Royal Derby Hospital

On this page

• 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

We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood. We also looked for evidence that people could access care in ways that met their personal circumstances and protected equality characteristics.

People were involved in decisions about their care. The service mostly provided information people could understand. People knew how to give feedback and were confident the service took it seriously and acted on it.

Due to high levels of demand patients sometimes spent longer in the department than they needed to. However, people were involved in decisions about their care. The service mostly provided information people could understand. People knew how to give feedback and were confident the service took it seriously and acted on it.

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 service made sure patients were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in their needs.

To recognise the individual needs and preferences of young people, children aged 16 and 17 could choose to receive their care in the CED or ED.

Staff in the CED described offering a holistic service to patients. They could offer extended intervention which reduced the need for children to be admitted to the ward. For example, they could do a lumbar puncture in the department.

The CED was bright and airy and modern. It had wall art to engage the imagination of children and young people. There was a sensory cubicle with padded walls and equipment designed to engage or relax children. The room had special lighting and sound equipment. Two parents whose children had used the room told us how helpful they found it.

There was a play specialist in the CED. Parents told us the play worker had been very good at engaging their children, and the play worker brought bubbles, toys and drinks to help entertain their children.

The play specialist had created a passport that could be completed to support children using the CED it was called the children’s emergency boarding pass. The play specialist reported that this was particularly useful for children with anxiety or autistic children. Children were supported to fill out the passports to indicate what their preferences were. There were tools to support children to manage their emotions. For example, there was a tool called ‘how can I calm down’ there were different options for the children to select such as a tv screen, or a cuddly toy. Staff had access to single use ear defenders, bubbles, and fidget toys which could help soothe children.

There was ‘would you rather’ sheets in the CED which provided specific choices to children. Offering specific options can be beneficial to children with a learning disability or autistic people as it enables the child to make a meaningful decision, whilst increasing compliance to required or important tasks.

Staff said they normally observed children and young people in mental health crisis 1 to 1 but sometimes, if the patient was assessed as low risk they asked parents to do this.

Within both waiting areas in the CED there were televisions playing child appropriate programs. The Department was decorated in a child friendly way. The play specialist had access to a range of toys and books designed to entertain younger children. There were also portable DVD players and a choice of DVDs for older children and young people. There were activity sheets for children of all ages. For example, word searches and colouring.

All patients (apart from those in the ED waiting room) had been offered food for example, toast and cereal for breakfast or a sandwich for other meals and biscuits if people wanted a snack. There were water stations for patients in all areas of the CED and ED. Patients and relatives told us they been offered hot and cold drinks.

Patients in the quad were nursed by a combination of emergency nurses and medical care nurses. This was because these patients were clinically well and typically waiting to go home and therefore needed a different type of nursing than is normally associated with being in an ED. However, none of the patients we spoke with had had a wash or been offered support to have a wash. Staff said they could bring a bowl of water and toiletries to the patient’s bedside if requested.

Patients in the ED told us they were not always able to get pillows. Staff confirmed there was a lack of pillows in the department. Instead, staff issued patients with additional blankets so patients could fold these up and use them as pillows.

In the ambulatory area (ED waiting room) there were paper pain scores which patients could fill in and hand in at reception.

There was a long length of stay checklist for patients who remained in the department for longer than expected to ensure their personal and emotional needs were being met. However, leaders told us this was rarely used as it was no longer unusual for patients to spend more than 24 hours in the ED.

Nurses in the CED had received training to help them manage the sudden and unexpected death of a child. The training prepared them to care for families with empathy and compassion, and to equip them to clearly communicate with parents and carers about the processes and procedures that would need to take place so the cause of death could be investigated.

The rooms for mental health patients did not have any windows and were decorated in a clinical style. The room was only ever used to accommodate one patient at a time. Carers were allowed to be in the room with the patient. Other areas and bays of the department were used for “overspill” when there was more than one patient presenting with a mental health concern in the department. Side rooms and bays could be used to accommodate patients but assessments were not completed in bays with curtains for privacy reasons. Patients could also wait in an area in the department with reclining chairs (majors B).

When it was not being used as an escalation area ward 101 was used to observe patients who needed little physical clinical intervention. For example, it could be used for patients presenting in mental health crisis. The lights on the ward could be switched on and off making it more suitable for people that needed to relax and for people who were likely to have a long length of stay in the ED.

Staff in the ED created an activity box for patients with mental health, it contained activities that could help them relax.

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 service supplied appropriate, accurate and up-to-date information. However, some information was only available in English.

The trust had an Accessible Information Standard policy to ensure patients with sensory loss, learning disabilities, or impairments received accessible care and communication support. Patient information leaflets were available on request in alternative formats such as Braille, Easy Read, large print, or different languages. Face-to-face, telephone, and video British Sign Language and foreign language interpreters were available. The website contained step-by-step facility access guides to help map out hearing loops, accessible parking, and walking distances.

We saw signs in all patient areas in the ED and CED stating, “if you want a BSL (British Sign Language) interpreter you can point to this picture”. The signs also had an image depicting signing. Staff could access a telephone or face to face interpreter for people whose first language was not English, including people who used BSL. Staff told us there was also an electronic tablet that could be used for instant translation of written information.

The providers website had a recite function so people with a sight impairment, or people who could not read English could listen to the information on the website. Text size could be altered, and the screen could be magnified to make browsing the website easier for people with sight impairments. The website could also be viewed as text only. The website could be accessed in multiple languages. The trust was still working towards making its website fully accessible in accordance with the Public Sector Bodies Accessibility Regulations (2018). However, most of the information, videos and documents aligned with the regulations.

There were a range of communication aids available in the CED. For example, staff had access to emotion cards with pictures so children could indicate how they were feeling without having to verbally express this. There were child friendly pain charts and pictures of the examination rooms and equipment to help relieve anxiety about what might happen next. There was a ‘now and next’ signage system which was used by staff to explain to patients what was happening now and what would happen next. There was a keyboard sheet which children who were non-verbal or were unable to speak for other reasons could use either by pointing or blinking.

There were television screens in the waiting areas that provided information about the wait times for triage and estimated wait times to see doctors.

There was a range of information displayed on walls in the CED, including options for giving feedback and a poster which display information about different parts of the body with quick response (QR) codes that patients and parents could interact with. Health promotion information was also displayed on walls. There were posters showing leaflets about managing common illness and injuries in the ED. The leaflets could be accessed through a QR code. Leaflets and other information available through quick response (QR) could be accessed in any language.

Most, but not all patients, their parents and other relatives were happy with the level of information they were given. One parent in the CED said, “there is nothing worse than not knowing what is happening, and communication is lacking here, there is no sense of urgency. My perception is there are a lot of staff in a huddle in the centre of the room but they're not giving us any information about what’s happening”. A patient in majors in the ED told us, “It would be nice to be kept more up to date with what is happening. They leave you hanging here".

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

The staff we spoke with knew what to do if patients wanted to make a complaint, including providing them with a leaflet for the patient advise and liaison service (PALS).

The trust’s website provided clear information about how to make an online, written, or verbal complaint and how quickly people could expect a response. Staff told us complaints were regularly reviewed by senior leaders to ensure they were being appropriately investigated and responded to.

Feedback was gathered through patient surveys and concerns were responded to. We saw ‘you said, we did’ posters in the patient area. The posters gave details of suggestions that people had made to improve the service and what had been done by the department to implement the suggestions.

The service worked to ensure people could access the care, support and treatment they needed when they needed it. However, due to the continued pressure on the department caused by a lack of available beds, from delayed discharges of patients mostly to social care, patients were waiting far too long in the department.

Managers tried to plan and organise services, so they met the needs of the local population but, due to pressures in the wider health and social care system, the ED, along with the wider hospital, was gridlocked. This meant facilities and premises were not always appropriate for the services being delivered and there was not enough staff to meet the needs of patients. The service was consistently in escalation due to the capacity of the department. This was because patients could not always be transferred out of the department in a timely way. Subsequently patients, including in the CED, were being looked after in parts of the department that were not always designated clinical spaces.

The trust worked with their system partners to establish alternatives to hospital care so patients received the right care, at the right time, in the right place, for example, virtual wards. They had an established frailty service, and same day emergency care (SDEC) units, and other initiatives to help keep people out of the ED and therefore reduce demand on the service. However, demand on the department continued to exceed the resources available.

To ensure patients with the highest clinical acuity received the right care at the right time a risk stratification process was used in the ED to enable patients at the lowest risk to be stepped down into the ambulatory care area (main waiting room) while the sicker patients received treatment in minors, majors, or in the resuscitation room.

Under the NHS England Plan there are 2 targets that trusts must work to achieve. Firstly, 78% of patients should not wait for more than 4 hours in the emergency department from arrival to admission, transfer or discharge. Secondly, 10% of patients should not wait for more than 12 hours in the emergency department from arrival to admission, transfer or discharge. Data from 2025 showed neither of these targets were consistently met for the adult ED. Flow was significantly better in the CED, where staff told us they saw 86-88% of patients within 4 hours.

There was a considerable increase in the percentage of patients waiting over 12 hours from the decision to admit to admission in October 2025, with 1,234 patients waiting for 12 hours or more in the department. The long length of stay checklist was not consistently being used by staff to reduce the risks associated with a long length of stay in the ED.

Patients presenting with mental health symptoms was higher than that of other similar services since May 2025.

Once patients entered the adult ED, they often experienced long waits for assessment, care and treatment. Evidence from the hospital for 2025/2026 showed the longest wait to be seen for initial assessment was 33 hours and 26 minutes. The longest time spent in the department by a patient for a single episode of treatment was more than 6 days. While we were onsite there were patients that had been in the department for over 35 hours.

The long waits to be seen had resulted in some patients leaving before they were assessed by a doctor. Although this was less (better) than the England average. Some patients reattended the ED within 7 days of their first visit. Sometimes this was relating to the same condition, other times it was due to a new condition. The number of patients that did this was mostly lower (better) than the England average.

The NHS England plan sets a 45‑minute maximum ambulance handover time. Between September and December 2025, long handovers fluctuated more than the England average. The England average for handovers over 60 minutes was around 14%. The hospital performed worse, reaching 26% in October. The hospital also reached 27% in December. These delays occurred despite the extended pit stop area opening in mid-December 2025.

The psychiatric liaison team collected data that indicated they responded to almost all (90%) emergency referrals within one hour. Staff directed patients to other resources in the community where appropriate, such as the mental health crisis team or the local substance misuse services. Staff could follow a clear process to escalate when a person requiring an inpatient mental health admission remained in the department. This included escalating to senior managers when a person had been in the department more than 12 hours.

Despite the long stays, staff worked to try and make sure patients did not have to stay in the ED longer than they needed to. Managers and senior hospital leaders met regularly throughout the day to look at how flow could be created within the hospital to ensure adults and children who needed to be admitted to a ward could be. Senior departmental leaders escalated waiting times in bed management and capacity calls with their system partners. When there were issues with beds for mental health patients this was escalated through bronze and silver command through the local Integrated Care Board.

To reduce (improve) the amount of time all patients spent in the department there was a designated ‘progress chaser’. The progress chaser made sure patient’s paperwork was completed and blood test results, and other diagnostic test results, came back in a timely way so they could be reviewed by a doctor.

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.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.