Derbyshire Healthcare NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe - this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question as requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with 23 patients across the Hartington and Radbourne Unit; all of them reported that community meetings were well attended by patients and staff. They felt staff listen to them and took action to make their experience on the ward better. Issues they raised would be addressed and fed back in the next meeting and displayed on the notice boards on the wards. We spoke with 23 staff members and reviewed minutes of team meetings. It was evident since the last assessment that the staff teams had been developing their learning culture. Team meetings minutes highlighted that learning and changes in practice from complaints and lessons learnt were shared with staff. In response to serious incidents of ligation and our last assessment leaders developed an environmental ligature essential booklet which outlined examples of the types of ligatures, equipment that could be used to ligate from following serious incidents in the service. This included proactive interventions that staff can use to support patients. This was then given to staff who had to read it and complete a competency assessment. The ICB (Integrated Care Board) supported shared learning about ligation risk reduction with an independent health hospital which was led to positive changes for the trust. The ICB acknowledged that significant work had been undertaken to reduce the risk of ligatures within the service. At the last assessment we noted that the incidents of absence without leave (AWOL) were unusually high. Leaders learnt from this and took action to mitigate the risk of AWOL. As 10 May 2024 the service made the decision to lock inpatient acute wards doors. Leaders recognised this was a blanket restriction but deemed it necessary to keep patients safe. Due to these actions that has been a reduction in the numbers of absconsions from 63 to 5 episodes between May and November 2024.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients felt safe on the wards and that staff supported them when they had a difficult day and their risks were high. Staff and leaders had a good understanding of safeguarding and what action they needed to take. Evidence of this was found in the care records we reviewed. Ward round meetings discussed any safeguarding incidents. In addition, a weekly safeguarding meeting took place where cases were discussed and to ensure that actions had been taken to keep people safe. Staff were able to explain what action they would take to safeguard patients on the ward. They were confident in making referrals to the local authority and praised the support they got from the wards social work team. Safeguarding information was displayed on patient information boards on all wards. The trust had a robust safeguarding process which leaders from acute services feed in to. All safeguarding issues were fed into the safeguarding adult or children committee for oversight. Data provided by the trust evidenced that there had been a decline in safeguarding incidents since the last assessment. Safeguarding referrals had reduced from 52 referrals in April 2024 to 10 in December 2024. Section 42 reviews (a procedure that local authorities use to investigate concerns that an adult might be at risk of abuse or neglect) had reduced from 11 to 2 in the same time period.

The trust was required by the commission, to take immediate action to ensure that all service user risk management plans were in place, accurate, effective, reviewed as appropriate and updated regularly. The trust met this requirement and are no longer in breach of this regulation. Patients were involved and supported by staff in managing their individual risks and writing their risk assessments. Patients were offered debriefs by staff after risk incidents had occurred on the ward. This was an improvement since the last assessment. Since the last assessment staff felt that managing risks on the ward has improved. Staff interacted with people that were displayed risk behaviours to deescalate and redirected them to keep them safe. Staff completed nursing and zonal observations to not only meet the individual needs of the patients observations of the ward environment. Clinical risk management had improved significantly since the last inspection. Staff completed risk management plans within 24 hrs of admission. Staff used a risk screening tool to help complete this. A safety plan was also written with the patient to identify potential triggers to risk, maladaptive coping strategies and positive interventions. We reviewed 18 case records and all of them had an up to date risk management plan in place that had been regularly reviewed after a risk incident and in ward round.

Patients felt safe on the wards. They recognised that even if the ward was busy staff kept them safe and gave them reassurance. Patient’s possessions were stored in lockable lockers behind a locked door. We saw throughout the inspection that when patients requested their property, staff allowed them access without delay. Staff and leaders had been proactive in addressing the concerns we found at the last assessment. The trust was required by the Commission, to take immediate action to remove or reduce ligature risks and blind spots. They met this requirement and are no longer in breach of this regulation. Ligature risk assessments had been fully reviewed and updated. Areas of high risk where serious incidents had occurred on Ward 33 and 35 had been completely closed and not accessible to staff other than estates and domestic staff. Blind spots had been identified and mitigated against by the placement of convex mirrors. Staff knew where to find electronic and paper copies of the ward ligature risk assessment. In the case of a ligature incident, they also knew where the ligature cutters were stored which they could access easily. Nurses in charge of the shift would delegate the role of zonal nursing observations to ensure that the safety of patients in the ward was optimised. We observed zonal nursing in practice throughout our assessment on the female and mixed sex wards. Staff identified that zonal nursing supported them to keep patients safe and maintain same sex accommodation guidance. However, they were concerned that zonal nursing would be stopped before they had moved to the new building and if this happened risks could increase again. Due to the seriousness of the concerns at the assessment in March 2024 we required the trust to instruct an internal independent review of the physical environment at the Radbourne Unit. The trust has met this requirement and are no longer in breach of this regulation.

Patients felt that staff were always available to them to provide support or complete tasks, even if they were busy. For example, Section 17 leave paperwork or taking them to sessions. We were pleased to hear that patient activities or leave were not cancel due to lack of staffing. Care hours per patient per day was 10.52hrs. This was an improvement since the last assessment. Staff had noticed a positive increase in the number of staff on the ward. Although they acknowledged at times due to sickness or incidents, the number of staff could be lower than the safer staffing levels, this was the exception and not the rule. Leaders had been engaging with staff to review the shift patterns to support breaks whilst on shift. This began with a series of engagement calls and moved to face to face sessions. Staff took breaks when on shift but these were not designated breaks. Staff numbers throughout the assessment met the acuity of the patients on the ward. We observed senior nursing teams working together to support each other to share staff across different units to meet the needs of the patients. Since the last assessment recruitment processes had not changed. However, senior leaders were now more proactive in recruiting of new staff, reviewed the number staff required within each ward to meet the acuity of patients. A review of the safe staffing data highlighted that this was an improving picture. In September 2024 the trust introduced an evidence based establishment review tool for staffing. The vacancy rate for band 5 registered nurses for inpatient wards had reduced by 7% from a vacancy rate of 22% to the current rate of 15%. Whilst band 6 qualified nurses had achieved 18% over their establishment figure to mitigate the vacancy rate with the band 5 staff.

Patients reported that the wards were always clean and tidy. Cleaning records were up to date and staff adhered to infection control principles, including handwashing. The toilets and bathrooms had towel and soap dispensers in place. There was enough clean linen on the wards to change patients bedding when required. Staff knew how to order more linen if their stock levels were low. This was an improvement since the last assessment.

Patients had no concerns about their medication. They were given information about the medication that had been prescribed for them and staff administered on time. Staff adhered to good practice when managing medicines including dispensing, administration, medicines reconciliation, recording and disposal. Staff remained positive about the electronic prescribing system. Medication was reviewed on admission and in ward round. Although if staff noted patients displaying side effects of medication, a review would take place without delay. The service had electronic prescribing in place. We found no issues. They were accurate and completed in line with the trusts policy. Pharmacy staff completed audits to ensure that medicines management was in line with policy. No issues were found in dispensing, administering and reconciliation of medication.