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

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 and fair culture. At our last assessment we rated this key question good. At this assessment the rating has remained good. Leaders had the skills, knowledge and experience to perform their roles.

Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported and valued. Governance processes operated effectively. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care. Staff collected and analysed data about outcomes and performance. They used this to identify improvements.

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.

Staff co-designed the services strategy, and understood the vision and values of the organisation, and described how they applied them in their day-to-day work. The provider’s 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 both patients and staff and that they were embedded into recruitment, training, supervision, and decision-making about disciplinary matters.

Senior leaders modelled behaviours, and enthusiasm which promoted an open culture with a clear emphasis on equality, diversity and inclusion. Leaders held regular engagement meetings with staff which fostered a culture of shared identity, ownership and purpose. Managers encouraged responsibility throughout their teams, with staff members having lead roles, such as a service co-production champion and a freedom to speak up champion.

Staff had opportunities to contribute to discussions about the strategy for their service. Managers shared updates through regular meetings, and internal 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 patient needs, such as additional training and promotion of mental health rehabilitation.

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 teams were delivering safe, effective care. Leaders were visible and approachable to both staff and patients. Staff reported that leaders maintained an open and transparent culture, where concerns could be raised without concern. Ward round summaries were shared to keep everyone informed. The provider’s vision and values were clearly communicated and embedded into daily practice.

Leaders promoted an inclusive culture underpinned by openness, equity, diversity, and respect. Patients and staff actively shaped the service through participation in meetings, reviews and feedback. Leadership development opportunities were available to staff through the suite of leadership training; the training was delivered collaboratively by the organisation and joined up care Derbyshire. 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.

Leaders fostered a positive and open culture where patients, carers, and staff were encouraged to speak up and their voices heard. Patients had opportunities to provide feedback in ways that suited their needs. They could raise concerns directly with staff and contributed to regular community meetings. Patients were supported to raise concerns, felt listened to, and received feedback on outcomes that were generally positive and communicated back to them.

The provider provided a clear framework to support staff to speak up. A Freedom to Speak Up policy was available, and posters displayed throughout the environment outlined how to access the service. A designated Freedom to Speak Up Guardian provided confidential advice and support to staff who wanted to raise concerns. Staff reported that they 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.

The provider ensured escalation routes were available beyond the local service. Staff and patients had opportunities to meet with senior leaders during visits, further strengthening the culture of openness. When things went wrong, leaders demonstrated honesty and transparency. Staff reported that patients received timely explanations and apologies where appropriate, along with information about actions taken to prevent recurrence.

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, and a rights and inclusion guardian was present on all employment interviews. The organisation’s human resources, and wellbeing teams assisted and supported overseas staff with the transition into employment and ongoing support. Service leaders ensured that all overseas staff completed role-relevant training and competencies prior to commencing work. They felt listened to, valued and were recognised by colleagues for their positive contributions and roles within the service.

Staff cooked and shared cultural meals with patients and colleagues, which promoted inclusion, education and gave an insight into diverse cultures, and food types. Staff accessed structured development and progression opportunities, including nursing pathways and preceptorships. 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 and inclusion was clearly embedded in the organisation’s values, policies and strategic priorities.

The service had clear governance and management processes that worked well and supported safe, high-quality and sustainable care. Staff understood their roles and responsibilities within the service and were held accountable by leaders where appropriate.

Leaders implemented a clear framework for ward and team meetings to ensure essential information was shared and discussed. Staff reviewed and analysed data, such as incidents, complaints, and safeguarding alerts in regular meetings, and implemented recommendations at service level. Staff participated in local clinical audits and acted on any findings.

Collaborative working with the wider teams and externally was promoted to meet patient needs, for example the getting it right first time rehabilitation network. The service maintained emergency plans for adverse weather, flu outbreaks, and other contingencies. The service ensured that cost improvements did not impact the quality of patient care.

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.

Staff and leaders were open, transparent and effectively engaged with external stakeholders and partners in care. They collaborated with commissioners 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 with fellow rehabilitation services via AIMS Rehab Quality Network for Mental Health Rehabilitation Services. AIMS wasa peer-review initiative and accreditation program designed to improve the quality of inpatient mental health rehabilitation services. and was part of the Royal College of Psychiatrists’ College Centre for Quality Improvement.

Staff and leaders promoted networking, and engaged with patients, 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 patients.

Leaders maintained a strong focus on continuous learning, improvement, and innovation across all areas. Staff developed and implemented innovative projects, which led to improvements in patient care and outcomes. For example, a quality improvement project for transformation and improved therapy and assessment delivery by transforming an existing building into a therapy, assessment and activity hub which would enhance the current service provision.

The service was also working collaboratively with the community enhanced rehabilitation team (CERT) on a quality improvement project designed to improve patient flow from acute inpatient services by bringing rehabilitation expertise earlier into the pathway. This enabled rehabilitation thinking, goal setting, and pathway planning to begin earlier, reduced delays in transfers of care when acute treatment was complete, and reduced reliance on out-of-area rehabilitation placements.

Staff implemented innovative approaches to carer support, including psychology support, and aftercare for families and carers of patients rejoining their communities. Home assessments facilitated safe and supported home leave, while physical health assessments, and initiatives ensured timely access to national screening programs, improving equity of care for patients with mental health challenges.

With the support of leaders, the occupational therapy team completed a quality improvement project. The project had been implemented to enhance occupational therapy input and person-centeredness into care planning. They utilised numerous recognised improvement tools, such as, goal directive care planning (GDCP), plan, do, study and act cycles (PDSA) and smart goals. The project increased person centredness care planning from 63.64% to 84.34%. Occupational therapists reported that the enhanced approach had also generated more time for them to collaborate with patients on care plans, and sustainability had been maintained with the project continuing to be effective beyond its completion.

Innovations extended to risk reduction, restrictive practice management, safe wards and trauma-informed strategies were integrated to further enhance patient care. 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.