CQC finds East Sussex Hospitals NHS Trust failed to protect the safety and welfare of people who use its services

17 May 2011

Care Quality Commission (CQC) inspectors have found that East Sussex Hospitals NHS Trust is failing to meet a number of essential standards of care for patients.

CQC carried out a review of all five hospitals which make up the East Sussex Hospitals NHS Trust in February this year as part of our routine schedule of planned reviews of NHS organisations.

CQC inspectors reviewed all the information we hold about this provider, carried out visits in February 2011, observed how people were being cared for, talked to people who use services, talked to staff, and checked the provider’s records.

As a result, CQC raised immediate concerns with the trust's chief executive, demanding that the trust address problems identified in A&E, the maternity unit and the wards at Eastbourne District General Hospital and Conquest Hospital in Hastings. Inspectors required the chief executive to, provide plans showing how the trust would improve to meet the essential standards.

Inspectors also identified that there were insufficient numbers of staff available to support proper patient care in some areas, that care plans and risk assessments were not completed or were inaccurate, that patient dignity was compromised by facilities and staff attitudes and that patient rights were not adequately respected.

Eastbourne District General Hospital

At Eastbourne District General Hospital there were major concerns with five essential standards:

Care and welfare of people who use services: Comprehensive assessments of need were not always carried out and appropriately recorded for those patients tracked. Staff could not demonstrate through their nursing records that individual welfare and safety needs were met.

Safeguarding people who use services from abuse: CQC was concerned that staff did not understand adult safeguarding processes and did not recognise signs of abuse and how to raise them with the right person and in a timely fashion. The culture of care and the delivery of treatment in A&E and the wards lacked a personalised approach.

Staffing: There were long and short term staff shortages across the Trust and at all levels including consultants, middle grade doctors, qualified and unqualified nursing and midwifery staff. There was heavy reliance on locums and bank staff. There was clear evidence that this impacting negatively on the quality and safety of the service in the areas that we visited.

Supporting workers: There were inadequate arrangements in place to support staff with annual appraisals and supervision. Staff were not always able to meet the requirements laid down by their respective professional bodies. Not all staff had met their mandatory training needs. Staff reported low morale and not feeling valued by the trust.

Assessing and monitoring the quality of service provision: As a result of the issues identified we were significantly concerned about the effectiveness and efficiency of monitoring and audit arrangements at the trust, and the trust’s ability to accurately assess and monitor the quality of the services being provided.

Conquest Hospital

At the Conquest Hospital in Hastings there were major concerns about meeting seven essential standards:

Respecting and involving people who use services: People using the service were not treated in a way that promotes privacy and dignity. Inspectors observed and noted that involvement of people in care and treatment decisions were not routinely embedded in practice and that there were inadequacies in the amount of information provided to people to inform their choices.

Consent to care and treatment: Not all junior doctors were sufficiently trained or prepared to be able to obtain informed consent from patients. Low numbers of staff were trained in the safeguarding of vulnerable adults, and in the Deprivation of Liberty and Mental Capacity Act. Inspectors heard and observed that care and treatment decisions were routinely imposed upon patients, rather than informed consent being sought.

Care and welfare of people who use services: Comprehensive assessments of need were not always carried out and appropriately recorded for those patients tracked. Staff could not demonstrate through their nursing records that individual welfare and safety needs were met.

Safeguarding people who use services from abuse: CQC was concerned that staff did not understand adult safeguarding processes and did not recognised signs of abuse and how to raise them with the right person and in a timely fashion. The culture of care and the delivery of treatment in A&E and the wards lacked a personalised approach.

Staffing: There were long and short term staff shortages across the Trust and at all levels including Consultants, middle grade doctors, qualified and unqualified nursing and midwifery staff. There was heavy reliance on locums and bank staff.

Supporting workers: There were inadequate arrangements in place to support staff with annual appraisals and supervision. Staff were not always able to meet the requirements laid down by their respective professional bodies. Not all staff had met their mandatory training needs. Staff reported low morale and not feeling valued by the Trust.

Assessing and monitoring the quality of service provision: As a result of the issues identified both across the Trust and specifically within the Conquest hospital we were significantly concerned about the effectiveness and efficiency of monitoring and audit arrangements at the trust, as well as their usefulness in monitoring and changing the quality of the services being provided.

CQC’s inspection team returned to East Sussex NHS Hospitals Trust at the end of April to undertake a further review and confirm that urgent action had been taken to address the major areas of concerns we raised.

By law, providers of care services have a legal responsibility to make sure they are meeting the essential standards of quality and safety. Inspectors will continue to review progress with the trust’s plans to address the areas of concern, including making unannounced visits to the hospital. A further report on the Trust’s progress will be published shortly.

Roxy Boyce, Regional Director of CQC in the South East, said:

“When we visited East Sussex Hospitals NHS Trust in February, we were so concerned about the quality of care provided to patients in many parts of Eastbourne District General Hospital and Conquest Hospital that we raised immediate concerns with the Trust.

“The essential standards of quality and safety laid down in law are the standards of care people should be able to expect in any hospital. These include respecting the dignity of patients, helping them to make informed choices about their care and treatment, ensuring their care and welfare and protecting them from unsafe practice and abuse. The care at East Sussex Hospitals NHS Trust fell far short of these standards.

“When we returned to the Trust in April to review progress, it was clear that the Trust has made considerable efforts to address the outstanding concerns. However, more needs to be done and the progress already made needs to be accelerated and sustained.

“We will continue to monitor their progress extremely closely and will make further unannounced visits. We have a range of enforcement options open to us, including restriction or closure of services, and we will not hesitate to take further action if we consider it necessary.”

Ends

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

Notes to editors