Royal Derby Hospital

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• 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.

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

This meant people’s needs were met through good organisation and delivery.

Patients were generally positive, feeling informed, involved, and supported through clear communication, with good practice in future and end-of-life planning. However, these strengths were not fully consistent. Limited care planning documentation reduced assurance that care was always coordinated and personalised, and patient feedback processes, including complaint handling, were not always timely or effectively used to drive improvement. While reasonable adjustments supported access, some gaps in training and ongoing discharge pressures affected consistency in delivering timely care.

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.

The evidence showed some shortfalls. The service did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Patients often described receiving care that was responsive to their individual needs. However, this was not supported by consistent care planning documentation, and the absence of care plans limited assurance that care was structured, coordinated, and consistently reviewed. We observed staff involving patients and, where appropriate, their families in discussions about care. Information was generally shared clearly, and staff explained planned outcomes in a way patients could understand.

Staff made some adjustments to meet individual needs. For example, call bells were kept within reach to enable patients to request assistance, and bed heights were adjusted to support patient safety and comfort. These actions supported patient independence; however, these practices were not consistently reflected in care planning documentation.

The physical environment within the fSDEC was limited due to its size. The arrangement of large chairs in close proximity reduced privacy within the main clinical area. Although staff recognised this and described how they used quieter areas for sensitive conversations, the environment did not always support privacy or dignity without staff intervention.

We found that care plans on the medical wards visited during the inspection were largely absent from the patient records reviewed. This meant there was limited evidence of structured care planning or clear documentation of patients’ individual needs, preferences, and planned outcomes. The lack of care plans did not provide assurance that care was consistently planned, coordinated, or reviewed in line with best practice. It also limited the ability for staff to demonstrate how care was individualised and effectively communicated across the multidisciplinary team.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

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 told us they understood their care options and that information was explained in a clear and easy-to-follow way. They said they were given opportunities to ask questions, which helped them feel informed and involved in decision-making. Staff provided patients, their families, and carers with information that was accessible, easy to understand, and tailored to individual needs. Information was available in formats that supported patients’ rights, preferences, and choices, enabling them to understand their condition, treatment options, and follow-up care. This supported patients to make informed decisions about their treatment.

Staff communicated with patients in a way that supported their understanding of their care and treatment, including those with communication difficulties. For example, staff accessed telephone interpreters for patients whose first language was not English, ensuring they could fully understand the care and treatment being offered.

Each patient’s individual communication and information needs were identified and recorded at the point of admission. These needs were clearly highlighted in patient records and communicated across the multidisciplinary team to ensure continuity. Reasonable adjustments were made for disabled patients who required alternative communication methods in line with the Accessible Information Standard. Patients who had difficulty reading, writing, or using digital services were also supported by receiving information in alternative formats they could use.

Interpreters or translated materials were provided for patients who did not speak English as a first language.

There was a wide range of patient information leaflets available, including a welcoming leaflet about the ward and resources describing support services available after discharge. These materials helped patients understand what to expect throughout their admission and provided clear guidance on how to access help once they left.

The evidence showed some shortfalls. The service did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They did not always involve people in decisions about their care or tell them what had changed as a result.

While ward‑level feedback was collected, the service did not consistently show how this feedback was used to make improvements, and patient involvement in service planning was limited.

Following the recent inspection, leaders took action to address concerns relating to medicines safety, documentation and fundamental standards, supported by a short‑term improvement plan. However, these actions were taking place alongside ongoing issues with complaint handling in the Medicine division, particularly around delays in responding to patients.

Patients were generally positive about their care and spoke highly of staff. They felt listened to and said staff were responsive to their needs. However, this was not reflected in how quickly the service responded to concerns. Only 44.8% of complaints in Medicine were responded to within target timescales, meaning more than half were late.

There was also a significant backlog of complaints. In Medicine, 119 complaints were overdue and 32 had been open for more than six months, which is longer than the timescale expected under national guidance. This showed that delays were ongoing and not being resolved quickly enough.

Current activity showed that the service was not keeping up with demand. In December, 67 complaints were due, but only 46 were closed, leaving 121 overdue. This indicated that the backlog was continuing to increase.

Most patients and families we spoke with understood how to give feedback or raise concerns, and were aware of the different ways to do this. However, feedback from Healthwatch indicated that not all patients were clear on how to make a complaint, which meant communication could be improved.

The service had a complaints policy and staff knew how to escalate concerns appropriately. Information leaflets were available on wards explaining how to make a complaint. However, these systems were not working effectively in practice, as shown by the number of delayed responses.

The evidence showed some shortfalls. The service did not always make sure that patients could access the care, support, and treatment they needed when they needed it.

The service had some measures in place to support fair and inclusive access. A respiratory virtual ward enabled close monitoring for patients with respiratory conditions, offering an alternative to face‑to‑face appointments where needed.

Staff completed equality, diversity, and human rights training as required. However, not all staff finished extra training about specific conditions. Many staff completed basic dementia training, and some areas nearly met targets. Fewer staff completed advanced dementia training for more complex patient needs. Training about learning disabilities and autism showed big differences between groups. Some staff completed basic training, but many did not. Very few staff completed the advanced level of this training. Overall, advanced training levels were much lower than the Trust’s 90% target.

The physical environment promoted accessibility. Patients had access to induction loops for patients with hearing impairments and access to signing services for patients with British Sign Language as a first language. There was full wheelchair accessibility throughout the premises.

The service collected demographic information through patient experience surveys, enabling leaders to monitor feedback across characteristics such as disability, age, ethnicity, gender, sexual orientation, religion, long‑term conditions, and armed forces status. This helped the service identify any disparities in experience.

The data showed that information to the referral to treatment (RTT) recovery plan showed a 1.5% reduction in Did Not Attend (DNA) rates, allowing approximately 7,000 more patients to be seen compared with the previous year. This demonstrated improved appointment attendance across the service.

There were delays in the discharge process which meant some patients stayed longer than they needed to, and it could be difficult to find a bed for incoming patients. This was part of a wider issue than just the medicine assessment service group and involved the local system including adult social care and community NHS trusts. However, the local impact of this was extra pressure on the emergency department who had to keep patients there longer than they needed to and reduced capacity for elective care such as non-urgent surgery.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The evidence showed a good standard. 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 supported to make informed choices about their care and treatment, and staff referred them to specialist services when ongoing care or follow‑up was required. Records showed that discussions had taken place with patients and their families regarding DNACPR decisions. ReSPECT forms reviewed were appropriately completed, reflecting personalised recommendations for future emergency care.

The service had access to palliative care teams and was able to facilitate rapid discharge for patients who wished to return home to die.

Staff supported patients to make advance decisions when appropriate. In the medical records we reviewed, we saw examples of palliative care assessments and completed Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms for patients where this was clinically indicated