Nuffield Health Derby Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that patients had good outcomes because their needs were assessed and care was delivered in line with best practice.

Patients’ needs were assessed and reviewed throughout their care. Patients told us they received clear explanations about their treatment and felt supported to make informed decisions.

Care and treatment were delivered in line with national guidance. Staff worked collaboratively across teams, and outcomes were monitored through audit and governance processes to support improvement. Patients were supported to manage their health and wellbeing, and staff followed appropriate consent processes.

At our last inspection we rated this key question requires improvement. At this inspection the rating has improved to good. This meant patients’ outcomes were consistently good, and patients’ feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The service made sure patient’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Staff worked with patients to understand their needs before treatment started and continued to review these throughout their care.

In the oncology unit, we reviewed records which showed staff completed comprehensive assessments before treatment. These included patient’s medical history, blood results, treatment protocols, symptoms, performance status, activities of daily living and social circumstances. Staff told us these assessments were reviewed before each cycle of treatment and whenever people’s condition or circumstances changed, to ensure care remained responsive.

Patients consistently told us they were given time to discuss their needs and understand their treatment. One patient described explanations as “excellent” and said they had separate discussions with the consultant and nurse, allowing time to reflect and ask further questions. Another patient told us they had a full consultation before treatment started where prognosis, risks, benefits and side effects were clearly explained.

Staff reviewed patient’s physical health needs on an ongoing basis. In the oncology unit, symptom and toxicity checks were carried out at each visit, and staff responded to changes in patient’s condition by adjusting medicines, seeking specialist advice or amending treatment schedules. Patients told us staff were responsive to changes in their condition and regularly reviewed symptoms at appointments.

Staff assessed and supported patients’ wellbeing and emotional needs. Patients told us staff checked how they were feeling both physically and emotionally and signposted them to additional support where needed, such as talking therapies. Staff considered communication and additional needs, including arranging interpreters where required and assessing mental capacity where concerns arose.

Feedback from patients using endoscopy services also demonstrated that staff assessed needs and provided appropriate information before treatment. Patients told us procedures, risks and preparation were clearly explained in advance and staff checked for questions or concerns before treatment began.

We scored the service as 3. The service planned and delivered patient’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Care was delivered in line with national and professional standards. We saw clear policies for oncology and perioperative care. They followed recognised frameworks and national guidance, including UKONS and NICE standards. Meeting records showed leaders discussed updates on national guidance as a standing agenda item. Leaders said expert advisory groups reviewed this guidance. They shared updates with staff and used governance systems to monitor implementation.

Patients received systemic anti‑cancer therapy through structured, evidence based pathways. Staff used recognised SACT protocols and UKONS triage tools. They used these to assess, monitor, and respond to symptoms and deterioration.

Staff used nationally recognised clinical assessment tools to support consistent risk assessment and monitoring. These included NEWS2, VTE risk assessments, the UKONS triage tool, and WHO surgical safety checklists. For example, staff used structured VTE risk assessments to identify risk and guide preventive treatment where needed.

The endoscopy service at this location held Joint Advisory Group (JAG) accreditation. This confirmed that effective systems were in place for the safe use, cleaning, servicing and monitoring of equipment. This was supported by the provider’s endoscopy standard operating procedure, which set out requirements for appropriate equipment provision, routine servicing, safety testing and compliance with the medical devices policy. It also required the availability of essential monitoring, resuscitation and procedure-specific equipment, and adherence to decontamination standards for reusable devices to reduce the risk of harm.

We scored the service as 3. Staff worked effectively across teams and services to support patients and promote continuity of care. Information was shared appropriately between teams, so patients did not need to repeat their story when moving between services.

Staff took part in regular multidisciplinary working, including daily safety huddles, structured handovers and patient safety meetings. Nurses, RDOs, consultants, pharmacists and allied health professionals worked closely together to review patients’ needs, respond to deterioration and plan ongoing care. Handover processes ensured important information about patients was shared between staff working different shifts and areas.

Teams worked well across departments, including endoscopy and oncology services. Clear escalation pathways were in place, and staff understood when and how to involve senior clinicians and consultants.

Staff also worked effectively with external healthcare providers and support organisations to coordinate care. Patients were referred to the service through GP referrals, consultant referrals, insurance providers and other hospital clinicians. The oncology service worked closely with the local trust through a service level agreement that provided multidisciplinary team review for all cancer patients. Staff maintained links with Macmillan Cancer Support, Marie Curie and local palliative care services to support patients with complex needs..

The service also worked with patient transport services where required to enable timely access to treatment and appointments for patients.

We scored the service as 3. The service supported patients to manage their health and wellbeing to maximise their independence, choice and control. The service supported patients to live healthier lives and where possible, reduce their future needs for care and support.

The service took a proactive, person-centred approach to assessment, education and prevention, with clear systems to support physical health, emotional wellbeing and long term outcomes.

The service demonstrated a preventive approach and worked to reduce future health and care needs. In the oncology unit, patients were given clear advice on red flag symptoms, how to reduce infection risk and how to access advice out of hours.

There was a clear focus on supporting people’s wider health and wellbeing beyond immediate treatment. The service provided access to psychological and emotional support, including mental health first aid and direct referral to psychology services. Staff recognised that patients may not always verbalise emotional distress and offered support throughout the treatment pathway, not just at referral points. Staff used holistic needs assessments to help patients identify physical, emotional and practical concerns and access appropriate support.

The hospital also supported healthier lives through health promotion and community based initiatives. Leaders said the service worked with external organisations to deliver education and prevention programmes. These included courses for people with long‑term conditions, cancer support programmes, and community engagement events. These events focused on physical activity, wellbeing, and health awareness.

These initiatives supported people to manage long term conditions more effectively and remain active and independent.

We scored the service as 3. The service monitored patient’s care and treatment to continuously improve it. Staff ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of patients themselves.

The service routinely monitored patients’ care and treatment and used this information to promote continuous improvement. Outcomes were generally positive and consistent, supported by structured governance arrangements, audit activity and oversight at service, hospital and committee level. These processes helped ensure clinical outcomes met professional standards and reflected people’s expectations of safe and effective care.

The service demonstrated engagement with national accreditation schemes and external quality frameworks, which provided independent assurance of outcomes and supported continuous improvement. The hospital held Joint Advisory Group (JAG) accreditation for endoscopy, demonstrating compliance with national quality and safety standards. Oncology services had achieved the Macmillan Quality Environment Mark, reflecting positive patient-centred outcomes and environmental standards.

Audit and surveillance activity supported consistent delivery of care. The service undertook a wide programme of audits, including infection prevention and control, surgical site infection surveillance, medicines management, consent and clinical pathway audits.

Outcomes for people using oncology services were closely monitored. Staff used the UKONS triage tool to review urgent and out-of-hours contacts. Audit data showed high compliance with documentation standards, including toxicity assessment, escalation actions and consultant involvement. Documentation audit scores ranged from 95% to 98% and were comparable with, and in some cases better than, other Nuffield Health hospitals. UKONS audit scores ranged from 90% to 91%, which were in line with most comparator hospitals across the Nuffield Health network. Cancer governance reporting identified no themes of concern and no concerning trends in cancer-related incidents. Outcomes, audit findings and multidisciplinary team compliance were reviewed through local and national governance processes to support learning and service improvement.

Endoscopy outcomes were monitored through service specific governance arrangements, including the endoscopy user group. This multidisciplinary forum reviewed key performance indicators, audit findings, patient feedback and surveillance data, including JAG requirements, repeat procedures and complication rates. Performance was benchmarked against national standards through JAG accreditation and the National Endoscopy Database. Identified issues were discussed and addressed through agreed actions, with escalation to senior governance structures and the risk register where required.

The service also monitored outcomes against patients’ expectations. Patient experience measures, including satisfaction scores, feedback and complaints, were reviewed alongside clinical outcomes. Where feedback highlighted areas for improvement, actions were agreed and monitored through governance arrangements.

We scored the service as 3. Patients were supported to make informed decisions about their care and treatment, and staff respected patients’ rights around consent when delivering person centred care. The service had clear policies, guidance and documentation to support consent and decision making, and staff demonstrated a good understanding of capacity, best interests and lawful consent.

Leaders described governance arrangements that supported safe consent practice. They audited consent documentation. The service used standard consent processes that met legal and professional requirements. Policies covered consent for adults with capacity to consent, children, young people, and adults without capacity to consent. These aligned with the Mental Capacity Act. They guided staff on assessing capacity, making best interest decisions, and involving others when needed.

In oncology services, records showed staff gained patients’ consent to treatment. Patients signed chemotherapy consent forms which documented the risks, benefits, alternatives and potential side effects of treatment. Where additional procedures were required, staff gained separate consent. For example, if a patient needed a central venous access device (a tube which goes into a vein to given medicines or fluids) to be inserted. Staff revisited consent if treatment plans changed, and patients were given opportunities to ask questions and make informed choices about their care.

Patients told us staff gave them clear information about their treatment to support informed consent. They described detailed discussions with consultants and nurses, supported by written information.

Staff understood how to assess and support patients’ capacity to consent to care and treatment. Where patients showed signs they lacked capacity to consent, staff completed capacity assessments.

The endoscopy unit for this service sat within the theatres department. Details of consent arrangements within theatre department are included in the surgery service report.