Royal Derby Hospital

On this page

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

We looked for evidence that patients were always treated with kindness, empathy and compassion. We checked that patients' privacy and dignity were respected and people understood their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices to achieve the best possible outcomes for them.

Patients received care and support that was compassionate and kind, and staff demonstrated genuine empathy for the people they cared for. However, due to crowding in the ED staff could not consistently uphold the privacy and dignity of patients.

There was a culture of kindness and respect between colleagues.

The service was in breach of legal regulation in relation to privacy and dignity. Because of crowding in the adult ED staff could not maintain privacy and dignity for all patients.

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.

Most patients told us they were treated with kindness, empathy and compassion by everyone in the service. However, staff were consistently very busy due to the number of patients in the department, and some patients told us they felt overlooked. Because of overcrowding, and specifically the use of non-designated clinical spaces in the ED patients privacy and dignity was not consistently respected. Staff treated colleagues from other organisations with kindness and respect.

Patients mostly said staff treated them with respect and kindness. However, some patients disagreed. For example, one patient who had been in the ED for over 24 hours told us, “They walk by. They don't talk too much. They are task orientated. They smile when they go by but you feel like part of the furniture, invisible”.

Staff were not always able to provide privacy for patients when needed. Patients in non-designated clinical spaces, with 1 exception, did not have privacy curtains. Patients were supported to use nearby bathrooms and toilets but had observations and other medical tests performed and were given medicines on their trolley. Patients could request conversations with staff were held away from other patients, but most conversations continued to be held at the patient’s trolley/bedside. We heard staff telling patients why they were giving treatment. For example, we heard nurses telling patients why they were being given an intravenous glucose infusion. Staff used privacy curtains when patients in cubicles were having their personal needs met.

Staff were too busy to actively maintain the dignity of all patients all of the time. When we returned to the ED in the evening of our first day onsite, we saw a patient from the pit stop who was incontinent of urine walking around majors looking for a toilet. We had to locate a member of staff to support them. When we asked a senior member of the nursing team why the patient had not been supported to use the toilet they told us their care needs (including vascular dementia) had not been handed over to the night shift and they had not been aware they required additional support.

The members of staff we spoke with all spoke compassionately about the need to support people with mental health needs.

We observed staff engaging and interacting positively with a patient in the mental health assessment room during our inspection.

The patient satisfaction survey for the patients using ED from January 2025 to January 2026 had feedback from 5938 patients about their satisfaction with care in the adults ED. Seventy-nine percent of patients reported they were satisfied with their care. Older patients (over the age of 46) were more likely than younger patients to report they had been satisfied with their care. However, satisfaction declined in patients aged 85 or over.

The patient satisfaction survey for the patients who used the SDEC between January 2025 and January 2026 showed that patient’s long-term health condition, disability, ethnicity, gender, sexuality, religion or if they have served in the armed forces did not significantly impact on their level of satisfaction with treatment. The data, which was collected from 1598 participants, showed most (typically over 80%) patients were satisfied with their care, scoring it either very good or good, although again older patients (over the age of 46) were more likely to feedback they were satisfied with their care than younger patients. This, and the data above imply that there are differences in the experiences of patients’ dependant on the protected characteristic of age.

Minors had a series of treatment rooms that provided privacy and dignity for the patients being treated there.

Triage in the ED was performed in an area of the main waiting room screened off by a curtain. This made it difficult for staff to maintain patients’ privacy and dignity as their conversations could be overheard by patients and relatives sitting nearby.

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 service listened to and understood people’s needs, views and wishes. Staff could not consistently respond to people’s needs in the moment and act to minimise any discomfort, concern or distress.

Patients were asked for their preferred name so this could be used throughout their appointment. Staff wore visible name badges. We saw staff introducing themselves and identifying their role in the patient’s care. Staff asked patients if they needed help rather than presuming they did. For example, we saw staff asking patients if they required assistance getting on and off the commode.

All 8 of the patients we asked told us staff had not asked if they had communication or other additional needs. One patient who had not been asked about their communication needs told us, “It's difficult if people don't speak up or repeat what they're saying when you've got a hearing problem”.

Most of the patients and relatives we spoke with confirmed that they knew what their plan of care was and had been seen by a doctor.

Most, but not all patients had access to a call bell. In the quad 2 out of 4 patients did not have a call bell within reach. We saw call bells being answered quickly. All of the children and parents in the CED had call bells within reach.

Most patients said they had been asked about pain and that analgesia had been issued in a timely manner when required, but some of the patients we spoke to told us despite asking for pain relief this was not given. For example, a patient who had been in the pitstop for 6 hours said, “I keep asking for pain relief and they keep saying yeah, yeah but not giving me anything”. The hospital audited the time it took for patients with a long length of stay in the department to have an assessment of their pain, when analgesia was administered, and if their pain had been reassessed. The findings from October, November, and December 2025 showed little fluctuation. For example, in December all patients that were not taken straight to resuscitation had their pain assessed at initial assessment (triage), and most patients (80%) had their pain levels reassessed, but not all patients (65%) were administered pain relief. Apart from highlighting patients who were taken straight to resuscitation at the start of their treatment journey the audit did not show why pain had not been reassessed, or if patients had been offered but refused pain relief.

There were vending machines and water coolers in ambulatory care (the waiting room) for people to use. One person said, “The vending machines only take card payments. My dad is diabetic, he needs to eat regularly, and there is nothing here for him to eat”.

Patients in majors, the pit stop, and the non-designated clinical spaces who had been in the department for longer than expected told us staff offered them hot and cold drinks. Patients reported being offered sandwiches and biscuits but not hot meals despite long lengths of stay in the department. Senior managers told us hot food was available but it could be challenging for staff to get this for patients.

Senior managers said it was difficult to get 1 to 1 support for patients who needed it from outside the staff team. Typically staff would be moved from their designated task team to provide 1 to 1 care.

The ED had very few areas that offered privacy for private and sensitive conversations. Most areas had cubicles with curtains rather than walls so this made it difficult for staff and patients to have conversations that could not be overheard. Although there was a family room for breaking bad news to relatives. The CED was more modern, and cubicles had walls although curtains were used to separate cubicles in the resuscitation room.

There were examination rooms for intimate examinations in the ED in ambulatory care (main waiting room), SDEC and minors. Patients were offered chaperones to help maintain their dignity during intimate examinations or procedures and to provide emotional support and reassurance.

Staff explained that some patients who had presented in a mental health crisis had to stay in the department for several days while a bed was being found for them in a mental health setting. Staff demonstrated genuine empathy for this cohort of patients and explained they attempted to make their stay in the department easier by providing them with items that could reduce boredom and alleviate anxiety.

The Reducing Restrictive Practice team had completed a thematic analysis of incidents when restraint had been used and identified practice issues and hot spot areas. The ED had been identified as an area where patients were restrained, and a two-day training session had been developed in response. As a result of the training, there had been a reduction in restraints used in ED. An internal model had been devised around positive behaviour support and had been used to develop and shape the training delivered to staff most often involved in restraint (security team members).

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff were asked to provide annual feedback about working for the trust. The findings are discussed elsewhere in shared direction and culture, below.

Staff shared their concerns about low morale in the ED and the reasons for this with us. One member of staff told us, “People are demoralised because we cannot care for people the way we want to. We need more staff. Even when we're at template there’s not enough staff to do everything we need to do for our patients like pressure area care, or observations. Treatment always gets given but not always when it should be, like for sepsis, regular medications, and fluids”. We were told, “The skill mix isn't always good. Experienced staff are getting burnt out because there's not enough staff to support the newer members of the team. Often the staff that are sent here to help are from wards and they don't know what they need to do”. Nursing staff also said they had felt bullied at times by the flow team who brought additional patients into the department when they were already at capacity.

Senior leaders recognised that ED staff were increasingly being treated in an abusive manner by patients and staff, and that the work they were carrying out was becoming more stressful. They understood this was having a negative impact on staff morale.

Staff had been supported through the prosecution of perpetrators of violence, and the trust had introduced a red and yellow card system to deter people from acting in a violent and aggressive manner in the department. If patients or members of the public were violent, abusive, or aggressive towards staff they would be written to in the first instance explaining their behaviour was unacceptable and if their behaviour persisted further steps would be taken. This included issuing a yellow card as a final warning, and a red card to say the person could not receive treatment in the department for a set length of time.

Some senior managers told us because of the high volume of clinically well patients in the department waiting for a bed on the medical assessment unit, ED nursing staff were becoming deskilled. Rather than providing emergency nursing care, the staff were providing the type of nursing care delivered on wards.

There were areas for staff to take breaks and have warm food and drinks.

Staff in the CED described a “flattened hierarchy”. They said the opinions of all staff were valued equally and nurses felt well supported by the medical team. Staff also told us they felt supported in their development.

Resident doctors described feeling supported by their teams and said their consultants were kind and supportive, but they felt the constant pressure in the ED was leading to burnout. However, none of the resident doctors we spoke with could describe any wellbeing support offered by the trust.

Staff told us members of the executive team often visited the department and recognised “difficult days for staff and also their achievements.” However, staff said this amounted to a surface-level acknowledgement rather than structural support to solve the core issues of crowding and demand.

There was a trauma risk management (TRIM) practitioner in the CED. TRIM practitioners are trained peers who can support colleagues following traumatic incidents. Their training equips them with the skills to spot signs of distress in their colleagues, conduct structured assessments, and monitor psychological wellbeing of their team members. They signpost colleagues to expert help when they require ongoing specialist support.

The department did not have a wellbeing lead or wellbeing champions. However, in the CED a consultant had been identified for the role of health and well-being lead and was in the process of appointment. In addition, the paediatric urgent care pathway had two professional nurse advocates (PNAs). PNAs are accredited nurses whose role focused on supporting the wellbeing and resilience of nursing staff.