Royal Derby Hospital

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• 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

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Care was delivered in line with NICE guidance, with good multidisciplinary working and patient involvement. However, improvements are needed to ensure documentation, particularly medicines recording, is consistently clear and reliable.

Teamwork and outcomes were generally positive, though some gaps were identified in communication during transfers and consistency of care. Variability in audit results, including falls, tissue viability and deteriorating patients, suggests the need for more consistent practice to fully support safe, coordinated and effective care.

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.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

The evidence showed a good standard. The service planned and delivered patients’ clinical treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The service demonstrated that it used guidance issued by the National Institute for Health and Care Excellence (NICE). Updated sepsis guidance was published in November 2025, and the service was in the process of updating its local tools, clinical guidance and training programmes to reflect these changes. This showed that the service was proactive in responding to updated clinical standards and ensuring staff had access to current information. Patients told us they understood their care plans and felt informed about their treatment and what they were waiting for.

Where patients had identified nutritional needs, we saw that nutritional care plans were in place to guide staff in delivering appropriate support. Staff used both paper and electronic records, which were generally well organised and contained relevant clinical information. However, we had concerns relating to medicines documentation.

Patients had access to specialist support from a range of allied health professionals, including dietitians and therapy teams. A therapy presence was in place on the wards. Therapists were involved in assessments, contributed to treatment planning, and participated in daily reviews in support of patient mobility, function and discharge planning. We saw evidence of multidisciplinary team (MDT) working, with MDT involvement documented in patient records and staff working together to support coordinated patient care.

The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Patients and relatives provided consistently positive feedback about how well staff worked together, with one family member expressing satisfaction about the high standard of care their relative received. Feedback gathered through Healthwatch also highlighted coordination with external partners. One patient reported that “staff were really supportive, and the process to find out what was wrong with her was efficient. The GP ringing ahead meant the pathway was a super‑efficient system.” This demonstrated effective communication between the service and primary care, enabling staff to prepare for the patient’s arrival and deliver a smooth, well‑coordinated assessment.

Staff described positive and supportive working relationships within their individual units, and medical staff were reported as accessible. Patients were assessed promptly on admission and received regular clinical reviews, however, there was not always a thorough assessment of patient’s medicines.

However, communication and coordination during transfers between areas did not always show good practice. During the inspection, we observed a patient transferred from MAU to a ward that was not prepared to receive them, which led to a disagreement between staff in front of the patient. Staff told us this was a recurring issue, often linked to bed readiness. They also reported that some patients were transferred from MAU without a full or effective handover. Although these incidents were not representative of teamwork across the whole service, they presented potential risks, and staff acknowledged the need for more consistent cross‑department communication to ensure safer and smoother transitions.

Daily consultant‑led ward rounds involved the full multidisciplinary team, supporting shared decision‑making and coordinated care. Multidisciplinary meetings were well attended and thorough, with each patient discussed in detail. Regular contributions from social care and the local authority supported timely discharge planning, and staff were positive about how these meetings strengthened continuity of care.

When patients required support from other services, relevant teams were involved to maintain continuity of care. Staff could access virtual wards, physiotherapy, Speech and Language Therapy (SaLT), and a range of specialist teams, enabling well‑coordinated and timely support tailored to patients’ needs.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service monitored patient’s care and treatment to continuously improve it. However, outcomes were not always positive and consistent and did not meet both clinical expectations and the expectations of patients themselves.

The service had a programme of clinical audits across key areas of care which showed mixed results. Data showed falls audits demonstrated compliance in several indicators, including completion of falls assessments (94%) and escalation of confusion to medical staff (100%). Other areas showed variability, such as lying and standing blood pressure measurements (61–76%) and delirium screening (30–78%), indicating inconsistent practice across audit periods.

The service implemented a falls improvement plan with detailed actions relating to policy review, development of documentation within electronic systems, and strengthening post fall processes, with work ongoing through 2025–2026.

Tissue viability audits, completed monthly, showed high compliance in core preventive measures, including skin assessments and appropriate equipment use. Compliance was lower in areas such as timely initial assessments (74–81%) and consistent adherence to repositioning regimes (72–89%). The associated action plan outlines a range of improvement measures focused on standardising documentation, strengthening categorisation accuracy, improving early identification of skin damage, and reducing avoidable pressure related incidents. Several actions remain ongoing within defined timescales.

Audits relating to sepsis management and deteriorating patients showed variation across key clinical steps. Some interventions, such as oxygen administration and IV antibiotics, reached full compliance in several months, whereas other elements, including repeat observations, urinary output monitoring and fluid balance documentation, were less consistent across audit periods. These findings are reviewed through the Deteriorating Patient Improvement Group for oversight and organisational learning.

A discharge improvement report and action plan were provided, outlining trustwide work to standardise discharge processes and improve the timeliness and coordination of patient discharge.

The evidence showed a good standard. The service told patients about their rights around consent and respected these when delivering person-centred care and treatment.

Patients using the service told us that staff communicated with them in a way that supported their understanding of their care and treatment. They said they felt able to ask questions and that staff listened to their views. One individual also commented that staff consistently checked for permission before carrying out any treatment.

Patients described staff as approachable and supportive, noting that staff spent time building a positive rapport. This was said to help them feel more confident when discussing their care and making decisions. Several patient’s spoke positively about the time staff took to engage with them.

Individuals were aware of their rights in relation to consent, and they told us that staff explained care and treatment options clearly before seeking verbal consent for physical assessments.

Staff demonstrated an understanding of the legislative frameworks that guide consent and decision‑making, including the Mental Health Act and the Mental Capacity Act 2005. They knew where to access organisational policies and where to seek further advice on matters such as the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS). Records reviewed showed that consent was appropriately documented.