- NHS hospital
Royal Derby Hospital
Assessment report published 4 September 2026
Contents
Ratings - Urgent and emergency services
Our view of the service
Urgent and emergency care at the Royal Derby Hospital was managed and delivered through the medical division for adults and through the women and children’s division for children and young people. The adult emergency department (ED) consisted of an ambulatory care (walk in) unit that included a same day emergency care (SDEC) unit. There was also a minors area, a majors area, a resuscitation area, and an area called the ‘pit stop’ for patients arriving by ambulance to be triaged and treated. There were 3 escalation areas that were used when the department was at Operational Pressures Escalation Level (OPEL) 4. OPEL levels indicate how much pressure an emergency department is under. The escalation areas were ward 101, and an area called ‘the quad’. In addition to this, the fracture clinic was used overnight as an additional escalation area. Temporary escalation spaces are now referred to as ‘corridor care’.
The children’s emergency department (CED) consisted of a combined minors and majors area, a large observation bay, and a resuscitation area.
A team of 1 CQC operations manager, 2 CQC inspectors, 1 CQC national professional advisor, 1 CQC senior specialist, 2 CQC pharmacist specialists, 2 specialist advisors, an expert by experience, and the interim CQC chief executive officer visited the service on 3 and 4 February 2026. We spoke to 56 staff (including doctors, nurses, healthcare assistance, managers, pharmacists, administrative staff, and housekeeping staff), 33 patients, and 20 relatives. We looked at 38 sets of patients notes and attended 3 meetings.
At our last inspection we rated the service good. At this inspection we rated the service as requires improvement. We found 4 breaches of the regulations in the adult ED relation to safe care and treatment, staffing, privacy and dignity and governance. We have requested an action plan to show how the service will meet the breaches of regulation, this will be requested upon publication of the final report.
We inspected 25 quality statements across the key questions Safe, Effective, Caring, Responsive and Well-led and have combined the score for each of these areas to give an updated rating. We rated safe, caring, responsive, and well-led requires improvement and effective good.
Safe has been rated requires improvement. Safety was not a priority for everyone but when people raised concerns about safety the primary response was to learn and improve. Patients were safeguarded from abuse. There were not always enough skilled staff to deliver safe care that promoted patients’ wellbeing.
Effective has been rated good. Staff were not always able to achieve the best outcomes because patients’ needs were not consistently assessed. The department was understaffed, leaving managers and staff too busy to focus on improvement or on reviewing outcomes and best practices.
Caring has been rated requires improvement. Privacy and dignity was not consistently maintained. However, patients were treated with kindness, empathy and compassion. Every effort was made to take patients’ wishes into account and respect their choices, to achieve the best possible outcomes for them.
Responsive has been rated requires improvement. Patients and communities were at the centre of how care was planned and delivered, but high demand meant they could not always access care in ways that met their needs.
Well-led has been rated requires improvement. The service had a governance structure that did not consistently improve performance or ensure the delivery of safe care and treatment.
People's experience of this service
Feedback from patients and their family or carers was mostly positive. Despite their long waits for treatment they told us staff treated them with warmth and kindness. People said staff introduced themselves and were polite and friendly.
Patients also said they were informed about any delays in waiting times and mostly told what would happen next.
While most of the patients and relatives we spoke with expressed, they were happy with their care, our inspection found elements of the care did not meet the expected standards. This included some patients feeling ignored, others not being offered support to have a wash, and patients having long waits in the department, sometimes not on a bed or a trolley designed to be used for long periods of time.
One relative told us, “The ED was awful. At first, we were put in a small quieter area, that wasn’t so bad. But after a few hours we were moved to Majors A and that was like a war zone. Dad was lucky because he had a bed, but there were patients everywhere on trolleys. My brother and I had to look after Dad in shifts. The nurses were trying but they were just so busy. I felt we were being ignored. The nurses were just constantly on the computer filling in their notes – but where is the care? It was chaotic, loud, and dirty”.
A patient told us, “The ED was very busy. I had to wait a long time to be seen by a doctor. They kept moving me around, I’m not sure how many different places I was in. I was on a trolley for a long time. The nurses were trying their best though”.
However, care for children and young people and adults patients presenting in mental health crisis was good.