Chesterfield Royal 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

This means we looked for evidence that patients’ care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

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

The service had improved since the previous assessment and demonstrated that care, treatment and support were based on patients’ assessed needs and delivered in line with current evidence-based practice. Staff completed comprehensive assessments, using recognised tools to support clinical decision-making and reviewed patients’ needs regularly.

Patients were generally positive about their involvement in care and treatment decisions and described staff as keeping them informed about their condition, treatment and discharge planning. Good care and treatment were supported by clinical audits, quality improvement activity and governance processes that monitored compliance with national standards which drove improvements in practice.

Staff worked collaboratively across multidisciplinary teams to coordinate assessment, treatment and discharge planning. Ward teams worked closely with therapists, discharge coordinators, community services and social care partners to support safe transitions of care and reduce delays. There was evidence of effective communication and joint decision-making across services, including for patients with complex needs and those requiring best-interest decisions.

The service demonstrated a commitment to monitoring and improving outcomes through Patient Centred Assurance audits, Accreditation of Care Excellence accreditation (ACE), clinical audit programmes and research activity. There was evidence that audit findings were used to implement changes to practice, with re-audit processes in place to assess the effectiveness of actions taken.

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 evidence showed a good standard. The service made sure patients’ care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff assessed and monitored patients’ health, care, wellbeing and communication needs to ensure care and treatment remained effective. We reviewed 15 patient records and found all had risk assessments completed on admission. The electronic patient record system generated automated alerts when reviews were due, supporting staff to complete reassessments in a timely way. Staff used standardised templates for care plans that included additional information to reflect patients' assessed needs. Staff demonstrated a clear understanding of assessment and review processes and told us risk assessments and care plans were completed on admission, reviewed at least every 7 days and updated sooner if a patient's condition changed.

Staff assessed patients for a range of health and care needs, including falls, pressure ulcer risk, mobility, nutrition, hydration, pain, mental capacity and discharge planning. These were routinely completed and reviewed. Care plans reflected identified risks and support needs. We observed staff assessing patients' pain when undertaking routine observations and saw evidence that patients' needs continued to be monitored throughout their admission. We also saw completed “This is Me” documents which contained information about patients’ preferences, routines, communication needs, life history and what was important to them. These documents were detailed, person-centred and demonstrated that staff had taken time to understand patients as individuals and tailor care to their needs.

Staff completed patient centred assurance audits across the service to gain additional assurance that patients' needs were assessed and reviewed. These reviewed patient assessments, documentation, care planning and care delivery through observation, record reviews and conversations with staff.

Audits demonstrated high levels of compliance with falls, tissue viability, nutrition and mobility assessments. They also showed regular reassessments and evidence of appropriate changes to planned care following the identification of risks.

Most patients we spoke with understood their diagnosis and treatment plan and told us staff kept them informed about investigations, treatment and next steps. Patients described staff working together in a coordinated way and said they received support with mobility, personal care and pain management. One patient told us the multidisciplinary team was reviewing their condition and future treatment options and that staff listened to and respected their views when discussing ongoing care. Information was available to support patients and their relatives, including leaflets relating to dementia, delirium and advocacy services. However, during the inspection we did not identify information readily available in alternative formats such as easy-read versions or translated materials, which may limit accessibility for some patients with additional communication needs. A small number of patients reported they did not fully understand their care plan or next steps in treatment and described receiving conflicting information from different medical staff. This indicated that communication regarding assessment findings and treatment planning was not always consistent.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered patients’ care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence based practice and standards.

The service planned and delivered patients’ care and treatment with them, and considered what was important and mattered to them. Care and treatment were delivered in line with legislation and current evidence-based standards .

The service used clinical audits, quality improvement activity and governance processes to assess compliance against recognised standards. These tools also helped staff identify areas for improvement and implement changes to practice.

Care pathways, treatment decisions and clinical documentation were regularly reviewed against national guidance, with findings reported through governance structures and supported by action plans and re-audit programmes. For example, clinicians within gastroenterology services undertook audits against British Society of Gastroenterology guidance to assess the quality of care provided. An audit reviewing the management of inflammatory bowel disease in pregnancy found full compliance with vaccination reviews and management of higher-risk medicines. However, it also identified opportunities to improve pre-conception counselling, mental health screening and folic acid prescribing. In response, the trust introduced clinic checklists, prescribing prompts, and amendments to electronic documentation templates. The service also proposed joint obstetric and gastroenterology clinics to ensure joined up care. A re-audit was planned to evaluate whether these actions improved compliance with the standards.

Managers told us they ensured updates on medicines management, pharmacy safety alerts and evidence-based practice were communicated to staff. This was done using email communications, closed staff messaging groups and information displayed within staff areas. Staff told us they kept their knowledge and skills up to date through training, education sessions and professional development activities.

Staff used evidence-based approaches and nationally recognised assessment tools when planning and delivering care and treatment. We observed staff using the National Early Warning Score 2 (NEWS2), Malnutrition Universal Screening Tool (MUST) and Pressure Ulcer Risk Primary Or Secondary Evaluation tool (Purpose T) tool, to assess patients and support clinical decision-making.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support patients. They made sure patients only needed to tell their story once by sharing their assessment of needs when patients moved between different services.

Staff worked collaboratively within multidisciplinary teams and across services to support people’s care and discharge. We saw daily multidisciplinary team (MDT) meetings, ward huddles and patient flow discussions. These involved nursing staff, medical teams, therapists, and discharge coordinators. Staff used these meetings to review patients’ progress, discuss treatment plans, identify discharge needs and coordinate actions across teams. Staff told us MDT working was a key element of care delivery, and we observed joint decision-making regarding treatment, discharge planning and best interests’ decisions. We also observed a daily staffing and patient flow meeting, involving ward managers and staffing coordinators. These meetings reviewed staffing gaps, patient flow and high-risk patients, and enabled ward teams to share resources and support each other where required. Staff described this as an important process for maintaining safe staffing and coordinated care across the division.

Across the medical service, staff described a range of systems which supported communication and information sharing. Staff used electronic systems to coordinate care, monitor discharge status, share patient information and support referrals to internal and external services. Staff described discharge checklists, referral processes and structured handovers that ensured patient’s information followed them through their care journey.

We observed examples of effective multidisciplinary working on wards. Records we reviewed showed MDT involvement in complex decision-making, including best interest meetings for people who lacked capacity.

Discharge teams worked with community services, adult social care, care transfer hubs and district nursing services to coordinate ongoing support and reduce unnecessary delays. There were dedicated discharge coordinators across wards. Staff told us they aimed to identify discharge needs early, including social care requirements, therapy assessments and equipment. They described working closely with occupational therapists, physiotherapists, community teams and local authorities to support safe transitions from hospital. Staff recognised the importance of minimising unnecessary ward moves, particularly for people living with dementia or experiencing delirium.

Patient feedback was generally positive about how teams worked together. Patients told us staff appeared organised, coordinated and informed about their care. Patients told us doctors and nurses communicated well and provided regular updates. One patient told us staff had “good communication with each other”, while another said staff appeared coordinated and friendly in the way they worked together.

We scored the service as 3. The evidence showed a good standard. 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, reduced their future needs for care and support.

We found evidence that patients were supported to maintain their health, wellbeing and independence through assessment, rehabilitation, nutritional support and falls prevention initiatives. Patients were also well supported during discharge planning process. We saw evidence that leaders had governance processes in place to prevent deterioration, reduce avoidable harm and support patients to achieve the best possible outcomes during and following admission. Staff provided mobility assessments, therapy reviews, seating assessments, repeat faller reviews and individualised care planning to prevent falls. Patients had access to appropriate walking aids and staff monitored risks associated with reduced mobility and falls.

Patients told us staff supported them with mobility and personal care needs while encouraging them to remain as independent as possible. Patients described receiving assistance with toileting, mobilisation, washing and transfers when required. Several patients told us staff responded to their needs promptly and helped them maintain their independence throughout their hospital stay. We observed an activities coordinator on one ward who told us there was a planned weekly schedule of activities for patients. Staff described how activities and social engagement opportunities were used to support patients’ wellbeing during their admission and reduce the potential negative impact of prolonged hospital stays.

We reviewed patient records and saw evidence of multidisciplinary team involvement in the management of patients' physical health, nutrition and wellbeing. Records included plans, reviews and advice from specialist professionals such as dietitians and speech and language therapists. This ensured patients with nutritional concerns, swallowing difficulties or complex needs received specialist assessment and support. Staff understood how to access additional support for patients and were able to describe referral pathways to specialist services including, tissue viability nurses and the drug and alcohol service. Staff demonstrated an understanding of when specialist advice was required and how this could support patients to maintain their health, improve wellbeing and prevent further deterioration.

The service demonstrated a clear focus on preventing deterioration in vulnerable patients. They did this by providing frailty services, falls prevention programmes, pressure ulcer prevention initiatives and ongoing quality assurance activity.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored patients’ care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

We found systems and processes were in place to routinely monitor the quality, safety and effectiveness of care and treatment. The service monitored a range of quality indicators including incidents, falls, hospital-acquired pressure ulcers and medicine incidents. Leaders also reviewed, patient experience measures, complaints, risks and compliance with policies. Performance data was reviewed regularly, and areas of concern were identified with corresponding action plans and monitoring arrangements.

Leaders held regular divisional governance meetings, care unit governance meetings, risk meetings, incident reviews and complaints meetings. They also used quality assurance processes to identify trends, monitor performance and support continuous improvement. Governance reports described actions being taken, the responsible leads and mechanisms for assurance.

The service used Patient Centred Assurance (PCA) audits and Accreditation of Care Excellence (ACE) assessments to monitor the quality and safety of care. PCA audits reviewed key areas of care, including falls prevention, tissue viability, infection prevention and control, pain management, safeguarding, nutrition, hydration and elimination, the management of deteriorating patients through NEWS2 monitoring and escalation, discharge planning, complex needs and the patient environment. Leaders reviewed audit findings to identify themes, risks and areas for improvement. Where performance fell below expected standards, ward leaders and matrons implemented targeted actions and monitored progress through ongoing assurance processes.

Patient experience information was routinely collected and reviewed through compliments, complaints and Friends and Family Test feedback. Governance reports showed patient feedback themes were analysed and used to develop improvement actions. Common themes, including communication, discharge planning and patient experience were identified and monitored. Complaints were reviewed at weekly meetings and there was oversight of complaint response times, themes and organisational learning.

We scored the service as 3. The evidence showed a good standard. The service told patients about their rights around consent and respected these when delivering person centred care and treatment.

Staff understood their responsibilities regarding consent and involving patients in decisions about their care and treatment. Patients told us doctors, nurses and multidisciplinary teams explained their care, treatment and next steps in a way they could understand, which enabled them to participate in decisions about their care. Many patients felt listened to and involved in discussions about their treatment and discharge planning. However, some patients reported receiving conflicting information from different clinicians or they were not always fully involved in discharge decisions. This could impact patients' ability to make fully informed decisions about their care and treatment.

We reviewed patient records and saw evidence of discussions regarding treatment options, care planning and discharge arrangements. Records showed that consent had been obtained before information relating to patients' care and treatment was shared with relatives and family members. During our inspection, we also observed staff routinely seeking verbal consent before carrying out examinations, providing treatment or delivering personal care.

The trust had a consent policy and compliance was monitored through the PCA process, quarterly audits of Mental Capacity Act (MCA) assessments and best-interest decision-making. Findings were reported through governance committees. Following a review of consent processes, the trust had developed a more robust consent audit tool to strengthen assurance.

Staff demonstrated a good understanding of consent, capacity assessments and the need to support patients to make their own decisions wherever possible. MCA audit data showed consistently high compliance with completion of four-stage capacity assessments, achieving 97% compliance between January and March 2026. The trust had also set up MCA education sessions and masterclasses to improve staff knowledge and compliance.

MCA audits had identified variable recording of patient and family views. The trust recognised that documentation of patient and family involvement in decision-making required further improvement and were planning improvements through education, audit and governance oversight.