We focused our inspection on the experiences of the people using the adults Emergency Department (ED). This was in response to recent news reports that ambulance services are facing delays as they are left waiting with emergency patients when handing over to hospitals in England.

The department relocated to new premises at Royal Derby Hospital in May 2009, and is over four times the size of the previous department. The department sees over 300 people on average each day. The hospital has a separate children’s and adults department.

We talked with patients and their relatives as well as nursing, medical and support staff, trust management staff and paramedics. We made general observations of the environment and activities within the department.

Patients we spoke with said they were satisfied with the care and treatment they received and felt that their needs were been met. One patient told us ’’The department has a good team of staff and is well organised; I can’t fault the care and treatment I have received’’.

Patients felt that staff were polite and respectful in their approach and attitude. Most patients felt involved in decisions about their care and treatment.

Some patients said they had not been told how long they were likely to wait for test results or treatment, and whether they could eat or drink.

Relatives we spoke with said they were aware of the care and treatment their family member was receiving.

Our rating of services stayed the same. We rated them as good because:

• Staff understood how to protect patients from abuse and services worked well with other agencies to do so.
• The majority of services, controlled infection risk well. Staff kept themselves, equipment and the premises clean. They mostly used control measures to prevent the spread of infection.
• Whilst actual versus planned staffing levels were not always met. Services had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• Services provided care and treatment based on national guidance and evidence of its effectiveness.
• Managers monitored the effectiveness of care and treatment and used the findings to improve them.
• Staff cared for patients and women with compassion. Feedback from patients and women confirmed that staff treated them well and with kindness.
• The trust planned and provided services in a way that met the needs of local people.
• The trust had a vision for what it wanted to achieve and workable plans to turn it into action.
• Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
• There was a positive culture that supported and valued staff.

However:

• From December 2017 to November 2018 the trust consistently failed to meet the standard of 95% of patients being admitted, transferred or discharged within four hours and performed worse than the England average in eight out of 12 months.
• Mandatory training in key skills to all staff did not always achieve the trusts target.
• Complaints were not always deal with in line with the trust policy and often took longer than the trust target.
• Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) forms did not always contain sufficient evidence that mental capacity assessments had been carried out or considered.