Bradford Royal Infirmary

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

We rated this as outstanding. Leaders were dedicated to providing an inclusive , compassionate and highly effective service. Staff were consistently supported to develop their skills and succeed in the delivery of a high quality service. Staff felt respected, supported and valued. Staff were clear about their roles and accountabilities. The service was consistently committed to seeking constructive engagement with families and partners to plan and manage services well.

This service scored 89 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff felt highly respected, supported, and valued. They were focused on the needs of patients receiving care. We looked at a range of information in relation to culture in services for children and young people. We also spoke with staff in the neonatal unit. We found evidence of positive culture across the unit. Staff told us the culture on the unit was highly positive and they reported good teamwork and excellent morale. They told us they received high levels of support from their managers and colleagues. Staff displayed a high level of resilience to continue to provide the care to meet the needs and care of women and their babies despite difficult circumstances. They spoke positively about their roles and demonstrated pride in their work. Managers regularly praised the hard work and commitment shown by staff. There was an open and honest culture in the service. Staff told us there were no barriers between clinical staff and managers and that they were encouraged to raise concerns and speak up without fear. They described reporting incidents as a ‘no blame culture’. Feedback from listening events demonstrated that staff felt “happy” and “felt part of a caring team”. Staff reported that the safety culture was good.

Leaders ensured there was a process to work towards the vision and had a strategy to turn it into action. Staff and leaders ensured that the vision, values and strategy had been developed through a structured planning process in collaboration with staff, external partners and feedback from families. Staff and leaders demonstrated a positive, compassionate, listening culture that promoted trust and understanding between them and people using the service, and was focused on learning and improvement. The 5 year 'Excellence project' includes investing in workforce, streamlining services, family experience as partners in care, building fit for the future (family accommodation) and going digital with an Electronic Patient Record (EPR) that works for the service.

Leaders told us they believed they had the necessary skills, knowledge and capability to lead the service to deliver on the vision for Bradford neonatal services whilst consistently improving and ensuring risks were managed well. Leaders spoke with confidence and demonstrated a compassionate and in-depth working knowledge of all aspects of the service. Staff told us that they had confidence in their leaders who were visible and approachable at all times.

Through highly effective systems and processes, leaders had up to date knowledge about issues and priorities for the service. There were appropriate appraisal processes in place to ensure effective retention and succession planning. Leaders were able to recognise where they needed to strengthen service provision to maintain safe care and used individual approaches to target specific staff groups for recruitment.

Staff were aware of the freedom to speak up guardians (FTSUG) across the trust and told us the freedom to speak up (FTSU) service was actively promoted. At this assessment staff told us they felt confident to actively speak up and raise concerns without fear of detriment or reprimand. As a result of the open, honest and supportive culture within the neonatal services staff told us that they would rarely need to use the more formal FTSU routes available to them.

There were several processes in place for staff to escalate any concerns. Freedom to speak up (FTSU) was promoted and staff were encouraged to speak up. There was resource for staff to raise concerns in confidence which were all then referred onto the Guardian. There had been no concerns raised within the last twelve months from the neonatal unit staff groups. This was understood to be as a direct result of visibility and openness from leaders and a positive listening and learning culture within the neonatal services.

Leaders told us they continually reviewed staff survey results and took action to encourage job applicants from a wide range of communities and backgrounds. Leaders were cited on staffing groups that were under-represented and gave examples of support to encourage staff from all backgrounds to progress.

Leaders were consistently proactive in seeking staff feedback from all staff within the neonatal services through recognised processes within the service. Processes for seeking feedback included all staff groups, this also included, for example, students and trainee doctors.

The service had effective governance processes, throughout the unit and with partner organisations. Staff at all levels were clear about their roles and accountability and had regular opportunities to meet, discuss and learn from the performance of the service. Senior leaders told us they felt well represented and listened to at trust board level. Staff we spoke with understood what their individual roles and responsibilities were, what they were accountable for and to whom they were accountable. Staff told us that they were provided with information relating to learning and performance via themes of the week, safety huddles and staff meetings. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were submitted to external organisations as required.

There was a clear escalation of risks for any concerns raised from these meetings up to the divisional operations and performance and governance board monthly meetings. The divisional risk register, incidents, complaints summary and audit updates were examples of standard items at monthly clinical governance meetings for review and action planning. These were used to identify and manage known risks. We reviewed several governance and risk meeting minutes which evidenced clear oversight and assurance of risk, audit, national work streams, training, NICE guidance, incident review and support services.

We did not hear specific feedback from people about working in partnership to develop services. However, staff told us about parent focus groups that had been re-launched in September 2023 with the aim of engaging families in the co-production of future projects.

Staff and leaders told us about joined up working initiatives with other key organisations and the local community. For example, there was positive partnership working with local hospices, infant mental health services and other voluntary organisations within the community. Staff took pride in developing and creating positive partnerships within the community and told us how important they believed this was in supporting families journeys.

We heard from staff about effective partnership working with multiple agencies across the community. The team were active participants in regional networks for sharing of best practice.

There were recognised partnership working arrangements in place with other regional services. These partnerships supported learning in an open and transparent way. We heard about shared learning opportunities within these networks. We saw evidence of collaborative working that supported continuous development of services regionally. There were strong local partnerships with other service providers ensuring the needs of the local community were constantly under review with opportunities for innovative ways of working to lead to better outcomes for people. We heard that neonatal services worked effectively in partnership with other teams within the wider trust.

All staff were highly committed to continually learning and improving services. They had a strong understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research and staff felt empowered to lead and deliver change. Senior leaders and staff had a good understanding of quality improvement projects and provided positive examples of when they were encouraged to contribute to improvement initiatives.

There were processes to ensure that learning happened when things went wrong, and from examples of good practice. Leaders encouraged reflection and collective problem-solving. The service was committed to improving by learning when things went well or not so well. They were involved in various research and innovation projects to develop the service. Leaders held debrief sessions with staff following any serious incidents. Leaders encouraged staff at all levels to speak up with ideas for improvement and innovation.