Derbyshire Community Health Services 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

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.
At our last assessment, we rated this key question as good. At this assessment, the rating has remained good.
 

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 had a shared vision, strategy, and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of patients and their communities. Leadership and culture supported staff to feel valued, engaged and focused on delivering high-quality care.
Leaders ensured that staff across the service understood the trust’s values and strategic priorities. Staff were able to explain how their individual roles contributed to delivering safe, compassionate, and person-centred care, and how this aligned with wider organisational goals.
Leaders described how the vision, values and priorities had been developed and reviewed through structured planning processes, with input from staff, patients using the service and system partners. Staff reported feeling involved and informed through regular team meetings, engagement events, and ongoing communication from leaders.
We observed a positive and compassionate, listening culture. Leaders were visible, approachable, and encouraged open discussions. Staff felt able to raise concerns, share ideas and reflect on practice, and leaders used feedback to support learning and service improvement rather than blame.
Staff at all levels demonstrated a good understanding of equality, diversity, and human rights. They consistently promoted respectful, inclusive, and compassionate care. Leaders actively promoted equality and addressed workforce inequalities when identified, including supporting staff who experienced discrimination from patients and encouraging appropriate reporting and follow-up.
Leaders understood the risks to delivering the service’s objectives, including workforce pressures and local system challenges. They had action plans in place to manage these risks and monitored progress through regular reviews, staff feedback, and performance oversight, adjusting plans where needed.
 

Leaders were compassionate, inclusive, and development-focused, which helped create a positive working environment and supported the delivery of high-quality care.
Leaders at all levels were inclusive. They understood the context in which they delivered care, treatment and the support 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 had the experience, capacity, and capability to deliver the service’s vision and manage risks effectively. Staff at all levels spoke positively about leaders and described them as knowledgeable supportive and credible. Ward leaders demonstrated a clear understanding of operational and workforce challenges and led with integrity.
Leaders at all levels were visible and led by example. Staff described leaders as approachable and inclusive, modelling respectful behaviours and promoting a supportive culture. One staff member said, "Managers are 100% supportive and there for us, I'm happy to go to my manager whenever I need to. It's a great team to be part of, and a fab place to work.” One ward manager told us their line manager had previously worked as a ward manager and understood the pressures of the role, which helped them feel supported and understood.
Leaders took a compassionate and balanced approach to performance management. They focused on understanding the wider context when staff experienced difficulties, offering support and development before formal processes. Leaders escalated concerns appropriately when performance issues remained, while continuing to provide support.
Leadership development and succession planning was evident. Leaders identified staff with leadership potential and supported them to progress, including Band 6 staff undertaking leadership training and rota management responsibilities. Leaders also encouraged career progression for nursing associates and Band 5 staff, supporting top-up training, skills development, and overseas qualification conversion, including preparation for Objective Structured Clinical Examination (OSCE ).
Leaders remained alert to behaviours and practices that could negatively affect culture or care quality and addressed concerns promptly. Staff felt confident that leaders listened, took action, and provided the appropriate support when issues were raised.
 

Leaders and staff demonstrated a strong culture of speaking up, where staff felt safe, supported and empowered to raise concerns, contributing to continuous improvement and a positive workplace culture.
Staff and leaders acted with openness, honesty, and transparency. Leaders promoted an open-door approach. Staff told us they felt able to speak directly with managers about concerns, ideas, and feedback. Managers encouraged open discussions and regularly reinforced the importance of speaking up in ward meetings.
Leaders actively empowered staff to raise concerns and contribute to service improvement. One ward manager said, “The standards you walk past are the standards you accept,” and felt confident challenging practice that did not meet expectations. For example, when staff raised concerns about bank staff not completing safety rounds, leaders investigated and identified training gaps, which they addressed promptly.
The service had clear Freedom to Speak Up arrangements in place, and staff were aware of how to access them, including the Trust’s Freedom to Speak Up Guardian. Staff demonstrated confidence in using reporting systems and raising concerns without fear of detriment.
Leaders responded to concerns sensitively and constructively. For example, when a newly appointed healthcare assistant raised concerns about interpersonal conflict and bullying, the ward manager facilitated an open and respectful discussion between those involved. Leaders worked with HR to support mediation, resolve the issue, and restore positive working relationships.
When concerns were raised, leaders investigated them appropriately, maintained confidentiality and focused on learning and improvement. Staff felt listened to and reassured that leaders would take actions when issues were identified.

Overall, leaders demonstrated a proactive and inclusive approach to equality, diversity, and inclusion, creating a positive culture where staff felt supported and able to contribute fully.
Staff valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for patients who work for them.
Leaders demonstrated a clear commitment to equality, diversity and inclusion, and staff told us they felt respected, valued and supported in their roles.
Policies and procedures were in place to promote equality and prevent discrimination. Leaders took action when concerns related to discrimination, bullying or harassment were identified and addressed issues promptly and sensitively. We saw examples where leaders worked with HR to resolve concerns and improve working relationships.
Leaders made reasonable adjustments to support disabled staff and volunteers to carry out their roles effectively. The service supported volunteers with disabilities by allocating meaningful, purposeful tasks based on individual strengths, ensuring they contributed positively to the ward and enriched patients experience.
The workforce was diverse, and leaders actively supported equality of opportunity through recruitment, development, and retention. The ward supported international recruitment and sponsorship, which leaders described as a deliberate decision to invest in workforce diversity and long-term stability. This approach also benefitted patient care, for example by enabling access to staff who spoke community languages such as Cantonese and Punjabi, improving communication and patient experience.
Leaders took steps to engage staff at all levels and ensured their voices were heard, including those with protected characteristics. Ward away days played a key role in this, providing opportunities for team building, learning, shared ownership of outcomes and celebration of excellence. Many sessions were led by Quality Always Champions, with external teams invited to support learning and inclusion.
Leaders regularly reflected on workforce experience and took action to address any disparities. Staff felt empowered to raise concerns, suggest improvements and influence ward culture.

Leaders and staff had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment, and support. They acted on the best information about risk , performance and outcomes, and share this securely with others when appropriate.

Leaders and managers supported staff effectively. All staff we spoke with understood their individual roles, responsibilities, and lines of accountability. Managers met with staff regularly to complete appraisals, supervision and performance reviews, and staff told us they felt supported and well managed.
There were clear and effective governance and management arrangements that were appropriate for the size and complexity of the ward. Managers held regular team meetings where they discussed clinical issues, patient safety, incidents, complaints, risks, and service improvements. Managers clearly recorded actions from meetings and shared updates with staff to ensure learning and accountability.
Staff had access to up-to-date policies and procedures and demonstrated good awareness of information governance, patient confidentiality, and data protection. Leaders maintained robust arrangements for the availability, integrity and security of patient records and used information effectively to monitor care quality and identify areas for improvement.
Leaders used proportionate risk management systems that supported both safety and innovation. The service monitored risks through an electronic incident reporting system, audits, huddles, and quality improvement activity, enabling early identification and management of concerns while allowing new ways of working to be tested safely. Leaders had effective systems to monitor and implement change. The Quality and Safety team took responsibility for identifying, reviewing, and communicating updates, such as changes related to antimicrobial resistance and national safety campaigns. Information was shared through meetings, display boards, and local communication systems to ensure staff awareness. Clinical leads and champions took responsibility for ensuring compliance with policies and procedures within their service. They completed regular self-audits and shared learning, which encouraged ownership and positive challenge. This approach promoted staff empowerment and a culture of continuous improvement, with leaders supporting shared responsibility.
The service also completed effective documentation and clinical record audits. Audit programmes were clearly structured, and findings were reviewed to support learning and improvement. Staff and leaders were encouraged to learn about new and innovative approaches where evidence showed these could improve care delivery.

The service submitted required data and notifications to external organisations in line with regulatory requirements. Leaders also implemented recognised quality frameworks and mandatory standards, for example the trust’s Recognition of the Deteriorating Patient (RODP), which provided resuscitation training three times a year to maintain staff competence and patient safety.
Leaders demonstrated a strong focus on sustainability and succession planning. Managers identified staff strengths and leadership potential and supported development through additional responsibilities, training, and leadership opportunities. This proactive approach helped ensure continuity of leadership and supported the long-term stability of the service.
 

Leaders and staff understood their duty to collaborate and work in partnership. They shared information and learning with partners and collaborated for improvement.
Staff and leaders worked openly and transparently with external stakeholders and partner organisations to support joined-up care, effective discharge planning, and service development. They demonstrated a collaborative approach that helped improve outcomes and experiences for patients.
Staff worked closely with local voluntary and community organisations to support timely and safe discharge. Staff partnered with a voluntary service that supported patients returning home by providing transport and assisting with grocery shopping. This reduced delays in discharge and helped prevent unnecessary ambulance use.
Pharmacists worked with community pharmacies through the NHS Medicines Service, ensuring accurate and timely sharing of discharge information and medication summaries to support continuity of care after discharge.
Staff also worked in partnership with voluntary organisations including referrals to befriending services to reduce isolation and support patients’ wellbeing in the community. In addition, the service engaged with organisation which supported carers, who were due to begin regular monthly visits to support carers and ensure their needs were identified early.
Leaders and staff used these partnerships to share learning, identify gaps in support, and explore new ways of working. This collaborative approach supported continuous improvement, strengthened community links, and contributed to more coordinated, person-centred care.
 

Leaders and staff described a culture of trust, engagement, and shared responsibility for improvement. Leaders consistently encouraged innovation, supported staff development, and embedded learning to improve the quality and safety of the care delivered.

Leaders focused on continuous learning, innovation, and improvement. They encouraged creative ways of delivering equality in experience, outcomes, and quality of life for people. They actively contribute to safe, effective practice and research.
Staff and leaders demonstrated a clear and consistent understanding of how to make improvements happen. They used structured quality improvement approaches to identify issues, test changes, and review impact. Leaders supported staff to measure outcomes where appropriate and used learning to maintain the drive for continuous improvement.
Leaders embedded the Quality Always approach to ensure the service consistently delivered high-quality care, regardless of geographical location, service type, or time of delivery. Quality and Safe Care Champions (QSCCs) received ongoing support to embed best practice within clinical areas and to drive improvements in line with the Quality Always Clinical Assessment and Accreditation Scheme (CAAS) standards. Leaders ensured the champion roles were active and meaningful, with nurses and healthcare assistants taking ownership of specific quality priorities, such as tissue viability.
Staff and leaders ensured that patients, families, and carers were involved in improvement activity through established feedback mechanisms, including discharge feedback. Staff used feedback to identify areas for development and to evaluate whether changes had improved patient experience and outcomes.
There were effective processes in place to ensure learning occurred when things went wrong and when good practice was identified. Leaders encouraged reflective practice, open discussion and collective problem-solving, and they shared learning through ward meetings, safety huddles, and quality forums.
Staff were supported to prioritise time to develop their skills in improvement and innovation. Leaders encouraged staff to contribute ideas and actively listened to suggestions. This included work led by the ward manager to develop an interactive discharge planning board to improve communication, support patient flow and enhance staff confidence.
Leaders and staff demonstrated strong external collaboration to support innovation. Staff worked closely with the community intravenous (IV) team to develop an IV therapy service on the ward. Leaders supported staff to complete IV training and competency assessments, with plans for all registered nurses to be trained by December. This reduced the need for acute hospital admissions and enabled patients to receive treatment locally, improving access, continuity of care and patient outcomes.