Chesterfield Royal Hospital NHS Foundation Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. We rated this key question Good. This meant the service was consistently managed and well-led. Leaders and the culture of the service promoted high-quality, person-centred care.

Staff understood and promoted the services vision and values and knew how they applied to their roles within the service. Staff felt respected, supported and valued. Governance processes were effective. Performance and risks were managed effectively. Staff throughout the service had access to the information they needed to provide safe and effective care. Leaders pro-actively collected and analysed data about outcomes and performance. They used this to continually drive improvement for the service, which enhanced the experience for staff working within the service, and the children, young people, parents and carers they supported.

This service scored 82 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Description: We have a shared vision, strategy and culture that is based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding and meeting the needs of people and our communities.

We scored the service as 3. The evidence showed a good standard of care.

Staff understood the vision and values of the organisation and described how they applied them in their day-to-day work. The organisations’ purpose, vision, and mission to deliver safe, compassionate care within a culture of openness, honesty, and inclusivity were clearly communicated and visible across the service. Managers explained that values, culture and practice had evolved and been shaped with input from children, young people, parents, carers, and staff, and were embedded into recruitment, training, supervision, and decision-making.

Senior leaders modelled behaviours, and enthusiasm which promoted an open culture with a clear emphasis on equality, diversity, inclusion and human rights. Leaders held regular “Ask the service leads” engagement meetings with staff and regularly attended all the sites across the service to engage with staff which fostered a culture of inclusivity.

Staff had opportunities to contribute to discussions about the strategy for their service. Managers shared updates through regular meetings, and internal and external information sharing, ensuring all staff were kept informed. Both clinical and non-clinical staff benefited from tailored training packages to ensure they understood the environment, and children and young people’s needs, such as additional diagnosis specific training and promotion of monthly topical training packages.

Children, young people, parents and carers were also able to feed into discussions around visions, values and service development through feedback and consultation events. There were also well-established participation and support groups for children and young people (Be an influencer, have your say) and a parent and carer support group. These groups were regularly consulted on any changes and encouraged to develop their own ideas for service improvements.

Leaders ensured all staff received regular and clear communication promoting the shared goals and direction of the organisation. Staff felt included and valued, which fostered and promoted a positive culture within the service.

Description: We have inclusive leaders at all levels who understand the context in which we deliver care, treatment and support and embody the culture and values of their workforce and organisation. They have the skills, knowledge, experience and credibility to lead effectively and do so with integrity, openness and honesty.

We scored the service as 3. The evidence showed a good standard of care.

Leaders at all levels demonstrated the skills, knowledge, and experience needed to perform their roles effectively. They understood the services they managed and could clearly explain how their teams delivered safe and effective care. Leaders were visible, available and approachable to staff, children, young people and carers. Leaders maintained an open and transparent culture, where any issues could be raised without concern. Leaders promoted an inclusive culture underpinned by openness, equity, diversity, and respect.

Leaders fostered a culture of development, and progression within their teams, with staff having progression and development opportunities which were visited regularly through supervision, and appraisals. For example, NHS elect training and the NHS leadership academy. Staff received support to develop their skills, and non-clinical staff were offered additional training to build understanding of the environment and service. Leaders valued their staff teams and proactively challenged and addressed any cultural issues that could impact care or have a negative impact on the wellbeing of staff.

Description: We create a positive culture where people feel that they can speak up and that their voice will be heard.

We scored the service as 3. The evidence showed a good standard of care.

Managers provided a clear framework which supported staff to raise concerns. A whistleblowing policy was available, and posters displayed throughout the environments we visited outlined how to access the service. An organisational freedom to speak up Guardian and team were available, and provided confidential advice and support, this ensured staff could raise concerns outside of their local service if they felt they needed to. There had been 2 freedom to speak up concerns raised in the 3 months prior to our visit, we found evidence that both concerns had been acknowledged, with 1 concern investigated thoroughly, and concluded with positive outcomes achieved for all involved, and 1 remained open with investigations ongoing and the appropriate support provided for all involved.

Managers also promoted a “Report and Support” initiative. Staff felt confident raising issues without fear of reproach. Managers promoted openness and transparency and acted with integrity when concerns arose. Leaders investigated and shared learning to drive improvement.

Leaders ensured escalation routes were available beyond the local service. Staff had opportunities to meet with senior leaders on a regular basis, further strengthening the culture of openness. When things went wrong, leaders demonstrated honesty and transparency. Staff received timely explanations and apologies when needed, along with information about actions taken to prevent re-occurrence.

Description: We value diversity in our workforce. We work towards an inclusive and fair culture by improving equality and equity for people who work for us.

We scored the service as 3. The evidence showed a good standard of care.

Leaders fostered a culture of inclusion and promoted a zero-tolerance stance against bullying and harassment. They also endeavoured to ensure that all staff, including those who may be less heard, had input into shaping services. Equality, diversity, inclusion and human rights were clearly embedded in the organisation’s values, policies and strategic priorities.

Managers supported flexible working arrangements for staff to accommodate caring responsibilities, health needs, cultural needs and other personal circumstances. They put reasonable adjustments in place to help staff carry out their roles effectively. The service monitored workforce equality through formal mechanisms, including the Workforce Race Equality Standard (WRES) and the Workforce Disability Equality Standard (WDES).

The service participated in a successful sponsorship programme for overseas staff. The organisations human resources, wellbeing and freedom to speak up teams provided comprehensive support with all aspects of employment and relocation, support was ongoing and included support to find suitable accommodation. Leaders ensured that all overseas staff completed role-relevant training and competencies prior to commencing work.

Managers promoted a work buddy system for all new staff. The buddy system provided an experienced member of staff who offered support to a staff member new to the service. The buddy system provided orientation, shadowing opportunities and emotional and psychological support, and fostered a culture where staff genuinely cared about one another. Service managers worked with the trust’s occupational health team and facilitated flexible working patterns for staff who needed them.

Description: We have clear responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support. We act on the best information about risk, performance and outcomes, and we share this securely with others when appropriate.

We scored the service as 3. The evidence showed a good standard of care.

Clear governance and management processes were in place, and worked well, which supported safe, high-quality and sustainable care. Leaders implemented a clear framework for service and team meetings to ensure all information was effectively shared and discussed. Staff reviewed and analysed data, such as incidents, complaints, and safeguarding alerts, and implemented recommendations at service level. Staff participated in local clinical audits and acted on any findings.

The service was part of the family care division, and collaborative working within the services wider teams and externally was promoted to meet the needs of children and young people. For example, participation in the children and young people’s delivery board. Attendees included children’s services commissioning bodies, the county council, local GP’s and NHS England. Any external recommendations were discussed and implemented where appropriate. Leaders attended regular service manager meetings, clinical governance meetings, daily operations meetings and business meetings.

Staff maintained emergency plans for adverse weather, flu outbreaks, and other contingencies. Senior leaders and managers accessed timely, and accurate information on service performance, staffing, and patient care, enabling them to identify areas for improvement. Leaders implemented recognised quality frameworks and supported innovation through effective and proportionate risk management practices. This ensured that governance structures remained resilient, flexible and sustainable.

Description: We understand our duty to collaborate and work in partnership, so our services work seamlessly for people. We share information and learning with partners and collaborate for improvement.

We scored the service as 4. The evidence showed an outstanding standard of care.

Staff and leaders promoted networking, and engaged with children, young people, parents, carers, communities, and partners to share learning that resulted in continuous improvements to the service. Networks were used to identify new or innovative ideas, and practice that could lead to better outcomes for children and young people.

Leaders, and their staff were open, transparent and effectively engaged with external stakeholders and partners in care. They collaborated with commissioners, Education providers, GP’s, the local authority and other relevant organisations to support and maintain service delivery and integrated care.

Leaders shared learning across local and national networks and used partnerships to support and drive improvement within the service. For example, collaborative working and information sharing with the children and young people’s board, and the East Midlands Provider Collaborative. The East Midlands Provider Collaborative worked with providers of mental health services across the East Midlands and completed clinical benchmarking and audits. For example, inpatient admission type, service demand and length of stay. CAMHS day services were also commissioned by the east Midlands Provider Collaborative. CAMHS day services participated in benchmarking with CAMHS services across the East midlands. Benchmarking fed into clinical audits and research, assisted and informed service planning, inspection and regulation, local and national performance management and benchmarking and was collated for national reporting and analysis.

Integrated care and support pathways enabled effective information sharing with other services. For example, GP’s, education providers and the local police force, which ensured strategic planning that supported children, and young people’s treatment and safety was delivered consistently. This ensured a shared care approach was maintained and supported children and young people’s wellbeing and health needs which enabled them to improve their treatment and recovery outcomes.

Staff from the intensive home treatment team engaged children and young people in community activities. For example, visits to farm parks, walks and visits to coffee shops within their local communities. Community assessments were also completed with children and young people to ascertain their current level of resilience when engaging in social situations within their local communities. Children and young people were encouraged and supported to challenge themselves in increasing their levels of community engagement, and this was done at a pace that they had agreed to and were comfortable with.

Description: We focus on continuous learning, innovation and improvement across our organisation and the local system. We encourage creative ways of delivering equality of experience, outcome and quality of life for people. We actively contribute to safe, effective practice and research.

We scored the service as 4. The evidence showed an outstanding standard of care.

Leaders had a strong focus on continuous learning, improvement, and innovation across the service. Staff developed and implemented innovative projects, which led to quality improvements in children and young people’s care and outcomes, for example, the waiting well project. Waiting well was implemented in response to long waiting times for routine assessments and interventions, which left children, young people, parents and carers with little or no clinical contact while waiting. This created risks of deterioration, increased crisis presentations, and reduced opportunities to support recovery early. There was also a need to align practice with national guidance on measuring waiting times and to ensure that children and young people were directed to the “right service at the right time”, particularly where CAMHS was not the most appropriate provision. Overall, the project aimed to maintain safety, promote recovery, and reduce the negative impact of waiting for support. The project delivered sustainable improvements, such as, improved safety and risk management, better support for families during waiting periods, reduced escalation to crisis services, more appropriate use of CAMHS resources, improved partnership working and greater transparency and consistency. Overall, the project had transformed waiting times into an active period of support, improving outcomes for children and young people, reducing risk, which made the service more efficient and responsive.

Leaders implemented a band 5 development and talent management programme quality improvement project in response to increasing pressures following the COVID-19 pandemic. After a significant rise in referrals alongside persistent difficulties recruiting and retaining skilled CAMHS clinicians, particularly at Band 6 level. This led to heavy reliance on costly locum staff, inconsistent care for children and young people (with frequent changes in case holders), long waiting lists, high caseloads, and staff leaving due to skills gaps, low confidence, and workload pressures. Leaders identified the need for a sustainable workforce solution that would build skills, improve retention, reduce costs, and ensure consistent, high-quality, evidence-based care. The band 5 development programme delivered clear service and workforce improvements. A structured induction and 12 to18 month development pathway which increased staff confidence, competence, and job satisfaction and led to improved staff retention. Multiple cohorts progressed successfully to Band 6 roles. Reliance on locum staff significantly reduced, which generated cost savings and greater continuity of care. Unallocated caseloads reduced, and despite growing referral numbers, the service maintained stable waiting times and caseloads. Children and young people experienced fewer changes in clinicians and more timely, consistent, and higher-quality care, while staff benefited from strong supervision, targeted training, better wellbeing, and a supportive learning culture that supported long-term workforce sustainability.

Staff and leaders also completed a quality improvement project and launched a CAMHS day service, which was implemented in response to increased numbers of children and young people experiencing high risk and complex mental health [SD16.1] crises. Where existing Core CAMHS and Intensive Home Treatment Team (IHTT) support was not sufficient, but inpatient admission was either avoidable or not clinically optimal. The day service was designed to fill the gap between community support and hospital admission and provided an alternative to inpatient care, and reduced pressure on paediatric wards, emergency departments, and specialist inpatient units, while keeping young people closer to home and their support networks. The project delivered sustainable improvements, such as, reduced inpatient admissions and length of stay, more intensive and timely support during crisis, improved continuity and quality of care which enhanced outcomes for young people, reduced pressure on emergency services, including fewer repeated emergency department attendances for mental health crises, greater flexibility and access to services and a stronger system flow, which supported smoother step up and step down pathways between the intensive home treatment team, inpatient services, and longer term therapy.

Innovations extended to risk reduction, and trauma-informed strategies were integrated which further enhanced the safety, care and treatment of children and young people. Staff engaged in research and embedded evidence-based practice into care delivery. Strong external links supported innovation. Leaders maintained open and clear communication with staff and promoted a culture of trust and involvement where ideas for change were encouraged, welcomed and acted upon.