Royal Derby Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs. We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and they were actively involved in planning care that met these needs. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics. At our last inspection we rated this key question good. At this inspection the rating has remained good. This meant people’s needs were met through good organisation and delivery

We have not awarded this service a score for Responsive.

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

Staff made sure people were at the centre of their care and treatment choices. Staff decided, in partnership with patients, how to respond to any relevant changes in patients’ clinical needs.

Staff within all areas of outpatients understood the importance of ensuring that patients understood their choices and were provided with adequate information to empower them to make decisions around their care. To support this, information was available in different formats and languages and the service had introduced a video translation system to support patients requiring interpretation. This reduced the need for face‑to‑face interpreters and provided instant access to more than 100 languages.

The service made reasonable adjustments, when necessary, such as extending the length of appointments and providing quiet areas for patients whilst they waited for their appointment. In the breast clinic we saw an area which had recently been used as a separate waiting area for a neurodivergent patient.

Patients who had been attending outpatient clinics for a long time told us that staff were aware of their personal circumstances, including the challenges some experienced when travelling to the hospital using public transport. One patient explained that they needed to take three buses to attend appointments, but if they encountered difficulties, the administrative team were understanding and accommodating. We observed this during the inspection when a patient attended in person for what should have been a telephone consultation. Reception staff responded sensitively and arranged for the patient to be seen in clinic.

Staff in areas such as the breast clinic and gynaecology outpatient department told us they were involved in a patient’s journey from diagnosis onwards, which enabled them to tailor care and focus on providing a positive experience. Staff in the breast clinic were able to tell us of a recent example of caring for a male patient in a predominantly female environment. Staff worked with the patient to understand his preferences and made adaptations to ensure he felt comfortable and involved.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Teams within the outpatient departments worked closely with patients to ensure their diverse needs were recognised, respected and met during their interactions with the service.

Clinic staff worked closely with other teams and referrers to ensure patients experienced a smooth pathway and joined‑up care. Most departments liaised directly with local GPs, who were often the main referral route for patients. Staff updated records and shared information with relevant stakeholders to ensure patients’ current needs were accurately documented. Clinic teams also worked with external services and ancillary staff to support patients in continuing their recovery within the community.

Leaders also worked local patient transport providers to ensure a collaborative approach helped to ensuring that patient transport ran as smoothly as possible and supported a positive and safe experience for patients attending outpatient appointments.

Patients told us there was flexibility when arranging appointments, with options to manage bookings electronically using the online portal ‘Patient knows best’ or receive appointment letters by post, depending on their preference.

Across the outpatient areas we visited, we saw that patients were signposted to local community support groups. In the ophthalmology department, patients were able to access support from an eye care liaison officer from sight support Derbyshire who was based within the hospital and could offer both practical and emotional support.

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Patients were provided with appropriate and accurate information during their appointments, and we observed this in the consultations we reviewed. Most patients told us they were kept informed about the next steps in their care and felt able to ask questions. Staff gave clear guidance to patients who needed to manage their condition at home using new or unfamiliar equipment.

The trust had guidance in place to support compliance with the Accessible Information Standard (AIS). The AIS is a legal requirement that ensures people with disabilities, impairments or sensory loss receive information in a format they can understand.

Across outpatient areas, we saw hearing loops available for patients with hearing loss, and signage to help patients indicate if they required a British Sign Language interpreter. In some departments, such as ophthalmology outpatients, information was presented in an easy‑read format to support accessibility.

Patient information could be accessed in a range of languages and formats by scanning a QR code, and interpreter services, including British Sign Language, were available by telephone, video or face to face when required.

The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Patients were encouraged to provide feedback, both positive and negative, about their experience of the service. Information signposting patients to the Patient Advice and Liaison Service (PALS) was displayed in waiting areas, and details on how to make a formal complaint, including access to the trust’s complaints policy, were readily available.

Data reviewed during our inspection showed that between October 2024 and October 2025, outpatient services at Royal Derby Hospital received 318 complaints. Of these, 128 were upheld or partly upheld, and two were closed and subsequently investigated under the Patient Safety Incident Response Framework, this is the framework used when investigating incidents to ensure that incidents are looked at properly, learned from and learning used to improve. Complaints covered a range of themes, with the most common relating to delays or failures in diagnosis and delays or failures in treatment or procedures. The trust had a formal complaints policy that aligned with NHS complaints standards and relevant legislation. Complainants were offered the choice of attending a complaint meeting followed by a written response or receiving a written response only.

Clinic managers were encouraged to resolve concerns informally at the point of contact wherever possible, to prevent escalation to a formal complaint. Staff we spoke with felt confident doing this and told us they found it an effective way to address patient concerns promptly. Staff also told us they received support when involved in a complaint and were provided with feedback following any investigation.

Staff told us that they listened to patient experience to continuously improve the services that they offered.

The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Most outpatient clinics operated Monday to Friday between the hours of 08:00 and 18:00 however we were told of some clinics providing extra capacity by running clinics on a Saturday to allow flexibility for patients. Telephone appointments were also offered in some areas, when appropriate, to reduce patients’ requirement to travel.

The orthopaedic outpatient service had introduced virtual fracture clinics for patients diagnosed with a fracture in the emergency department. These clinics were run by orthopaedic nurses, advanced clinical practitioners and orthopaedic consultants. Staff explained that this improved continuity of care while reducing the need for patients to attend the hospital in person, as clinicians were able to review X‑rays and emergency department documentation prior to conducting telephone consultations. By minimising unnecessary face‑to‑face appointments, the service increased the availability of clinic slots for patients who required in‑person assessment, helping to ensure more equitable access to timely care.

The service continuously monitored outpatient waiting lists using recognised tools to identify opportunities to reduce delays and improve access to treatment. Although waiting times for first appointments had already improved, staff understood their responsibility to continue reducing waits and were aware of the potential for patient harm associated with long delays. Leaders demonstrated a clear commitment to mitigating this risk by prioritising actions that supported improved performance.

We were told of ongoing work to improve the appointments system and artificial intelligent technology was being used to allow patients to manage their appointment. It was recognised that not all patients would be comfortable or able to use this service and traditional methods such as letter and telephone did remain in place to ensure all patients could seek the same support.

Clinics were busy and often fully booked. In most areas, clinics were running behind schedule; however, we saw that staff worked hard to minimise these delays. Patients were routinely informed if their clinician was running late. In all areas we saw that these delays were displayed for patients, in the urology outpatient department a traffic‑light system was used to visually indicate the expected waiting time, helping patients understand how long they might be waiting.

The trust recognised the difficulty that patients may experience with the cost of parking due to the frequency and length of time they may be in clinic because of the long waits. We saw posters offering free parking to frequent attenders who met the criteria and capped parking charges at 2 hours for patients who were impacted by long waits.

Throughout some clinic areas we saw adapted equipment such as bariatric equipment to ensure that all patients could be treated comfortably.

Patient initiated follow up (PIFU) was used to reduce the number of appointments offered for follow up patients who were managing their condition, being monitored in the community and were low risk with no requirement for surgery or further diagnostic investigations. This allowed more flexibility in the system for appointments to be offered to new patients a PIFU patients were asked to contact their specialist team should there be a change in their condition.

Leaders recognised the importance of reducing the number of missed appointments (DNA – Did not attend) and data that we reviewed showed that from October 2024 to November 2025 that DNA rates varied between 5.5% and 8.5%. There had been a steady decrease in DNA rates since August 2025 which correlated with when the trust had begun an improvement programme with a specific focus on reducing missed appointments.

All patients including those using wheelchairs, could access the outpatient areas at the hospital. Some outpatient clinics were not on the ground floor and lifts were available to help patients access these. Volunteers were available to transport patients around the ground floor on patient buggies.

Signage in the hospital was mostly clear and easy for patients to follow, however the breast clinic which was accessed from outside the main hospital building was difficult to find. This was raised with leaders in the department who agreed that this was an issue and that patients did find the department difficult to access, however they were unaware of any plans to improve this.

Where appropriate, patients were offered a choice between face‑to‑face and telephone appointments. While text message reminders could only be sent in English, appointment letters were provided in a patient’s first language whenever possible.

Most services offered clinics across multiple locations within the University Hospitals of Derby and Burton trust and at local community health centres. Staff told us this helped reduce waiting times in some cases, as patients could be offered an earlier appointment at an alternative site. However, some patients preferred not to travel and chose to wait for an appointment at their nearest location. Staff told us that patient choice was respected and that patients were supported to attend the site that best suited their needs.

The trust had signed the Armed Forces Covenant and had received accreditation from a national veteran’s charity. It had also collaborated with AccessAble to produce detailed accessibility guides for all hospital sites within the trust.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff had completed training in equality, diversity and human rights, with over 95% of outpatient staff having undertaken this training at the time of our inspection. The service had an inclusion and belonging policy in place, which was accessible to all staff.

Staff demonstrated awareness of the diverse needs of patients and understood how to access additional support when required. Staff told us that patients were encouraged to share their views, and this was reflected in the positive feedback we received.

The service collected data on the patient groups accessing outpatient services through NHS Friends and Family Test feedback. Appointment letters were automatically generated in the patient’s recorded preferred language; however, text message reminders were only available in English.

A quality and equality impact assessment policy was in place, aligned with NHS England guidance. This ensured that equality impact assessments were completed appropriately for policies and procedures, helping to prevent any disadvantage to vulnerable people or those with protected characteristics.

Patients referred for non‑urgent consultant‑led care were managed in line with the NHS Constitution, which states that treatment should begin within 18 weeks of referral. Patients referred with suspected cancer were monitored against the 28‑day Faster Diagnosis Standard, the 31‑day decision‑to‑treat standard and the 62‑day referral‑to‑treatment standard.

Performance against the national 18‑week Referral to Treatment (RTT) standard remained below the national average; however, the trust performed better than average for the proportion of patients waiting over 52 weeks. Performance against the national cancer waiting time standards also remained below expected levels. The trust was not meeting the 28‑day Faster Diagnosis Standard, the 31‑day decision‑to‑treat standard or the 62‑day referral‑to‑treatment standard. Leaders described a range of actions implemented to support improvement and reduce waiting times, including pathway redesign, increased outpatient capacity and targeted validation of waiting lists.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Patients were given time to discuss ongoing treatment plans and provided with adequate information to allow them to consider options and make informed choices. Where patients would be undergoing an invasive procedure the risks of this were discussed to allow the patient to be fully informed before consenting.

Staff understood that patient’s approaching the end of life and their families may require additional support and were able to signpost appropriately. Staff demonstrated an understanding of DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) and ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) forms.