The Care Quality Commission (CQC) are demanding improvements after taking urgent action to keep people safe following an unannounced focused inspection of surgical services at the Royal Sussex County Hospital part of University Hospitals Sussex NHS Foundation Trust.
The inspection in August was prompted following concerns received about the safety and quality of the upper gastrointestinal services surgery at the Royal Sussex County Hospital. The inspection was also to follow up on the progress of improvements that CQC previously told the trust to make in surgical services more widely, when they were issued with a warning notice and urgent conditions were imposed on them to ensure these were done rapidly.
Following the inspection, CQC took urgent action to suspend the activity of planned upper gastrointestinal surgery at the Royal Sussex County Hospital site.
This was a focused inspection and does not impact on the overall rating for the service which remains inadequate overall.
Carolyn Jenkinson, CQC head of hospital inspection, said:
“Following our inspection of surgery at the Royal Sussex County Hospital, I am concerned that our teams have not seen any improvements, particularly in the upper gastrointestinal services. Despite issuing the trust with a warning notice and imposing urgent conditions following our previous inspection to help keep their focus on these areas, the lack of pace means we have taken action to suspend non urgent upper gastrointestinal services surgery at Royal Sussex County Hospital until we are assured that the trust can keep people safe.
The trust leadership need to take ownership of the issues they are facing by having far better governance and tackling the issues we have highlighted. We know the local integrated care system is supporting the trust, as are NHS England. They should use this additional expertise and resources to make the rapid improvements that we need to see.
“Despite the leadership issues that were impacting on wider care, during individual interactions, our inspectors observed nursing staff providing consistent, safe, dignified care. However, there were some who told us that because they were tired and didn’t have enough time to monitor patients, they felt they were letting the people they care for down. Leaders need to listen to staff who are in the best position to help them make the changes needed to make things better.
“We will re-inspect to ensure improvements are being made and won’t hesitate to take further action if needed to protect patients.”
Findings from the inspection included:
All nursing staff on both the gastrointestinal surgical ward and the gastrology ward told inspectors that the wards were short staffed. Although staff were being recruited, shifts were not always fully staffed. Staff said there had been an increase in patient falls and medicine errors which they said were due to staff being tired and not having enough time to effectively monitor and support patients. Some staff felt the staff shortages made them feel they were letting their patients down. Staff told inspectors there was a heavy reliance on agency staff and that the insufficient numbers of experienced staff meant there was not enough support for junior staff
Clinical outcome data for mortality at the Royal Sussex County hospital was twice the national average when compared to other NHS trusts, raising concerns to inspectors.
Nursing staff told inspectors that they felt respected and supported by their immediate leaders and inspectors found them committed to providing the best possible care to their patients.
However, senior medical staff did not share a culture that was respectful or supportive. Inspectors found some of the practices and culture between medical staff were not fully focused on meeting needs of patients.
There were not enough cancer nurse specialists as part of the multi-disciplinary team whose job it was to provide care and support for both upper gastrointestinal and lower gastrointestinal patients. The number of cancer nurse specialists did not enable them to fulfil their job plan. This included not being able to carry out patient reviews, attend clinics and an inability to complete all inpatient reviews.
The number of consultant upper gastrointestinal surgical consultants did not meet the NHS standard contract specifications for cancer: oesophageal and gastric services. To support a safe service, the specifications sets out that a centre carrying out oesphagectomy surgery should have between four to six upper gastrointestinal surgical consultants. At the time of the inspection there were three named upper gastrointestinal surgical consultants, but only two of them had specialist training in oesphagectomy resection surgery. Records showed that it was only these two consultants who carried out oesphagectomy resection surgery.