclusion training was high at 94% exceeding the 90% target. This demonstrated a strong organisational commitment to promoting inclusive and equitable care.

The evidence showed some shortfalls. People were mostly supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. However, record keeping was inconsistent surrounding this.

We identified inconsistencies in where Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms were uploaded and stored across the electronic patient record (EPR) system. This issue was evident trust wide.

The trust discontinued DNACPR forms in July 2024 following the implementation of an electronic ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) process which includes DNACPR where appropriate.

The ReSPECT process is a key initiative to embody respect for patients within the NHS. It allows individuals to express their preferences regarding medical treatments in emergency situations when they may not be able to communicate their wishes. This process involves discussions between patients, their families, and healthcare professionals to ensure that care aligns with the patient's values and needs.

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) assessments were completed by medical staff.

On ward 15, we reviewed 15 electronic patient records for patients who were not recommended for resuscitation. 6 of these patients electronic ReSPECT forms could not be located by the inspectors.

We escalated this to senior leaders post inspection. Nurse leaders undertook an audit to determine whether DNACPR decisions were in place without a corresponding ReSPECT form. The audit confirmed that all 15 patients reviewed had a fully completed ReSPECT form, providing assurance that documentation was compliant and aligned with trust process. However, we were not assured that staff consistently recorded information under the correct section on the electronic record.

We reviewed the electronic patient record (EPR) system with digital clinical facilitators who confirmed that all documents uploaded to the EPR via the documents section, automatically saves information within the media section. However, it was evident there were clear inconsistencies across patient records.

Staff had access to a digital team for training and advice. It was evident that practice was inconsistent with regard uploading information into specific sections. Work was ongoing to address this.

A refreshed quality assurance framework had been developed through co- production with key stakeholders describing roles and responsibilities with clear governance and oversight to ensure accurate data collection from the clinical record.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Patients were supported to plan for end-of-life care and were given sufficient time and information to make informed decisions about their future.

Staff recognised the importance of early discussions about care preferences, including at the point of admission. They ensured these were clearly recorded and shared so care could be delivered in line with individual wishes. Relevant healthcare professionals and partner services were involved in planning care for people with complex needs.

Palliative care and discharge liaison teams were actively involved in personalised care planning. Staff reported they could readily refer patients to Macmillan nurses, cancer support workers, and specialist palliative care teams, who provided clinical, emotional, and practical support to both patients and staff.

Bereavement packs were available and included personalised cards and small boxes containing condolences and signposting to local bereavement services. Chaplaincy services provided spiritual, pastoral, and emotional support to patients, families, and staff.

The service offered a bereavement service where families and carers could access support. The service also offered a café environment where bereaved individuals could come together in a supportive environment.