URGENT and emergency care services at Derriford Hospital have once again been rated ‘requires improvement’ by the Care Quality Commission, despite inspectors recognising clear signs of progress since their last visit.

The October inspection followed up on concerns raised in March 2024, when the department was also judged to require improvement. While inspectors said staff and leaders had worked hard to drive change, overcrowding, long waits and compromised privacy continue to blight the service.

Run by University Hospitals Plymouth NHS Trust, Derriford is the South West peninsula’s largest specialist teaching hospital and the region’s major trauma centre. But sustained demand is piling pressure on its emergency department, affecting both safety and patient experience.

The CQC said the service remains in breach of regulations covering safe care and treatment, dignity and respect, and good governance. The trust has been ordered to produce a clear action plan setting out how it will tackle the issues.

Inspectors re-rated the emergency department as requires improvement for safe and well-led. Caring was downgraded from good to requires improvement. However, effective and responsive were upgraded to good, reflecting better teamwork and improvements in patient flow.

Overall, Derriford Hospital remains rated requires improvement. Effective stays remains good, while the hospital’s caring rating has fallen from outstanding to good as a result of the emergency department findings.

Catherine Campbell, CQC deputy director of hospitals for the South West, said the department had demonstrated a “positive and compassionate culture” with a strong focus on learning. But she warned that relentless demand is undermining consistency.

“The continued high number of people attending the department is placing significant pressure on the service,” she said. “In some cases, this is affecting the consistency and safety of care.”

Inspectors found patients were sometimes left waiting too long for medical reviews, slowing movement through the department. Some were treated on trolleys in corridors due to lack of space – conditions not always appropriate for safe or dignified care. Sensitive conversations could be overheard, and privacy for distressed relatives was limited.

Space constraints were also reported to make it harder for staff to move patients safely and access equipment. The ambulatory care area was described as cramped, with mixed-sex cubicles and minimal privacy.

Concerns were also raised about infection prevention, with staff not always following hand hygiene procedures or changing gloves between patients.

Despite the challenges, inspectors noted encouraging signs. Staff morale appeared relatively strong, with 88% saying they would feel confident raising concerns again – a key marker of an open safety culture. The trust has also built stronger links with community organisations to redirect patients to more appropriate services, helping to relieve pressure on A&E.

Work has begun on a new purpose-built emergency care building, with a four-year construction programme planned. Staff have been involved in shaping the design alongside senior leaders.

Until that facility opens, however, CQC says urgent improvements must continue. The regulator confirmed it will monitor progress closely and return to assess whether standards improve.

University Hospitals Plymouth NHS Trust have been asked for comment, but as yet have not responded.