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.

The trust had a Corporate Strategy called “Our Patients, Our people, Our Place, Our Partners, Our Corporate Strategy 2022-2027.” The trust told us they developed this strategy with patients, people, the public and partner organisations. With help from Healthwatch Bradford, events were held to get input, and a public survey was undertaken,

The trust updated and launched three new strategies in the last 12 months. The Patient Experience and Engagement Strategy replaced the previous patient experience strategy, their equality, diversity and inclusion strategy ‘We are Bradford: We value diversity and champion inclusion’ was launched in May 2023 and their Improvement Strategy was approved in November 2023. The trust reported that these three pivotal strategies set out their commitments to ensure that the voices of patients and staff were heard, decisions were made collaboratively and that they would drive change and improvement by continuously listening and learning.

The trust had a set of values which were, ‘We Care, We value people, We are one team.’

Staff knew there was a corporate strategy in place. Staff were able to tell us about the Nursing Strategy and had been involved in its development.

The trusts Pharmacy Vision and Strategy document had been drafted in December 2023; however, the staff we spoke with were not aware of the document and there were no timelines for delivery of any of the objectives.

We were told about the “outstanding pharmacy” work stream which involved front line pharmacy staff setting the agenda for change and improvement in key areas such as patient journey and medicines supplies. Although these workstreams were talked about in a positive manner by pharmacy staff they only covered aspects of the service delivery and not wider strategic concerns.

There was a recognition from leaders that up until now the focus of the trust had been on operational delivery and performance. Leaders told us they wanted there to be greater focus on the strategy with leaders saying it was underdeveloped.

We found evidence of the potential for a closed culture at the board. Over the previous 6 months there had been a breakdown of relationships amongst leaders which had led to a lack of trust within the board. The difficulties at the board were not recent and had culminated in October 2023 when the previous chairman left his post. The Governors told us there was a lack of trust within the board and some of the relationships between the board members had broken down. The tensions within the board meant there was a risk they were not focused on their core purpose.

Leaders acknowledged that due to more recent challenges at the board, they were more internally focused than they would have liked to have been.

There were several staff networks and groups in place who spoke positively about the commitment of trust leaders to improve the culture within the organisation.

In the 2023 NHS staff survey, the trust scored above the national average for all people promise elements and themes. In seven of these eight themes there was a significant improvement from the previous year.

The trust CEO had been the place-based lead since 2022 and had just stood down from this at the time of the inspection. They also held a number of other system roles including lead for Local Maternity and Neonatal System Board. Other members of the trusts leadership team also took on a range of system lead roles.

The trusts corporate strategy dovetails with, and was aligned to, the 5-year strategy for the Bradford District and Craven Health and Care Partnership.

The trust had engaged with the public, with staff and partners as it developed its strategy. Engagement was a key part of the strategy development process with input gathered including collaboration with Healthwatch Bradford. Alongside this, the trust contributed to the development of the broader system strategy by sharing insights and aligning work with place partners. The strategy was shared with place partners and across the wider West Yorkshire network before being finalised.

The trust had Quality Priorities for 2023/24 which were:

• Improving the management of deteriorating patients
• Implementing Saving babies Lives Care Bundle version 3
• Improving patient experience by advancing equality, diversity, and inclusion
• Implementation of the Patient Safety Response Framework

Progress against the key metrics was monitored. The 2023-24 Quality Account provided analysis of delivery against the four quality priorities for that year. It also recorded the four priorities for 2024-25 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’s medicines optimisation strategy had been developed and signed off, however, there were no defined objectives and pledges within the strategy so it was unclear how these could be reviewed.

There was a focus on promoting equality and diversity and the leadership team were very clear this was very important to them and were committed to this. We saw a range of initiatives and actions that had been taken to address workforce inequalities. However, we heard from staff and some leaders that despite the actions the trust had taken there were problems across the trust relating to diversity and inclusion and not all staff felt there were equal opportunities for career development, and that they had experienced discrimination.

The trust had a ‘Thrive Live’ programme where the CEO and executive team visited services and held conversations with teams. As part of the trust’s maternity champions model, non-executive directors had conducted visits to the maternity and neonatal services.

The NED’s told us there was no formal arrangement in place to provide feedback and follow up after they had carried out a ward/area visit. Two of the NED’s told us they received feedback from patients and communities within which they lived which they escalated to the leadership team, but they didn’t always feel this feedback was acted upon.

In the 2023 national staff survey the trust scored above the national average, in relation to having a compassionate culture, compassionate leadership, and inclusion. Scores in each of these areas had improved in the last year.

Staff knew who the leadership team were. There was no doubt the CEO and the CNO were visible leaders, and staff could tell us who the Chief Executive was. The Chief Executive used different fora and media to communicate with staff across the trust, although staff working at St Lukes Hospital told us they felt the main site got more attention.

The board was made up of experienced leaders and there was a clinical voice at board level. Through our discussions with the board, we could see they were committed and compassionate people however, the difficulties and tensions at the board were affecting them. The challenges the board had faced dominated many of our interviews with leaders. We did not find evidence to suggest this was directly impacting on the delivery of front-line services at the time of the inspection.

Some staff told us they felt some of the executive leaders were not open to challenge.

We were not always assured that board considered feedback with an open approach to learning and development for example, the CEO had reported to the March 2024 board that a letter was received by the trust advising that the Quality Improvement Group which had been overseeing previous concerns raised about the neonatal unit was now closed. The board report stated, “The letter and the findings on which it is based finally provides external validation that the neonatal service is safe and high quality and contrary to allegations, clearly chronicles that the board and the Quality and Patient Safety Academy were fully sighted throughout on all matters subsequently raised as concerns.”

Concerns were raised about the fitness of some of the board, including both NED’s and Executive Directors. There were various allegations about the behaviours and integrity of the board which we will follow up as part of our Fit and Proper Person Review process.

The trust did have a Fit and Proper Person policy, and we found records to be in line with the requirements.

From our interviews with staff and leaders within the divisions, staff told us they knew there were tensions at the board and there had been a breakdown of relationships. We did not find evidence to suggest this was directly impacting on the delivery of front-line services at the time of the inspection.

We didn’t always find that leaders had role modelled behaviour. We were concerned they did not always demonstrate a culture of openness and welcomed challenge. Some staff perceived the behaviour of the executive and non-executive team to be incongruous with the trust’s values. There was some evidence that leaders saw challenge as a personal attack on their competence causing them to become defensive, rather than using this as an opportunity to develop. We saw improvements were in place to address these concerns through the Chair and Board Development Programme, put in place in April 2024.

The pharmacy department was in a period of change with a significant role at a senior leadership level either being vacant or becoming vacant. This had led to a lack of clear leadership and oversight resulting in operational failings for example, disposal of controlled drugs at ward level was not in line with legislation. We were told that pharmacy key performance indicators were under review and were being refined so they were appropriate.

Staff within the pharmacy team spoke about a lack of visibility of senior leaders in the department and it was not clear what actions had been taken to address this.

The Governors raised some concerns with us about the challenges the board had been facing and how this had impacted on their role. They were supportive of the new Chair and hoped the board could move on from the difficulties, nevertheless the division at the board had also created tension for the Governors and for some Governors a lack of trust had begun to develop.

In the months leading up to the inspection, the board had experienced significant transition. At the time of the inspection, the new Chair had been in post for only three weeks and was therefore unable to provide full oversight. The board was comprised of a Chair, ten Non-Executive Directors (NEDs), and nine Executive Directors. Two new NEDs had joined in February 2024, and two Executive Directors had joined in April 2024.The new Chair of the board told us about their plans to ensure all of the board had clear objectives and received an annual appraisal. The roles and responsibilities of the NED’s were under review at the time of the inspection. This review was initiated by the Chair who told us they had consulted on the proposals and addressed the comments made by the NED’s. However, there was concern expressed by some of the NED’s about this review and the decisions to change roles and accountabilities that had been made.

Shortly after her appointment, the Chair put in place a new board development programme that was designed to take account of the challenges and turnover at the board. It included clarification of ways of working, roles and responsibilities. Development sessions were planned on a wide range of topics, with a focus on culture and values.

The trust ran a comprehensive leadership development programme which included both the board and the Council of Governors, with sessions held across the year. All sessions were facilitated by a specialist governance and leadership development consultancy external to the trust.

Culture was a standing item on the agenda of the People Academy. The People Academy received regular workforce reports and reports on progress against the People Plan and People Priorities, as well as items on EDI, staff surveys and FTSU. Each meeting started with a staff story.

A People Charter was created by staff to bring to life the trust values and the behaviours to be role modelled. The Charter had been incorporated into recruitment, induction, appraisal and development processes.

Assurance about culture in the clinical service units was obtained through regular meetings and review of information.

The trust was chosen as an NHS People Promise Exemplar Site from April 2022-April 2024, and implemented initiatives under all 7 people promise themes, aiming to reduce turnover and increase staff engagement.

Although there were many proactive and positive steps being taken across the trust, the challenges faced by the board had the potential to impact on staff and ultimately the quality of patient care. It was not always clear if the actions being taken were effective as there were ongoing cultural issues at the board.

The staff survey showed that 62% of staff agreed the statement ‘I feel safe to speak up about anything that concerns me in this organisation’. This was higher than the national average of 61% and slightly higher than the trust’s 2022 score of 62%. The survey also showed that 50% of staff agreed the statement ‘If I spoke up about something that concerned me, I am confident my organisation would address my concern’. This was higher than the national average of 49% and slightly higher than the trust’s 2022 score of 49%.

However, we were contacted by 16 staff working in different roles and areas of the trust who wanted to talk to us. These people raised a similar theme in that they didn’t feel supported, respected and valued. Furthermore, we heard from staff they did not always feel safe to speak up. Bradford Teaching Hospitals is a large organisation, employing well over 6500 staff, so it is not surprising to hear a range of views, opinions and experiences from staff.

There was a perception amongst some of the staff who spoke with us that leaders wanted to know who was speaking up and they would suffer detriment from doing so. We saw no evidence of this and noted that the number of people speaking up had increased. We also noted there was a way of staff reporting concerns anonymously.

The Freedom to Speak Up Guardian (FSUP) was the Associate Chief Nurse and reported to the Chief Nurse. Some staff told us they felt uncomfortable that the Guardian was also the Associate Chief Nurse due to them being line managed by the trust’s Chief Nurse.

The Guardian explained that she had proactively sought clarification from the National Guardian’s Office regarding the appropriateness of her reporting line.

In addition, there were robust and established governance measures in place to ensure the independence of the Guardian role. These included quarterly reporting to the trust board and the appointment of a named Non-Executive Director as the Freedom to Speak Up Guardian. The trust also completed the FTSU Board Assurance Framework every two years using the national framework and tool, with the National Deputy Guardian attending the session in 2023. Quarterly oversight meetings were held involving the Associate Medical Director (Deputy Guardian), Freedom to Speak Up Guardian, Chair, NED Guardian, Chief Nurse, and CEO to review high-risk concerns and provide strategic oversight. Further scrutiny was provided through the Audit Committee and the use of the internal audit function.

The Freedom to Speak Up (FTSU) Annual Report 2023/24 included a staff feedback infographic that reflected the experiences of individuals who have used the FTSU service. Once a concern was closed, staff were asked for feedback on their experience, including whether they would speak up again and whether they experienced any detriment as a result. This feedback was a critical component in evaluating the culture surrounding the FTSU function, as it provided insight into staff confidence and perceptions of safety. We saw positive comments made by staff about the FSUP process.

The Guardians were engaged with the work of the National Guardian’s Office and were active as Guardians outside of the trust.

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 trust had a Freedom to Speak Up policy in place. 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.

There were 101 concerns raised through the Freedom to Speak Up route during 2023/2024. This was the most the trust had ever received (65 in 2022/23). The highest reporting category related to inappropriate attitudes and behaviour and bullying and harassment, and the vast majority of concerns were raised by Nursing and Midwifery staff. The majority of concerns were resolved following interventions by the leadership team or HR. Equality monitoring data was presented in the FTSU reports to the board.

There were ways for staff to speak up anonymously. The trust had developed an “app” via which staff could report concerns anonymously. Amendments had recently been made so that feedback could also be given anonymously. Out of 101 speak up contacts for the year 2023/24, 25% were raised anonymously.

We noted there were 12 hours of protected time for the Freedom to Speak Up Guardian. There were 11 Ambassadors who supported the Guardian and worked across the trust.

The Guardian had participated in work with the National Guardian’s Office and was passionate about her role. She had worked hard to promote Freedom to Speak Up across the trust.

Staff and managers had access to training developed by the National Guardian’s Office via the eLearning platform.

There were 2,905 responses to the 2023 NHS Staff Survey, with a response rate of 43% which was slightly below the national average. The trust scored higher than the national average for all people promises elements and themes. The trust scored above the national average for taking positive action on health and well-being and better for staff experiencing bullying and harassment from patients/carers/public, managers, and other colleagues. The trust scored above the national average for reporting bulling and harassment and were above the national average regarding acting fairly with regard to career progression regardless of ethnic background, gender, religion, sexual orientation, disability or age.

For questions not linked to people promise elements or themes, the trust showed poor results compared with other trusts, for colleagues experiencing discrimination on the grounds of gender and religion. The question ‘On what grounds have you experienced discrimination? – Religion’, the trust score of 16.27% was the worst of all trusts nationally (average score of 4.47%). This has also been the case in each of the previous three years. When broken down by religion, the score for those who responded as Muslim was considerably higher than other religions, indicating poorer experiences for Muslim staff at the trust.

For each of the questions, poorer outcomes were seen for staff from all other ethnic groups compared to white staff at the trust. The largest discrepancy was for ‘Q16b – In the last 12 months have you personally experienced discrimination at work from a manager/team leader or any other colleague?’, with a score of 13% for staff from all other ethnic groups combined compared to 6.6% for white staff.

For ‘Q14d – the last time you experienced harassment, bullying or abuse at work, did you or a colleague report it?’, staff from all other ethnic groups scored 48.5% compared to 55% for white staff, meaning that staff from all other ethnic groups were less likely than their colleagues to report any occurrences of harassment, bullying or abuse.

We spoke with some members of staff who told us about their experiences of bullying, harassment, misogyny and racism. Some of the people we spoke with recounted their experiences including the impact it had on their health and wellbeing. Some of the people we spoke to told us they had experienced racism in the trust, but they did not want to come forward for fear of retribution. We also heard from some internationally recruited staff who felt there was bullying and racism in the organisation.

We were concerned about the wellbeing of some of the board due to the impact the recent problems had had on them. There were further opportunities to utilise occupational health support for all staff, including non-executive leaders.

Allegations about Islamophobia at the trust had been reported in the media. A Race Inequality and Victimisation investigation (RIV) had been commissioned as a result of complaints made by 3 NED’s in November 2023 and in writing in January 2024. This investigation was ongoing at the time of the inspection.

Staff reported mixed views about the initiatives to promote inclusion. The trust’s Ramadan Allies project received mixed feedback from staff. Many spoke very positively about the initiative, praising its efforts to promote inclusivity, and the trust was proud to have won a national award for this work. However, some staff reported concerns that the project did not feel genuine, that it singled people out, and that it created division rather than fostering respect for all colleagues.

There were other activities centred around diversity which were driven by staff networks and the Spiritual, Pastoral and Religious Care team (SPaRC).

The trust facilitated a range of networks to support staff, for example, a Lesbian, Gay, Bisexual and Transgender+ staff network. The network chairs were generally positive about the leadership in the trust and felt supported in their roles. However, not all of the chairs had the protected time they needed to fulfil their roles.

Staff side representatives were less positive about managers and leaders listening to concerns and taking appropriate action. There was a feeling that managers were not trained to deal with mental health or reasonable adjustments, leaving staff in post without the necessary support. However, we noted the trust had a number of initiatives to support staff.

We had mixed feedback from partners relating to equality and diversity with some partners feeling the trust engaged well and others feeling less confident that leaders were genuinely committed to partnership working in relation to equality and diversity. The trust was an active partner in EDI initiatives and the Head of Diversity held a system role.

The Bradford District and Craven Health and Care Partnership stated that the trust improved patient experience by advancing equality, diversity and inclusion, and highlighted examples such as the EDI strategy having clear objectives to reduce health inequalities and had strong executive leadership.

The trust took part in the Race Equality Week in February 2024 with colleagues across the Bradford District and Craven partnership. The week was used to launch the second stage of the “Root Out Racism” movement, which was launched in 2021 by the West Yorkshire Health and Care Partnership and has won a HSJ award.

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.

During the inspection we heard from some people about concerns relating to unfair recruitment practices. We raised these concerns with the Executive team, but they told us that it did not resonate with them. The trust had introduced independent panel members into the recruitment process. They were able to tell us about different initiatives to support people to develop and commented there was increased diversity in their executive team. However, they did accept that the number of staff from minority backgrounds in leadership roles needed improvement.

The SPaRC team had developed a comprehensive and innovative mobile web app to supplement its face-to-face practice. The SPaRC web app provided a range of multi-faith support services that patients, their loved ones and colleagues working within the trust could access directly from any device.

The trust fulfilled its responsibilities for reporting on Workforce Race Equality Standard (WRES), Workforce Disability Equality Standard (WDES) and Gender Pay Gap reporting. It was encouraging to see the trust also incorporated WRES data for bank staff.

The trust performed better than the national average for 5 of the 7 WDES metrics from the 2023 staff survey.

The trust exceeded its target of having a workforce that was representative of the local population, with 40.5% ethnic minority representation (against a target of 35%). There had also been an increase in the proportion of senior leaders from an ethnic minority background, increasing from 17.84% to 18.7% in the last year.

The proportion of voting members of the board from an ethnically diverse background remained at 36%, which put them in the top 10% in 2023 for this Indicator. The proportion of executive members from an ethnically diverse background was 17%.

The trust achieved an Equality Delivery System rating of ‘achieving.’

The trust had a dedicated and committed EDI team whose role it was to facilitate and advance the EDI agenda including the 5 key strategic objectives identified in the trusts EDI Strategy and objectives for 2023-2025. A strategic equality and diversity council, chaired by the CEO, was reported to have placed a wider focus on inclusion and belonging, and an increased focus on engagement and involvement with both communities and the workforce. Key achievements over 2023/24 were increasing the workforce that was representative of the population, improvement in staff survey results for diverse staff, winning a Nursing Times award for Best Employer for EDI.

The EDI annual update to the trust board in March 2024 summarised key areas of activity over the past year, including launching the trust’s first EDI strategy, supporting teams and departments to develop EDI actions plans aligned to the strategy, launch of the EDI and Workforce Civility training for managers, replacing the Harassment and Bullying Policy with the Respect, Civility and Resolution policy , and championing the health inequalities agenda. The report also set out key areas of focus for the next year.

The trust had a range of policies with the associated equality impact assessments in place. We found policies were in date and in line with national best practice.

The trust was implementing EDI/workplace civility training for managers. This was a new initiative, but early feedback was positive. We noted there were more opportunities to use this to talk about racism instead of just about incivility.

Both turnover and sickness levels for Medical and Dental staff were worse than comparators. Whilst the turnover rate has seen some improvement and was statistically within the expected range, in January 2024, it was still 15-17% higher than the sector average. The trust was now double the national average for those medical staff leaving with no reason.

The Guardian of Safe Working reported to the trust board. We noted it was reported to the Board that the Guardian felt “The trust was medically understaffed given it is an incredible busy trust with high acuity and high attendances to AE which resulted in a pressured Junior Doctor workforce, and he would continue to feed back this message.”

Between December 2023 and March 2024 there was an overall increase in all staff groups of 136 FTE to 6,458.21 FTE, with the largest increase being seen in nursing and midwifery staff of 52% FTE. The trust reported nursing and midwifery fill rates were consistently above 80% for Registrants and 95% for Healthcare Support workers.

The trust reported a turnover rate of 9% in May 2024 which decreased from 11% in April 2023. Turnover had reduced slightly across all staff groups apart from Additional Clinical Services, Allied Health Professionals Medical Dental where it had increased slightly.

We spoke with one of the triumvirate teams who felt there was challenge and scrutiny by the board who appropriately held them to account.

At the time of the inspection there was an NHS England Quality Improvement Group in place to oversee improvements in the neonatal services.

The trust was a signatory to the Bradford District and Craven place Strategic Partnering Agreement. Additionally, the trust was leading system wide efforts on the redesign of vascular surgery, neurology services, and pharmacy aseptic services, as well as non-surgical oncology.

The Bradford District and Craven Health and Care Partnership acknowledged and congratulated the Trust for its achievements against its quality priorities for 2023/24.

There was a governance structure at the trust, with processes and systems of accountability. This allowed for escalation of information and key risks to the trust board through various committees and assurance groups. During 2023/24, the trust had continued to embed its academy governance model, which was developed and introduced in the latter half of 2020/21. Academies were 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 November 2022.

The trust had a Board Assurance Framework in place. In order to provide assurance that there were effective processes in place for identifying, managing and reporting risks that might compromise the achievement of the organisation’s strategic and other key objectives, an audit of the trust risk management framework was completed in April 2024. The auditors reported there was significant assurance, in that, there were appropriate risk management processes in place that oversee the management of risks from Clinical Service Units (CSU) to Board level.

A Risk Management Strategy was in place that outlined the governance structure that was to be followed throughout the trust from operational to strategic management. Regular reporting took place through the Executive Team Management (ETM), the Academies and the Board around the High-Level Risk Register (HLRR).

An external review of governance arrangements within the trust had been commissioned during Q3 2023/24. This was still ongoing at the time of the inspection.

The trust's month 2 2024/25 income and expenditure position was a deficit of £6.5m. This was £2.3m worse than the originally planned deficit of £4.2m The Closing the Gap programme was £1.5m behind plan and was the key driver for the adverse IE position. NHSE required providers to re-phase their plans in June 2024 to ensure the plan at month 2 aligned exactly to the reported actuals. Against this revised plan, the trust has formally reported zero variance to NHSE.

The integrated performance report was presented to the Board. It used a Statistical Process Control (SPC) approach to presenting data. There was some narrative to accompany the performance report, and we saw evidence of what actions were being taken for learning and improvement.

Board papers were lengthy, but the board told us they had been working to reduce the number of papers over recent months to allow a focus on key issues.

The trust had business continuity and emergency preparedness policies and plans in place.

The trust reported in May 2024 referral to treatment (RTT) performance was stable at 65% of patients being seen within the required timeframe. A process was in place to ensure those waiting the longest and most clinically urgent were prioritised and treated first. A plan was in place for both the trauma and orthopaedic and ear nose and throat services to recover the actual and project breaches for 65 weeks waits.

Risks relating to pharmacy services were identified on the risk register. However, it was not clear how progress to mitigate these risks was being actioned or updated as meeting minutes and risk registers were not consistently updated.

Pharmacy staffing was identified on the risk register in May 2023. The staffing/workforce plan for this risk contained detailed capacity planning for aseptic services but minimal information was provided for the wider pharmacy staffing levels that were needed to provide good quality pharmacy services.

At the time of the inspection, the medication safety officer post was not in position so was being undertaken by the chief pharmacists role. It was not clear from the governance minutes how medicines incidents were reviewed and how learning and actions were being shared.

The trust had an antimicrobial pharmacist who worked collaboratively with the wider trust on antimicrobial stewardship.

In January 2024, the non-medical appraisal rate was 78%, core mandatory training was 92% compliant and turnover was 9%.

The Trust achieved a “standards met” outcome for the Data Security and Protection Toolkit for 2022/23.

In the Friends and Family Test, the overall position for 2023/24 was a score of 88.6% of patients scoring the Trust as ‘very good’ or ‘good’. This was an increase from the previous year’s score of 79%.

The trust was committed to tackling health inequalities as well as listening to the views of patients, carers and communities. We heard mixed feedback in relation to how effective this was. Some people felt they could influence the shape and design while others felt it lacked inclusivity.

Leaders told us they had been more internally focused than they would have liked over recent months. They acknowledged the challenges the board faced had left them less time to focus on their wider obligations.

The trust was a member of the Bradford and Craven Place Partnership. The trust Chair and CEO were members of the partnership board and a Non-Executive Director from the trust was chair of the System Finance and Performance Committee. There were seven priority programmes as well as a Reducing Inequalities Alliance.

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 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 shared a Chief Digital and Information Officer post with another NHS Trust and had a partnership arrangement with two NHS trusts in relation to its electronic patient record system.

Some partners felt the trust was working well to reduce health inequalities. Other partners felt there were further opportunities to work more closely with the communities they served so they could tailor services to meet the needs of the local community.

The Bradford District and Craven Health and Care Partnership commended the trust for numerous patient and public involvement projects that had taken place to improve facilities and services and ensure they were inclusive to the local community and continued community engagement and inclusion. Healthwatch Bradford and Craven commended the Trust for the use of ‘Experts by Experience’ to improve inclusivity in all areas including facilities, communication and clinical service delivery.

Governors were supported to undertake their roles and represent local communities. Governors received training and induction for their roles. Governors were supported to attend operational activities.

The trust was part of the place-based partnership and the trusts CEO had only recently stepped down as the place-based CEO.

One of the trust’s strategic objectives was in relation to “Our Partners”. The trust’s plans in this area were to work with other providers of acute hospital care to best meet the needs of their shared patient populations, work with partners across West Yorkshire to improve services and address health inequalities, continue to develop as a hub for specialist services in the west of West Yorkshire, and meet their commitment to sustainability and delivery of the NHS Net Zero Carbon target.

The trust had a complaints policy in place and monitored performance against their policy.

Patients were encouraged to give feedback on their care. The trust had a complaints policy which was advertised within the trust. Feedback from the assessments we carried out of the neonatal, maternity and medical services showed good evidence of services adapting based on feedback from patients.

As referenced elsewhere in this report, some people felt the trust executive leaders didn’t always have an open approach to learning when things went wrong.

In the 2023 national staff survey the trust scored above the national average, and improved in the last year, for the people promise element “we are always learning.”

Some partners felt leaders could be defensive when they were challenged and wanted to see a more open and transparent relationship.

Healthwatch commented in the trusts quality account they were pleased to have seen numerous changes to services that put patients, and their carers at the heart of decision making. These included involvement in the NHS England ‘Worries and Concerns’ Improvement Collaborative and the multiple improvements within maternity services, both demonstrating an embedded and ongoing commitment to listen and improve.

The trust had an incident management structure in place. There were a total of 10,813 patient safety incidents reported within the Trust during 2023/24. This represented a slight reduction when compared with the previous reporting period when there were 11,109. There were 43 (0.38%) patient safety incidents that resulted in severe harm or death during 2023/24. This number had remained relatively stable and was 40 in 2022-23.

Incidents graded as Severe Harm or Death had increased over a 5-year period, however, this period covered the Covid-19 pandemic and, since October 2021, the Medical Examiner Service at BTHFT had been operating at 100% capacity. This meant 100% of patient deaths were scrutinised by the independent Medical Examiner Service. In turn their scrutiny fed into the Learning from Deaths Programme, which began full operation in March 2022.

There had been an increase in reporting for those incidents classed as “death” due to the trust’s increased awareness and maturity of the Mortality Governance arrangements, over the last 5 years.

We reviewed the trusts mortality governance arrangements and found these to be strong and working very well. The trust’s mortality governance processes had also been included in the Royal College of Anaesthetists’ good practice library as an exemplar in the field of reporting, investigating and learning from patient deaths.

The trust undertook 64 structured judgement reviews in 2023-24, and identified key learning points and areas for improvement that were captured in the Quality Accounts report.

The trust transitioned to PSIRF in December 2023. 94 staff had been trained in safety event investigation, Patient Safety Partners had been recruited and the successful transition from the National Reporting and Learning System (NRLS) to the new Learn from Patient Safety Events Platform (LFPSE), had taken place in January 2024 in line with the national contract.

The trust had a quality improvement approach in place and used improvement methodologies to improve outcomes and performance.

The new cancer IT system was in its project scoping phase with a planned go live of September 2024. The trust told us this would bring many benefits, including supporting Personalised Stratified Follow Up (PSFU) and a digital remote monitoring system (RMS) for patients after cancer treatment. The aim was to reduce unnecessary follow-ups for patients.

Web-based waiting list management tools were planned to be implemented across the CSUs in July which was expected to improve oversight of pathways.

The trust had a research strategy in place and an active research portfolio led by the Bradford Institute for Health Research. More than 25,000 patients were recruited to participate in clinical trials in 2023-24. The Trust was the highest recruiting site to the National Institute of Health and Care Research portfolio studies in the United Kingdom.

During 2023-24, the Trust participated in 59 national clinical audits and two national confidential enquiries.

The leaders within the trust demonstrated a commitment to environmental sustainability and had started to develop an approach to reaching this goal. There was a vision for their strategy around sustainability and leaders were aware of their role in delivering upon this, with a board level lead for Net Zero.

The trust worked well with systems partners, ensuring collaboration on sustainability initiatives and contributing to the ICS Green Plan. The trust was working with the ICS lead on several projects to ensure effective leadership on sustainability across the ICS

The trust’s Green Plan was published prior to the national publication of the statutory guidance of ‘Delivering a Net Zero NHS report’. This Green Plan should be updated as soon as possible to reflect statutory guidance and updated three-yearly thereafter. Whilst there were areas, such as Estates, in which the trust was demonstrating a reduction in emissions there were still reasonable steps which could be taken to minimise the adverse effects of climate change across other areas such as clinical pathways and processes. The trust needed to take active steps towards ensuring the principles of net zero care were embedded into all aspects of the planning and delivery of patient care. We heard some examples of this taking place, such as sustainable procurement in renal services and the capture of anaesthetic gases and safe disposal of inhalers.

There wasn’t appropriate governance to ensure leaders were tracking their progress against their targets outlined in the Green Plan. The Green Plan outline was reported annually to the board, including the trusts carbon footprint, but there had been no reporting on progress against targets. The leaders identified this as a gap and planned to report against targets on their next annual report.

There did not appear to be a clear method of communication of the trusts actions around Net Zero to its workforce and patients. The workforce should be engaged by leaders, so they are aware of the trusts sustainability goals and encouraged to seek education on sustainable healthcare, empowering them to work with the trust to ensure these goals are achieved. The trust had ensured educational modules were available for staff to access.

Although National and local initiatives had been actioned, for example, the removal of desflurane, medicines sustainability did not feature in the medicine’s optimisation strategy.