Bradford Teaching Hospitals NHS Foundation Trust

On this page

• 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
• Environmental sustainability – sustainable development

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.

In a well-led trust, leaders should ensure a clear, shared vision and strategy across the organisation, and staff understand how their roles contribute to achieving these goals. The vision, values, and strategy are developed collaboratively with staff, service users, and external partners through a structured planning process. Both staff and leaders should foster a positive, compassionate culture focused on trust, understanding, and continuous improvement. They should aim to prioritise equality, diversity, and human rights and promote safe, high-quality, and compassionate care. Efforts should be made to address any workforce inequalities, with actions taken to resolve identified issues. Additionally, leaders and staff should assess and manage risks that could impact the delivery of the strategy, ensuring there are actions in place.

We scored this quality statement as 2. The evidence showed some shortfalls. Whilst the trust did not have a clear shared strategy and direction for the future, they were working with partners to develop this for the Bradford and District place. Although, the trust and its board members had a positive attitude to improving the culture of the organisation, they recognised further work was needed in this area. Particularly around staff feeling able to speak up and raise concerns, as not being able to do this may affect the quality of people’s care. The trust’s vision and values were well-established, and staff described a supportive culture within local teams.

The trust had a corporate strategy for achieving trust priorities and developing good quality care. The trust’s corporate strategy ‘Our Patients, Our People, Our Place and Our Partners 2022 to 2027’ was approved in June 2022. Patients, staff, carers and external partners had the opportunity to contribute to the development of the strategy in a series of workshops and engagement events held in 2022, along with contribution to a public survey. This included meetings with Healthwatch Bradford, community stakeholders from local businesses, volunteers and community groups as well as Bradford District and Craven Health and Care Partnership (BDCHCP) and West Yorkshire Integrated Care System (“Act as One” partners) representatives.

The trust was part of the Bradford District and Craven Health and Care Partnership (BDCHCP), and the corporate strategy aligned to local plans in the wider health and social care economy.

Twelve board approved sub-strategies underpinned the corporate strategy, with each additional strategy describing its purpose, governance arrangements, measurable objectives and implementation plans. Progress reports for these strategies were reported to the board committees. The trust identified board level leaders who held responsibility and accountability for delivering each component of the trust’s strategy and delivery plan. The trust monitored and reviewed how it delivered strategic objectives with a board-level report.

Despite having a number of strategies in place, the trust did not have a clear clinical services strategy. Instead, the trust worked with neighbouring trusts to develop a collaborative clinical strategy. The principles of collaboration had been set out and some clinical networks established. In the absence of a clear clinical strategy linked to a longer-term financial improvement plan, it was unclear how the financial plan, workforce plan and activity plan supported the future delivery of sustainable clinical services. There was also a risk of confusion due to the number of supporting strategies and lack of alignment to an overall clinical strategy.

The trust had a vision ‘to be an outstanding provider of healthcare, research and education and a great place to work’. The trust had established three values which were:

• We care
• We value people
• We are one team

The trust objectives were:

• Quality. To provide outstanding care of patients delivered with kindness.
• Improvement. To be a continually learning organisation and recognised as leaders in research education and innovation.
• People. To be one of the best NHS employers prioritising the health and wellbeing of our people and embracing equality, diversity and inclusion.
• Partnership. To collaborate effectively with local and regional partners to reduce health inequalities and achieve shared goals.
• Sustainability. To deliver our financial plan and key performance highlights

The feedback we received during our assessments of the trust’s frontline services was mostly positive about the culture within services. Staff and leaders were proud to work at the trust, and most staff could describe the trust's existing vision and values.

The trust had mechanisms to identify and address behaviours that were inconsistent with the values of the NHS. We reviewed two recent examples of disciplinary processes and three examples of grievance processes. All examples had been carried out in line with the trust’s policies with the processes completed within reasonable timescales.

NHS Staff Survey results in 2024 showed similar or slightly higher levels of engagement, with the trust achieving continuous improvement over time in some areas. The trust score for:

• ‘We are safe and healthy’ had increased from 5.8 in 2021 to 6.2 in 2024
• ‘We are a team’ line management sub score increased from 6.4 in 2021 to 7 in 2024
• ‘We are compassionate and inclusive’ People Promise element was higher than the overall average for comparable trusts with the sub-element ‘compassionate leadership’ scoring slightly higher than the average.
• There were no themes or sub scores in the 2024 NHS staff survey results that saw continuous yearly deterioration. The ‘Staff engagement’ theme was comparable at 7.1 in 2020 to 6.9 in 2024 of which, the trust score remained just above the national average of 6.84.

The trust and its board members had a positive attitude to improving the culture of the organisation and did recognise further work was needed. We heard from some staff across a range of services that they did not feel psychologically safe to raise concerns outside of their clinical support unit to members of the executive team. We wrote to all staff including bank staff and volunteers working at the trust to ask for feedback on their experience. We received limited responses although some staff told us that there were pockets of poor culture, particularly within some non-clinical areas and pharmacy services.

With a new chief pharmacist in place, work was underway to address the long-standing cultural concerns identified in the department. In focus groups staff told us that they felt culture was not where it needed to be and that little progress had been made. However, we saw staff engagement plans were in place and events had taken place with staff to listen to their concerns. A draft medicines optimisation strategy had been developed and was awaiting sign off. There were clearly defined challenges covering core medicines optimisation areas of practice, each with individual actions identified. Risks had been identified and documented, and monitoring was clearly set out. The pharmacy strategy and workforce strategy had not yet been developed however staffing was captured in the trust wide medicines optimisation strategy.

The trust had Quality Priorities for 2025-26 which were:

• Building on our previous work to improve the management of the deteriorating patient we will fully implement all 3 components of Martha’s Rule to all adult in-patient wards.
• Building on our success in implementing Saving Babies Lives will continue to make improvements in our maternity and neonatal services with a focus on reducing health inequalities.
• We will continue to develop and embed our approach to patient safety and clinical governance by implementing fully the recommendations from our internal audit reports relating to risk management and patient safety.

Progress against the key metrics was monitored. The 2024-25 Quality Account provided analysis of delivery against the four quality priorities for that year. It also recorded the four priorities for 2025-26 to which the trust had been working. The priorities were established following engagement and feedback from key stakeholders within and outside the trust. This was part of an annual cycle of the Quality Account.

The trust had mechanisms to ensure staff were fit and proper for their roles at the point of recruitment although the trust did not check this on an ongoing basis. The trust provided information about Disclosure and Barring Service checks for 519 staff who had joined the organisation into roles during the past 15 months which required a DBS check. The trust did not have a robust process, including self-declaration, to ensure staff remained fit and proper persons for their roles, unless they applied for another job in the organisation. The trust had effective systems to monitor professional registration.

We received positive feedback from partners about how the trust met the ‘shared direction and culture’ quality statement and specific examples of how the trust had worked in collaboration with partners. We heard how the trust was working with external partners to develop a new clinical strategy.

In a well-led trust, leaders should have the experience, capacity, capability and integrity to ensure the organisational vision can be delivered, and risks are well managed. Leaders should be visible at every level, lead by example, and model inclusive behaviours. High-quality leadership is sustained through safe, effective, inclusive recruitment and succession planning. Leaders must be knowledgeable about issues and priorities for the quality of services and can access appropriate support and development in their role. Leaders should be alert to any examples of poor culture that may affect the quality of people’s care and have a detrimental impact on staff. They address this quickly.

We scored this quality statement as 2. The evidence showed some shortfalls. The trust board had been through a period of challenge over the past two years and there had been a considerable change of membership. As a result, the board had identified areas for development, and a programme was in place to deliver this. Leaders described this as an improvement journey to enable board members to work more effectively together. Leaders had the skills, knowledge, experience and credibility to lead effectively.

The trust board was comprised of executive and non-executive directors. Four new executive directors and three new non-executive directors (NEDs), had joined the trust since April 2024. A new chair of the trust was appointed in 2024, and the non-executive team had more newly appointed NEDs to enhance capacity and balance the board. The trust’s board members described a forming relationship and reported there was an appropriate mix of skills and experience to ensure effective and visible leadership, including clinical leadership, across the board. The board had previously experienced a period of instability within the executive and non-executive team and described to us the change of focus to working together for people who used services. The trust had one non-executive director vacancy at the time of assessment.

There were six voting executive directors including the chief executive officer; chief operating officer, chief medical officer; chief nurse, chief finance officer and director of strategy and transformation. The chief operating officer held the role of deputy chief executive. The executive team included the non-voting a director of estates, chief digital and information officer and director of human resources. There were seven non-executive directors including the trust’s chair.

THRIVE was an internal staff wellbeing, development, and inclusion program focused on creating a positive, supportive, and equitable culture for employees to flourish, emphasise kindness, teamwork, valuing people, and continuous improvement. Resources were accessed via the Thrive Portal and we received positive feedback from staff about this resource and content. Following historical challenges and turnover of board staff, a board and Council of Governor’s development programme was in place. Sessions were facilitated by both internal and external agencies to promote clarification in ways of working, roles and responsibilities linked to the trust’s THRIVE programme. Sessions focused on developing the new board and included population health management, getting to know each other, culture vision and values, working together, risks and issues. Leaders we spoke with were knowledgeable about the issues and priorities affecting the quality of services and recognised their role in supporting improvement. A board effectiveness survey was undertaken in September 2024 and repeated in April 2025 and the participants recognised improvement in the board’s efficiency and effectiveness, ambitions, collaboration with communities, neighbourhoods and workforce. As a result of the survey, further areas for focus were identified including how the board of directors and Council of Governors worked together, clarity on the roles and responsibilities of the Council of Governors and to create more informal, face to face opportunities for the board.

During our assessments across urgent and emergency care, maternity care and community care most staff told us leaders were visible within the trust. However, staff at St Luke’s hospital told us they knew who the leaders were, but they did not visit the service often.

The executive team held lead roles for specific priority areas. The chief nurse was also the director for infection prevention and control and the board level lead for safeguarding, maternity, freedom to speak up and other areas. The chief digital and information officer was the senior information risk owner (SIRO). The chief operating officer was responsible for the corporate team, corporate governance and equality, diversity inclusion and other areas.

The board was supported by a senior leadership team with the appropriate range of skills, knowledge and experience. This included deputy directors for estates, information, finance, medical, nursing, operations, and people. The trust leadership team had a good knowledge of current priorities and challenges. However, staff told us the leadership relationships were sometimes informal and lacked professional challenge.

The executive and non-executive team had more recently started to undertake structured safety walk arounds to services across the trust. In addition, there was a structured visiting programme for non-executive directors and governors. The visits were planned in advance and observations written up and shared at board meetings. Leaders told us the visits provided greater understanding of how services worked, provided an opportunity to engage directly with staff and patients and triangulate the information received through the trust’s governance systems.

Visibility of senior leaders in the pharmacy department had improved since our previous visit. Staff engagement was a priority for the new chief pharmacist. The department had taken part in “The Big Pharmacy Conversation” a programme to engage staff in shaping the future of the department. In addition, a monthly pharmacy team briefing had been introduced for all pharmacy staff, information shared included performance, learning and celebrations.

The trust had systems to ensure leaders were suitable for their role. We reviewed a sample of files for voting members of board. The sample included files of both executive and non-executive directors. All members of the board had received an annual appraisal within the previous year. The trust maintained a record of annual appraisal dates for both executive and non-executive directors.

Succession planning was in place throughout the trust THRIVE programme. The trust had implemented processes to ensure succession planning at senior levels. Leaders told us deputies were supported to act up in interim leadership positions for an extended period ahead of formal recruitment processes.

Partners shared mostly positive feedback about their experience of working with the trust’s leaders, noting recent improvements.

The Governors welcomed the opportunity to undertake the development sessions with the board and recognised improvements in working relationships.

Staff and leaders must act with openness, honesty and transparency. Staff and leaders should actively promote staff empowerment to drive improvement. Leaders should encourage staff to raise concerns and promote the value of doing so. All staff should feel confident that their voices will be heard. Leaders should ensure a culture of speaking up, where staff actively raise concerns and those who do (including external whistleblowers) are supported without fear of detriment. When concerns are raised, leaders should investigate sensitively and confidentially, and lessons would need to be acted upon. When something goes wrong, people should receive a sincere and timely apology and be told about any actions being taken to prevent the same from happening again.

We scored this quality statement as 2. The evidence showed some shortfalls. There were processes in place for people to speak up, in line with national requirements. The trust’s freedom to speak up guardian was competent and had clear support from the non-executives. However, we received mixed feedback about the confidence levels some staff felt about speaking up and whether their voice would be heard. Feedback indicated that some staff continued to perceive biases and personal preferences amongst board members, which contributed to a lack of psychological safety.

The trust had appointed a freedom to speak up (FTSU) guardian who undertook this role 20 hours per week. The deputy freedom to speak up guardian role was being recruited to at the time of inspection. The guardian was an active member of the regional FTSU group and was also a mentor for the National Guardian’s Office for new FTSU guardians.

The board had a identified a new non-executive FTSU lead and the Chief Nurse was the executive lead. The guardian was supported by 24 FTSU ambassadors. Staff had access to the guardian and a FTSU web application accessible by a QR code, downloadable on electronic devices. The app enabled people to speak up anonymously which was in line with guidance from the National Guardian’s Office.

Leaders were seeking to build a culture where all colleagues within the trust felt able to raise concerns. We heard differing opinions within the trust’s leadership team how this could be further developed. This was monitored by the board through the FTSU communications plan.

Leaders referred to the recently launched Respect, Civility and Resolution policy which was being rolled out across the trust and a Managers Toolkit which included a staff and manager handbook. Leaders acknowledged further work was being undertaken to embed a robust culture allowing staff to speak up, be listened to and ensure action is taken.

The trust’s current FTSU policy was issued in 2024 with a review date of February 2029.The guardian reported speak up data to the trust board and complied with the national reporting requirements. They told us they had access to speak with the Chief Nurse and Chief Executive as required.

The trust board received quarterly and an annual report focussed on freedom to speak up. These showed staff increasingly using the trust’s freedom to speak processes as a way to raise concerns. Data provided by the trust showed 122 cases were raised by staff in 2024/25 which was a 20% increase from 2023/24 which is in the low to middle range compared to similarly sized local trusts. Of those cases reported, 22 were anonymous. Most cases were raised by Nursing / midwifery staff, and Estates and Ancillary staff, followed by Administration and Clerical staff, then Medical and Dental staff.

The main reasons for speaking up were ‘inappropriate attitudes or behaviours’ and ‘bullying or harassment’. The trust provided a good level of detail regarding FTSU case numbers and categories and the board was sighted on the work underway to help reduce and remedy the causes of concern.

We reviewed NHS Staff Survey results for 2024 relating to People Promises, themes and sub scores that relate to ‘We each have a voice that counts’. The trust scored slightly better than the national average for these questions and for ‘I am confident that my organisation would address my concern’ changed from 55.7% in 2023 to 57.2% in 2024. Staff survey results identified multiple ethnic background staff were not as confident about speaking up, and not as confident that it would be addressed. Additionally, staff with a long-term condition also felt less confident about the trust addressing concerns raised, or secure about raising issues concerning clinical practice. Staff from the ‘Pharmacy’ and ‘Medical / Dental - In Training’ teams were lower scorers for more themes and sub scores compared to other areas in the trust.

Board papers referred to the staff survey at a high level, the trust’s action plan included a range of initiatives which intended to make the trust a better place to work.

The trust’s freedom to speak up communication plan 2024/25 had ongoing actions with the last completed action dated October 2024. Progress against actions identified in the trust’s refection and planning tool was not regularly monitored by the board.

Frontline staff told us that there had been investment in promoting FTSU processes and most felt empowered to speak up and that action would be taken within the clinical service units. However, some felt that if they did speak up, they would not be wholly confident matters would be addressed due to staff’s previous experiences.

As part of the assessment, we analysed feedback received directly to CQC. Qualitative analysis of feedback from staff cases highlighted historical issues of culture within the trust. Concerns of bullying, harassment, racism, or incivility were described at board level of the trust as well as in various departments of Bradford Royal Infirmary. Due to reported fear of reprisal, several people were concerned about speaking out against the trust. There were also concerns about conflicting interests of those in FTSU roles due to their positions at the trust. Whilst we did not find any evidence of the historical issues continuing during this assessment, staff confidence in issues being addressed at board level remained a concern.

The trust provided training in freedom to speak up. The three FTSU training modules available for staff were Speak Up; Listen Up; Follow Up. All staff including senior executives were required to complete the Speak Up Module. The annual FTSU report for 2024/25 reported 70% of all staff had completed this module. Band 7 (and above) module, ‘Listen Up’, compliance was 65% and ‘Follow up’ was 89%.

Partners felt the trust did have a culture where staff could feel free to raise concerns. There was mixed feedback and confidence in whether leaders would always take effective action to address concerns.

In a well-led trust, leaders should be committed to continuously improving the organisation's culture, focusing on equality, diversity, and inclusion. Leaders should actively address disparities in the experiences of staff with protected characteristics and those from marginalised groups, ensuring that interventions are regularly monitored for impact. Steps will have to be taken to remove bias from practices, ensuring fairness in opportunities and experiences for all employees. This includes reviewing policies and procedures to tackle structural discrimination and promote an equitable culture. Leaders also work to prevent and address bullying and harassment, particularly for those with protected characteristics, and ensure that disabled staff receive reasonable adjustments to support their roles.

We scored this quality statement as 2. The evidence showed some shortfalls. The organisation demonstrated commitment to Equality, Diversity and Inclusion (EDI) through positive initiatives such as talent management, civility programmes, and the use of health inequalities data. A new EDI strategy was in development and leaders promoted belonging and inclusion across the trust both internally and externally. As a result of historical challenges, which included a lack of psychological safety and inconsistent board-level accountability, the trust had identified a range of priorities and key actions that were in progress at the time of the assessment.

Bradford is one of the most ethnically and culturally diverse cities in England. It has the second largest population of people who identify as Pakistani (25.5%) nationally and 56.7% of the Bradford District population identified as white British. Of the trust’s workforce, 43% were black and ethnic minority staff which represented the diversity of the trust’s patients. Of the registered nurses working at the trust, 39.5% were from a black and ethnic minority background, compared to 19.7% nationally. A similar trend was seen for midwives, allied health professionals, and scientific, therapeutic, and technical staff. In non-clinical roles, 35% were black and ethnic minority staff compared to the national average of 18.8%. The proportion of medical and dental staff from black and ethnic minority backgrounds was broadly in line with the national average.

The trust noted that the workforce was diverse. At a senior leadership level, 20% of senior leaders were from all other ethnic background which had steadily increased over the three previous years. Employer data reflected positive trends, although gaps remained in diverse representation at senior leadership levels. Whilst not nationally reported, the trust were aware and we observed women from global majority backgrounds were underrepresented in executive and senior roles. The trust’s Workforce Race Equality Standard (WRES) highlighted potential differences between the experiences of white and all other ethnic groups staff. The 2024 NHS Staff Survey results for the WRES were worse for staff from all other ethnic groups at the trust when compared to white staff. This indicated more instances of discrimination, harassment, bullying or abuse, and a lesser sense of equal opportunities within the trust. Although it should be noted that there has been some improvement in scores over time.

Experiences of some white staff have worsened over time particularly in terms of discrimination at work from a manager/team leader or other colleagues however, staff from all other ethnic groups were twice as likely to experience discrimination from this source. The trust’s results showed 15.7% of staff from all other ethnic groups had experienced discrimination from their manager or colleague, compared to 6.6% of white staff. Although it should be noted that for other ethnic groups, this indicator improved overall from 2020 (15.7%) to 2024 (13.9%), whilst for white staff at the trust this worsened over the same period (5.0% in 2020, to 6.6% in 2024).

The proportion of staff experiencing harassment, bullying and abuse from patients, relatives or the public in the last 12 months had decreased for both staff types from 2020 to 2024. The most recent figures indicated 23.8% of staff from all other ethnic groups and 23.4% of white staff experiencing harassment, bullying and abuse from patients, relatives or the public in the last 12 months. The national average for all other ethnic groups experiencing this was 28.3%. Staff experiencing harassment, bullying or abuse from staff in the last 12 months was 23% for all other ethnic groups and 17.8% for white staff. These figures had decreased overall for both staff types since 2020.The percentage of all other ethnic staff at the trust believing that the organisation provided equal opportunities for career progression was 50.5% compared to 49.7% nationally. This had improved overall from 47% in 2020 to 50.5% in 2024.The percentage of white staff at the trust believing that the organisation provided equal opportunities for career progression was 61.5% compared to 58.8% nationally. The trust acknowledged the key findings of the staff survey regarding workforce equality gaps, including higher rates experiencing harassment, bullying and abuse for staff from all other ethnic groups. As a result, the trust had outlined a range of priorities and key actions to improve staff experiences in 2025 which included an Equality, Diversity and Inclusion (EDI) staff conference collaborating with the four staff equality networks and review of the trust’s EDI strategy.

The THRIVE resource was familiar to staff, and we received positive feedback from people who attended the inaugural Equality, Diversity and Inclusion conference which took place in October 2025. The board recounted how impactful this had been and recognised further work was required to maintain the momentum and build upon the conference’s success. We also heard how the trust had recognised further work was required regarding EDI, especially in relation to people with disabilities, LGBTQ+ colleagues and developing staff as future senior leaders and human resource leadership, where greater clarity and engagement was required.

In the 12 months to June 2025, the sickness rate at the trust for ‘all staff’ was 6.2% which put the trust above the sector average of 5.0% and trust target of 4.5%. Monthly sickness rates for ‘all staff’ increased from 5.8% in September 2024 to 6.7% in January 2025, before decreasing to 5.8% in May 2025, and the slightly increasing to 6.1% in June 2025. The main reason for sickness absence at the trust was anxiety/stress/ depression/other psychiatric illnesses, with 3,177 days taken in June 2025. This is the most predominant cause of sickness for all staff groups, except for Medical and Dental staff which was recorded as ‘other’. This could indicate a learning need to record the reason for absence for medical and dental staff. Staff turnover rates (across a 12-month rolling period) for all staff groups were comparable to other trusts.

The trust was invested in talent management and succession planning, alongside initiatives to promote civility and respect in the workplace. These efforts demonstrated a commitment to cultural improvement and supported the development of an inclusive leadership pipeline.

A Race Inequality and Victimisation investigation (RIV) had been commissioned because of complaints made by senior staff in 2023/24. This investigation was ongoing at the time of the inspection.

The Workforce Disability Equality Standard (WDES) allows NHS trusts to compare the experiences of staff with a disability, a long-term condition (LTC) and/or other types of illnesses, with those of non-disabled staff. The trust’s WDES results showed the results from the 2024 NHS Staff Survey were better for staff with a long term condition or illness at the trust than the national average in all seven WDES metrics, indicating better experiences for staff when compared nationally. For context, 23.7% of respondents stated that they have a physical or mental health condition or illness lasting or expected to last for 12 months or more. The most variation between those with and without a long-term condition or illness was for the percentage of staff who were satisfied with the extent to which the trust valued their work. The percentage of staff who were satisfied with the extent to which the trust valued their work was 17.8% for those without a long term condition or illness. Of those with a long term condition or illness 26.2% were satisfied with the extent to which the trust valued their work compared with the national average of 26.9%. Staff networks were in place to represent staff who identified as LGBTQ+ (LGBT+ Staff Equality Network), staff from all other ethnic groups (Race Equality Staff Inclusion Network RESIN); staff with long term health conditions or disabilities (Enable Staff Network) and Gender Equality Network. Network chairs told us the trust had recently relaunched staff networks and they linked into the trust’s Equality, Diversity and Inclusion agenda. Network Chair’s had allocated time to fulfil their duties with administrative support to share key messages with the wider organisation.

The trust’s Equality Diversity and Inclusion strategy 2022 to 2025 concluded in December 2025. At the time of inspection the trust was reflecting on progress made, lessons learned and the opportunities ahead to shape the next phased of the strategy.

The Spiritual, Pastoral and Religious Care (SPaRC) team had developed a web app that provided a range of multi-faith support services for patients, their loved ones and staff working at the trust. This could be accessed directly from any device. It was developed in conjunction with patients and staff to offer a broad mix of helpful and multi-faith inclusive resources. The Ramadan Allies initiative was developed to foster an inclusive environment where staff could observe Ramadan fully and comfortably during working hours, while maintaining patient care and service delivery. Fast packs including water, a prayer timetable and a cool bag were distributed across the trust to support staff. PROP packs provided to managers and Allies enabled the creation of prayer areas in wards and departments. Over 200 staff had signed up to become Ramadan Allies. Staff we spoke with referred to both initiatives and described how the web app was a useful resource when caring for patients and how becoming an Ally supported colleagues in the workplace.

Since 2021 the area of greatest improvement in the 2024 NHS Staff Survey was in relation to the Appraisals sub score. The areas which saw continuous improvement over this time were: We are safe and healthy; We work flexibly; We are a team; We are compassionate and inclusive.

We received limited feedback from partners in relation to this quality statement, although some partners shared they felt the trust promoted equality, diversity and inclusion.

In a well-led trust, there should be clear and effective governance, management, and accountability structures in place. Staff should fully understand their roles and responsibilities, while managers hold staff accountable for their actions, behaviours, and performance. The systems designed to manage current and future performance, as well as risks to service quality, should take a balanced approach that allows for innovation and new ideas to be tested safely within the service. Data and notifications should be regularly and reliably submitted to external bodies as required, and there should strong systems in place to ensure the availability, integrity, and confidentiality of data and records. Information must effectively utilise to monitor and improve care quality. Leaders need to implement relevant quality frameworks, standards, and best practices to enhance equity in service delivery and address existing inequalities, ensuring better outcomes and experiences for those using the services.

We scored this quality statement as 3.

The trust had clear responsibilities, roles, systems of accountability and good governance. Governance and risk management systems and processes were in place. The systems for identifying, recording and managing strategic risks and mitigating actions were well-established.

The trust had governance structures in place with systems, processes and regular meetings in place. The trust board was supported by four board committees. These were the audit committee; the finance and performance committee; the quality committee and the charitable funds committee. A people academy board committee, chaired by a NED, had been introduced to focus on learning, improvement and assurance in relation to quality and patient safety; people; and finance and performance. The terms of reference and work plans were last approved by the Board in May 2025 and scheduled for review November 2025.

Senior leaders had a monthly executive team meeting to manage operational business. This was chaired by the chief executive officer and attended by senior leaders including the chief operating office and chief nurse. The trust’s waste reduction programme board, Green Plan implementation group and Clinical Service Unit (CSU) meetings fed into the monthly executive team meeting. The trust’s frontline services were organised into one of three CSU structures; Planned Services; Unplanned Services and Diagnostic and Corporate Operational Services. Each CSU had their own unit level quality and safety and performance meeting that fed into a quality committee. The CSUs also maintained their own risk registers and escalated scores of 15+ to the monthly executive team meeting.

Board papers were lengthy, but the board told us they had been working to reduce the number of papers over recent months to allow focus on key issues. The trust had suitable information systems with strong digital leadership and developments were moving at pace.

The trust’s quality committee was accountable for the oversight and governance of quality of care within the trust. This committee was supported by sub-groups for areas including patient experience group, patient safety group, clinical outcomes group, safeguarding, the EXCEL (transforming urgent and emergency care programme), the chief nurse senior leadership team meeting, infection prevention and control, and mortality governance.

We observed meetings of the trust’s board of directors and quality committee. Committee papers contained appropriate information and a report summary, although relied on lengthy narrative. We observed meetings were chaired effectively, although long agendas, substantial papers and limited meeting time impacted on the discussion of specific agenda items.

Senior management groups and the board reviewed performance reports. Performance reports were of good quality and identified areas of high-performance and persistent shortfalls using statistical process control. The trust was aware of its performance using key performance indicators and other metrics mapped to board committee reports which fed into the board assurance framework. This data fed into the considerations of strategic risk within the board assurance framework.

At the time of assessment three new non-executive and four executive directors had joined the organisation within the last 12 months. Areas of responsibility had been reviewed and changes had been made to align with non-executive areas of experience. Leaders told us they were confident the changes would support enhanced board oversight of the trust. There were seven non-executive directors including the trust’s chair. Each board committee had a non-executive director as chair and at least one other as a voting member. Non-executive directors told us they were also members of working groups and other committees within their areas of expertise. They had a good understanding in terms of their primary responsibilities as unitary board members and as members of their board committees.

The trust had systems and processes in place to monitor and maintain safe staffing levels, however these did not always operate effectively. At the time of the assessment the safer nursing care tool update from 2024 had not been rolled out. Further staff training in the updates and roll out of the tool was underway during this well led assessment. Whilst improvement had been demonstrated with national safer staffing requirements in maternity, other services did not always have sufficient numbers of suitably qualified staff, and some services fell below national staffing standards. The trust did not always have sufficient and appropriately qualified staff in the emergency department to meet requirements. Staff working in the emergency department told us they raised this consistently with leaders and had shared they did not feel the service was safe. We escalated this to the trust’s senior leaders and asked the trust to take action at the time of the inspection. The trust implemented interim measures to improve staffing within the department and had agreed a longer-term uplift in staffing shortly after our visit in September 2025.

The trust had a six-monthly safer staffing report in line with requirements of the National Quality Board. The latest report for July 2025 broke down the staffing levels for each area and was not presented as a trust overall. However, the latest figures available for August 2025 demonstrated that staffing fill levels had improved as they had been over 85% for more than 6 continuous months. The overall trust position for Registered Nurse cover during the day was 91% of expected staffing and overnight was 89%. The overall care staffing levels during the day were 96% of expected staffing, and overnight were 94%, with some wards reporting over 98%. The trust nurse vacancy was 5.3% in June 2025 and there were 140 whole time equivalent healthcare vacancies reported in October 2025. The trust had an ongoing recruitment programme for healthcare staff.

The trust relied on bank and agency staff to maintain safe staffing levels. Of the trust’s workforce, 2.49% were agency staff in August 2025. This was a reduction from 3.72% in April 2025. Bank staff as a percentage of the workforce remained around 1.7%.

The trust’s overall compliance with mandatory training was 92% which was above the target of 90%. Basic Life Support was highlighted as a training risk where compliancy was most recently 86%; this was attributed to an increase of operational activities carried out by the resuscitation team. Safeguarding Adults Level 3 training compliancy was only 39%, and the trust anticipated that although this training is becoming mandatory, compliancy will remain below 85% for some time. The trust highlighted that where training compliancy was below 85%, then targeted actions have been outlined, including maintaining robust systems for reporting, analysis into low compliance rates, data quality checks, proactively targeting staff with low compliance, and working with individual community support units to meet training capacity needs.

In September 2025, the non-medical appraisal rate was 76%, with the medical appraisal rate at 93%. Staff turnover was within the expected range, however reasons for leaving had not been collected in the national electronic staff record for the past 12 months. This may affect knowledge and the understanding of actions in terms of retention of staff.

Appropriate governance arrangements were in place in relation to Mental Health Act administration and compliance. The trust had a service-level agreement with another NHS provider for support in relation to the Mental Health Act.

The trust had well-established systems for identifying, recording and managing strategic risks and mitigating actions. The trust board had sight of the most significant risks and mitigating actions were clear. Risks to the delivery of the trust’s five strategic objectives were monitored through a Board Assurance Framework (BAF). The trust had identified 15 strategic risks, of which 5 were assessed a posing high or significant risk (risk scores of 15-20). The BAF included details of the trust’s risk appetite. During our assessment, we observed consideration and review of strategic risk within the trust board and board committee meetings, showing that these processes were well-embedded. Leaders had consistent view of the highest risks facing the trust, and their concerns mostly matched the strategic risks identified on the BAF.

The trust maintained a corporate risk register to identify, record and manage operational risks and mitigating actions. This was reviewed monthly at the executive team meeting and presented to the board alongside the BAF where it was reviewed six times a year by the board and trust’s audit committee.

Leaders expressed confidence in the quality of data provided by the trust although recognised there were improvements needed in the visual presentation. Systems were in place to collect data from wards/service teams. Leaders told us there further work was underway to simplify the presentation of the data collected to promote accessibility.

In September 2024, the Data Security and Protection Toolkit (DSPT) changed to adopt the National Cyber Security Centre’s Cyber Assessment Framework (CAF) with the new framework including additional cyber and information governance requirements. The trust had assessed compliance against 47 outcomes within the framework and declared it met the standard across all outcomes.

Information governance systems were in place and the trust had a mature integrated electronic patient record system which required passwords to access. We did identify as part of our assessments, that some allied health professionals continued to use paper patient record. This meant there was potential for gaps in oversight of patients’ care.

There were plans in place for emergencies and other unexpected or expected events.

Where cost improvements were taking place there were arrangements to consider the impact on patient care. The trust’s Closing the Gap (CTG) programme and Equality Quality Impact Assessment (QIA) process ensured that all financial efficiency schemes were reviewed for their potential effect on the quality, safety, and experience of patient care. Leaders monitored changes for potential impact on quality and sustainability. The trust’s chief medical officer and chief nurse jointly led on quality impact assessment processes. The trust had a process which established the criteria triggering the need for quality impact assessments. The process also identified the processes for undertaking equality impact assessments in cases of service redesign.

Risks relating to pharmacy services were identified on the risk register. Mitigations had been put in place for some risks, however areas such as the estate not being fit for purpose and the aseptic unit required further action plans following external assessment to ensure they were mitigated to meet the needs of the hospital long term.

The new chief pharmacist had set clear KPIs for the department and these were being monitored as part of governance processes. Figures for October 2025 showed for all wards 34% of people admitted to the trust had received a medicines reconciliation within 24hrs of admission the trusts target was 70%. This increased to 74% on wards 1,3 and 4 in October 2025. It had been identified that IT systems did not always give live data and so some manual data collection continued. We were told that work was underway to review IT systems so that data quality could be improved.

At this inspection the new medication safety officer was in place, and it was clear to see from meeting minutes and speaking with staff that there was documented review of incidents and sharing of learning. The trust had an antimicrobial pharmacist who worked collaboratively with the wider trust on antimicrobial stewardship.

Although the trust had a track record of historically delivering its financial plans, in recent years this was achieved using non-recurrent measures and funding. For 2025-26 it had planned to spend c £17.7m more than it received as income after delivering an ambitious savings target of £33m. Following in-year changes to planning assumptions and delivery of a further £5.3m of increased savings, it was expected to deliver a deficit of £2.7m. This marks a significant shift in financial deterioration, which was reflected in the trust’s placement in NHS Oversight Framework (NOF) Segment 3.

The trust was currently under NHS England’s Integrated Quality Improvement Group (IQIG), monitoring quality improvements, financial plan delivery, and regulatory compliance related to governance and leadership challenges. It was announced in September 2025 that the trust would be one of fourteen trusts nationally subject to a review of NHS maternity and neonatal services.

Leaders submitted notifications to external bodies as required. The trust responded appropriately to central alert system (CAS) notifications, closing all within the required deadline in 2025.

Fire risk assessments had been completed in all trust-managed premises within the last years. A quarterly meeting of the fire safety working group convened to monitor progress against the actions identified and report into the Health and Safety Committee.

Partners described the trust’s governance processes as clear and well-structured governance, however the length of board papers could improve.

In a well led trust, staff and leaders should be open and transparent and should encourage collaboration with all relevant external stakeholders and agencies. Staff and leaders should work in partnership with key organisations to support care provision, service development and joined-up care. Staff and leaders should actively engage with people, communities and partners to share learning with each other that results in continuous improvements to the service. They use these networks to identify new or innovative ideas that can lead to better outcomes for people.

We scored this quality statement as 3. The evidence showed a good standard.

The trust collaborated with relevant external stakeholders and partners. There were working examples of joint service development and working together to identify and address health inequalities. Further system work was required to release the full potential partnership working for the benefit of the local population. There were proposals in development for the wider Bradford area, to affect this and the trust were actively involved.

The trust was a member of the Bradford District and Craven Health and Care Partnership. The trust Chair and CEO were members of the partnership board. There were nine key areas of action to reduce health inequalities and improve the health, care and well-being of the population. The trust contributed to the Reducing Inequalities alliance which coordinated collective action to reduce inequalities in Bradford District and Craven.

All executive directors were chairs and/or members of a range of partnership fora.

The trust was a key player in the West Yorkshire and Harrogate Health and Care Partnership, and trust staff and clinicians took part in system wide improvement programmes. The trust was also a member of the West Yorkshire Association of Acute Trusts. The CEOs of the six acute trusts met monthly to discuss strategic issues and provide oversight to collaborative programmes.

The trust was involved in 11 community (neighbourhood) partnerships which provided more personalised, proactive and preventative care and support for local people.

The trust had a health equity lead and health inequalities project manager who focused on using data and partnership knowledge to develop staff training and improve services delivered to patients to reduce inequalities. The trusts Making Every Contact Count programme enabled staff to hold opportunistic health promoting conversations with patients to address issues such as smoking, hypertension and improve well-being. We saw examples of how this was promoted during our inspections.

The trust’s Equality, diversity and Inclusion Strategy 2023 to 2025 included a Population Health Inequalities objective to tackle health inequalities and strengthen the system approach to population/place based health care and management. The trust was a key player in the Bradford District and Craven Health and Care Partnership and responsibilities outlined in joint policy and strategy. The trust Patient Experience and Engagement Strategy 2023 to 2028 and Corporate Strategy 2022 to 2027 referenced the work it was undertaking to address health inequalities across the Bradford and Craven District. The trust provided several examples of work to identify and address health inequalities across child and adult acute services which included details of specific actions.

Leaders viewed partnerships and system working collaboratively to improve the health of the local population. Leaders described strong and valued relationships with system and local partners and we heard from several leaders how positively providers worked together. The trust recognised the need to work with other NHS providers to develop joint clinical and estates strategies and described the governance arrangements in place to support this through the new Committee in Common. However, at the time of the inspection, the trust did not have a joint clinical or estates strategy document with place partners.

Prior to our assessment we wrote to over 30 partners and stakeholders to request feedback on their experience of working with the trust. We received positive examples of how the trust engaged and worked in partnership with voluntary sector organisations. Partners told us the trust’s senior leaders ensured the trust worked as a strong partner.

We undertook specific interviews with partners within the local health and care system and received mixed feedback in relation to how well the trust acted as a system partner. Leaders within the trust provided examples of how they engaged with the system including some who had lead roles for specific workstreams.

The trust had worked in partnership with an independent supplier to build and implement a digital command centre which launched in June 2024. Leaders told us the Command Centre had improved hospital efficiency and enabled a reduction in length of patient stay, increased timely admissions and discharges, and ensured patients received care in the most appropriate wards. Using real-time and predictive data, it helped to manage bed capacity, reduce cancellations, and ease pressure on staff, while supporting consistent processes and anticipating future demand. The hospital’s 880 bed capacity was running at 96% utilisation as a result since the Command Centre was operational.

Another trust provided a mental health liaison service within the trust and support for Mental Health Act Administration and compliance. The trust had a service level agreement in place for the provision of psychiatric liaison services with appropriate governance arrangements in place.

The trust had processes to support people using services to raise complaints. Complaints were monitored through the trust’s governance systems. We reviewed four examples of complaints. The complaints were handled within the trust’s process and included an apology to the patient. Whilst the content was appropriate, there was also an opportunity to better personalise complaint responses and improve the tone of the correspondence.

The trust’s Quality Committee received an annual complaints report and a quarterly ‘patient experience report. The trust’s annual report for 2024/25 showed the trust had received 641 formal complaints, an increase of 22% from the previous year. Of the formal complaints 3% required an extension. The Parliamentary Health Service Ombudsman had contacted the trust about 9 complaints that were previously responded to, that were under review at the time of assessment. The trust monitored the themes of complaints. The top three themes were communication and information, appointment waiting times and doctor led care. The trust had received over 907 compliments over the same time period and 2,097 patient advice and liaison (PAL’s) concerns. This was an increase of 18% on the previous year. The annual report provided examples of where the trust had made improvements to services as a result of complaints and feedback. In response to improving communication, the trust reported during 2024/25 57,000 interpreting plus sessions were provided in over 60 languages via face to face, telephone, video and British Sign Language (BSL) consultation to support communication. Patient information and leaflets were available in different formats and languages which included via audio, BSL and in over 60 languages via an App based scripted cards.

The trust had processes to engage with and seek feedback from people using services.

Patient-Led Assessments of the Care Environment (PLACE) involve local people (known as patient assessors) going into hospitals as part of teams to assess how the environment supports the provision of clinical care, assessing such things as privacy and dignity, food, cleanliness and general building maintenance and, more recently, the extent to which the environment is able to support the care of those with dementia or with a disability. The trust showed comparable PLACE scores for the assessed areas of food (combined), dementia, disability and privacy, dignity and wellbeing. Both Bradford Royal Infirmary and St Lukes Hospital scored lower, compared with other trust’s nationally, for organisational food.

The patient experience group received a quarterly report on patient experience activities within the trust. The report included results of the trust’s Families and Friends Test (FFT) which highlighted consistently positive results across most of the trust’s services although lower satisfaction with the trust’s emergency department. The trust were working with the survey supplier to access real time results to enable quicker action to be taken as a result.

The CQC Adult Inpatient Survey 2024 looks at the experiences of 62,444 people, across 131 NHS trusts, who stayed at least one night in hospital as an inpatient during November 2024. Responses were received from 381 people using the trust’s services. The trust’s results were about the same as comparable acute trusts with score of 7.8/10 for overall experience. The CQC Maternity Survey 2024 received 396 responses from people using services at the trust with the results somewhat better for three areas and better than expected for two areas. The frequency of seeing or speaking to a midwife at home was worse than expected. The CQC Children and Young People's Survey 2024 received responses from 221 people at the trust. The overall experience for parents and carers was worse than expected and for children and young people, about the same results were also about the same as comparable acute trusts.

Engagement at external partnership events such as controlled drug local intelligence network meetings, alongside other clinical specialist networks was encouraged and supported by the pharmacy senior leadership team. Sharing of good practice and learning from risks and incidents as well as collaborative working with other trusts was being developed to support the pharmacy team further develop and learn.

The trust worked appropriately with trade unions. Trade union representatives were positive about their relationship with senior leaders. They told us leaders were visible and approachable. There were bimonthly alternating formal and informal meetings between trade unions and senior leaders. Trade unions were engaged in policy development. Trade union representatives were less positive about the trust’s Freedom to Speak Up processes and told us staff in frontline services lacked confidence in this process.

The trust encouraged volunteering and was well supported by over 177 dedicated volunteers. Volunteers undertook different roles within the trust including signposting and supporting patients and visitors to move around the hospital.

In a well-led trust, staff and leaders should demonstrate a strong understanding of how to drive improvements, using a consistent approach that includes measuring outcomes and impact. They need to involve service users, families, and carers in the development and evaluation of improvement initiatives. There should clear processes to learn from both mistakes and successes, with leaders promoting reflection and collaborative problem-solving. Staff need to be encouraged and supported to develop their skills in innovation, guided by a strategic approach that emphasises continuous improvement. Leaders should actively listen to staff ideas and foster a culture of trust and openness. The service needs to also benefit from strong external partnerships, engaging in research and integrating evidence-based practices to enhance innovation and care quality.

We scored this quality statement as 3. The evidence showed a good standard.

The trust 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 contributed to safe, effective practice and research.

The trust had processes to identify, report and investigate incidents. The trust had a patient safety and incident response policy which was due for review in December 2026.

The Patient Safety Response Framework (PSIRF) was launched nationally in the autumn of 2022 and implemented by the trust in December 2023 in line with the required national deadline for transition. The trust’s implementation of PSIRF had been externally audited with an assurance rating of significant. The trust’s implementation of PSIRF included recruiting a Patient Safety Partner who was a member of the patient experience group. Patient Safety Partner volunteers provide patient and family representation in governance processes focussed on improving patient safety.

The trust was in the process of reviewing is PSIRF plan which was due for publication in April 2026. The trust had also identified local priorities in relation to patient safety incidents and resulting investigations which included incidents relating to:

• People (adults and children) admitted in a mental health crisis with medical or surgical needs
• Safe internal hospital movement of patients
• Emerging patient safety themes where learning and improvement can be gained

Between 1 October 2024 to 30 September 2025 10 significant incidents had been reported at the trust. For the same period 15,558 learning from patient safety incidents had been reported of which 61 (0.004%) resulted in severe harm or death.

Between 1 September 2024 to 31 August 2025, 167 incidents had been reported relating to the trust’s local priorities. Of which, 67 incidents were categorised under safe internal hospital movement of patients and 88 people admitted in a mental health crisis with a medical or surgical need.

The current PSIRF plan noted the trust’s achievements and ongoing areas for improvement in implementing PSIRF. The training compliance rate for staff to undertake human factors and patient safety training was 93%.

We reviewed five examples of patient safety incident investigation reports. The reports showed investigations took between 3 to 6 months to complete. There was consistent evidence of family involvement in patient safety incident investigation processes. The trust had appropriate processes in place to comply with the requirements of the duty of candour.

Audits were used to drive improvement within services. Data provided by the trust showed that as of June 2025 the trust delivered 100% of the internal audit plan reported through the Audit Committee. Leaders were satisfied that clinical and internal audits were sufficient to provide assurance.

The trust was a national test and evaluation site (known as a Clinical InSite) as part of the NHS Clinical Entrepreneur programme. The programme aimed to remove barriers and accelerate the introduction of ground breaking treatments and diagnostics that had the potential to transform care. Three pilots had been adopted as business as usual at the trust and included a web application that allowed physiotherapists to prescribe exercise plans for their patients, using videos how to remind the patient how to perform their exercises correctly. A language translation web application for cardiac patients and their families and an initiative to support children with complex medical conditions to swallow pills rather than liquid medicines.

The trust had a quality improvement methodology aligned with the NHS improvement approach. The trust provided examples of quality improvement to showcase how the methodology was operationalised within services within the last year. The examples included the implementation of Martha’s rule and transforming emergency care EXCEL programme.

A pharmacy education and training strategy had been developed to support the department in ensuring there were clear pathways for development for all staff in the department.

Leaders within the pharmacy department supported and encouraged staff to publish work undertaken to showcase good practice and areas for further development. In the last year two posters had been submitted and presented at clinical pharmacy congress and one at the British computer science conference.

The research team we spoke with were committed to quality improvement, to learning, innovation and research, particularly the focus on patient outcomes. There was strong evidence of both the commitment and passion for partnership working and innovation to involve communities and partners. Researchers shared the outcomes of several works in progress and future proposals.

The trust had systems to identify and learn from deaths. The trust’s quality committee received a quarterly report on how the trust learned from deaths. The most recent report showed that 2024/25 there were 1,438 deaths at the trust and 20% were subject to a structured judgement review. External feedback had identified further work was required in respect of clinicians’ understanding of their responsibilities under coding clinical diagnosis to feed into the learning from deaths process.

The Summary Hospital-level Mortality Indicator (SHMI) reports on mortality at trust level across the NHS in England using a standard methodology. NHS Digital describe SHMI as the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there. The SHMI includes deaths occurring in hospital and deaths occurring outside hospital within 30 days of discharge. The SHMI does not make any adjustments for patients receiving palliative care and is not a direct measure of quality of care. The SHMI for August 2025 was 1.13, which was above the national baseline of 1.0. The trust were aware of the higher SHMI rate due to coding issues and had taken action to address this.

The trust had opened a new learning and development hub which included a simulation centre and technical skills lab. This was a bespoke education facility and learning space for staff. Leaders highlighted the hub to us as an example of how the trust had responded to feedback from students and created additional space to support learning. A team of clinical and non-clinical educators worked across the trust supporting staff in their roles. The trust also supported practice placement environments for students and doctors in training.

The trust health research team were exceptional in their approach to considering research to improve new care and treatments and the health and wellbeing of people who used services and wider community. They had a strong track record of research having been involved in research activities for over 25 years.

The trust research strategy and portfolio included the Bradford Institute for Health Research, Yorkshire Quality Safety Research (YQSR) – Patient Safety Research Collaboration, Lead for Implementation Science and Knowledge Mobilisation for the YH Applied Research Collaboration and Born in Bradford applied research programme. The Born in Bradford (BiB) is one of the largest collections of research projects globally, that followed 30,000 Bradfordians. BiB used its findings to implement changes into the community that improve health and wellbeing. The trust also hosted the NIHR Policy Research Unit in Quality, Safety and Outcomes – only one of two NHS accredited early phase clinical trial facilities in the UK.

The trust collaborated closely with the University of Bradford and other local and regional NHS organisations. A research and innovation performance and delivery report was produced annually. The most recent report included 265 ongoing studies across 35 specialities. The trust had recruited 4,650 study participants. MRVin was a mobile research unit designed to bring clinical research directly to communities across Bradford and West Yorkshire. It featured flexible clinic research space for outpatient studies, laboratory facilities like a phlebotomy room, and pharmacy services. MRVin visited local areas and events, such as festivals, concerts, sports centres, places of worship, shopping centres and supermarkets, and enabled residents to participate in vital health studies without lengthy journeys.

We received positive feedback from partners in relation to this quality statement. They shared examples of initiatives to support learning and development including apprenticeship schemes, details of research studies and collaborative working to improve the health of the local community.

In a well-led trust both staff and leaders should recognise climate change as a major threat to public health and empower their teams to understand sustainable healthcare practices aimed at reducing the environmental impact of healthcare services. They should aim to promote a shared vision of delivering preventative, high-quality, low-carbon care, emphasising the health benefits of reducing environmental factors like air pollution, which can lower risks for conditions such as heart disease, stroke, and lung cancer. Green Plans should be implemented to make care settings as low carbon as possible, focusing on energy efficiency and renewable energy use. Additionally, leaders actively embed net-zero principles into care planning, ensuring resource-efficient, timely, and sustainable healthcare delivery.

We scored this quality statement as 3. The evidence showed a good standard. The trust had not complied with national directives in relation to Green Plans. However, the trust demonstrated how it understood any negative impact of its activities on the environment. There were examples of how the trust was striving to make a positive contribution in reducing environmental impact and supporting people to do the same.

In 2020, the NHS became the world’s first health system to commit to reaching net zero emissions. The Health and Care Act 2022 reinforced this commitment, placing new duties on integrated care boards (ICBs), NHS trusts and foundation trusts (referred to collectively in this guidance as trusts) to consider statutory emissions and environmental targets in their decisions.

An additional duty was placed on trusts in 2025 to publish and share a refreshed green plan by 31 July 2025. The trust Green Plan for 2025 to 2028 was presented to the board in July 2025.

The Executive Director for Estates was the board’s ‘green champion’ supported by the board Chair. A full-time member of staff was dedicated to the delivery of NHS Net Zero and wider environmental sustainability.

The trust’s 2020 to 2025 Green Plan captured staff engagement with a network of Green Champions. A Green planning group had been established. Progress within the Green Plan was formally reported to the Finance and Performance Committee twice a year and a carbon report was included in the trust’s annual report. Carbon use was included in the Estates Returns Information Collection (ERIC) data. These calculations for the trust demonstrated an annual saving of £15K.

Despite much of the hospital estate being old and challenging to maintain, significant progress had been made. Over the last 15 years the carbon footprint linked to the use of electricity had decreased by 2.7 less than the 2010 value. Where there have been new builds within the estate (for example a new endoscopy suite) this was specified and built to be net-zero in terms of carbon use. A commitment was made that all applicable new building and major refurbishment projects were compliant with the BREEAM Healthcare requirements. Other examples of positive estates management included the replacement of all lighting with LEDs funded by a successful grant application. Digital technology was upgraded to more efficient units. Plans were underway to install multiple EV chargers throughout the estate including plans for Ambulance charging facilities near the emergency department. The trust aimed to have a fully electric fleet for all their directly owned vehicles.

The trust was phasing in the offer of zero emission vehicles acquired by staff salary sacrifice schemes with a trajectory for all such vehicles being zero emission by the end of 2026. Secure and safe bicycle storage was provided for staff and appropriate changing facilities. Waste recycling had been introduced across the trust. There was clear staff engagement with a network of green champions.

Vegetarian meal options were readily available for staff and patients bringing together cultural and religious considerations with sustainability. An updated patient meal ordering process was introduced aimed at minimising food waste and saving money. All generated food waste was sent for bio digestion.

The trust was aware of the local environment and their role in supporting biodiversity. A small wildflower meadow has been established as a garden of reflection. If a tree needed to be felled, then it was replaced.

The trust had considered the environmental impact of medicines with specific work focussing on inhaler prescribing and the timely transition from intravenous antibiotics to oral preparations. There were also positive examples of delivering care closer to patient’s homes. Desflurane had been removed from use, and a programme of work was underway to minimise Nitrous Oxide leakage. The trust was engaged in a piece of work identifying and managing people who are very high users of inpatient services.

The executive lead for sustainability was outward facing and was also the regional chair for The Health Estates and Facilities Management Association HEFMA. The organisation supported the dissemination of best practice. The trust was an Anchor organisation and a key partner in the development of a Local Heat Network. The Bradford Heat Network planned to low carbon heating network across civic and hospital buildings across the city. The trust had adopted the NHS net zero supplier roadmap including a 10% weighting for environmental sustainability in all tenders. The trust worked in partnership with ‘Clean Air Bradford’ promoting improved lifestyles and reducing a recognised driver of ill health.

The trust adopted the Climate Change Risk Assessment (CCRA) tool and included adaptation of the estate and services with climate change driven extreme weather in their Emergency Preparedness Plan.