Derbyshire Healthcare 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

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

Good: Leaders had the skills, knowledge and experience to perform their roles. Staff knew and understood the trust’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued and the service encouraged staff to speak up if they had any concerns. Governance processes mostly operated effectively, and ongoing work to improve data quality had identified performance improvements. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care. The service worked well with partners and shared information with them as needed. Staff had opportunities to be involved in quality improvement projects that directly improved people’s care. The trust shared learning with external partners to support multi-system improvements.

This service scored 75 (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 mostly had a shared vision, strategy and culture. However, some staff were concerned about some of the details of the proposed restructuring and how this might impact care.

Staff at all levels demonstrated a shared commitment and passion for delivering safe and effective care. Some staff told us they felt ‘privileged’ to work so closely with people and their families to support them through a mental health crisis.

Staff and managers knew and understood the trust’s values and how they were applied within their teams. For example, most staff told us about the importance of collaborating with other teams and partners, such as housing services, to support people’s needs holistically.

One of the trust’s values, ‘ambitious’, was demonstrated throughout the mental health crisis service in the standards it had set in its operating procedures. For example, the NHS Standard Contract requires patients who are discharged from inpatient mental health services to have a follow up within 72 hours. However, within the CRHTTs, staff were required to follow up within 48 hours of discharge.

At the time of the inspection, the service was undergoing a significant organisational restructure as part of a wider transformation programme. Senior leaders told us they actively engaged with staff at each stage of the process to ensure the plans were shaped by staff feedback. For example, staff had expressed they wanted to better understand each other’s teams, so work was underway to support teams visiting and learning from each other. Most CRHTT staff told us they had strengthened working relationships with community mental health teams (CMHT), for example, which had helped staff to understand the roles and pressures within different teams. Some staff told us this work had helped to reduce inappropriate referrals made by CMHTs, who now better understood what CRHTTs provided.

All staff and managers could explain the purpose of the trust’s transformation to improve outcomes for people who used services. However, some staff told us they were concerned that the proposed restructuring would reduce clinical oversight and affect people’s safety. Senior leaders told us they had changed the initial proposed restructuring to ensure that no patient-facing roles were affected. They told us this was because the focus of the transformation was to become fully clinically effective and outcome focused.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders of the mental health crisis service and the trust spoke to us with openness and honesty. They demonstrated a good understanding of their services, teams and the challenges their staff faced. Most of the team managers had developed their career within the trust and understood the pressures faced by their staff.

Managers and senior leaders told us about the importance of role modelling the trust’s values. At the time of our inspection, some service manager and clinical lead roles had been placed at risk of redundancy as part of the restructuring. Although they were going through the consultation process, they remained focused on ensuring staff and people who used services were fully supported. Senior leaders demonstrated empathy and concern for staff wellbeing during the transformation and told us about the additional support they had implemented to help staff through the process. For example, an enhanced employee assistance offering had been created to support staff through restructuring, which included support such as stress workshops and wellbeing sessions.

Some senior leader roles had changed at the end of November 2025 as part of the transformation. Therefore, at the time of our inspection some senior leader roles were not fully embedded. However, some staff told us that senior leaders had visited Chesterfield CRHTT a few weeks prior to our inspection. They told us they had an informal chat about the opening of the Derwent Unit and listened to staff concerns about safety.

In all teams, staff told us managers and clinical leads were visible and could be approached at any time. We observed an ‘open door’ culture at all teams we visited, and saw staff freely approach managers and clinical leads with queries.

Leadership development opportunities were available, including opportunities for staff. Most of the managers and senior leaders we spoke to had developed their careers with the trust. They told us they had been supported to complete training and professional qualifications that enabled them to progress their careers.

Most staff told us there were opportunities available to access training and develop their career. Some staff told us about specific courses they had recently completed, such as care certificates. One manager told us they were currently supporting an administrator who had expressed an interest in clinical roles by looking at opportunities across the service to be involved in more clinical work. Most staff told us they were not looking at development or career progression whilst the trust was in the transformation process.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff in the mental health crisis service could access the trust’s freedom to speak up process. We observed posters on site with contact details for the trust’s freedom to speak up guardian and champions. Staff told us they knew how to raise concerns and felt able to do so. Staff told us they felt able to approach their manager or speak to colleagues if they had any concerns. All staff we spoke to told us they had not felt the need to use the freedom to speak up process.

The trust’s freedom to speak up policy and procedure clearly detailed the different ways staff could raise concerns and what they could expect in response. Freedom to speak up champions were employed across all services in the trust, which meant staff could choose who they felt most comfortable to approach when raising a concern.

Senior leaders told us they supported staff’s psychological safety and encouraged staff to raise any concerns they may have. Psychology staff, for example, could use a QR code to raise any questions or issues away from team meetings. Senior leaders told us this had been used by some staff, who might otherwise feel less confident to speak up in front of others.

In the 12 months prior to our inspection, staff across the mental health crisis service had raised 7 concerns through freedom to speak up, 5 of which came from staff in Chesterfield CRHTT. Of the other 2 concerns, 1 was in relation to a different trust, and the other was not pursued by the staff who initially raised it. We saw a freedom to speak up report that identified concerns raised by staff in Chesterfield CRHTT had highlighted areas of concern related to leadership, culture, governance and risk management within the team. The report highlighted significant concerns that staff were stopped from speaking up and feared retaliation if they raised concerns.

However, the freedom to speak up report acknowledged some improvements had been made because of concerns that were raised. For example, the report stated recent interaction with a senior nursing leader during a mock regulatory inspection resulted in acknowledgment of concerns and commitment to improvements.Relevant action had been taken with individual members of staff after the freedom to speak up guardian became involved. Oversight of high-risk cases had been increased, and senior leaders were supporting the team. The report noted the improvements had happened too recently to have become fully embedded. The report did not state how many individual members of staff had raised concerns. At our visit to Chesterfield CRHTT, all staff told us they knew how to raise concerns and they felt able to but had not needed to.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

The trust told us it had a strong focus on staff equality and diversity. For example, the trust required all job interviews to include an equality, diversity and inclusion related question. In interviews for more senior roles, a recruitment inclusion guardianhad to be invited onto the interview panel. The trust’s induction included equality, diversity and inclusion training.

The trust undertook equality monitoring to ensure its staffing was diverse and representative of the people who used services. The trust reviewed its 2024/2025Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) results andidentifiedactions to improve equity for racialised and disabled staff.The action plan was progressed and reported through the Equality,Diversity andInclusionworking group.WRES and WDES data are only available at trust-wide level.

The trust also reviewed equality and diversity data across the entire employee lifecycle, from recruitment through to staff leaving the organisation. It compared this to local census data to identify if its staff was representative of the people who used services.

Staff in the mental health crisis service could access a range of trust staff networks that supported equality and diversity. The trust told us its staff networks played a crucial role in advancing inclusion, offering support and driving change across the trust. Staff could join the following networks:

• Christian and Multi-Faith Networks
• Armed Forces Community Network
• Black and Minority Ethnic (BME) Network
• Disability and Wellbeing Network
• Women’s Network
• LGBT+ Network

The staff networks provided support and advocacy and helped raise awareness of different equality issues. They also helped introduce initiatives that improved equality for staff, such as adjustment passports, which some staff told us about.

Managers put reasonable adjustments in place for staff members to help them carry out their role. Some staff told us about their workplace reasonable adjustments. Senior leaders told us that identifying reasonable adjustments was an important part of the transformation and consultation process to ensure staff were properly supported.

Staff could apply to work flexibly to account for personal circumstances such as caring responsibilities and health issues. Some staff told us about their flexible working arrangements that allowed them to fulfil their caring duties.

The trust had recently launched its anti-racism strategy and anti-racism statement. To support this, some staff had been trained to provide ‘active bystander’ training to colleagues across the trust. Active bystander training teaches staff how to recognise discriminatory, harassing or bullying behaviours and safely intervene.

Staff in the mental health crisis service could take part in reverse mentoring. Reverse mentoring pairs junior staff with senior leaders so senior staff can learn from their experiences, particularly around culture, inclusion and newer ways of working.

Some managers told us about the regular equality, diversity and inclusion training opportunities that were available. For example, the mid-tier managers’ training programme includeda whole dayon equality, diversity and inclusion. The trust told us there were masterclasses, workshops and other training sessions arranged by the trust’s People and Inclusion team and the BME Network throughout the year.

The trust told us equality, diversity and inclusion were frequent topics during the chief executive’s all-staff engagement hour sessions. In 2025, the chief executive delivered a session in relation to growing tensions in local communities.This was followed by sessions dedicated to the topic, to which all staff were invited.

The service had identified data quality issues that prevented them from gaining full assurance about performance. However, the service had clear responsibilities, roles and systems of accountability. They acted on available information about risk, performance and outcomes, and shared this securely with others when appropriate.

At the time of our inspection, the mental health crisis service was in the process of refreshing its governance processes in line with its organisational transformation. Managers and senior leaders told us they were aware that some of their current systems required improvement. For example, the service could not yet separate call data for the mental health helpline and NHS 111 Option 2, which affected the accuracy of its performance metrics. Additionally, data about response times to emergency and urgent referrals had sometimes been inaccurate due to data entry and triage practices.

The service had taken action to address its data quality in the months before our inspection and had implemented an improvement plan. The trust told us the improvement plan introduced clearer guidance, additional training, and strengthened oversight, which they felt had improved data quality and completeness significantly. We saw evidence that the improvement plan had strengthened data accuracy, and the updated data now aligned more closely with staff and managers’ knowledge of service performance.

Some managers and senior leaders told us about ongoing work to ensure data collection systems were not burdensome for frontline staff. Staff across teams told us the electronic patient record system could be cumbersome. Senior leaders told us they had reviewed the system with staff across the trust, which led to streamlined processes, additional training and guidance, and drop‑in sessions to improve staff confidence and capability.

All paperwork was completed for Mental Health Act admissions for patients detained in a health-based place of safety (HBPoS), however, there was a backlog of these documents being added to the electronic patient care record system. Some staff told us this was due to absences within the Mental Health Act office team. There was an action plan in place to clear the backlog, but this meant prioritising inpatient admission paperwork over Section 136 paperwork. We found this to be an issue when visiting the Derwent Unit as we were unable to review Section 136 paperwork for patients admitted after November 2025 as paperwork had not yet been uploaded to the system.

The trust told us they captured learning from all improvement work to feed into ongoing performance improvement plans for the service. They told us improvements had been underpinned by targeted actions across the pathway, including recruitment initiatives, strengthening of clinical supervision, and a renewed focus on workforce capability and consistency of practice. This had led to measurable improvements, including enhanced crisis response performance, which contributed to the trust’s improved NHS England National Oversight Framework rating and high ranking nationally as third for crisis response times.

Managers displayed a good understanding of their teams’ performance and had access to the information needed to support them with their management role. This included information on the performance of the service and staffing.

All policies and procedures we reviewed were in date, had clear review and approval processes, and included equality impact assessments to ensure they did not negatively affect vulnerable people or those with protected characteristics.

Standard operating procedures were easy to follow and supported staff to perform their roles, including knowing when, how, and who to escalate any matters to. Staff understood the arrangements for working with other teams, both within the trust and external, to meet the needs of the patients.

Senior leaders told us that all changes made through the organisational transformation went through additional quality impact assessments and safeguarding impact assessments. These provided extra safeguards to ensure there was no negative impact on quality and safety.

There was a clear framework for what teams and services needed to discuss at different operational and clinical meetings. The governance structure ensured essential information, including learning from incidents and complaints, was shared. Meeting minutes from team to trust level showed clear agendas, good attendance, and actions allocated to named staff to ensure follow‑up.

The mental health crisis service had business continuity plans that clearly outlined the actions staff, managers and senior leaders should take when events disrupted service delivery, such as staff shortages or technology failures. Staff told us they had recently implemented the plan during a period of heavy snowfall earlier in the month, and ensured people continued to receive support through necessary visits. The business continuity plan was written in 2024 and had not yet been updated to reflect the current HBPoS but all actions in the plan remained relevant.

Managers maintained and had access to the service’s risk register. Staff at team level could escalate concerns when required. Concerns raised by staff and managers during our inspection matched those on the risk register. For example, the increased demand on the mental health helpline since the introduction of NHS 111 Option 2 was listed as a risk. To mitigate this, the service had increased staffing and refined triage tools.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. For example, we reviewed audits of risk assessments and saw they led to improvements in their quality.

Information governance systems included confidentiality of people’s care records. We observed staff followed the trust’s staffcodeof conductfor confidentialityof person identifiable informationpolicyandprocedure.

Staff had access to the equipment and IT systems they needed. The IT infrastructure, including the telephone system, worked well and supported the quality of care. We saw evidence staff promptly reported and escalated any technology issues in line with local procedures.

The service understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Senior leaders engaged well with external stakeholders. The trust was part of the Derby and Derbyshire integrated care system, which included the Integrated Care Board (ICB), local authorities, primary care services and other health and care organisations. Trust senior leaders worked closely with the ICB, who were responsible for planning, organising and funding health services. Feedback from the ICB reflected that the trust acknowledged where improvements could be made and were responsive and open to external partners. For example, ICB commissioners had raised concerns about the number of abandoned calls to the helpline. They were working with the trust to understand the problems and the trust was developing an improvement plan.

ICB commissioners praised the mental health crisis service for playing an “instrumental” role in implementing the local Right Care, Right Person (RCRP) multi-agency agreement. RCRP is an agreement between policing, health and other relevant partners that sets out the principles around the RCRP approach, which aims to ensure that individuals in mental health crisis are seen by the right professional. Commissioners told us the service had been proactive in managing any learning from RCRP events in a multi-agency learning from events meeting.

We saw evidence that any incidents related to the use of Section 136 were investigated and learning was shared with relevant partner organisations, such as the police.

The trust had robust service level agreements with other providers such as the local acute trusts regarding the administration of the Mental Health Act 1983.

Most staff told us about the wide range of services they regularly worked with or signposted people to. These included other NHS services and organisations in the voluntary, community and social enterprise sector, such as those supporting people affected by domestic abuse, or people in farming or veterans’ communities. The mental health crisis service also worked closely with its partner organisation to co-deliver the mental health helpline and NHS 111 Option 2.

The mental health crisis service alerted partners to incidents when required and shared learning. The trust had a clear reporting framework, and their patient safety incident response policy outlined external reporting requirements.

The service was committed to continuous learning, innovation and improvement across the organisation, local system and the UK. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

At the time of our inspection, the mental health crisis service was undergoing significant changes as part of the trust’s organisational transformation. Senior leaders told us the transformation’s focus was on improving experience and outcomes for people who used services, with a lot of work going into improving people’s experience and treatment flow. Some work had already taken place, such as the alignment of care groups, to support improvement through closer working of key teams such as CRHTTs and CMHTs.

The trust had recently hosted a multi-agency delegation from Northern Ireland, including representatives from emergency medicine, psychiatry, policing, commissioning, public health, and patient representatives. During the visit, the trust shared learning from their improvement initiatives. They provided a comprehensive overview of the pathway, including their approach to service access, crisis response, workforce development, and system working.

Senior leaders told us there was a community and crisis transformation programme underway. They described plans due to be implemented in the coming months, including the opening of an urgent assessment hub. The hub was planned to provide a more streamlined point of access and reduce people’s time waiting to access services. It would also help reduce pressure on emergency department staff who regularly supported people in mental health crisis.

Senior leaders told us they had considered all aspects of the urgent assessment hub, from operational processes to walking through the actual journey people would take, to ensure it supported a positive and trauma‑informed patient experience. Experts by experience were involved in all aspects of the planning and implementation of the hub, including the development of the clinical model. Experts by experience are people who have experience of using or caring for someone who uses services. The hub was planned for the south directorate, and managers from north‑based teams were involved in planning to support learning ahead of future replication in the north.

Most staff and managers told us about the gatekeeping work the service had focused on as part of its efforts to improve patient flow and experience. They had introduced a gatekeeping multidisciplinary meeting that aimed to reduce hospital admissions and instead provide suitable alternatives in the community, such as crisis resolution, home treatment and crisis houses. Data showed that across all the CRHTTs from April to December 2025, the gatekeeping multidisciplinary meeting process had supported over 40% of people to avoid hospital admission and instead receive care and treatment in the community. Some managers told us they were keen to use the gatekeeping multidisciplinary meeting principles to other multidisciplinary meetings to consistently ensure people who used services were always at the focus of any clinical discussion or action.

The service valued involvement from experts by experience in improvement projects. For example, they had supported the development of a joint working protocol between CRHTTs and Approved Mental Health Professionals (AMHPs) and had supported a review of the service specification for the mental health helpline.

Some managers and senior leaders told us a mental health crisis text service was planned for introduction later in 2026. They told us this service would be able to support people who preferred to communicate by text message.

Staff in the mental health crisis service had opportunities to participate in research and quality improvement initiatives. For example, some staff told us about a recent trial they had taken part in that used artificial intelligence to assist in administrative tasks, to increase staff availability to see people who used services. We were also shown a ‘distress management plan’ booklet a member of staff had developed to support the distress management work staff carried out with people who used services.

Staff had opportunities to learn from research projects. We saw evidence in team meeting minutes that quality improvement and research projects were regular agenda items. Psychology staff also held monthly ‘bitesize’ sessions to provide updates on research.

Derby City CRHTT had taken part in a triage pilot in 2025 that reviewed how calls to the service were triaged and logged. The service quickly identified areas for improvement and updated processes and staff guidance in response to the learning.

Some staff and managers told us about the successful introduction of discharge multidisciplinary meetings. The project was in its evaluation stage at the time of our inspection, and the trust was seeking feedback from GPs about areas for improvement and undertaking engagement sessions with primary care networks. However, staff told us that initial feedback was positive and that holding discharge multidisciplinary meetings helped ensure people received more joined up care.

Staff had opportunities to get involved in supporting the training and development of other staff and students. For example, medical students from nearby universities had placements at the trust and consultants provided them with teaching and supervision as part of their role and the consultant at High Peak CRHTT told us they had one day a week dedicated to supporting professional activities, focusing on professional development and academic engagement.