Calderdale Royal Hospital

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• 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

This means we looked for evidence that the service met people’s needs.

At our last inspection we rated this key question good. At this inspection the rating has remained the same.

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

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.

We scored the service as 2. The evidence showed some shortfalls in how person centred care was delivered. The service did not always make sure people were at the centre of their care and treatment choices although they did work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

We spoke with patients about their access to pain relief. Some patients told us they were not asked about their pain relief needs either at initial inspection or later, or if they requested pain relief, they waited a long time for it to be given. The department used Patient Group Directions (PGD) for ibuprofen, paracetamol and codeine phosphate to lessen the time patients had to wait however there were still delays. These were up to date.

The trust experienced poor patient flow across the hospital, which affected the emergency department and contributed to delays in moving patients to wards. This also meant patients did not always see specialist teams as quickly as they needed to which in turn could lead to a poor impact on their health.

People who used the service and those close to them, including carers and dependants, were involved in their care and understood their condition, treatment options and care plans. The 2024 Urgent and Emergency Care Survey showed the department scored 9.4 out of 10, rated as about the same, for being informed by a health professional about what would happen after their first inspection. It also scored 1.9 out of 10, rated as worse than expected, for information about waiting times. Overall, for the theme of ‘waiting’, the department scored 4.9 out of 10, which was also about the same as expected.

Most patients we spoke with told us they had an initial inspection of their health needs in a reasonable amount of time and were consulted about their treatment plan. Many understood the challenges faced by staff and said their tests and treatment were explained to them. The 2024 Urgent and Emergency Care Survey showed the department scored 7.9 out of 10, rated as about the same, for explaining why tests were needed in a way people could understand.

The department was able to access support from specialist teams in the hospital such as dementia specialist nurses, stroke specialists and support for people with a learning disability, or poor mental health. Although the department tried to accommodate the individual needs of patients, such as placing them in high visibility cubicles or low ligature risk rooms, this was not always possible and therefore the department was not always able to meet individual needs.

Staff generally considered people’s individual needs and preferences. Patients were given blankets, pressure‑relieving equipment and additional pillows when needed. However, staff did not always complete risk assessments to identify needs such as falls risks or, bed rail use and we saw the majority of patients had bed rails raised without the rational for the decision recorded.

People who regularly attended the emergency department had care and support plans in place. These were discussed by multidisciplinary teams, who made sure people were supported and that other relevant organisations were involved. This included mental health services, homelessness support services and local authority teams, ensuring people received the most appropriate support for their wider needs.

The children’s emergency department was child‑friendly, with toys available to support play and reduce anxiety. There was no dedicated play specialist in the department, but staff could request support from play specialists based on the children’s ward. Staff had completed training in distraction techniques to reduce stress and anxiety in children.

We scored the service as 3. The evidence showed a good standard of care provision, integration and continuity. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supportive of choice and continuity.

Staff worked hard to make sure all relevant health and care professionals internally and externally, including from other organisations were involved in planning people’s ongoing care and treatment. This included social workers, GPs and community health teams. Staff told us they used the BLOSM service who could refer or redirect people to other services such as addiction support services, counselling organisations, charities and social care providers.

Mental health care was provided by the local mental health trust who carried out assessments and, where relevant, provided ongoing care for adults who needed specialist mental health input. There were often significant delays in these assessments due to waiting for external staff to come to the department. People who needed ongoing care in the emergency department or the observation unit because of their mental health needs were supported by emergency department staff until specialist services were able to attend. For people who needed admission to a mental health facility—whether voluntary or under the Mental Health Act—the local mental health trust was responsible for locating a suitable bed and arranging the admission. If a person required admission outside the local area, the responsibility sat with the relevant mental health provider.

All patients attending the department were registered on the electronic patient record (EPR) system. Staff recorded hospital handover information on the same system, which meant all staff could access a patient’s information easily.

Staff highlighted the value of early consultant involvement. They said this supported quicker access to diagnostics such as X‑rays, CT scans and MRI scans. This helped identify conditions earlier, including respiratory issues, and allowed for timely treatment such as inhalers. If sufficient staff were available, nurses in triage and the waiting room could ask a consultant for advice to support early decision‑making, improve patient outcomes and prevent unnecessary delays.

We scored the service as 2. The evidence showed some shortfalls in information provision. The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The waiting room had a board where waiting times were electronically displayed and this was updated regularly. However, the trust scored 1.9 out of 10 for information about waiting times in the 2024 Urgent and Emergency care survey. We spoke with patients about waiting time information and they told us they felt frustrated at the length of time they waited because once they had seen the nurse it wasn’t always clear how long they would have to wait to see a doctor.

Patients could access information about their condition using QR codes. This support was also available to parents whose children attended the emergency department. We saw QR links to information on common conditions such as coughs and colds, headaches and stomach upsets. This helped people manage minor health needs and decide whether they needed to attend the emergency department. Patients and their families were supported to make informed decisions about whether a visit to the department was necessary. However, we did not see evidence of how patients who may not be digitally literate, may have a learning disability or may not have the means to access digital information could access these resources in a comparable way. We did not see printed information leaflets in patient areas.

Information for patients was accessible and available in different languages and formats to meet people’s health and communication needs. This included information about how to complain and how to access other organisations that could offer support. The department met accessible information standards. Interpreters were available for people whose first language was not English. However, we still saw staff using relatives or friends as interpreters even when an interpreter was available. Using family members or friends in this way carries risks and does not follow best practice. There is a risk of misunderstanding, miscommunication and breaches in confidentiality.

Staff told patients about other support available to them and referred people to external services such as mental health support, services for young adults and support for parents and carers.

The evidence showed a good standard in the way people were involved and listened to whilst in the ED. 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 or told them what had changed as a result.

We asked the department how it listened to and involved people in feeding back their experience of care and treatment. The trust told us it received feedback through several routes, including surveys, compliments, complaints and the Friends and Family Test.

We reviewed results from the 2024 Urgent and Emergency Care Survey relating to interactions with health professionals. The department scored 8.0 out of 10, rated as about the same, for people feeling they had time to discuss their condition with a health professional. It scored about the same as expected for people feeling their condition and treatment were explained clearly and 8.3 out of 10, rated as about the same, for people feeling listened to. It scored 8.1 out of 10, rated as about the same as expected, for confidence and trust in the health professional examining them. For whether family, friends or carers had enough opportunity to speak with health professionals, the department scored 7.1 out of 10; based on national survey scoring, this result was about the same as expected. The service performed the same as the England average for 25 questions and “worse than expected” for two questions, which were around getting help whilst waiting and medication information.

When we asked patients and relatives how they would give feedback or make a complaint, most said they would first speak with the person in charge. If their concern was not resolved, they said they would make a written complaint or contact the patient experience team.

Staff told us they aimed to resolve complaints locally wherever possible by addressing issues at the time. If they could not resolve a concern, they escalated it to a more senior member of staff. Staff encouraged people to give feedback so managers could understand concerns and make improvements. Staff also told us they directed patients to the Patient Advice and Liaison Service (PALS) when needed. This helped the department identify themes and trends and address them.

We spoke with staff about Duty of Candour. All staff we spoke with were able to explain to us their role and responsibilities, what duty of candour was and what needed to happen, such as apologising and escalating to senior leaders to investigate. We reviewed the policy which was in date and due for review in March 20206. Staff could access the policy via the intranet.

Complaints were analysed to identify themes. The main themes included delays in diagnosis and treatment, inadequate pain relief, concerns about dignity and communication issues. The department shared patient stories with staff at meetings and in newsletters to help highlight the impact a poor experience can have on people and their families.

Staff said feedback about compliments, concerns and complaints was shared in newsletters, staff updates and at safety huddles and briefings as well as 1:1 meetings if individual feedback was needed.

We scored the service as 3. The evidence showed a good standard in equity of access. The service made sure that people could access the care, support and treatment they needed when they needed it.

We looked at ambulance arrival information and found 2% of patients waited over 60 mins for ambulance handover which was better than the national average.

Time to initial assessment for emergency ambulance was 8 minutes and consistently better than the national average of 10 minutes.

Data we reviewed showed that between April 2025 and December 2025, the proportion of patients who left the UEC department before being seen ranged from 3%- 4%. This was better than the England average of 5% nationally. The department had a standard operating procedure (SOP) for patients who left the department without being seen. This included a documented risk inspection to identify what action to take to find the patient. Reattendance rates within 7 days of previous attendance were around 7% which was also better than the England average of 9%. The trust worked with an MDT including external providers to manage high intensity users, providing action plans and other pathways of support to help avoid unnecessary attendances. The department also looked at themes and trends for reasons for reattendance.

We reviewed data sent to us by the trust about patient waits after decision to admit (DTA) and found the percentage of patient waiting more than 12 hours from DTA had increased from 3.3% in July 2025 to 16.4% in January 2026. This reflected to difficulty the hospital had with flow of patients and discharges to free up beds for patients in ED.

The service had various patient pathways that started at the entrance to the department. Patients were able to access support for minor injuries and illnesses including GP access in the Minors area of the department. Based on an initial conversation before entering the department, patients were directed to the most appropriate area of the hospital or diverted to other services. When we observed this process, we saw examples of patients being taken straight for tests or for an immediate medical opinion.

Access to tests and x-rays was prioritised on a needs basis thus making sure that those with the most urgent need were seen first. Staff worked around potential barriers to access to make sure all patients received the care they needed. We reviewed waiting times for diagnostic tests and found that patients waiting for ultrasound waited between 2 hours and 23 hours, for MRI between 3 hours and 10 hours and for CT scans, between 90 minutes and 6 hours. However, the department carried out point of care testing which delivered some test results such as blood tests and ECGs more quickly.

Staff were alert to discrimination and inequality that could disadvantage people in accessing care, support and treatment. Staff worked hard to remove barriers to access.

Leaders and staff acknowledged that people could not always access support and treatment when they needed it because of poor patient flow and capacity issues across the hospital. For example, people we spoke with, including patients and families, told us about long waits in the emergency department, including after a decision to admit had been made. However, staff worked hard to make sure people received timely care in line with national performance standards. At the time of our inspection, this challenge was not unique to this department.

People who required a mental health bed outside the trust were often cared for in the department for several days while a suitable placement was identified. This meant cubicles remained occupied for long periods, staff were required to provide ongoing support, and managers spent considerable time working with external providers and commissioners to arrange appropriate placements.

We scored the service as 3. There was a good standard of evidence that the department considered the needs of all patients including those with protected characteristics. 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.

The trust had systems to support people at risk of experiencing inequitable care, including those with learning disabilities, autism, poor mental health or language needs. This included a liaison service, learning disability and autism champions and staff training. Discharge summaries and test results were shared electronically with people’s GPs to support continuity of care. Staff worked hard to remove any barriers to access for patients and sought solutions which met individual needs.

The service made reasonable adjustments to support diverse needs, including interpreter services for people with communication barriers. For those unable to access digital information, printed leaflets were available on request. Staff also signposted people and their carers to additional services such as community pharmacies and dentists thus helping patients and carers to access appropriate support services in a timely way. Doing this improved outcomes for patients and reduced pressure on the department.

When we spoke with staff they told us about the BLOSM service run by the trust which supported vulnerable adults to make sure they were well supported and received additional support to meet their needs, such as for addiction, homelessness, domestic violence and poor mental health. This service worked to make sure some of the most vulnerable people in the department were not disadvantaged.

The trust analysed hospital data to understand the characteristics of the population using the emergency department. These factors influenced the type of services the hospital needed to provide. The trust also reviewed Friends and Family Test results to identify any concerns that required further investigation or improvement.

Staff received training in equality, diversity and human rights. However, only 81% of medical staff had completed this training. This created a risk that some staff may not always treat people in accordance with trust policies or be fully aware of their responsibilities.

The trust had appropriate policies and procedures in place and carried out equality impact assessments for new or revised policies to make sure they did not place vulnerable people or people with protected characteristics at a disadvantage. We saw that these assessments had been completed for all policies we reviewed during the inspection.

We scored the service as 3. The evidence showed a good standard of supporting people to plan for the future. 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, relatives and carers were supported to plan for important life changes so they could make informed decisions about their future, including at the end of their life. Staff told us that people on end of life care pathways were prioritised for admission to the most appropriate ward whenever possible. If a ward bed was not available, staff moved people to a private and suitable space within the department so they and those close to them had privacy during difficult and emotional times. We observed this whilst carrying out our inspection.

Staff had access to the trust‑wide resuscitation policy and demonstrated a clear understanding of the trust’s do not attempt cardiopulmonary resuscitation (DNACPR) policy. This helped safeguard people from inappropriate application of DNACPR decisions. Where DNACPR orders were put in place, these were made through conversations between the patient (when possible), their family, and their health and care professionals to ensure decisions reflected what mattered to them and what was realistic in terms of treatment and outcomes.

Multi‑agency working helped ensure care for people nearing the end of their life was delivered sensitively and with dignity. When people wished to return home for their end of life care, staff worked with other agencies to facilitate this safely and as quickly as possible in line with the person’s preferred place of death.

Staff told us discussions with patients and carers about their wishes were recorded in electronic patient notes. When relevant, information about support services was shared with patients and relatives. Staff also ensured other healthcare professionals and organisations were involved in planning people’s onward care and treatment wherever possible. This included therapy and rehabilitation teams, social workers, mental health services and addiction support services. Staff could refer or redirect people to other services to help plan their future care. People were encouraged and supported to make informed choices about their care while they had capacity to do so. However, whilst 91% of nurses had completed end of life care level 2 training, only 70% of medical staff were compliant. Nurses were 100% compliant for level 3 training. Medical staff were not required to complete level 3 training. This meant patients at the end of life could have been cared for by medical staff who did not have the required training, increasing the risk that their needs, preferences and comfort were not fully understood or met.

Staff told us they reviewed and assessed people approaching discharge to determine whether they needed additional health or social care input from community or social care services. This included considering whether they needed community nursing support, rehabilitation, domiciliary care or mental health services.