Royal Derby Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last inspection we rated this key question good. At this inspection the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

We have not awarded this service a score for Well-led.

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

The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

There was a clear shared vision, strategy and culture which appeared to be embedded within each outpatient area.

Staff told us they worked well with teams at Queens Hospital and the community hospitals within the trust, explaining that they had worked hard to build strong links and often collaborated to ensure services ran smoothly. Clinic leaders said they would welcome more opportunities to meet collectively as outpatient leaders to share good practice and further strengthen relationships between the different speciality teams.

Staff within the clinics were engaged and passionate about the service they provided, with a clear focus on delivering person‑centred and safe care. They worked in line with the organisation’s 3 values of compassion, openness and excellence. Across the outpatient areas we observed positive working relationships, and staff confirmed that the culture within their departments was generally good. This was supported by the low turnover of staff. Staff told us that morale was good and that, despite daily challenges, they worked well together as a team.

Leaders demonstrated concern for the wellbeing of their staff and were focused on promoting a culture of high quality and safe patient centred care.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Within outpatient areas there were clear management structures and staff felt supported by leaders who worked within the outpatient speciality areas. Staff at all levels told us they had leaders who were visible, approachable and supportive and most leaders told us that they had an open-door policy to allow staff to seek support and raise concerns when needed. However, staff reported that senior trust leaders were not always visible within outpatient areas.

Leaders in the outpatient areas were knowledgeable about their teams, patients and the operational demands of the service. They were visible within the departments, and we observed leaders providing hands‑on support and working clinically when required to ensure clinics were not cancelled. They were committed to improving patient experience and used patient feedback to identify ways in which to do this. One example was the introduction of refreshments in waiting areas for patients where long waits were frequently experienced.

Staff felt respected, supported and valued. They were encouraged to develop their skills and were given opportunities within their speciality.

Leaders within the outpatient departments told us that they did not always feel supported by senior leaders and other areas of the trust when addressing staff performance concerns. We were told of situations where attempts to manage capability issues were perceived as bullying. A lack of consistent support affected confidence in managing these difficult situations.

People did not always feel they could speak up and that their voice would be heard.

The trust had policies and procedures in place to support staff to speak up formally and staff were able to raise concerns either in person or anonymously. There was a freedom to speak up guardian; and champions throughout the trust who were accessible to staff. Staff told us that they were aware of the freedom to speak up process, and we saw information and contacts displayed for staff who wished to raise concerns. Data reviewed as part of this inspection showed that in the 12 months prior to the investigation two concerns from staff working in outpatients had been raised through the freedom to speak up process with one concern relating to staff safety/wellbeing leadership and management and the second relating to staff safety/wellbeing HR process. Leaders within outpatients told us that they did not always find it easy to address individual concerns raised through the freedom to speak process due to the anonymous nature.

Staff told us that they felt confident that they could approach their direct leaders to raise concerns . However, data from the annual staff survey indicated that only 61% of staff across the trust felt safe to speak up and only 46% felt confident that these concerns would be addressed.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them.

There were equality and diversity champions within the divisions that the outpatient areas sat within, and equality networks within the trust such as EMBRACE (Ethnic Minorites Broadening Racial Awareness and Cultural Exchange) Colleague Network, ThisAbility and Long-Term Conditions Colleague Network, Pride Colleague Network, Gender Equality Colleague Network, Age Positive Colleague Network, Armed Forces Colleague Network and the Carers Colleague Network who helped promote an inclusive working environment. There were policies in place to ensure that the services were inclusive to staff and patients accessing the service. These policies contained action plans to ensure inclusive recruitment, progression and a diverse representative workforce.

Staff were able to request flexible working arrangements to accommodate personal circumstances such as caring responsibilities or health needs, and where possible managers accommodated reasonable adjustments to support staff in carrying out their roles effectively.

The service had clear responsibilities, roles, systems of accountability and good governance. Managers used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Most outpatient areas operated independently within the speciality division which they were placed (Medicine, Surgery and Women’s and Children’s services). Staff and leaders within the outpatient areas told us that this meant that learning was not consistently shared across divisions. Staff told us that while teams discussed feedback and incidents within their own departments and this was shared within divisional governance meetings, there were limited opportunities to ensure that learning, improvements or good practice were routinely shared across all outpatient services.

Leaders from outpatient areas contributed to their divisional governance structures and participated in monthly governance meetings. These meetings followed structured agendas, ensuring that attendees understood what information and data needed to be presented. As part of this inspection, we reviewed governance meeting minutes across all divisions, which showed that key areas such as performance, risk, quality and safety, and workforce and culture were routinely discussed. Areas of concern were identified, and actions were taken to support learning and improvement within the division.

Governance data was used effectively across outpatient services to drive improvement. Learning from incidents and complaints was shared with staff in a range of ways tailored to each area. We saw examples of information displayed on noticeboards, and staff told us that learning was also shared by email and through departmental huddles.

Regular clinical audits, including infection prevention and control audits, were undertaken to monitor standards and identify where improvements were required. These were discussed at governance meetings, and the minutes we reviewed showed that action plans had been developed in response to audit findings.

There was an up‑to‑date risk register, and leaders within outpatient areas were able to clearly describe the risks relevant to their services. The risk register outlined key risks and the control measures in place to mitigate them. Documentation within the register, along with the governance minutes we reviewed, demonstrated that risks were regularly reviewed and mitigation actions considered.

As outpatient services operated across multiple sites, staff were aware of the arrangements required to work effectively with other teams to ensure patients received safe, coordinated care. Staff told us they felt confident raising concerns with their direct leaders when challenges arose. Due to the nature of outpatient services, multidisciplinary working was common, and staff understood the processes required to communicate with internal and external teams.

Staff were confident in reporting incidents using the trust’s electronic reporting system. Patient records were primarily electronic; however, temporary paper files were created for clinic appointments before being securely scanned into the system. Staff told us these paper records were stored securely when not in use, but during our inspection we observed patient records left unattended in one outpatient area.

Staff received information governance training as part of the trust’s mandatory training programme and had access to the equipment needed to carry out their roles. However, during our inspection we observed a member of staff leaving their computer unlocked with their NHS Smartcard inserted, which could have allowed unauthorised access to sensitive information.

Clinical staff used paper patient records during clinics, which were subsequently scanned into the electronic patient record and then disposed of securely. The trust had a standard operating procedure to support good practice and compliance with information governance requirements. During our visit, we observed that patient records were mostly stored securely while in use.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Staff worked collaboratively with teams across the trust’s multiple sites, supported by visible leadership at each location to help ensure services were delivered smoothly.

The service also engaged effectively with external stakeholders. Leaders told us about ongoing monthly meetings with a patient transport provider, which allowed ambulance‑related queries and issues to be raised and resolved so that patient care and experience were not compromised.

The service had worked in partnership with NHS England and commenced the use of a pre-operative screening tool which aims to speed up the pre-operative process.

In the ophthalmology department, we observed the presence of an external charity enabling the team to offer both clinical and holistic support to patients. Staff in all outpatient areas were also able to signpost patients to other relevant services, such as Macmillan to provide further support.

Leaders engaged with Healthwatch, and feedback from them was considered as part of the outpatient transformation project.

When patients raised concerns or submitted formal complaints, they were offered the opportunity to meet with departmental leaders to discuss their issues and work towards an appropriate resolution.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Although staff in outpatient areas were aligned to specific specialty teams, leaders told us that staff were encouraged to develop their skills across the wider outpatient department. Training opportunities and rotational posts were available for those wishing to broaden their experience. We were told that healthcare support workers had been supported to access nursing associate training to progress their careers, and nursing staff were able to undertake specialist training relevant to their clinical areas to support ongoing professional development.

Continuous improvement was a clear priority within each outpatient area, and leaders shared examples of changes introduced to enhance service delivery. One example of this included the implementation of an AI‑based dictation system designed to reduce the delays in producing written correspondence following clinic appointments.

The trust had also launched a major transformation programme for outpatient services, focusing on improving capacity, clinic utilisation and the effective use of digital technology. Key elements of the programme included standardising administrative processes and improving appointment‑booking systems. Phase 1 began in August 2025 and was expected to end in January 2027. Data reviewed by the trust in December 2025 showed increased outpatient attendances, alongside reductions in cancellations and missed appointments. Clinic capacity had also improved following changes to the booking system.

However, when we spoke with staff, they were not aware of any active improvement initiatives or transformation plans which demonstrated a gap in communication between senior leaders and staff. Whilst staff were not aware of this transformation programme, they were able to tell us of departmental improvements in the areas which they worked. Staff were able to tell us how they worked together to deliver high quality care to patients.