Royal Derby Hospital

We carried out an unannounced, on‑site assessment of medical care (including older patient’s services) at Royal Derby Hospital on 3 and 4 February 2026.

Medical care at Royal Derby Hospital is provided across several wards and departments. These areas deliver both planned and emergency care. They treat patients with acute and long-term medical conditions.

The service incorporates specialist areas such as respiratory, cardiology, gastroenterology and stroke, and admits patients with a wide variety of complex needs. The service also manages areas such as the Medical Assessment Units (MAU) and medical Same Day Emergency Care (mSDEC), all of which were included in this assessment. F[LH1] railty Services are provided through the Frailty Same Day Emergency Care Unit (fSDEC), along with an in-reach model for ED delivered by geriatricians and the multi-disciplinary Frail Elderly Assessment Team (FEAT).

Overall, the inspection identified concerns affecting safety and reliability. These included environmental risks, inconsistent medicines management, gaps in safeguarding training and mandatory training, workforce shortages, and variable discharge processes. Staff were committed, and teamwork within units was positive, but ongoing operational pressures such as overcrowding, delays in assessment, handover challenges, and reliance on temporary spaces limited the service’s ability to consistently deliver safe care.

Leadership was visible and supportive across many areas, and we saw evidence of improvement work and innovation. Nonetheless, cultural issues, low morale, reports of bullying, and limited confidence in Freedom to Speak Up processes highlighted the need for stronger oversight, clearer accountability and more consistent governance to achieve sustainable improvement.

We found 4 breaches of regulations relating to dignity and respect, safe care and treatment, premises and equipment and good governance. An action plan will be requested upon publication of the final report and followed up through engagement and future inspections.

Urgent and emergency care at the Royal Derby Hospital was managed and delivered through the medical division for adults and through the women and children’s division for children and young people. The adult emergency department (ED) consisted of an ambulatory care (walk in) unit that included a same day emergency care (SDEC) unit. There was also a minors area, a majors area, a resuscitation area, and an area called the ‘pit stop’ for patients arriving by ambulance to be triaged and treated. There were 3 escalation areas that were used when the department was at Operational Pressures Escalation Level (OPEL) 4. OPEL levels indicate how much pressure an emergency department is under. The escalation areas were ward 101, and an area called ‘the quad’. In addition to this, the fracture clinic was used overnight as an additional escalation area. Temporary escalation spaces are now referred to as ‘corridor care’.

The children’s emergency department (CED) consisted of a combined minors and majors area, a large observation bay, and a resuscitation area.

A team of 1 CQC operations manager, 2 CQC inspectors, 1 CQC national professional advisor, 1 CQC senior specialist, 2 CQC pharmacist specialists, 2 specialist advisors, an expert by experience, and the interim CQC chief executive officer visited the service on 3 and 4 February 2026. We spoke to 56 staff (including doctors, nurses, healthcare assistance, managers, pharmacists, administrative staff, and housekeeping staff), 33 patients, and 20 relatives. We looked at 38 sets of patients notes and attended 3 meetings.

At our last inspection we rated the service good. At this inspection we rated the service as requires improvement. We found 4 breaches of the regulations in the adult ED relation to safe care and treatment, staffing, privacy and dignity and governance. We have requested an action plan to show how the service will meet the breaches of regulation, this will be requested upon publication of the final report.

We inspected 25 quality statements across the key questions Safe, Effective, Caring, Responsive and Well-led and have combined the score for each of these areas to give an updated rating. We rated safe, caring, responsive, and well-led requires improvement and effective good.

Safe has been rated requires improvement. Safety was not a priority for everyone but when people raised concerns about safety the primary response was to learn and improve. Patients were safeguarded from abuse. There were not always enough skilled staff to deliver safe care that promoted patients’ wellbeing.

Effective has been rated good. Staff were not always able to achieve the best outcomes because patients’ needs were not consistently assessed. The department was understaffed, leaving managers and staff too busy to focus on improvement or on reviewing outcomes and best practices.

Caring has been rated requires improvement. Privacy and dignity was not consistently maintained. However, patients were treated with kindness, empathy and compassion. Every effort was made to take patients’ wishes into account and respect their choices, to achieve the best possible outcomes for them.

Responsive has been rated requires improvement. Patients and communities were at the centre of how care was planned and delivered, but high demand meant they could not always access care in ways that met their needs.

Well-led has been rated requires improvement. The service had a governance structure that did not consistently improve performance or ensure the delivery of safe care and treatment.

Date of inspection: 11 to 13 November 2025

We carried out a short notice announced comprehensive inspection of diagnostic imaging from the 11 to 13 November 2025 due the length of time it has been since the service was previously inspected. We inspected all the quality statements across the five key questions: safe, effective, caring, responsive and well-led. This was the first assessment of diagnostic imaging at this service under the standard assessment framework.

Diagnostic imaging refers to non-invasive, technology driven procedures used to create visual representations of the body’s internal structures. This aids medical staff in diagnosing, treating and monitoring diseases and injuries. During our inspection we visited: accident and emergency x-ray and computed tomography (CT), outpatient department X-ray and CT scanners, breast clinic, maternity outpatients, magnetic resonance imaging (MRI), fluoroscopy, nuclear medicine and clinical measurements across the hospital.

We spoke with members of staff including radiographers, radiologists, physicists, imaging assistants, sonographers, receptionists, and managers. We also received feedback from patients who were using the service.

We rated the service as good.

Safe:
We rated safe as good. This meant that patients were safe from avoidable harm. The service established and maintained safe systems of care, maintained safe and effective staffing levels and worked with patients to understand and manage risks. Staff assessed and managed the risk of infection and had a proactive and positive culture of safety.

Effective:

We rated effective as good. This meant that patients’ care, treatment and support achieved good outcomes, based on best available evidence, their care needs were assessed and reviewed.

Caring:

We rated caring as good. This meant patients were treated with compassion, kindness, dignity and respect. The service treated people as individuals, promoted patients’ independence and understood patients’ needs. The service cared about and promoted the wellbeing of their staff.

Responsive:

We rated responsive as good. This meant the service met patients’ needs by providing person-centred care and providing information. The service understood the health and care needs of people and their local communities and people could access the service in a timely manner and had equitable outcomes.

Well led:

We rated well led as good. This meant that leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

We inspected outpatient services at Royal Derby Hospital between 11 and 13 November 2025 as it had not been assessed since 2015. The previous inspection was completed using our old methodology when outpatients and diagnostic imaging were inspected as one combined service. In 2015 outpatients and diagnostic imaging was rated as good. We now inspect these services separately.

During this inspection we inspected outpatient clinics within the hospital and the Kings Treatment Centre which is based on site at Royal Derby Hospital. A wide variety of clinics including gynaecology, breast clinic, ear nose and throat (ENT), medicine, ophthalmology orthopedics, surgery, hand clinic and spinal clinic were visited. During this inspection we looked at all quality statements across the Safe, Effective, Caring, Responsive and Well Led key questions and the rating remains good.

The service demonstrated a strong learning culture where people felt able to raise concerns, and staff routinely reported incidents which were investigated thoroughly. People were protected from harm through effective risk management.

Facilities and equipment were clean, safe, and well maintained. Staff received appropriate training and regular appraisals.

People were actively involved in assessing their needs. Staff reviewed assessments holistically, considering communication needs, personal circumstances, and health conditions. Care was aligned with current evidence and good practice, and people were given clear information to support healthy living and to help them make informed decisions about their treatment.

Care was delivered with compassion and kindness. Staff treated people with dignity and respect and supported one another in a way that promoted a positive working environment. There was a strong culture of kindness among colleagues and a clear commitment to protecting staff health and wellbeing.

Date of assessment. 13 March 2025. This was a scheduled assessment as the service had not been assessed since March 2015.

University Hospitals of Derby and Burton provide critical care for people in Derby, Derbyshire, Staffordshire and surrounding areas at Royal Derby Hospital and Queen’s Hospital Burton. Critical care at Royal Derby Hospital was last inspected in March 2015 and was rated as good.

During this assessment we assessed 31 quality statements across the safe, effective, caring and well-led key questions. Following this assessment the rating for critical care remains as good.

Staff were positive about the culture of the service and worked well together as a multidisciplinary team to provide safe care in line with best practice. There were clear processes in place for shared learning with a focus on continuous learning and improvement.

The service was committed to ensuring the unit was staffed appropriately. Whilst the staffing levels met the national guidance, the service had not met national guidance for the numbers of nursing staff who had obtained a post registration qualification in critical care, however the trust had a clear plan in place to meet the minimum guidance by the end of 2025.

The environment was clean and tidy. Medications were stored and administered safely. However, they did not identify or dispose of out-of-date medications.

Staff did not always manage hazardous substances in line with Control of Substances Hazardous to Health Regulations 2002. and during our on-site assessment out of date medications were found.

Date of assessment: 16 and 17 December 2024. This was a scheduled assessment to review compliance with the urgent enforcement action we took in August 2023

University Hospitals of Derby and Burton NHS Foundation Trust provide maternity services for women in Derbyshire at Royal Derby and Queens Hospital. This service was last inspected in August 2023 and was required to take urgent action to as the Commission believed a person will or may be exposed to the risk of harm if we did not do so.

The service had made some progress since the last inspection to reduce the risk within the service. The risk or potential risk to women’s safety was still a concern. Due to this continued concern the Commission took urgent action as we believed that a person will or may be exposed to the risk of harm if we did not do so. The Commission placed 5 more conditions on the trust's registration.

The service did not have a coordinated approach for the care they provided. Visible leadership by the obstetric medical team was poor which meant appropriate actions and prompt responses to issues with the service were delayed at times. We were concerned that the system in place to identify, escalate and manage women and birthing women and their babies who require induction of labour was ineffective and not in line with national guidance. Handovers of care were also ineffective as the Situation, Background, Assessment, Recommendation (SBAR) tool was not fully completed or entered in to care records. The birthing centre did not have easily accessible resuscitation equipment if an emergency took place the trust could not be assured that the equipment could assessed quickly to keep mothers and babies safe.

However, the trust had met some of the conditions places on their registration at the inspection in August 2023. Senior midwives were in post, hourly ‘fresh eyes’ were completed hourly during intrapartum care, audits of PPH and MOH were completed monthly. Midwives had completed annual mandatory fetal monitoring training. These have been removed from the trust registration.

The culture within the service did not always promote the values of the trust or support staff to speak up. Whilst leaders had the required knowledge and experience, they did not promote a culture were staff felt empowered to speak up and or raise concerns.