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 inspection we rated this key question as good. At this inspection the rating remained the same.

This meant that leadership, management, and governance were well led, promoted person-centred care, and supported learning and innovation within an open and fair culture.

We found an inclusive and compassionate culture focused on learning and continuous improvement, underpinned by a shared vision to meet patient’s needs. Leaders were capable, compassionate, and inclusive, and actively supported staff. Governance systems were in place to manage performance and maintain clear oversight of risks. There was also a commitment to collaborative working across the local health and care system.

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.

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.

The service strategies had been co-created with teams using key quality, experience and performance data. Calderdale & Huddersfield Hospital Foundation Trust (CHFT) used the Work Together To get Results (WTGR) quality improvement and transformation methodology, and several teams had used this approach to inform the strategy. For example, clinicians in stroke services had contributed to the development of the improvement and transformation plan. Additional sessions were held with other services to work through challenges and plan for safe and sustainable models of care.

Data provided by the service reflected the year 1 strategy and demonstrated the alignment with the organisation`s vision, behaviours and goals. Clear targets were set to transform and improve patient care. For example, the service planned to continue to work towards a frailty short stay/direct admissions unit (embedding frailty within ward 3) with an appropriate substantive frailty Multi-Disciplinary Team (MDT).

Key priorities were communicated to stakeholders through directorate meetings and established governance structures. The service had transformed the governance arrangements to support oversight and delivery of objectives, using the well organised ward approach to strengthen accountability and consistency.

Progress against the strategy was reported to the executive team through monthly performance review meetings. Risks, barriers to delivery and challenges were highlighted as well as celebrating achievements.

Each strategy was evaluated at the end of the year with the opportunity to feedback ongoing issues into the trusts planning informing future strategies.

Leaders supported and developed staff, so they felt valued and proud to work in the service, while also targeting improvements to reduce health inequalities.

However, lower band staff (2-4) told us they did not feel included in the service strategy and were not always aware key changes or developments.

Senior leaders told us that information about the vision and strategy was cascaded in through team meetings, WhatsApp groups, screensaver information, updates via the intranet and monthly ‘Ask Rob’ calls with the chief executive. Matrons told us they knew their own teams to know the best ways to interact with them, this included explaining the ‘why’ behind decision making and key initiatives.

Staff told us there was recognition for all staff members across the organisation through the STAR and CHuFT awards. These awards celebrated the dedication and excellence of nurses and midwives in the NHS, particularly in the care of patients with learning disabilities. We saw evidence of staff nominated for awards in differing wards.

The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders were visible and approachable. During the onsite inspection we observed positive interactions between leaders and staff during ward visits. Staff told us that they felt valued and supported by senior leaders.

Leaders had the skills, knowledge and experience to perform their roles. Leaders understood some of the challenges faced by the medical division; however, they were not sited on all risks. We highlighted a number of risks during the onsite inspection, leaders immediately reviewed and acted upon these. Assurances were given by the leadership team to address non-compliance, and these points are listed throughout the report.

Leadership development opportunities were available, including opportunities for all staff.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The service actively promoted the importance of speaking up and had ongoing dialogue with the Freedom to Speak Up (FTSU) team on a regular basis. The service team met monthly to discuss current concerns and ongoing actions. The action log was overseen by the FTSU team who held the service team to account for completion.

Where themes were identified the service commissioned bespoke improvement activities to better understand the issue and develop an action plan. Themes were triangulated with other data sources such as Friends & Family Test (FFT), complaints and staff survey results.

The services management team had developed a responsive and proactive approach evidenced through a number of actions which include improved visibility through a restructure of the head nurse and matron structure to support single site presence and visibility. This is supported by senior nursing leadership at the weekend where each area is visited and 15 steps reviews are also completed which involve understanding any staff concerns.

The service supportive FTSU ambassadors across clinical areas who promoted speaking up and provided peer support.

The services Assistant Director of Nursing (ADN) had attended the FTSU guardian Ambassador meeting in September 2025 to share work completed in relation to the services culture surveys and processes around FTSU.

Leaders regularly met confidentially with colleagues who raised concerns which demonstrated trust in the services leadership team.

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.

The trust had active staff networks for example, race equality network, men's mental health, change society and women’s voices which provided peer support and promoted awareness of diverse needs across the workforce. Equality and diversity champions supported this work across clinical areas.

Staff spoke positively about the workplace culture and reported no negative behaviours or discrimination, reflecting a workplace where diversity and respect were embedded in everyday practice.

Staff were able to apply to work flexibly, for example through flexible working agreements, to account for personal circumstances such as caring responsibilities and health issues.

Managers put reasonable adjustments in place to support staff in carrying out their roles. For example, managers modified work shift patterns, facilitated job sharing and implemented other adjustments to accommodate individual needs and also collaborated with occupational health to support staff.

The service mostly had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. However, we noted inconsistencies in record keeping within the electronic patient record. We reported this within the safe section.

Senior leaders commissioned a focused review of the clinical data and accuracy of the data extraction to provide assurance and oversight of clinical documentation within the EPR record in relation to risk assessments, care plans and accurate record keeping.

They act on information about risk, performance and outcomes, and share this securely with others when appropriate.

The service had a clearly defined governance structure that covered quality, patient safety and risk, workforce and people, finance and use of resources and performance. Each directorate reported monthly into the divisional senior management team.

The trust governance framework described the routes of assurance from service level to board level, including the frequency and membership of each committee and group.

The governance structure included a service business meeting, which considered key aspects of performance and finance; patient safety and quality board which considers all aspects of patient safety and quality as well as risk and compliance; a digital board which considers digital access and compliance.

Quality, safety, workforce, performance and finance are discussed at performance review meetings with the executive team. Key issues from this are reported to the trust Finance and Performance Committee.

Patient Safety and Quality Board reports were discussed at the trust quality committee each quarter.

The service had a clear clinical governance and audit process whereby there is an overarching quarterly clinical governance meeting. Outside of this, specialties have monthly clinical governance meetings. This is a refreshed process that has been put in place to strengthen this process.

The service was represented at key quality and safety meetings, and this is regularly reviewed within the service to ensure that attendance is appropriate. The Assistant Director of Nursing shares updates from these key meeting in the weekly Thursday Matron huddle as well as any slides, papers etc. The Director of Operations shares updates weekly in the operational team meeting.

Matrons reported back on meeting and improvement groups during the weekly matron's huddle which took place every Thursday. They also cascaded key information through ward manager meetings.

Senior leaders were able to explain how risk was managed within the service. Where risks are identified and in line with policy, they were recorded onto the risk register as ‘proposed for acceptance. Risks were submitted to the Patient Safety Quality Board (PSQB) for discussion and approval if accepted it becomes a live risk.

The Well Organised Ward (WoW) meetings supported conversations around ward level risks for escalation and informed proposal for escalation.

The monthly directorate business and performance (B&P) meetings captured current directorate risks on the risk register and included discussions about other potential risks that may require escalation to the PSQB.

The service held quarterly risk review meetings with each directorate to review all risks on the risk register. These meetings ensured risks were in date, relevant and accurately reflected current concerns. Emerging risks were identified and added where required. Closed risks were submitted to PSBQ for oversight and assurance.

The service reported high level risks and emerging risks to the bi-monthly corporate risk and compliance group as well as the bi-monthly performance review meeting (PRM) for executive director oversight and insight into service mitigations and plans.

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.

Directorate leaders engaged with external stakeholders, such as commissioners and Healthwatch. The trust works with a number of partners.

Both local authorities collaborative working had resulted in the carers charter supporting carers across the geographical patch and across organisational boundaries.

The trust work with a number of partners in relation to carers for example, Barnardo’s (young carers Kirklees) and Voluntary, Community, and Social Enterprise (VCSE) such as Unique Ways and peer support groups within the communities to support improvements and hear feedback from carers

Since October 2025, a group had been set up to improve the experience of carers through the discharge process. This included membership from Admiral Nurses, Healthwatch, Carers Count, Experts by Experience, CHFT colleagues and the Local Authority.

We saw examples of shared partnership working. This included a joint non-surgical oncology (NSO) service developed with a local trust working in partnership to deliver a single NSO service. The trust was also working in partnership to provide a single instance chemotherapy prescribing system across the NSO service. Across Haematology and NSO the trust also operated joint outpatient clinics with a large NHS teaching hospital.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service provided multiple examples of learning, improvement and innovation. The service had focused on a frailty model which was based on ward 3. The frailty model reduced patient moves, improving experience and journey with a focus on earlier in the day discharges. There was a focus on movement to the discharge lounge where suitable.

The service worked with the charity team to improve the ward environment and ensure it was dementia‑friendly.

A new quality improvement approach was developed and adopted within the division to support emergency department sepsis management and care of the deteriorating patient.

Several Work Together to Get Results (WTGR) sessions had been held within the service to support continuous improvement, with examples provided in the evidence folder.

The service had implemented an urgent same‑day emergency care (USDEC) model, enabling patients to receive assessment, tests, treatment and specialist review on the same day without overnight admission, reducing waiting times and hospital admissions while ensuring prompt and efficient care.

The Trust provided a clinical leadership program for band 6 staff nursing staff in line with the WoW, supporting colleagues to improve with dedicated time for learning. The program was supported by divisional legacy matrons and band 7 Ward Managers.

The service received national recognition from John’s Campaign, including attendance at parliament showcasing innovative work to support carers. John’s campaign is a movement within the NHS aimed at improving the care and support for people with dementia.