Derbyshire Healthcare NHS Foundation Trust

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• 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

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

Good: Staff consistently delivered person-centred care that met individual needs and preferences and, in some cases, reduced the need for services. Care was well integrated with other relevant teams and services and supported continuity. People who used services and carers were given information about their care and how to raise concerns. The service treated concerns and complaints seriously, investigated them and learned lessons from the result. The service met the needs of all patients and people who used services, including those with a protected characteristic. Staff supported people to work towards their future goals. The service had improved its responsiveness and data recording improvements were beginning to evidence this.

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.

Staff across all teams made sure people 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 people’s needs. Personalised approaches to care helped to reduce people’s reliance on services.

The mental health helpline and NHS 111 Option 2 had identified in September and October 2025, about 10% of all calls were made by the 3 most frequent callers, and over 20% of all calls were made by the 10 most frequent callers. They identified the top 10 frequent callers were all open to community mental health teams (CMHT). Therefore, they worked with CMHT staff to better understand people’s needs. They then created call care plans for high‑frequency callers, setting out how staff could best support them. Staff told us this included actions such as signposting people to befriending services, and they had begun to see the benefits of this. For example, the most frequent caller made 345 calls in August 2025, which reduced to 186 in September 2025 after their care plan was implemented. Feedback the trust received about the mental health helpline and NHS 111 Option 2 included several comments from people who said that staff “knew what works” for them.

Staff ensured people’s needs and preferences were the focus of all care and treatment they provided. We reviewed 25 care records, and all care plans and safety plans were created in collaboration with people who used services. Staff explained treatment options to people so they could decide which approach they wanted to take. Carers were involved in care planning where consent was given.

Staff based people’s care around individual needs and preferences. For example, we observed a call to CRHTT duty cover in which staff talked through someone’s worries with them, before arranging to visit them the next day to further discuss their request for advocacy and signposting. Staff also advised the caller of their right to an assessment under the Care Act.

Most staff told us that delivering person-centred care was a priority for the service. Some staff told us their gatekeeping multidisciplinary meetings, for example, had a focus on the person who used services being at the centre of any decision making, with their voice always being represented.

We reviewed Section 136 implementation meeting minutes and saw staff participated in risk strategy meetings to see how the service could better support people who were frequently detained in the health-based places of safety (HBPoS).

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported continuity.

The mental health crisis service worked with other teams and partner organisations to provide joined-up care. Most staff told us they worked closely with community mental health teams (CMHT), the specialist autism team, the local authority, drug and alcohol services and emergency services. We reviewed 25 care records and consistently saw examples of CRHTT staff working with staff from other services and carrying out joint visits to support people.

People on CRHTT caseloads were allocated a small number of named key workers who held overall responsibility for co-ordinating their care. This ensured there was a named staff member for each shift to support continuity. However, teams remained flexible so that any appropriately skilled staff member could visit when required. We saw that next actions and care plans were easily accessible on electronic care records, which enabled staff to understand people’s care and treatment plans.

The mental health crisis service worked closely with primary care providers. Most staff told us their electronic patient record system allowed them to send “tasks” to other teams and services. We saw examples of staff sending “task” requests to GPs for blood tests, for example.

Staff emphasised the importance of involving carers in people’s care, where consent was given. Care records showed that when people consented, staff made sure carers were informed of care plans and safety plans, so they understood how to support the person’s care and treatment.

Some staff told us about biweekly complex case panels. These meetings brought together a multidisciplinary team to consider how best to meet the needs of people with more complex presentations.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The service was committed to ensuring carers were fully supported.

We spoke to 8 people who had been supported by CRHTT and 1 carer. They all told us they had received lots of information about their care and that staff had explained things well to them. They told us they understood their care plan, how to seek more help, how to make complaints and what the next steps were in their care.

Most staff and managers told us about work the mental health crisis service was doing to better support carers. For example, carers calls had been introduced. The calls took place within 72 hours of someone being assessed by the service. The carers calls ensured carers were given information about how to access help if needed and ask any questions they had. Carers calls were monitored via a carers dashboard to ensure all carers were given the information and support they needed. Staff and managers told us the service was committed to supporting carers and meeting their needs, while respecting people’s wishes about whether information about their care could be shared. In 2025, the trust had co-produced a carers information leaflet that staff gave to carers of people who used services.

The mental health crisis service complied with the Accessible Information Standard. We saw people’s care records included information about any language needs they had, including British Sign Language (BSL).

Staff in the mental health helpline could support Deaf callers by using a video service that connected them to BSL interpreters who interpreted the call handler’s words. The trust’s website had clear instructions for Deaf callers to follow if they wanted to use the video BSL option. The trust’s website contained a video about its strategy with BSL interpretation.

Leaflets were available in different languages. Some staff told us they used translation services to ensure people and carers received any leaflets or care documentation, such as care plans, in their first language.

Staff could use a telephone interpreter service or book interpreters for face-to-face appointments. Staff told us the booking system was easy to use.

Most staff told us CRHTTs sent people information about the service via text message to ensure people had easy access to it. We saw examples of communication via text message in people’s care records. Staff used text messages to share links to helpful guidance, remind them about planned visits and send information about the service.

The service gave people patient information leaflets about medicines. The leaflets were easy to understand and advised people on side effects to look out for and how to respond to them, including when to seek emergency medical attention.

Staff in the mental health crisis service provided people and carers with information about a range of topics to support their health and wellbeing. We observed leaflets about local services and support groups people might benefit from attending, and leaflets about treatments and how to make a complaint. There were information posters in the waiting area at Chesterfield CRHTT.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

People who used services and carers had opportunities to provide feedback to the mental health crisis service. Most staff told us the service was looking at how it could encourage more feedback from people. We saw an action plan was in progress at the time of our inspection which aimed to increase the response rate to the friends and family test questionnaire. One of the actions was to have feedback boxes and questionnaires in waiting areas. We saw a feedback and suggestions box in the Chesterfield CRHTT waiting area. Team leaflets had QR codes for the friends and family test.

In the 12 months prior to our inspection, the service received 37 compliments and 15 complaints. Of those 15 complaints, 1 was upheld. During the same period, no complaints were referred to the Parliamentary and Health Service Ombudsman.

We saw evidence of complaint responses that included apologies and acknowledgements of people’s experiences. The complaint responses explained any learning the team had taken from investigating the complaint. For example, one complaint response explained the steps the service had taken to involve carers more, for example through the introduction of carer calls within 72 hours of someone’s assessment.

Carer calls were monitored via a carer dashboard. Most staff and managers told us about the carer dashboard. They told us it helped ensure staff contacted carers and provided them with information as part of standard operational practice.

The service provided patient information leaflets that explained the purpose of CRHTT and what they offered. The leaflets explained how CRHTT worked with agencies, provided information on how to access support in a crisis and had a QR code to provide feedback on the service. We spoke to 8 people who had used mental health crisis services and 1 carer. Everyone knew how to raise any complaints or concerns they had. Some people told us they had been given information leaflets with information about how to make a complaint or provide other feedback.

The trust was a member of the Triangle of Care. The Triangle of Care is an improvement tool created by Carers Trust, based on 6 principles to ensure providers include and support carers. Carers could attend the trust’s carers forum. The trust had co-produced a carer survey which was planned to go live later in 2026.

The trust told us it reviewed all feedback from people who used services and carers, whether submitted formally through complaints, or more informally through online platforms or directly to staff. It told us all feedback was logged and reviewed, then themes and learning were shared through governance and quality meetings. Compliments were shared with teams to recognise good practice, while complaints and concerns were used to inform improvement actions and strengthen service delivery.

The trust’s patient and carer experience strategy 2024-27 stated the trust’s commitment to increase co-production across services. Its action plan included establishing a role for co-production champions in teams. Each CRHTT already had carers’ champions at the time of our inspection.

The service was committed to improving timely and equitable access to everyone who used services. The trust was working to improve data capture issues and processes that affected performance data.

In the 12 months prior to our inspection, the trust had undertaken significant work to improve its data recording, after identifying that performance data did not accurately reflect service delivery. For example, the integrated performance report in the December 2025 public trust board meeting highlighted the service’s mental health helpline and NHS 111 Option 2 phone lines had high rates of call abandonment, at 50%, suggesting people were not always able to access support in a timely manner. However, the 50% abandonment rate included calls made to the mental health helpline, those made to NHS 111 Option 2 and those made to the professional line. Some senior leaders told us they were looking at how they could get a breakdown of call data that separated the phone lines to more accurately reflect performance. The trust later provided additional data about the phone lines that showed the 50% call abandonment rate included around 18% of call attempts via the professional line, which did not have a voicemail facility, and about 15% of calls where the caller had disconnected before reaching a handler. Call numbers had increased in the months prior to our inspection, and the month before they had received over 6,000 calls, which was a 248% increase on the number of calls received in April 2024. A performance improvement plan had been developed in August 2025 to improve responsiveness and was in progress at the time of our inspection.

The mental health crisis service was available 24 hours a day, all year round, but trust data had not always shown that people received a timely response. Data for the 12 months prior to our inspection showed the service had not always met the national standard of 4-hours from very urgent (emergency) referrals to assessment. The service’s crisis assessment and home treatment operational policy stated that emergency cases should receive a response within 4 hours, while urgent cases should be seen within 24 hours.

The trust shared data with us that showed between February 2025 and January 2026, the average time from referral to assessment across all CRHTTs was 30.8 hours. Between February 2025 and January 2026, CRHTTs recorded 36 emergency cases and 1,915 urgent cases. Of those, thirteen emergency cases were responded to within 4 hours, and 1,084 urgent cases were seen within 24 hours. However, the trust told us this data did not accurately reflect performance. They explained that staff had not always recorded response times correctly, which affected data quality. They also highlighted that, in September 2025, one CRHTT piloted a triage system that required all referrals to be initially logged as needing a 4‑hour emergency response. This resulted in further inaccuracies, as all telephone contacts were recorded as referrals at first contact, even when they did not meet the criteria for the service.

The service told us that the low number of emergency cases was because people in immediate crisis were more likely to present to Emergency Departments, where they were then assessed by Psychiatric Liaison Services. At the time of our inspection, the service was progressing plans to develop an urgent assessment unit to provide a more appropriate immediate response.

From September 2025, response times improved across all CRHTTs as actions from the service’s performance improvement plan became embedded. Between 1 October 2025 and 31 January 2026, the average response time across all teams for all referrals was 21.7 hours. During this period, there were 14 emergency referrals across all CRHTTs, of which 11 were seen within 4 hours. The trust told us it had completed audits of triage processes and was confident staff were now applying response times more accurately on the system. Alongside the improved performance data, the trust’s rating against the NHS England’s National Oversight Framework had improved and at the time of our inspection, the trust was ranked as the third highest in the country for crisis response times.

Senior leaders acknowledged that previous performance data, though inaccurate, did not reflect the responsive service their teams strived to deliver. The service had an action plan to improve response times. All actions were either well progressed or completed at the time of our inspection. These included reviewing the triage and recording process to ensure people were appropriately assessed and allocated the correct response.

Senior leaders told us there were higher levels of acuity in Derby City, which was reflected in referral and caseload numbers. Between February 2025 and January 2026, High Peak CRHTT had 145 referrals, Chesterfield CRHTT had 419, South County CRHTT had 669, and Derby City had 718.

Commissioning arrangements required the service to always have a minimum of 1 HBPoS open at any time, which the service consistently maintained. Occasionally, HBPoS had to be closed due to lack of available staff to support new admissions. Between 1 July 2025 and 31 January 2026, Derwent Unit was closed 17 times, Carsington Unit was closed 25 times, and Radbourne Unit was closed 26 times due to insufficient staffing levels. There were 6 occasions when 2 of the HBPoS were closed at the same time due to lack of staff. The trust told us that inpatient wards had seen an increase in incidents of violence and aggression that meant sometimes ward staff were unable to be deployed to the HBPoS. There were no occasions when all 3 HBPoS were closed due to lack of staff at the same time. In each recorded closure, we saw evidence staff followed the closure process which included contacting the mental health helpline, who advised police which HBPoS was closed, and which remained open.

A December 2025 report on the mental health response vehicle included in depth analysis of calls it had responded to between October 2024 and September 2025. The report concluded that across nearly 600 deployments, the mental health response vehicle team spent an average of 1.5 to 2 hours on scene to carry out thorough assessments of people. The report stated 82% of people did not need to be taken to hospital and instead were able to be assessed and supported in more appropriate environments.

The staff in HBPoS were responsible for contacting the local authority’s Approved Mental Health Professionals (AMHP) team, who requested the trust’s Section 12 approved doctors to attend to carry out Mental Health Act assessment. Most staff told us they sometimes experienced delays in securing Section 12 approved doctors to carry out Mental Health Act assessments overnight. Staff and data confirmed this did not result in people being detained for longer than legally permitted. The mental health crisis service had carried out a deep dive into delays to Mental Health Act assessments, and a task and finish group was focused on improving doctor availability.

The service was committed to providing equitable access to people who used services. For example, it had implemented specific arrangements to ensure equitable access for individuals who were Deaf or had hearing impairments and made sure that reasonable adjustments were embedded within the service model.

Discharge from the mental health crisis service was planned with people to meet their needs. We saw an example in 1 care record, for example, of someone having a long discharge period with several joint visits with community mental health team (CMHT) staff, because CRHTT and CMHT staff recognised the person’s heightened anxiety about being discharged from the crisis team.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The mental health crisis service promoted a culture in which people who used the service felt empowered to give their views. There were people and carer forums, surveys and regular communications with people and carers. The trust told us it was in the early stages of planning a carer support group specifically for CRHTTs.

Staff were trained in equality, diversity, inclusion and human rights. In January 2026, all teams had a minimum of 89% training completion, with most teams at 100%.

Staff understood local demographic needs and how equality, diversity, inclusion and human rights issues affected people who used services. Some staff told us they tried to ensure everyone experienced the same high standards of care and treatment. For example, some staff told us they had supported asylum seekers who were staying in temporary accommodation.

The trust had implemented the Patient and Carer Race Equality Framework (PCREF), which is a mandatory framework designed to support trusts to become actively anti‑racist and reduce racial inequalities in services. At the time of our inspection, the trust was recruiting a full‑time PCREF lead and planned to publish its PCREF self‑assessment and action plan later in 2026. In January 2026, the trust hosted a PCREF workshop that focused on learning from other mental health trusts and reviewing progress against its own action plan.

The trust was a partner in its local health inequalities partnership and the trust’s strategy included reducing health inequalities. One of the strategy’s key priorities was to build partnerships that delivered on the needs of their communities. We saw the trust’s quality plan, which supported the strategy, included a strong focus on working with people, carers and those with lived experience, to improve people’s experiences and outcomes of care.

The trust had a community and stakeholder engagement plan which explained its aim to better understand their communities' needs and health inequalities, in order to provide targeted support that improved people’s access, experience and outcomes of their services.

Some staff told us their clinical discussions helped them to plan care and treatment for people in demographics they knew were at risk of inequalities. They told us this helped them to ensure they planned care accordingly, for example by booking interpreters if needed.

The trust had completed equality impact assessments for its policies and procedures to ensure they did not disadvantage vulnerable people or those with protected characteristics. We reviewed a range of policies and procedures, and each had an accompanying equality impact assessment. The trust also had an equality impact assessment toolkit that supported staff to consider equity when developing projects, policies and procedures.

We saw evidence from team meeting minutes that a research project focused on underserved communities was underway. The minutes stated that at that stage, there had not been a great deal of engagement from men in the community despite reaching out to various communities and voluntary organisations.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Staff supported people to make informed decisions about their care and treatment and their future. We reviewed 25 care records and saw care plans were recovery-focused and included the goals people wanted to work towards, such as returning to employment.

Some staff told us, and we saw evidence in care records, that staff routinely asked people what they would like to do if their mental health deteriorated. For example, if people would prefer home treatment or hospital admission.

Staff ensured all relevant healthcare professionals were involved in planning people’s care and treatment. We saw examples in care records of staff sending updated care plans to people’s GPs, sometimes with requests to amend prescriptions.

Staff could refer people to other services if needed. For example, some staff told us about drug and alcohol and housing services they referred people to.

When patients with a learning disability or autistic people were detained in the HBPoS, staff implemented the local emergency protocol that ensured a multi-professional meeting would take place. However, this only took place within office hours as there was no out-of-hours learning disability team available. We queried with staff and the AMHPs whether this put this specific group of patients at a disadvantage as they were potentially required to wait longer for a Mental Health Act assessment if admitted during the night or early hours of the morning. However, they told us that the process provided the best outcome for the individual as their local team would be involved in the meeting and this often avoided admission as an inpatient. Data showed nobody had been detained for longer than 24 hours because of the local emergency protocol.

Daily rapid reviews in CRHTTs enabled staff to respond promptly to people’s changing needs.