Let $H^2(\Omega)$ be the Hardy space on a strictly pseudoconvex domain $\Omega \subset \mathbb{C}^n$, and let $A \subset L^\infty(\partial \Omega)$ denote the subalgebra of all $L^\infty$-functions $f$ with compact Hankel operator $H_f$. Given any closed subalgebra $B \subset A$ containing $C(\partial \Omega)$, we describe the first Hochschild cohomology group of the corresponding Toeplitz algebra $\mathcal(B) \subset B(H^2(\Omega))$. In particular, we show that every derivation on $\mathcal{T}(A)$ is inner. These results are new even for $n=1$, where it follows that every derivation on $\mathcal{T}(H^\infty+C)$ is inner, while there are non-inner derivations on $\mathcal{T}(H^\infty+C(\partial \mathbb{B}_n))$ over the unit ball $\mathbb{B}_n$ in dimension $n\gt 1$.

The index theory considered in this paper, a generalisation of the classical Fredholm index theory, is obtained in terms of a non-finite trace on a unital $C^\ast$-algebra. We relate it to the index theory of M.~Breuer, which is developed in a von~Neumann algebra setting, by means of a representation theorem. We show how our new index theory can be used to obtain an index theorem for Toeplitz operators on the compact group $\mathbf{U}(2)$, where the classical index theory does not give any interesting result.