The Care Quality Commission (CQC) has told University Hospitals Sussex NHS Foundation Trust that it must make immediate improvements to its maternity and surgical services.
CQC carried out an unannounced focused inspection of the trust’s maternity services during September and October at four of the trust’s hospitals; Worthing Hospital, St Richard’s Hospital, Princess Royal Hospital and Royal Sussex County Hospital. Surgery was only inspected at Royal Sussex County Hospital. The inspection was undertaken in response to concerns received about the safety and quality of the services. These included staff whistleblowing, patient complaints and information from other healthcare partners.
After the inspection, a warning notice was issued to the trust requiring it to take action to ensure significant improvements were made to staffing, training, governance and the overall culture of the services, to ensure the safe care and treatment of patients.
Following the inspection, the ratings for maternity services at Worthing Hospital and St Richard’s Hospital dropped from outstanding to requires improvement overall, and the overall rating for maternity services at Princess Royal Hospital dropped from good to requires improvement. Surgery and maternity at the Royal Sussex County Hospital both dropped from good to inadequate overall.
This is the first rated inspection since Western Sussex Trust merged with Brighton and Sussex NHS Trust in April 2021.
Nigel Acheson, CQC Deputy Chief Inspector Hospitals, said:
“We are acutely aware of the pressure that the NHS is under and how hard staff are working to provide good care for patients. So when staff are brave enough to raise concerns with us, we owe it to them, as well as to patients, to inspect services so there is transparency around the challenges being faced that can lead to increased support and improvement.
”Inspectors saw the impact that staffing shortages were having in both surgery and maternity at University Hospitals Sussex NHS Foundation Trust, with delays in patients accessing emergency surgery, and women in the maternity assessment unit waiting up to six hours to be assessed by a doctor. Midwives told inspectors that they had too many women to care for at one time in the antenatal, postal natal and triage area and they were frightened of missing a deteriorating woman or baby. Staff also told us they often did not have time during their shifts to report patient safety incidents and only reported what they considered to be serious incidents after their shift had finished. They told us they been instructed to stop reporting low staffing as an incident as it was a known risk.
"Staffing shortages are a national problem affecting the health and care system as a whole. However, while some other trusts have put steps in place to mitigate the impact of the risks posed by staffing shortages on patients and staff, this was often not the case at University Hospitals Sussex. We also found that not enough had been done to ensure that staff were listened to when they raised concerns, with the result that they described feeling unsupported and undervalued.
"Other concerns raised with inspectors by staff, or observed by inspectors, included a poor culture - bullying and harassment was reported by some staff - and a perception that leaders were doing little to address concerns. After listening to staff about their experiences working in main theatres and recovery, inspectors had serious concerns about the culture amongst colleagues.
"It was clear that the integration of the different hospital sites was still a long way from being complete - and that this integration would have posed a significant leadership challenge, even without the wider difficulties currently faced by the NHS. We have highlighted areas for urgent local improvement, and the University Hospitals Sussex has developed a detailed improvement plan - but the trust will need also additional support from the wider system in order to overcome these challenges and ensure that its staff are supported to deliver safe, high quality care.”
Throughout the trust four maternity departments, inspectors found the following:
- The departments did not have enough staff to care for women and babies to keep them safe
- Staff were not up to date with training in key skills
- Women attending the triage service were not managed on the basis of risk. Instead, individual risks were assessed in a subjective way
- Midwifery leaders at Worthing Hospital and St Richard’s Hospital were visible and approachable in the department but staff could not always identify other members of the leadership team. The way in which they were having to work to support the service was having an impact on their capacity to lead and develop the service. Leaders at Princess Royal Hospital and the Royal Sussex County Hospital were felt to be far less visible and accessible.
At Worthing Hospital inspectors found:
- Staff morale was low, and the workforce was exhausted
- Staff were not completing daily and weekly safety checks in line with the trust’s policy, or national guidance
- Staff did not always have time to report incidents and when they did, they did not always receive feedback. Opportunities to learn when things go wrong were lost
- Leaders had the skills to run the service but had to take on additional clinical roles in order to support the delivery of safe care. This meant there was a gap in the leadership structure.
At St Richard’s Hospital inspectors found:
- The design and layout of the premises did not ensure women and their babies were safe
- Records were not always clear and easily available to all staff providing care
- Staff did not always receive feedback from incidents across the trust
- Leaders had the skills, but had to take on additional roles to run the service. This meant there were sometimes gaps in the leadership structure
- Staff at all levels were clear about their roles and where they were accountable. But they did not have regular opportunities to meet and learn from the performance of the service.
At Royal Sussex County Hospital inspectors found:
- Not all infection risks were controlled well
- Leaders did not support staff to develop their skills. Staff did not feel respected, supported and valued
- Staff collected safety information, but this was not always accurate.
During the inspection of surgery at the Royal Sussex County Hospital inspectors found:
- Theatre lists often operated with fewer staff than required
- Infection prevention and control practices were not consistently applied Not all staff were up to date with emergency life support training. The service did not manage safety incidents well and did have the time to learn lessons from them
- Mangers were not running services well in order to support staff to develop their skills
- Staff did not feel respected, supported and valued and were not always clear about their roles and accountabilities.
However, inspectors also found:
- Within maternity services, staff always investigated poor outcomes in order to identify opportunities to learn
- Doctors, midwives and other healthcare professionals worked together as a team to provide good care
- Staff treated women with compassion and kindness. Women’s individual needs were taken into account, and they were helped to understand their conditions
- Staff provided emotional support to women, families, and carers. They felt valued by their immediate team members and told inspectors the emphasis on team working brought them pride
- There was a collaborative and respectful relationship between medical and midwifery staff
- Surgery staff were focused on the needs of patients receiving care
- The surgery team engaged well with the community to plan and manage services.
Read the report published on the CQC website:
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