Chesterfield Royal Hospital

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

At our last assessment we rated this key question requires improvement. At this assessment the rating has improved to good. This meant patients were safe and protected from avoidable harm.

The service had improved since the previous assessment. Staff demonstrated a positive safety culture. Staff understood how to report incidents and raise concerns. They described feeling able to speak up and learn from incidents and complaints. Safeguarding concerns and mortality reviews were used to support service improvements. Governance systems supported oversight of safety, and leaders had implemented actions in response to identified risks, including falls prevention, pressure ulcer reduction and discharge processes.

There were systems in place to support safe care and manage deterioration and discharge. Staff used recognised escalation processes and worked collaboratively with internal and external partners to support safe transitions of care. The service managed safeguarding, infection prevention and medicines management through policies, audits and specialist oversight.

Leaders used a range of information, including risk registers, audits, operational meetings and assurance processes, to monitor safety, quality and performance. Risks identified by staff and leaders aligned with those recorded on risk registers. This indicated that leaders were aware of key safety concerns and had oversight of improvement actions.

However, there were environmental risks identified during the inspection, including cluttered corridors, blocked fire exits, inconsistent access control arrangements and unattended devices displaying patient information. Staffing pressures also remained in some areas due to vacancies, sickness absence. There was a reliance on temporary staff and training completion was below trust targets. Although leaders had systems in place to monitor and mitigate these risks, they were not always fully effective at ward level. Despite these concerns, leaders had oversight of the risks and had systems in place to monitor, escalate and mitigate their impact on patient safety.

We have not awarded this service a score for Safe.

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

We scored the service as 3. The service had a proactive and positive culture of safety, based on openness and honesty. Staff and leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Learning was shared with staff.

The service had established systems to support a positive learning culture. The staff followed the trust’s incident and safety event reporting and management policy. Staff understood how to report incidents and raise concerns. Staff described feeling able to speak up without fear and incident reporting was embedded in daily practice. Staff could describe the reporting process and confirmed raising concerns was expected within their role. Staff were also able to explain duty of candour requirements. Duty of Candour means being open, honest, and transparent when things go wrong.

The service used an electronic system to report incidents, and the reporter had an option to request feedback following incident investigations. Learning from incidents was shared with staff through staff emails, a shared computer drive, closed social media groups and, messaging applications. The trust also held a monthly shared learning forum, which was open to all staff. The forum was used to share learning from incidents and complaints across the organisation. There were also regular team huddles, and information was displayed on staff notice boards.

Managers used structured tools to investigate safety incidents. This approach helped identify lessons and improve safety. Evidence showed that incidents were investigated and the duty of candour was followed. Minutes from morbidity and mortality meetings showed discussion of reviews, key learning points, and examples of good practice.

The service reported that there had been no never events within medicine services during the previous 12 months. Never events are serious, preventable patient safety incidents that should not occur.

The service had two Freedom to Speak Up (FTSU) Guardians who were accessible to staff. Staff could contact them through online forms, in person, or by telephone. The guardians actively engaged with staff through regular outreach activities. They introduced themselves to new staff, including permanent and locum staff, during their induction process. They also visited universities to ensure students knew how to contact them.

We scored the service as 3. The evidence showed a good standard. The service worked with patients and healthcare partners to establish and maintain systems of care in which safety was managed or monitored.

The service worked effectively with patients and partner organisations to maintain safe systems of care. Communication, information sharing and risk management processes supported safe care and continuity across services. We observed an effective nursing handover where staff shared critical information about patients' risks and care needs. This supported continuity of care and helped keep patients safe.

Systems were in place to help ensure patients received safe and coordinated care when moving between teams, departments or services. Staff who worked as discharge coordinators were allocated to each ward. They completed a holistic assessment for each patient in preparation for discharge planning. Discharge coordinators sent these assessments to their discharge team who made a referral to the care transfer hub (a team or service that helps coordinate a patient's move from one place of care to another).

The care transfer hub staff reviewed the form to plan the discharge pathway for patients. Referrals to community services such as district nurses were done on the ward by either the discharge coordinator or the nurse in charge. This ensured patients were provided with appropriate continuity of care and support after discharge.

Where patients could not be discharged, despite being medically fit, staff managed this by providing a dedicated ward for patients awaiting discharge. These patients had access to an established a dedicated therapy team to help maintain patients’ mobility and other activities of daily living. Managers conducted weekly reviews of patients who had been on the wards for a long period and took rapid follow-up actions.

The service used a digital system to provide operational oversight of patient flow. Leaders worked with ward teams to support this flow and ensure sufficient bed availability for overnight admissions. This reduced the need for patients to be moved late at night.

We scored the service as 3. The evidence showed a good standard. Staff worked with patients and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving patients’ lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were able to describe how to identify patients at risk of abuse or harm. For example, staff explained how unexplained injuries, or signs of neglect would prompt further assessment and escalation. They were also able to describe the process for making a safeguarding referral.

Staff protected the rights of patients who lacked capacity to make decisions around their care. Staff completed Mental Capacity Act (MCA) assessments and Deprivation of Liberty Safeguards (DoLS) documentation. During our visit, we observed a patient with restrictions in place to prevent them from leaving the hospital. For example, staff provided one-to-one monitoring. We reviewed their documentation and found that MCA and DoLS assessments had been completed, with the rationale clearly recorded. This meant although the patient’s freedom was being restricted, this had been done lawfully and in line with the patient’s best interests. We did not observe any use of physical restraint. Staff supported the patient to move freely around the ward with appropriate supervision.

Training compliance for safeguarding, MCA and DoLS was below the trust target of 90%. For nursing staff, safeguarding adults and children level 3 training compliance was 77.1%, safeguarding adults level 3 was 74.2%, and MCA and DoLS training was 83%. For medical staff, safeguarding adults and children level 3 training compliance was 33.8%, safeguarding adults level 3 was 47.1%, and MCA and DoLS training was 58%. However, the service had put in place an action plan to improve compliance. This included protected training time, automated reminders, and manager escalation.

We scored the service as 3. The evidence showed a good standard. The service worked with patients to understand and manage risks by thinking holistically. Staff provided care to meet patients’ needs that was safe, supportive and enabled patients to do the things that mattered to them.

Staff told patients about the risks to their wellbeing and worked with patients to manage these. During our visit, we observed staff communicating with patients to discuss their plan of treatment and care. Patients told us staff kept them informed about investigations, treatment and discharge planning and involved them in discussions about next steps.

Staff actively identified and managed patient risk. We reviewed 15 patient records and saw evidence that risk assessments had been completed, including falls risk assessments, waterlow assessments, malnutrition universal screening tool (MUST). We saw that risk assessments were reviewed in a timely manner. Staff reported they reviewed risk assessments regularly; every 7 days or sooner if there had been any change in a patient’s risks. Staff also told us that the electronic patient record system generated alerts when risk assessments were due for review. We saw audits which demonstrated compliance in these areas.

Staff engaged with patients or their relatives’ following incidents and involved them in discussions about risks and actions taken to reduce the likelihood of recurrence.

The service used the National Early Warning Score (NEWS2), a standardised tool that uses physiological observations to identify and respond to clinical deterioration, to monitor patient observations. Staff confirmed that the electronic patient record automatically generated an alert to the nurse in charge and the medical team when patients recorded high NEWS2 scores. We saw evidence that patients with high scores were escalated to the medical team, which conducted an appropriate review and treatment in a timely manner. We reviewed audits which showed the service had 100% compliance in managing deteriorating patients.

We scored the service as 2. The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. They did not always ensure equipment, and facilities supported the delivery of safe care.

During our inspection, we observed environmental risks on some wards. Some of these related to the age and design of older ward environments that remain scheduled for refurbishment. We identified risks including clutter in ward corridors and bays. Several pieces of equipment and trolleys were stored in corridors creating a potential risk to safe movement and emergency access.

We found that staff did not always maintain fire safety arrangements. For example, two fire exits were blocked. One fire door was not kept clear, and one was partially obstructed by a resuscitation trolley. This arrangement may have impeded the door's ability to close fully in the event of a fire, compromising its fire safety function. These risks were escalated at the time of inspection and were addressed promptly by ward leads.

We identified a maintenance issue which had not been addressed. For example, we observed a dripping tap in one of the clean utility rooms. We escalated this to the nurse in charge, who was not aware of the issue at the time.

While environmental risks such as obstructed corridors and blocked fire exits were identified during inspection, the trust had recognised this risk at organisational level. The trust’s fire safety site-wide risk assessment identified the hazard of escape routes becoming sufficiently blocked to prevent a safe exit and had implemented a range of mitigating controls. Fire wardens conducted regular inspections of ward circulation areas, checked public and shared corridors and review of escape routes during local fire risk assessments. Measures were also in place to ensure wheeled equipment could be removed quickly during an evacuation.

Leaders had identified further actions to mitigate this risk longer term. One approach was to incorporate additional storage within ward refurbishment programmes to reduce the need for equipment to be stored in corridors.

The trust also had a fire safety management policy in place, alongside a fire response procedure which set out roles, responsibilities and actions required in the event of a fire.

In addition, we found that not all ward entrances had access control systems in place, which meant that access to some clinical areas was not always secured.

Although not all ward entrances had access control at the point of entry, arrangements were in place whereby wards had access control through intercom systems located on main ward entrance corridors. This provided a level of control over access, although it did not fully mitigate the risks identified at ward level.

Staff responded promptly when risks were escalated during the inspection and took immediate action to address concerns. However, this demonstrated that while the trust had identified risks and established systems and controls to manage them, these were not consistently implemented at ward level. This resulted in environmental and fire safety risks not always being identified or addressed promptly.

The trust had a security management policy in place which outlined how it ensured a safe and secure environment. These included identifying risks, defining roles, and outlining procedures to manage and respond to security incidents. We also saw evidence of ward-based security risk assessments which identified risks to staff, patients and visitors, outlined existing control measures, and specified further actions to reduce risks.

Emergency equipment was accessible and appropriately maintained. Resuscitation trolleys were in accessible areas and were regularly checked. Equipment we reviewed had been serviced and was within date. We also saw sufficient functioning oxygen ports and appropriate airway equipment to support safe emergency care.

The service had implemented a bed rail assurance process to support safe practice. Staff used ward-based assurance tools to review bed rail use and whether decisions regarding raised bed rails were reflected in care plans. This provided evidence of ongoing monitoring of bed rail use to reduce the risk of falls but ensure there was no inappropriate restriction.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision, and development.

Mandatory and statutory training compliance was below the trust target, which meant leaders could not be assured all staff had completed essential safety training. Medical staff training compliance was approximately 56% to 57%, significantly below the trust target of 90%, including in key safety areas such as resuscitation, safeguarding and moving and handling. Nursing staff training compliance was higher, with statutory training at approximately 84.6% and mandatory training at 77.8%. However, this remained below the trust’s compliance target and varied across training modules. Leaders told us operational pressures had affected training delivery, and some training had been reduced or deferred during the winter period to maintain safe staffing levels. The trust had identified areas where training compliance was low and was taking action to improve this, including providing protected time for training, sending reminders, monitoring completion rates more closely and providing additional support where needed.

The service identified that training delivery had been impacted by operational pressures, with some training reduced or deferred during the winter period to maintain safe staffing levels. Leaders had identified training areas where compliance was lowest and had plans in place to improve this. Actions included giving staff protected time to complete training, sending reminders, monitoring compliance more closely and providing additional support where needed.

Leaders had calculated staffing establishments for inpatient wards using recognised tools, including the Safer Nursing Care Tool (SNCT), to inform staffing requirements and acuity-based planning. However, although reported staffing metrics, including care hours per patient day, suggested planned staffing levels were broadly achieved, this was not consistently reflected in practice.

To cover nursing staffing gaps, leaders relied on bank staff. Bank staff usage remained consistently high, ranging between approximately 77 and 99 whole-time equivalent (WTE) staff per month. Agency use was lower but increased during periods of higher staffing pressure.

Total nursing staff unavailability, including vacancies, maternity leave and sickness absence, fluctuated between approximately 8% and 14% from December 2025 to May 2026. Unavailability increased in January and February 2026, reaching 14%. However, these improved in March 2026 and remained at approximately 9% to 10% in subsequent months. At ward level, the highest rates of staff unavailability were recorded in Pearson Ward (26%), Durrant Ward (18%), Basil Ward (18%) and Ashover Ward (17%). This indicated staffing establishments were not consistently achieved across all wards.

Medical staffing vacancy rates were lower overall, varying between approximately 5% and 8.5% across the same period, although these increased towards May 2026. There was variation across specialties, with some areas demonstrating higher vacancy levels. Ward teams included medical staff of different grades, including consultants, registrars and junior doctors. Staff in alternative roles, such as advanced clinical practitioners and physician associates, also supported clinical cover and escalation.

The service continued to rely on locum and bank doctors to support medical staffing gaps. Although this helped maintain medical cover and service delivery, it may have affected continuity of care and staff familiarity with ward environments.

Allied health professional staffing was generally stable across occupational therapy, physiotherapy and dietetic services. However, speech and language therapy had experienced higher vacancy levels following a period of increased staff turnover. Leaders had undertaken recruitment activity, reviewed workforce requirements and continued to monitor staffing levels. Sickness absence across allied health professional services remained broadly in line with trust targets.

High vacancy levels and reliance on temporary staffing created workforce pressures and had the potential to affect the skill mix and experience available on shifts. Although there were systems in place to monitor and escalate staffing concerns, including the use of red flag reporting and redeployment of staff between wards, these actions were largely responsive and did not address staffing gaps in the longer term.

Staff described workforce pressures and the impact of sickness absence on staffing levels. However, they consistently reported working together as a team to meet patients’ needs. We observed positive collaborative working between nursing staff, healthcare assistants, therapists and ward leaders during the inspection.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Systems and processes were in place to assess, monitor and manage the risk of infection prevention and control. The service had a comprehensive, up-to-date infection prevention and control (IPC) policy aligned to national standards. IPC performance was monitored through the organisation’s integrated performance framework and reported at board level, supported by organisation-specific dashboards to oversee infection rates and trends.

Staff demonstrated an understanding of IPC principles and consistently applied these in practice. Housekeeping and cleaning staff were able to describe their cleaning schedules and specific tasks such as daily water outlet flushing to reduce the risk of water-borne infection. We observed staff implementing appropriate isolation precautions and infection prevention measures when managing patients with suspected infectious illnesses. We also saw staff comply with key infection prevention measures, including the appropriate use of personal protective equipment and adherence to hand hygiene. Patients were clean and cared for in visibly well-maintained environments. This was supported by IPC audit data, which demonstrated good overall performance, with infection control scores ranging between 89% and 96% across wards.

Routine water sampling identified the presence of Legionella bacteria in some water systems. Leaders were aware of this and had processes in place to monitor, review and manage the risk, including ongoing water safety testing and oversight arrangements.

Inspection observations identified an area where assurance processes could be strengthened. Equipment was visibly clean; however, "I am clean" (green) stickers were not consistently present. Staff were informed of this during the inspection. This was a documentation issue rather than a cleanliness concern, as inspectors observed equipment to be visibly clean. Although the absence of stickers did not indicate that equipment had not been cleaned, it reduced consistency in the service's cleaning assurance processes. In one area, reduced housekeeping capacity had resulted in cleaning tasks being undertaken by clinical staff, which staff advised was a temporary arrangement.

Staff demonstrated appropriate risk management in their infection prevention practice. During inspection, we observed staff proactively closing a bay and implementing isolation precautions for patients with a suspected infection while awaiting the results of diagnostic samples. This showed that staff were responsive to potential infection risks and followed appropriate processes to prevent transmission.

Staff worked to reduce the risk of hospital acquired infections. During the inspection, we saw patients receive MRSA decolonisation treatment in line with the provider’s protocol. MRSA is a type of bacteria that is resistant to some antibiotics and can cause infections, particularly in healthcare settings.

The IPC lead told us this approach had been introduced in response to a previous increase in MRSA bacteraemia in 2019. Patients received a five-day decolonisation treatment on admission. This had contributed to a sustained reduction in MRSA bacteraemia, and there had been no reported cases in the six months prior to inspection.

However, there remained some ongoing healthcare-associated infection activity. There were 20 cases of Clostridioides difficile (C. diff) during the same six-month period, the majority of which were hospital-onset across multiple wards. In addition, catheter-associated risks were identified, including cases of urosepsis and catheter-associated urinary tract infections. These were recognised and monitored through established IPC processes.

Governance systems were in place to monitor IPC performance, including ward assurance audits, cleanliness audits and targeted IPC audit tools. These demonstrated compliance across areas, with some variation between wards. There were some gaps in the completion and documentation of specific IPC processes. Compliance with intravenous cannula documentation and recording of MRSA decolonisation and infection risk assessments varied across wards. Where compliance fell below expected standards, actions such as point-of-care education and re-audit were implemented, supporting ongoing improvement.

Training compliance in IPC varied across staff groups when compared with the Trust target. Nursing staff achieved compliance rates of 98% for IPC Level 1 and 85% for IPC Level 2. Medical staff compliance was lower, particularly for IPC Level 2, with rates of 83.43% for IPC Level 1 and 51.61% for IPC Level 2.

We scored the service as 3. The service made sure that medicines and treatments were safe and met patients’ needs, capacities and preferences. They involved people in planning, including when changes happened.

Medicines were stored securely in all areas we inspected. Some wards used digital medicine cupboards to store medicines, including controlled drugs (CDs), and prescribing stationery such as prescription pads (FP10). Staff checked resuscitation trolleys on wards daily and reviewed contents regularly to ensure items were in date and in working order. Oxygen cylinders on wards were secured appropriately and were in date.

Staff checked medicine fridge temperatures daily and clinic rooms were managed to ensure medicines were kept within the recommended temperatures set by manufacturers.

Staff mostly managed stock in line with national guidance and there was good support from the pharmacy team at ward level. However, we found medicines that had been stored beyond their expiry date in a fridge, and medicines that hadn’t been labelled with their date of opening, which could risk them being administered outside of their expiry date.

Staff maintained accurate CD records in line with legal requirements. There were systems to support safe CD storage and transfer when patients moved wards. CDs were destroyed when patients no longer required them.

Record keeping for the use of FP10 prescriptions did not always follow local policy. During our inspection we found records that did not account for all issued prescriptions. However, the local pharmacy team were able to investigate this on the day and provide assurance. FP10 prescription pad security has been identified as an action on the pharmacy risk register.

Staff used an electronic system to record people’s medication administration and care details. The electronic prescribing system supported staff to undertake timely medicines reconciliation and recording of allergies on admission. We saw evidence that a medicine reconciliation was completed within 48 hours of admission in line with national guidance.

Patient record we reviewed had received a venous thromboembolism (VTE) risk assessment on admission, which is important for assessing the risk of developing a clot during hospital admission. VTE risk assessments were embedded into the electronic prescribing system, and prescribers received weekly alerts to remind them to re-assess patient risk. However, some patients’ VTE risk were not re-assessed during inpatient stay according to local policy. This meant that risk assessments were not accurate for some people.

Antibiotics were prescribed in line with national guidance, and the indication for treatment was recorded. However, course lengths and review dates were not always documented, increasing the risk that antibiotic treatment may not be reviewed in a timely way.

The hospital had identified discharge as an area where a considerable number of medicine-related incidents occur. A dedicated governance team have been reviewing processes such as safe dispensing of medicines from the discharge lounge and issues relating to the electronic prescribing system.

The hospital had effective audit processes in place for the safe and secure handling of medicines. The audits identified issues picked up on this inspection and showed clear action plans for ongoing improvements to clinical areas. We were told by pharmacy staff how they work closely with ward leaders to make improvements following audits.