Royal Derby Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant people did not always feel well-supported, cared for or treated with dignity and respect.

While some patients experienced caring, responsive and personalised support, this was not consistent, with wider feedback highlighting concerns around communication, delays, unmet needs and staff attitudes. Environmental constraints also meant privacy and dignity could not always be maintained.

At the same time, significant workforce challenges including low morale, staffing pressures, limited wellbeing support and cultural issues were affecting staff experience and reducing their ability to consistently deliver safe, high quality, person centred care.

We have not awarded this service a score for Caring.

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

The evidence showed some shortfalls. The service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect.

Patients we spoke with during the inspection provided positive feedback about staff. They described staff as kind, caring and responsive, and said they felt supported throughout their care. Patients told us staff were polite and respectful, that they were given time to ask questions, and that they were involved in discussions about their care.

However, this was not fully consistent with wider patient feedback data. In December 2025, the Medicine division recorded 155 PALS concerns and 50 formal complaints, indicating that issues affecting patient experience remained. The most frequently reported concerns related to communication with patients, care needs not being met, inadequate support, and staff attitude. This suggests that, while some patients had a positive experience, others did not always feel listened to, involved in decisions about their care, or adequately supported.

Although overall satisfaction across the division remained broadly stable, analysis of feedback themes indicates ongoing pressures. Communication remained the most frequently reported concern, and reports relating to inadequate support increased, highlighting challenges in consistently meeting patients’ emotional and informational needs. There were also increases in complaints relating to delays in treatment and diagnostic testing, suggesting potential difficulties in delivering timely care.

Staff understood the importance of maintaining patients’ privacy and dignity; however, this was not always achieved. The environment within the corridor care areas made this more challenging, particularly due to limited space and the close proximity of patients. Staff described difficulties in managing sensitive situations privately, including when patients were very unwell or at the end of life. For example, it was not always possible to move patients or use screening effectively, which increased the risk of other patients or relatives witnessing distressing events. Although staff made efforts to act sensitively, these environmental constraints meant that patients’ privacy and dignity could not always be fully maintained.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Independence, choice and control during this assessment. The score for this quality statement is based on the previous rating for Caring.

The evidence showed a good standard. The service listened to and understood patient’s needs, views and wishes. Staff responded to patient’s needs in the moment and acted to minimise any discomfort, concern, or distress.

fSDEC was situated directly next to the ambulance entrance, which resulted in high levels of footfall and constant movement of staff and patients through the area.

During the inspection, we observed staff interacting with patients respectfully.

Staff demonstrated knowledge about tailoring care to each individual patient. They delivered personalised support based on patients’ preferences ensuring both patients and their families were actiYesvely involved in decision‑making. Staff also had timely access to telephone interpreters when needed.

Patients told us they felt well supported in understanding their treatments, medications, and ongoing treatment plans. Many commented that staff took the time to explain clinical information clearly and in a way that felt easy to follow.

Staff were quick to identify when patients required urgent help and responded appropriately, using recognised tools and processes to guide their actions. Observations were carried out consistently, and any concerns were escalated without delay, ensuring patients received the right support at the right time.

Autistic patients and individuals with learning disabilities were provided with enhanced support, which could include the allocation of an additional healthcare assistant to assist them during their care.

The evidence showed significant shortfalls. The service did not care about or promote the wellbeing of their staff. They did not support or enable staff to deliver person-centred care.

Staff wellbeing was not consistently supported, and several issues within the service had a negative impact on morale. Many staff told us morale was low, particularly in relation to ongoing staffing pressures. They reported feeling stretched and unable to provide the level of care they aspired to when staffing levels fell below what was required.

Staff also told us that when they escalated concerns about wellbeing, they did not always feel listened to. This included repeated reports of bullying and toxic behaviours from some managers. Although these concerns had been raised previously, staff told us the issues continued and they had not seen meaningful action or improvement. This affected staff confidence in the organisation’s ability to address harmful behaviours and promote a psychologically safe workplace.

The wellbeing related findings from this survey aligned with what staff told us during the inspection. For example, in the National NHS Staff Survey 2024, 45.8% of staff reported that they had felt unwell due to work‑related stress in the past year, meaning nearly half experienced stress‑related ill health. Additionally, 44.2% of staff felt the organisation took positive action on health and wellbeing.

Survey results also reinforced concerns about workload and staffing levels. Only 20.7% of staff felt they had enough time to meet the demands of their job, and 26.9% believed there were enough staff for them to do their jobs properly. These findings reflect the feedback shared during the inspection, where staff described feeling overstretched and unable to deliver the standard of care they aimed to provide.

Nurse educators expressed feeling particularly demoralised. They reported being regularly pulled from their educational duties to work clinically on the ward floor to compensate for staffing shortages. This was described as an everyday occurrence, leaving them unable to fulfil their core role of supporting, developing, and educating the nursing workforce. As a result, opportunities for learning, development, and bedside supervision were reduced, further affecting staff capability and confidence.

Cultural concerns highlighted during the inspection were also reflected in the staff survey results. Only 59.3% of staff reported feeling safe to speak up about concerns, and fewer than 50% felt confident that the organisation would take action in response. In addition, only 52.9% of staff who experienced bullying or harassment had reported it, suggesting that some staff may not feel supported or protected when raising concerns.

Themes and trends from the Freedom to Speak Up process confirmed a clear and recurring pattern of concerns relating to staff wellbeing and staff behaviours. These trends aligned with what staff told us during the inspection and further demonstrated that the service had not fully addressed longstanding cultural and behavioural challenges impacting staff experience.

Leaders were aware of the low morale across the service and were reviewing staffing as part of an ongoing recruitment plan, supported by weekly meetings chaired by the Director of Nursing.