CQC find some improvement at University Hospitals Sussex NHS Foundation Trust but more needed

The Care Quality Commission (CQC) has found variation in the quality of improvements University Hospitals Sussex NHS Foundation Trust have been told to make, across maternity and surgical services. Whilst improvements have been found in the trust’s four maternity departments, more urgently needs to be done in surgical services and the emergency department at Royal Sussex County Hospital.

In April CQC carried out an unannounced focused inspection of:

• Maternity services at four of the trust’s hospitals; Worthing Hospital, St Richard’s Hospital, Princess Royal Hospital and Royal Sussex County Hospital to follow up on the progress of improvements. Previously,  maternity services in Royal Sussex County Hospital was rated as inadequate, while Worthing Hospital, St Richard’s Hospital and Princess Royal Hospital were all rated requires improvement and the trust was issued with a warning notice in December last year
• Surgery at Royal Sussex County Hospital to follow up on the progress of improvements after they were rated as inadequate and issued with a warning notice in December last year
• The emergency department, due to concerns raised about the quality of services being provided.

Following this April inspection, CQC found the trust had implemented enough improvements to meet the warning notices in the maternity departments.  However, not enough progress had been made to combat the problems found in surgical services. CQC have imposed conditions in surgery to ensure immediate and urgent action regarding better oversight of risk and quality management of emergency and elective surgery. 

As the inspection of these two services were only to check on the progress of improvements, the ratings for maternity and surgery both remain rated as inadequate.

The overall rating for the emergency department at Royal Sussex County Hospital has moved from good to requires improvement following this new inspection which was prompted as a result of concerns.

Carolyn Jenkinson, CQC head of hospital inspection, said:

“At this inspection we saw a number of improvements at University Hospitals Sussex NHS Foundation Trust’s maternity department, which showed they have met their requirements in the warning notice. The trust still have work to do, but it is positive that so much progress has been made, and we’ll continue to monitor them to make sure these are embedded and built upon.

“We are concerned however, that very little improvement had taken place in surgery at the trust since our last inspection.  Leaders understood the issues that service faced but weren’t always able to manage them. Staff didn’t feel supported and it was worrying that those without the necessary skills, competence and training were caring for patients.

“Although managers told us they were addressing the issue of staff culture, which was something we had previously identified, and an external review had been commissioned, some staff said that they still felt worried about raising issues as they felt it would reflect adversely on them.

“We also found the number of cancellations for emergency surgery worrying. There was a lack of oversight around complications for patients associated with delays and cancellations of emergency surgery. Medical staff we spoke with told us that the management of these wasn’t good enough, meetings were often cancelled and poorly attended.

“This is something we need the trust to resolve as a matter of urgency and with that in mind we have now imposed conditions upon the registration of the trust to ensure immediate and significant improvements are forthcoming.  

 “We identified several areas in the emergency department that the trust needs to address as a matter of urgency. Patients were frequently accommodated in non-clinical areas, including corridors, which didn’t protect people’s privacy and dignity. It was also very concerning that short stay areas didn’t support effective care for patients accommodated there, which included patients with mental health illnesses.

 “We are aware the board are working with NHS England and Improvement and the local CCG who will support the trust in their work to drive these improvements.  In the meantime we will continue to monitor the trust and return to check what further improvements have been implemented and embedded.” 

During the inspection of surgery at the Royal Sussex County Hospital inspectors found:

• Some patients requiring emergency surgery experienced delays and cancellations placing them at risk of further complications. Staff felt there was a reluctance to cancel elective surgery to undertake or prioritise emergency and trauma surgery. The trust told us that no emergency surgery had been cancelled to meet an elective key performance indicator (KPI)
• The service didn’t always have enough nursing and support staff with the right skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment
• Theatres and recovery didn’t have enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. All staff in theatres and recovery spoke of poor staffing and exhaustion. This was the same as our last inspection
• Staff didn’t feel respected, supported and valued and weren’t always clear about their roles and accountabilities.

Throughout the trust’s four maternity departments, inspectors found the following: 

• The trust employed a number of new midwives to ensure safer staffing levels for the care and treatment of women and babies
• Previously staff were unable to complete mandatory training and there wasn’t clear governance around this. The department had made several improvements to ensure completion of mandatory training since our last inspection and staff were now up to date with training in key skills
• Women attending the triage service previously hadn’t been managed on the basis of risk. Instead, individual risks were assessed in a subjective way. At this inspection a nationally recognised triage tool which was audited and based on risk was now being used, meaning women were being treated the same, and in line with best practice
• Midwifery leaders at Worthing Hospital and St Richard’s Hospital and Royal Sussex County Hospital were seen as able and visible to lead and develop the service. Leaders at Princess Royal Hospital were felt to be far less visible and accessible particularly above matron level.

At Royal Sussex County Hospital emergency department inspectors found a number of issues.

The use of the environment didn’t always support keeping people safe:

• Patients were frequently accommodated in non-clinical areas, including corridors
• It didn’t always enable staff to protect people’s privacy and dignity. Discussions between the medical staff and patients weren’t always confidential and discreet, with other patients able to see and hear discussions
• Short stay areas didn’t support effective care for patients accommodated there, which included patients with mental health illnesses
• There were challenges in accessing the service. Poor patient flow throughout the hospital resulted in delays in ambulance handovers. There was an increasing number of patients staying longer than four hours in the department before leaving and an increasing number of patients in the department for over 12 hours after a decision to admit them
• Staff collected safety information, but this wasn’t always accurate. 

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.

Contact information

For enquiries about this press release, email regional.engagement@cqc.org.uk.