Derbyshire Community Health Services NHS Foundation Trust

On this page

• 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

Responsive - this means we looked for evidence that the service met people’s needs. This was the first inspection for this service. This key question has been rated 'Good', reflecting the quality of care provided.

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.

Patients were at the centre of their care and treatment planning, this ensured decisions reflected individual circumstance, preference, and need. The service worked collaboratively with patients, families, carers and external partners to provide and deliver personalised care and treatment, remaining future focused in preparation for future transitions in care.

Each patient had a “This is me” profile, offering detailed knowledge into their preferences, personal history, family members, important people, pets, and familiar places. Staff used this information to adapt care and support around what was most important to each person, from tailoring conversations, activities and therapies to recognising anniversaries and other dates of importance.

Staff completed thorough assessments with patients upon admission, and these were reviewed regularly. Staff responded quickly when needs changed and ensured care plans remained current and effective. Care and treatment plans reflected physical health, mental health, and included emotional, and social needs, including adjustments for protected characteristics under the Equality Act 2010.

Patients received accurate, accessible information about their diagnosis and conditions, treatment options, and any associated benefits or potential risks. Where appropriate, staff encouraged and supported the involvement of family members and people who knew the patient well, supporting shared decision-making and collaboration, which promoted the patient’s preferences and autonomy.

Staff understood the diverse health and care needs of patients and made sure care was joined up and flexible. They worked collaboratively across wider teams, and with external partners to ensure care was consistent and met each person’s individual needs.

Where appropriate the service encouraged and supported patients to involve their families and people who knew them well in decisions about their care. When patients moved between services or discharged home, staff ensured the process was smooth with the appropriate support in place. With patients’ consent, staff invited external partners to care and treatment reviews, this ensured ongoing and collaborative care. This maintained consistency and facilitated better outcomes.

Assessments ensured patients received the right care, treatment, and support for their current and future needs. By working closely and collaboratively with patients and external partners, the service provided joined-up care that met people’s needs and preferences.

Staff provided patients with accurate, and up-to-date information about their care and treatment in ways they could understand. The service used systems and processes to tailor information to individual communication needs, including easy-read formats, picture prompts, and different languages, with interpreter services used if required.

Clear policies and processes ensured the service managed patient information confidentially, and securely by adhering to General Data protection Regulation (GDPR). Staff actively identified, recorded, and reviewed patients’ information needs on a regular basis, and made reasonable adjustments when required and in line with the Accessible Information Standard. The trust’s website utilised Recite Me assistive technology toolbar, allowing users to customise their online experience to meet their individual communication needs.

Staff ensured patients, families, and carers were regularly updated on care and progress whilst maintaining privacy and confidentiality. The service displayed information about raising concerns or complaints and helped patients to understand their rights.

Staff involved families and carers when appropriate and adhered to processes that ensured timely and accurate communication, and information sharing.

Staff supported patients, families, and carers to provide feedback or raise concerns. Patients knew how to complain, and the service displayed clear information on how to access support, including advocacy services, interpreter support, and external organisations, for example, the patient advice and liaison service (PALS). The service had dedicated tablet devices, staff supported people to complete feedback on the ward by using a quick response code (QR).

In the three months prior to our assessment, the service hadn’t received any complaints.

Patients were encouraged to share their views during community meetings, and families or carers were supported to share feedback through carer forums, and carer café. Feedback and concerns were recorded, with any concerns raised being responded to promptly with clear actions, and feedback provided to those involved.

The service, and its staff valued feedback and looked on it as a positive tool for improvement. One staff member told us, “We always encourage, and support people to leave feedback. Learning from feedback and complaints is shared, and it helps us to improve.” Staff received regular updates on complaints and made changes based on outcomes, and what had been learnt.

By involving people in feedback and communicating actions taken, the service built and maintained trust. This ensured patients, and people visiting the service felt valued, listened to, respected, and included.

The service ensured patients could access care, treatment, and support in a way that worked for them and met their individual needs. They identified and removed barriers to care, particularly for people with complex needs, enduring mental illness, or protected characteristics under the Equality Act 2010.

Upon completion of the appropriate assessments, patients were supported with their mobility needs and provided with suitable equipment. The service ensured that assistive technology aids were available and provided when needed. The service provided transportation services which enabled people to access services when they needed them.

Medical cover was consistently available throughout the day and night. Doctors attended the ward quickly in cases of emergency. Patients could also be transferred to the local acute hospital without delay if the need arose.

The service worked collaboratively with external organisations to improve access and transitions between services. Staff coordinated with GP’s, community mental health teams, nursing homes, and integrated care boards to plan and facilitate care, treatment, and support that was tailored to each person’s individual needs.

The premises were accessible, and the environment supported access for all patients and visitors to the service. Staff were aware of social impact, with the service being part of the Joined-Up Care Derbyshire partnership initiative and worked to improve health and address inequalities for people who may be disadvantaged across the region.

The discharge coordinator with the support of staff, planned and had the appropriate links to aftercare provision, community teams, crisis services, and continuing care. Discharges happened when clinically appropriate. The service worked collaboratively with external partners to avoid delays in discharge wherever possible.

Staff actively captured the views of people who may be at risk of experiencing inequalities or poorer outcomes and used this feedback to individualise care, support, and treatment. Patients felt empowered to share their views and were encouraged and supported to do so. The service promoted a culture where people’s voices were heard, respected and feedback was acted on.

There were effective policies in place which ensured the service operated within the principles of Equality, Diversity and Inclusion (EDI). The policies aimed to prevent disadvantage for vulnerable people or those with protected characteristics and to promote fairness across all aspects of care within the organisation and to ensure the service was accessible.

Staff supported individuals with equality and human rights and adhered to legislation. Reasonable adjustments were made to meet each person’s social, cultural, and religious needs, for example, by working with independent communication support services, providing information in varying formats to support individual need, and welcoming religious and cultural leaders to visit the ward to spend time with patients when requested.

All staff completed mandatory EDI training, which ensured they recognised and addressed any potential inequalities or discrimination. Staff were alert to the risks of unfair treatment and took the necessary steps to ensure equity in patient experience and outcomes.

This approach ensured care was inclusive, responsive, and consistently delivered to meet the individual needs of people most at risk of experiencing poorer outcomes.

The service, and its staff supported patients and their families, or carers to plan ahead and make informed decisions about their future care, including at the end of their life. Families or carers were involved in discussions that ensured decisions reflected the patient’s wishes, needs and preferences.

Staff worked with patients to create personalised care plans that included their views, values, preferences, and individual needs. Plans were reviewed regularly and amended to meet changing needs. If required staff supported patients to complete advance care plans (ACP), for example, Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms and Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) documents. One staff member told us, “Patients are usually admitted with DNACPR forms, we can obviously complete the forms with them if they don’t already have one and involve family if they want this.”

The service worked collaboratively with external partners in care when formulating plans for patients with complex needs, which promoted consistency, continuity and coordinated support across different care settings. This ensured patients received compassionate, and effective care with a focus on their long-term wellbeing and future plans.