Calderdale and Huddersfield NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The community health service for adults had effective systems to learn from incidents and improve services. The senior leadership team review and monitor all patient safety events reported via the incident management reporting system (InPhase). All learning responses are commissioned by the Divisional Patient Safety Event Panel in line with the Patient Safety Incident Response Framework (PSIRF).

We observed staff raised safety concerns, investigated events, and shared learning to help embed best practice. All safety concerns of moderate risk or higher within the community health service for adults were referred to a weekly panel to review. The panel included the associate director of nursing, head of nursing, matrons, pharmacists, safeguarding representatives, tissue viability nurse, team leaders and clinical educators for community. The panel identified themes and learning and these were cascaded to staff at team or handover meetings and incorporated into bite sized learning. Immediate or priority learning was e-mailed directly to staff.

All pressure ulcers including moisture associated skin damage (MASD), deep tissue injury (DTI) and unstageable category two and above pressure ulcers were reported as an incident. The pressure ulcers were either community acquired when a patient was frail and on prolonged bed rest or when a patient was admitted to the service from secondary care. Pressure ulcer incidents were reviewed weekly by the Divisional Patient Safety panel to determine level of harm caused and identify any immediate learning. The tissue viability nurses, and safeguarding representatives attend the panel to provide advice and support to the district nurse team.

The head nurse encouraged the team leaders to follow a Getting It Right First Time (GIRFT) principles within their teams and encourage team members to discuss what went right and/or wrong and how this could be improved. This is a national NHS England initiative designed to improve patient care and productivity by reducing unwarranted variations in clinical treatment and service, aiming to get it right the first time to improve outcomes and efficiency.

Leaders and staff worked with patients and healthcare partners to establish and maintain safe systems of care, in which safety was monitored and managed. This helped to ensure there was continuity of care, including when patients moved between different services.

Staff worked collaboratively with partner agencies. Clinical teams regularly discussed ongoing care needs, including palliative care and falls management, through multidisciplinary team meetings and in liaison with GPs. Leaders reported strong working relationships with local hospital wards, supported by regular meetings throughout the day to monitor and coordinate patient discharges.

The community health services for adult’s provided a hospital at home service, which provided an alternative option for those who were frail, elderly, or with acute respiratory infections who became unwell and would normally be spending time in hospital. This aimed to help prevent admission into hospital, supported early discharge out of hospital, and increased the overall bed-base available for acute care.

The adult community service nursing team had a telephone service which acted as a single point of access, this operated 24 hours a day 7 days a week. The telephone team triaged calls referred patients to the nursing teams and provided advice when appropriate. Urgent referrals were responded to within 2 hours. Current patients who did not meet the urgent criteria were responded to the same day. For patients discharged by other providers with planned care in place, such as routine wound care or regular medication administration, response times were based on individual clinical need.

All district nursing team staff described a prompt response to patient referrals dependent upon patient risk.

The service only provided care and treatment for patients over the age of 18 years but there were systems and processes to safeguard children who they encountered during their work.

Staff we spoke with understood how to protect patients from abuse and told us the service worked well with other agencies to do so. They knew what to do in the event of any safeguarding concerns and could access safeguarding advice from the trust safeguarding lead. Staff reviewed the outcomes of safeguarding referrals in handover and team meetings.

Safeguarding group supervision was not mandatory and available every month. The attendance rate reported for the third quarter of the year at the end of December 2025 was 82.5%.

Information from the trust, showed the safeguarding adults training completion rate in January 2026 was 84.5%, the safeguarding children’s training was 92% and PREVENT was 98% (Prevent training is designed to prevent people from being drawn into terrorism or supporting it. It focuses on safeguarding and early intervention to support vulnerable individuals.) Team leaders had been requested to roster time for staff to undertake the required training. A safeguarding referral was considered for all reported pressure ulcers of category 3 and above. A referral is made where appropriate and reviewed in weekly risk and daily handovers.

All pressure ulcers of grade 3 and above were reported, as a safeguarding and were reviewed in weekly risk and daily handover meetings.

Staff we spoke with understood the Mental Capacity Act 2005 (MCA). We saw that staff completed capacity assessments when appropriate and detailed these in patient care and treatment records.

Staff told us they completed holistic risk assessments which brought together a range of clinical risk assessments to ensure safe, person centred planning and effective management of patients in their own homes. These had to be completed within 7 days of admission. The completion of risk assessments was monitored by the team leaders; in March 2026, 81.2% holistic risk assessments had been completed. The leaders explained the lower percentage was because some patients required a planned, one-off intervention and did not always need a full holistic assessment. The service had recently changed the pressure area care risk assessment and had identified staff had not always completed the new assessment. In response they had commenced a quality improvement project to increase the uptake to 95%. Information from the provider showed 85% had been completed in March 2026.

We reviewed a sample of patient care records and observed staff whilst providing care at home and in clinics and found staff mostly completed risk assessments. Identified risks were then managed or mitigated appropriately. This also demonstrated staff used recognised tools to assess the risk to people, For example, patient nutrition, mobility, skin care, frailty, continence and pain. Where applicable, staff assessed people who were at risk of physical deterioration using a national early warning score tool (NEWS2), and, where required, escalated them appropriately.

Specialist tissue viability nurses provided support and advice to the district nursing team when they were managing complex wound care.

The team leaders and matrons attended a safer staffing meeting daily in the morning to ensure there were enough staff on duty to safely manage patient demands. In addition, they followed Operational Pressures Escalation Levels (OPEL), an NHS framework used to assess, measure, and respond to capacity pressures in real-time, aiming to ensure patient safety.

District nursing staff ensured that all visits where the person required insulin were completed each day.

Staff passed on information about patients they had seen at daily handover meetings. This included all necessary key information to keep patients safe. Staff considered patients’ holistic needs during handovers and home visits. Out of hours on call and senior leaders were available for escalation of any priority issues.

Emergency equipment was available, checked and maintained, at Dean Clough, Allan House, Brighouse and Broad Street, where patients attended clinics.

Staff detected and controlled potential risks in the environment. They made sure equipment, facilities and technology were maintained and supported the delivery of safe care.

The service had suitable facilities to meet the needs of patients and their families. Buildings which patients needed to access to receive their care and treatment had appropriate adjustments in place, including the provision of ramps and lifts.

Staff could obtain specialist equipment for patients when they needed to, by ordering this through an external contractor. Hospital transport to support patients to attend appointments was also available. Staff told us it was their responsibility to ensure their personal equipment was properly maintained.

Following our inspection in 2016, the trust had implemented a trust asset risk register (database) to ensure all equipment was regularly maintained. At this inspection, we were informed all devices were logged on the central trust database. In addition, the community healthcare division operated a structured, scheduled visiting programme across all locations, during which the medical engineering team undertook the calibration and verification of all relevant medical equipment.

Staff told us there were generally enough staff to ensure that the service ran safely. We observed a daily safer staffing meeting, attended each morning by community health services for adults matrons and team leaders to ensure there were enough staff to meet patient needs in the nursing teams. Where demand exceeded capacity, the staff followed operational pressures escalation action cards and community nursing priorities during periods of surge and escalation.

The Public Board of Calderdale and Huddersfield Foundation Trust Directors meeting on 12 March 2026 approved the safer staffing bi annual report presented by the chief nurse. This stated they were satisfied that staffing was safe, effective and sustainable. This was achieved through mitigations identified in the Board Assurance Framework (BAF) associated risks, ongoing governance arrangements aimed at maintaining the daily staffing position and monthly safer staffing meeting forums.

Team leaders and matrons told us that they did not usually use bank or agency staff but managed by staff being flexible and working across nursing teams. The division used a health heatmap to monitor sickness, annual leave, turnover, vacancy rates and essential safety and role specific training, which was presented at divisional board monthly meetings. The information for January 2026 for community nursing, showed 5.8% of sickness in the last 12 months.

Caseload sizes within the community health services for adults were driven by a combination of patient need, service capacity, and operational requirements. As part of trust wide processes and in line with statutory requirements outlined in the Developing Workforce Safeguards (2018) guidance, the division undertook an annual and bi-annual review of all clinical teams. The outcome of the most recent review confirmed that no changes were required to the current workforce models based on existing caseload positions. The outcome was supported by the district nursing leaders and all the staff we spoke with told us the caseload sizes were manageable.

Staff completed mandatory training, the overall uptake at the time of our inspection (as of February 2026) was 94.5% for essential safety training and 90.6% for role specific training. The trust’s target was an achievement of at least 90%. The information provided by the trust demonstrated some teams were below the 90% target. Where training was below the target completion rate, team leaders were requested to roster time for staff to undertake the required training. Although 96% of staff had completed their learning disabilities and autism tier one training, staff told us there was an issue with tier 2 the face-to-face training due to the number of places being offered, but there were plans in place to resolve this. We have followed this up with the trust and have been given assurance this was being addressed.

Staff completed competency training dependent upon their role, this was during induction and covered areas such as the management and administration of safe medicines, diabetes, and catheterisation. Information provided by the trust demonstrated this was monitored, however it only included new starters and did not include whether competency training was reviewed and updated. Staff were not permitted to undertake any activity unless they have been signed off as competent.

Most staff we spoke with had received an appraisal in the last 12 months. Information supplied to us by the trust showed that 91% of staff from community health service for adults had completed their annual appraisal in the last 12 months. And 95.3% of district nursing staff had completed their appraisals., trust target was 90%.

During our previous inspection we found there were inconsistencies in the way staff received clinical supervision, and this required standardising and strengthening. At this inspection we found staff were offered clinical supervision which was the individual member of staff’s decision to take up, which was offered either individually or as a group monthly. Staff described taking up this offer when they had a difficult case. In addition, staff had a one-to-one line management session with their managers monthly to review performance. Although, staff told us they felt fully supported and supervised and team leaders described an open-door policy, daily handovers, accompanying staff on visits or following staff into visits to check compliance, we found there was an inconsistency and lack of formality to the approach.

However, community health services for adults had recently reviewed the supervision guidance, this was then approved at the February 2026 patient safety and quality board. The guidance included that there were two types of supervision, line management and operational supervision. Line management was to be completed and recorded as a minimum every 8 weeks. Clinical supervision would meet the needs of the member of staff dependent their knowledge, experience and competence within a particular clinical area.

The community health service for adults had a human resource business partner who ensured that safe recruitment processes were in place and followed. Performance information was reviewed at review meetings and reported monthly to divisional board.

Staff effectively assessed and managed the risk of infection. They promptly identified and controlled potential spread, sharing concerns with relevant agencies. A designated infection prevention and control lead was in place for each site and all staff received appropriate training. Cleaning schedules were followed. A number of infection prevention and control audits were conducted throughout the year, supported by additional audits and spot checks during outbreaks. Frontline ownership audits were completed bi-weekly by the band 7 team leads and monthly by senior managers.

Information provided by the trust demonstrated in March 2026 overall performance for infection prevention and control audit was 96.8%. Hand hygiene audits for Brighouse, Allan House and Dean Clough over a 3-month period for the district nursing service showed a 100% compliance rate.

We observed that during home visits staff practiced good infection control. They used aseptic procedures including hand hygiene measures when providing care and treatment. Staff kept the equipment they used during visits to patients’ homes visibly clean.

Information provided by the trust showed that infection control training completion rate for staff within the community health services for adults was 96.3% (January 2026), the trust target was 90%. One district nursing team had a lower completion rate, at 84.2%. This was attributed to new starters, and staff on maternity leave or sickness. Where training was below the trust’s target completion rate, team leaders were requested to roster time for staff to undertake the required training.

Nurses administered medication using a medicine administration record which was in the patient home, medicines were prescribed by a GP or secondary care and dispensed by the local pharmacy to patient homes. The nurses transcribed the prescription onto the patient’s administration record and administered the medicines. All nursing staff followed a transcribing policy and completed transcribing competency training which was reviewed as part of their annual appraisal and patient record review audits. As of 3 March 2026, 79% of clinical staff had completed their annual transcribing competency training. We were told the majority who had not completed were new starters, or staff on maternity or sickness leave. To provide stronger oversight competency transcribing was to form part of the divisional audit program and be a specific element of a two monthly report provided to the patient safety and quality board.

Qualified district nurses were independent prescribers, who prescribed under their level of competency and for their specific area of work. The trust carried out an annual affirmation of competence for each member of staff, which included a prescribing audit for the previous year. The trust provided information which showed 79% of staff had completed their annual affirmation of competency as of 3 March. 2026. The patient safety and quality board had recently requested the team leaders improve the current compliance.

Staff told us that the service only used patient group directions (PGDs) and patient specific direction (PSD) for patient immunisations.

All nursing staff told us the only medicines they carried were anaphylaxis kits which had adrenaline. Although, nursing staff told us they were responsible for checking the use by date of the medicine, we found the overall management of the anaphylactic kits would benefit from a review. Following our inspection the trust has put an action plan in place, to ensure a formalised process for checking and replacing anaphylaxis kits held by staff.

The hospital at home and district nursing team, administered outpatient intravenous antibiotics at patients’ homes. When a patient was discharged from hospital they coordinated and reviewed their medicines. The community nursing staff were trained to administer the medicines and escalate any concerns to IV antibiotic team lead. The hospital at home team reports any concerns to the daily multidisciplinary team meetings

Staff told us that they received the Medicines Healthcare products Regulatory Agency (MHRA) updates by e-mail from the pharmacy team, and these were discussed at team and handover meetings.