Derbyshire Healthcare NHS Foundation Trust

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

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

Good: Staff assessed the physical and mental health of all people who used services. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for people based on national guidance and best practice. Teams included or had access to the full range of specialists required to meet people’s needs. Staff from different disciplines worked together as a team to benefit people. People’s outcomes were monitored continuously to support improvement in their mental health. People were supported to live healthier lives. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

This service scored 79 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. They appropriately included carers in assessments.

Staff assessed people’s needs throughout their care journey, from initial triage to discharge from the mental health crisis service. We observed crisis resolution and home treatment team (CRHTT) duty calls in which staff ensured they had enough information about people’s needs to determine whether they met the criteria to be accepted by the CRHTT. They then used this information, in discussion with colleagues as necessary, and a mental health triage scale, to determine whether people needed an emergency assessment (within 4 hours) or an urgent assessment (within 24 hours).

Mental health helpline and NHS 111 Option 2 staff assessed people’s needs effectively over the phone to determine the most appropriate course of action. For example, we saw records of phone calls to the mental health helpline where staff assessed people’s needs and then signposted them to appropriate support, or contacted other services that already supported them to request a review.

Staff carried out comprehensive assessments to identify people’s needs. We reviewed 25 care records, and all contained a detailed and holistic core assessment. There was evidence of carers being included at appropriate stages to provide staff with information about people.

Care plans reflected people’s needs identified in their assessments. We saw evidence in all 25 care records we reviewed that people who used services were involved in planning their care. Care plans were personalised, holistic and recovery-oriented. They included people’s own words and were focused on supporting them through their mental health crisis in the way they, their carers and staff felt would best suit their needs. For example, we saw evidence in care records of staff discussing referrals to crisis houses with people who felt they were not safe at home but did not require inpatient admission.

We spoke to 8 people who used services and 1 carer. They all told us they felt staff understood their needs and that they were involved in creating their care plans. Everyone told us they had a copy of their care plan, apart from 1 person who could not remember.

We saw evidence in care records that staff noted the next actions to take at the end of all note entries. For example, after staff visited people who used services, or discussed their case in multidisciplinary meetings, they updated people’s notes to show the next visit date or referrals to be made to other teams or services.

The service planned and delivered people’s care and treatment with them. They did this in line with legislation and current evidence-based good practice and standards. They carried out robust internal inspections using professional, clinical and lived experience together to review the care and treatment provided. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice.

Senior leaders and people with lived experience carried out unannounced mock regulatory inspections to identify areas of good practice and areas for improvement. We reviewed the reports from unannounced inspections of CRHTTs, which considered all aspects of care and provided evidence to support any judgements made. The reports provided detailed explanations of findings and action plans with named action owners and timeframes to address any areas that required improvement. We saw evidence the mock regulatory inspections were effective at supporting improvements in the delivery of care and treatment. For example, Derby City CRHTT’s report from December 2025 included recommendations to improve risk assessments. When we reviewed 6 care records at Derby City CRHTT in January 2026, all 6 had good quality, detailed and person-centred risk assessments. Chesterfield CRHTT’s report identified areas for further discussion, including streamlining paperwork processes and reviewing the outcome measures used.

The mental health crisis service had a proactive approach to the continuous improvement of how it delivered care and treatment. For example, the service audited phone calls to the mental health helpline and NHS 111 Option 2 to identify good practice, areas for improvement, and any potential risks. At the time of our inspection, the service was carrying out audits of any phone calls that were 60 minutes or longer to see how they might better support people.

The mental health crisis service had access to the full range of specialists required to meet the needs of people who used services. CRHTTs had multidisciplinary teams comprising nurses, occupational therapists, engagement workers, healthcare assistants, pharmacists, consultant psychiatrists, medics, non-medical prescribers, service managers, clinical leads and social workers. High Peak CRHTT and Chesterfield CRHTT shared a clinical psychologist. Derby City CRHTT and South County CRHTT had a psychologist vacancy. Managers and senior leaders told us they were considering what psychology role, or roles, would best support the teams at the time of our inspection. Psychology support could be requested via the trust’s specialist psychology teams. The trust confirmed that all requests for psychology input were met.

The service provided a range of care and treatment interventions suitable for people in crisis. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. The service’s crisis assessment and home treatment operational policy and procedure outlined treatment options for crisis care to provide an alternative to inpatient admission. Treatment options included medication review and management, mental state monitoring, intensive home support, brief strengths-based psychotherapeutic interventions, practical help, and frequent contact.

Staff were experienced and appropriately qualified to deliver a range of care and treatment options. Senior leaders told us they made sure staff had the right training and specialism to provide interventions properly.

Staff participated in clinical audits, benchmarking and quality improvement initiatives. The trust told us it had a structured clinical audit programme to monitor compliance, quality, and safety. For example, clinical leads completed weekly care record audits to ensure people had robust and up to date care plans, safety plans and risk assessments.

Managers, clinical leads and senior leaders attended quarterly CRHTT service development meetings. The meetings covered all aspects of the service, including performance, feedback from people who used services, and areas for improvement.

Staff had access to regular meetings. For example, some staff told us about monthly clinical team meetings, during which incident themes, learning, and required actions were routinely discussed to ensure collective understanding and consistent practice. They told us the meeting minutes were shared with everyone so no staff missed out on important updates or information. Some staff told us monthly reflective practice sessions helped them consider their practice and anything they might do differently in the future.

Some mental health helpline and NHS 111 Option 2 staff told us they held weekly meetings with the partner organisation that ran the phone lines with them.

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Staff completed Mental Health Act training and were 93% compliant at the time of our inspection.

Staff monitored the use of the Mental Health Act to ensure it was applied correctly. From January to December 2025, there had been 536 detentions in the health-based places of safety (HBPoS), equating to an average of just over 44 a month. Staff audited handovers, and in most cases, a handover of Section 136 took place within 1 hour of arrival at the HBPoS. Staff audited the timeliness of Mental Health Act assessments and people’s outcomes at the end of their detention under Section 136. Audit data showed people were routinely risk assessed in HBPoS.

Patients can be legally detained under Section 136 of the Mental Health Act for 24 hours. The trust confirmed there had been no breaches from January to December 2025. In exceptional circumstances, an extension of 12 hours may be granted. The trust confirmed it did not detain patients in the HBPoS under any other Section of the Mental Health Act.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We spoke to 8 people who used services and 1 carer who used the CRHTTs. Everyone told us staff understood their needs and 2 people highlighted that they found it useful that their records contained the relevant information staff needed about them. Some people told us the service communicated well with their GP. The mental health crisis service used the same electronic patient record system as the rest of the trust and most local GPs. The service told us they were in the process of adding an alert onto people’s care records to highlight those whose GPs did not use the same electronic patient record system, to ensure staff were aware.

Staff held regular multidisciplinary meetings and effective handovers. In the meetings we observed, staff shared comprehensive information about people on the caseload and discussed the support they needed. This helped teams agree the appropriate actions to meet people’s needs.

The mental health crisis service had effective working relationships with other relevant teams in the trust. For example, most CRHTT staff told us they worked closely with community mental health teams (CMHT). Some staff in South County CRHTT told us they had focused on strengthening relationships with CMHTs in the year prior to our inspection. They told us this had allowed them to better understand each other’s roles, responsibilities and challenges. This had resulted in a reduction in inappropriate referrals from CMHT colleagues, as CMHT staff better understood the role of CRHTT and its referral criteria.

We observed CRHTT staff working effectively with other teams and services. In a bed management meeting, they clearly presented a person’s needs and risks and explained why a hospital bed was required. In the meeting it was agreed that the person could access a bed that met their needs.

Staff ensured they had effective working relationships with teams outside the trust such as the local authority and GPs. For example, some staff in South County CRHTT told us the introduction of discharge multidisciplinary meetings had improved their relationship with GPs, who would sometimes previously complain to the team after someone was discharged back to the care of their GP. However, the team had received no complaints from GPs in the 6 months prior to our inspection.

Some managers told us they had strengthened their relationship with the local authority by inviting them to attend risk strategy and professionals’ meetings.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives.

The mental health crisis service supported people with their physical health needs. We saw the mental health crisis service’s physical health assessment action plan. It included an action for people accessing crisis services to receive a physical health assessment within 7 days of admission to the service. Staff told us, and we saw evidence in care records, that staff monitored people’s physical health throughout their time under the care of CRHTT. We reviewed 25 care records and in all of them, people had physical health assessments, or were offered them and declined. We saw evidence that in all core assessments, people’s physical health needs were assessed.

Some staff told us the early discharge teams within CRHTTs tried to ensure physical observations were carried out on wards before people were discharged. However, if this did not happen the early discharge team staff carried out the checks and completed physical health questionnaires with people.

We saw physical health monitoring kits in CRHTT offices. Contact information for physical health nurses that staff could consult with if they had any physical health queries was located nearby.

Staff supported people to access help to improve their physical health. We observed information leaflets staff shared with people who used services on topics such as physical activity and stopping smoking.

Staff considered how people’s physical and mental health affected each other. For example, we observed care records in which staff noted the impact of people’s physical health conditions on their mental state. We also saw examples in care records of staff advising people about good sleep hygiene and nutrition.

The mental health crisis service worked with or referred to other organisations as needed to support people’s physical health. Some staff told us they referred people to external organisations such as substance misuse services if they identified a need.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The mental health crisis service had a strong focus on outcomes. Most staff and managers told us their work focused on supporting people to achieve the best outcomes when experiencing a mental health crisis. Senior leaders told us they hoped the trust’s transformation would increase the service’s ability to improve people’s outcomes.

Staff used a recognised rating scale to assess and record the severity of people’s mental health needs and their social functioning. We saw evidence in care records that staff routinely used the Health of the Nation Outcome Scales (HoNOS). The trust’s 2024-2025 data on use of HoNOS showed that 84.5% people had at least 1 score recorded. Most (53%) of those had at least 2 scores. Data showed that across all domains, average first and last scores showed improvements in people’s mental health and social functioning. Data showed people experienced a consistent level of improvement across all teams.

The service reviewed outcome measures to consider improvements to the service. For example, the minutes of a CRHT service development meeting showed staff discussed that ‘relationship problems’ had been commonly occurring overacross all teams overthe lastcouple of years with minimal improvement inHoNOSscores.Staff considered a review of theinterventionsthe service offered that supported relationship problems, and how to improve joint working with relevant pathwayssuch as relationship counselling services.

Staff in the early discharge teams within CRHTTs provided a 72 hour follow up visit following discharge from inpatient services. Trust-level data showed that from January to December 2025, 72 hour follow ups were achieved 90% of the time on average.

Staff adapted people’s care and treatment to meet their needs to achieve the best outcome for them. For example, we saw evidence in care records of staff making a crisis house referral after someone who used services and their carer found attempts to support them safely at home were not sufficient. The care record showed staff supported the person during and after their stay at the crisis house, which enabled them to be successfully discharged to a community mental health team once they were no longer experiencing a mental health crisis.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff were trained in and had a good understanding of the Mental Capacity Act. Across the mental health crisis service, Mental Capacity Act training compliance averaged 93.5%, with no team below 83% compliance.

Staff were knowledgeable about the practical applications of consent and capacity to consent. We reviewed 25 care records and saw evidence in all of them that people’s capacity to consent to care and treatment was assessed in their core assessment. Some staff told us that if there were any concerns surrounding people’s capacity to consent to care and treatment, they would revisit this as many times as was needed to ensure people understood their rights and had capacity to consent. We saw evidence in care records that consent and capacity to consent were recorded throughout people’s time under the care of CRHTT.

Staff encouraged people to make their own decisions about their care and treatment when possible. For example, people could request changes to their care and treatment. We saw evidence in care records that people’s requests for changes to medicines were discussed with them before being referred for a medicines review.

Mental health helpline and NHS 111 Option 2 staff considered consent when talking with people on the phone. We saw triage tools included questions that covered people’s capacity and consent. We observed a phone call in which staff explained to a carer that they did not have consent to share certain information about their loved one with them. However, they were able to support the carer appropriately by signposting to other support services. We also observed calls in which staff ensured people consented to other healthcare professionals such as GPs being contacted about them.

When patients lacked capacity, staff made decisions in their best interests and ensured they received the appropriate support. For example, we observed a multidisciplinary meeting in which staff discussed concerns for someone who was acutely unwell who they felt needed inpatient treatment. Staff arranged for a Mental Health Act assessment to be carried out that day. We were told later that day the person had been admitted to an inpatient ward, under the Mental Health Act.

People had access to advocacy services. We saw posters and leaflets about advocacy services. We spoke to 2 patients detained in HBPoS. They both told us staff had made them aware of their rights as required by Section 132 of the Mental Health Act 1983. They had both been provided with a Section 136 information leaflet.