Derriford Hospital

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• 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 reviewed the capable, compassionate and inclusive leaders quality statement for the well-led key question. Despite improvements, patients remained at risk due to crowding in the department. However, staff and leaders were focussed on patient care and trying to mitigate risks. The nursing leadership and staff team were dedicated to providing good care and treatment despite the increased demand on the department. The operations team was engaged and knowledgeable. There were initiatives to mitigate risks which included building an urgent treatment centre (UTC) in the short term and a larger emergency department in the long term. Building work had begun on the UTC with plans to open in December 2024. However, risks remained until the work had been completed.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

During the on-site inspection, leaders were honest and open about the current situation and challenges the service was facing. There was a strong, committed and capable leadership team in the department. It was evident they had worked hard to make improvements; however, there was still a failure to provide care and treatment in a safe way for service users. Senior staff said there had been a change in the trust since our last inspection with new executives in post who were listening, and the department was better supported. The trust had an improvement plan which took into account the wider health and social care system. Focus was now spread across the trust rather than just in the emergency department with improved relationships internally and support from medical and surgical services. Executives visited the department regularly and staff felt supported. Other staff said they never saw executives and if they did visit, they only spoke with senior staff. There was a culture of continuous learning and improvement. Despite improvements, staff viewed the biggest risk as walk-in patients, waiting room crowding and long waits for triage.

Nursing leadership had oversight of the whole department, working flexibly to accommodate high volumes of patients. However, some staff felt unsupported by their managers. The Internal Professional Standards (IPS) was signed up for by all specialities. This outlined the guiding principles and trust-wide standards for emergency patient flow as recommended by NHS Improvement plus Emergency Care Improvement Programme. However, there were still significant issues regarding the flow of patients through the department. There was a succession planning document to support the trust leadership group with guidance on planning and career development. The executives were engaged and knowledgeable about emergency care. The emergency department team were focussed on patient care and had insight into patient safety risks. Leaders had implemented medium and long term plans, to include the introduction of an urgent treatment centre in late 2024 and a new emergency department building in the next few years.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Governance, management and sustainability during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.