Derriford Hospital

On this page

• 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 people and communities had the best possible outcomes because their needs were assessed. We checked people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s the service provided effective care. However, outcomes were not always consistent. Monitoring of risks and checks on patients were still not always effective with delays in patients being triaged, screened or treated.

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.

The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Staff were not always able to complete comprehensive health assessments of patients in a timely manner due to the length of wait for assessment for both walk-in patients and those attending by ambulance.

We reviewed a random selection of 12 patient care records from different areas of the emergency department during the assessment. In-depth review of 9 patient records found records were mostly completed in detail including mental and physical health needs, safeguarding checks, falls risk assessments, diagnosis and management plans. Staff developed care plans to meet the needs identified during assessment.

Most patients received intentional rounding checks (a structured process for nurses to regularly check on patients to address fundamental needs such as pain, positioning, personal needs). However, clinical governance meeting minutes (September 2025) recorded only 41.7% of intentional rounding was completed every 2 hours. This was addressed by raising the issue with staff at handover meetings and emailing staff with reminders.

Patient records showed completion of patient observations and national early warning scores (NEWS2) (a nationally recognised tool to identify deteriorating patients) were escalated according to guidance. However, the risk of sepsis was not always identified and addressed. Leaders had taken action to support staff improve sepsis management.

Staff told us if patients presented with a high risk of a deep vein thrombosis (DVT) or pulmonary embolism (PE) they would be assessed as a priority. However, not all patients received a venous thromboembolism (VTE) risk assessment to identify risk of blood clots and determine appropriate preventative treatment. The assessment must be completed within 14 hours of admission and performed by a doctor or qualified nurse using a standard tool based on NICE guidelines.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Managers provided new staff with appropriate induction and all staff we spoke with had received a full induction when joining the department. Staff told us they completed mandatory training appropriate to their roles and received on-going training. However, we observed gaps in training compliance, including infection prevention and control, and safeguarding. This featured in department action plans as areas for improvement.

Staff said they had opportunities for professional development and appraisals of work performance (how managers check on the quality of staff’s work). Training boards were displayed in the department and recorded electronically. The trust set a target of 90% for staff annual appraisals and many staff told us they were up to date with their appraisals. However, data provided showed emergency department staff appraisal rates were low over the previous year, 63.39% (October 2024) and 58.70% (September 2025). Leaders told us it was challenging to complete appraisals within timeframes due to pressures on the service. The trust board paper (October 2025) recorded plans to improve appraisal compliance including a quality assurance workshop to allow peer review of appraisal practice. Across the trust, additional appraisal leads were being introduced to support doctors’ appraisals.

The team had access to specialists required to meet the needs of patients in the service. Staff told us they could access specialist input when required such as the end-of-life team, physiotherapists and the mental health liaison service.

Patients had access to hot and cold food which met dietary requirements of religious and ethnic groups and considered allergies. Patient service assistants (PSAs) worked with the patient coordinator to provide food and drinks to patients three times a day. Most patients we spoke with said staff were kept informed of their treatment plan and what they were waiting for next.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We saw multidisciplinary team working in all areas and observed an improvement regarding handover meetings. The multidisciplinary twelve-hour shift handover meetings were well attended and learning from incidents was discussed. Individual departmental handovers were also well attended when learning, staffing and patient risks and pathways were discussed and handed over to the next teams on duty.

Clinical staff including nurses, doctors and allied health professionals worked well together. Nursing staff told us they worked well as teams and had good relationships with surgeons and management. Nursing huddles (meetings) were held which we observed to be structured and well led by matrons to review staffing, patient handovers, medicines and themes. Staff had the opportunity to raise questions and concerns. Strategies to improve flow included changes to discharge planning as well as virtual wards, previous day discharge planning and increased weekend discharge.

Well-structured doctor huddles were held to review patients, staffing and medicines. We observed a doctors’ handover meeting from night to day shift when patients were reviewed including referrals, next steps, safeguarding and risks. Consultants told us there was very good multidisciplinary working within the department and good relationships with the rest of the trust. We attended a ward managers huddle where we observed they worked across teams to review patients and identified next steps required to encourage flow through the department. An electronic system to manage and share information internally, and externally with other providers and was fully integrated. This provided real-time information across teams and services to deliver effective care.

The hospital ambulance liaison officer (HALO) team had successfully taken ownership of the patient pathway and staff felt empowered to redirect patients or address learning from missed pathways. The team liaised with the medical assessment unit (MAU), the medical receiving unit (MRU), the surgical assessment unit (SAU) and the same day emergency care (SDEC) departments.

Leaders told us they had good relationships with staff and worked with them when required including night shifts. Staff have been concerned about leadership changes as the trust had been undergoing an organisational structure review this year. Staff told us examples of the team working collaboratively and we saw staff working cohesively to support a patient in resus.

Security and emergency staff said they had a very positive working relationship and security responded quickly when called.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

The trust worked with a system partner to help people maintain independence for as long as possible both at home and in the community. By supporting preventative health, the partnership aimed to help reduce health inequalities.

There was a flu and covid vaccination programme with details of eligibility, vaccination sites and opening times on the trust’s website. Clinics were available at Derriford hospital site and other clinics in Plymouth and the surrounding areas.

The trust operated a tobacco-free policy, meaning smoking and vaping were not permitted inside any buildings or in the hospital grounds. Support could be provided for patients who smoked and wished to quit or manage withdrawal symptoms during their stay and leaflets were available on the trust’s website.

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent or met both clinical expectations and the expectations of people themselves.

The trust had processes to monitor outcomes of people using the service and was working with partner organisations to look at improving the discharge process.

Staff told us they had timely access to test results and diagnostic imaging results. Electronic systems recorded patient information, results and monitoring of patients. However, staff told us there were a number of systems to navigate which were time consuming and could cause delays.

Staff told us ambulance staff were responsible for monitoring patient care on ambulances prior to handover and escalating any concerns.

There was an escalation process if a patient showed signs of deterioration. The NEWS2 audit data from 2024/2025 showed inconsistency in record keeping with patients’ deteriorating escalations triggered. The service took action by raising this during nursing handover meetings. The NEWS2 audit data improved to 100% in August and September 2025. Performance fell short for sepsis screening and monitoring which could produce poor outcomes for people. Actions were being taken by the service to improve this.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service maintained up to date policies and processes regarding the Mental Capacity Act (MCA) 2005 and restrictive practice, including rapid tranquilisation. Staff could access policies at any time on the trust’s intranet.

Consent to care and treatment was obtained in line with legislation and guidance, including the MCA and the Children’s Acts 1989 and 2004. People were supported to make decisions and, where appropriate, their mental capacity was assessed and recorded. When people aged 16 and over lacked the mental capacity to make a decision, “best interest” decisions were made in accordance with legislation. The use of restraint was understood and monitored, and less restrictive options are used where possible.

We did not find concerns in the completion of records or consent during our assessment. However, the service did not have a process to monitor the standards of record keeping or that consent was obtained correctly.

Staff knew the process for referral to emergency support, including a dedicated mental health liaison service from an external provider.

Staff developed care plans to meet needs identified during assessment. Care plans were personalised and holistic. We reviewed 9 sets of patient notes and found records were mostly completed in detail including mental and physical health needs, safeguarding checks, falls risk assessments, diagnosis and management plans.