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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

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 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 understood but could not always articulate the trust’s vision, values and behaviours. The trust had four behaviours to underpin its vision. These helped staff deliver compassionate care.

We saw staff embodied the trust’s culture of care by putting people first and working together to get results. The service had a pledge to patients based around the six C’s; courage, care, communication, commitment, competence and compassion.

The manager understood the strategic priorities and how they related to wider hospital services. They shared some examples of service improvements and project development.

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.

The OPD manager clearly demonstrated oversight, dedication and focus of all clinical and non-clinical governance processes, arrangements and issues within their department.

Staff told us leaders and especially their manager were highly visible and approachable. They would always make themselves available when required.

The manager was well supported and maintained good cross-site relations with the head of clinical services (HCS) and senior leadership team (SLT). The clinical lead, and operational manager often visited the department. Staff appreciated seeing SLT members. Senior and hospital leads were aware of the latest OPD issues. For example, they prompted regional provider teams or linked staff to be more responsive to the OPD manager.

The OPD manager attended all relevant meetings. This included a short weekly patient safety incident response group (PSIRG) to discuss any issues. For example, if complex patients were suitable to attend clinics.

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

Staff told us the service had a positive, friendly and inclusive culture. All OPD staff we spoke were positive about working for the hospital and felt respected, appreciated and well supported by managers and teams to raise any suggestions or concerns.

Staff knew how and where to contact the hospital’s freedom to speak up guardians (FTSUG). They were visible in the main outpatients reception area. No staff we asked had needed to use them recently, as they felt well supported and heard within their teams.

They could access support from occupational health and an external counselling service if needed. Posters signposted staff to wellbeing organisations and resources.

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.

Senior leads and managers reminded staff to complete the yearly staff survey. Leads shared survey results with the relevant teams for review and response. They set a divisional action plan yearly and captured actions for any overall themes identified. Divisional leads had assigned owners and strategic themes to help them monitor the progress of all actions. Directorates also set their own local action plans. Some specialties such as endoscopy had devised their own service-specific staff survey.

Service leads had taken actions in response to the 2024 results. They tackled areas where they saw the biggest staff decline in engagement compared to the previous year. We saw the OPD staff survey feedback overview for 2024. This divisional data was not broken down to location specific information. This had a reduced engagement score compared to 2023. As a result, leads’ area of focus was on setting up engagement activities. We heard this was a key strength across outpatient areas. Leads monitored the survey’s people metrics since these results. These had remained consistently high.

Directorate Performance Review Meetings (PRMs) included staff engagement and survey as a discussion topic. Teams provided updates on actions undertaken and planned. Leads discussed survey results and actions yearly in a range of trust forums and reported on their progress. We saw examples taken from Directorate PRMs and the Trust Workforce Committee. Leads shared other communication approaches such as ‘You Said, We did’ posters within OPD areas.

The directorate had a workforce strategy. This included diverse and inclusive workforce objectives, as well as local employment, career and voluntary opportunities. Leads monitored and RAG rated this one-year strategy’s workforce elements. Elements were also informed by the staff survey’s output. A culture of care and wellbeing open door policy with access to a human resources representative formed part of the best place of work commitment.

Staff could submit ideas and nominate colleagues for star of the month awards. They were given the opportunity to have a voice through ‘you said, we did’.

We found many staff in the department were long-term employees of the provider. They praised the senior staff’s responsiveness, accessible staff wellbeing facilities, social events and activities and the hospital’s open culture.

Staff were prompted to deliver compassionate and inclusive care on posters reminding them of the protected characteristics. The trust had an equality and diversity team OPD staff could contact.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

OPD managers and clinical staff used a system for reporting clinical governance issues. Leads reviewed reports to inform governance discussions. Staff attended patient safety meetings to promptly cover any issues.

Managers had a project underway to centralise all OPD appointment bookings through a hub and spoke model. They told us this would improve governance and oversight. They planned to recruit the newly created role of hub operations lead in preparing to launch the pilot by April 2026. This work sought to better capture outpatient’s person-centred needs and requirements using business intelligence tools.

The OPD manager had clinical representation through the governance structure and would review minutes and updates. They told us collaborative and clinically insightful discussions were held.

Leads proactively reviewed governance arrangements which reflected best practice. For example, gynaecology leads and antenatal staff attended a shared quality board. Ophthalmology staff had monthly clinical governance sessions. Consultants delivered this training to help staff complete essential safety training. Paediatric staff had bi-monthly meetings. However, they recorded no formal minutes but had plans in place to do so.

Service-specific risks were frequently reviewed and escalated appropriately. Relevant OPD related risks could be escalated up to the executive board through the audit and risk committee.

Leads and managers were aware of key areas of risk which affected their services. There were some legacy risks from our last inspection in March 2016. However, leads had actions to address and mitigate them.

We reviewed trust wide and divisional risk registers. The highest scored risk across all OPD specialties was ENT’s risk of prolonged waiting times for patients. This scored 16 out of a possible 25. Actions were in place, such as a healthcare contractor providing extra weekend capacity and a task and finish group to identify solutions and improvements. This divisional data could not be broken down to location specific information.

OPD’s second and third highest corporate risks were in children’s services and therapy. One related to limited paediatrics administrative capacity resulting in delays delivering timely correspondence. The other was financial and related to CYP not receiving timely and adequate clinical assessment for education, health and care plans (EHCPs). Both were scored 15 out of 25. Actions were in place to mitigate these risks.

All OPD investigations were governed through a clear divisional assurance structure. Learning responses were overseen at the Divisional Patient Safety Event Panels, where themes and actions were reviewed. Investigation outcomes and learning were then escalated to the Divisional Patient Safety Quality Board (PSQB) for further oversight and assurance. A key learning and actions summary was incorporated into the Quality Report. This was formally submitted to the Trust Quality Committee. In addition, the overarching Trust Patient Safety Panel oversaw and assured the quality and approval of all PSIIs.

The department’s patient safety incident response framework (PSIRF) response process was outlined in the trust’s PSIRF plan and policy. This used a system‑based learning method including SWARM huddles, PSIIs, after action reviews, multidisciplinary team or case note reviews and thematic analysis.

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.

The service actively fostered cross-site team development through engaging and inclusive activities. These helped strengthened collaboration, wellbeing, and shared culture across departments.

Leads held regular governance meetings with partner providers, stakeholders and other regional trusts. For example, OPD managers met with NHS ambulance service operations managers bi-monthly. They had open, honest discussions about any challenges or issues for a shared understanding and approach.

We were sent evidence of the department’s outreach work to engage minority groups and those less heard. For example, leads had taken part in carer’s week 2025 and shared their insights with staff.

Leads encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

However, the service could not always focus on continuous learning, innovation and improvement across the organisation and local system. This was due to seasonal or longer-term sickness of nursing staff impacting colleagues ability to gain shift cover for CPD and wider opportunities.

The service had improved continuity of care and outcomes for outpatients with dementia who had a fractured neck of femur. Leads had moved one resident doctor from OPD onto each hospital ward. This meant they had closer relations with this cohort once they became inpatients.

The service had research projects underway in orthopaedics, surgery and physiotherapy. One such study compared different approaches to physiotherapy after shoulder surgery. The orthopaedics department had a clinical support worker research champion and fracture clinic had allied health professional research nurses.

We were sent examples of service improvement work for OPD bookings. The new hub and spoke model supported timely scheduling, reduced waiting times, provided consistent communication, and an improved outpatient experience. For colleagues, the programme introduced clearer career pathways, improved support, defined expectations, and recognised specialist skills in booking teams.

Other service improvement examples included a new tiered workforce model (Bands 2–5). This had created clear roles, training pathways, apprenticeships and career development opportunities. This improved staff capability and wellbeing.

OPDs had improved digital integration, including electronic patient records (EPR), key performance plus dashboards, and the patient portal. These integrations enabled real‑time visibility, intelligent scheduling, and reduced manual workarounds.

OPD service improvements were underway in gynaecology, ophthalmology, paediatrics and integrated medical services.

However, the department had no examples of staff-led quality improvement (QI) training, staff-led projects or initiatives. Managers and nursing staff said they lacked time to complete any in their teams.