The Care Quality Commission (CQC) has downgraded the overall rating of University Hospital Sussex NHS Foundation Trust from outstanding to requires improvement after an inspection between October and December showed a decline in the care being delivered to people across several key areas.
At this inspection CQC looked at neurosurgery, children and young people’s urgent and emergency care, as well as management and leadership of the trust. The inspection was in part prompted by whistleblowing concerns from staff.
As well as the decline in their overall rating, how well-led the trust is has declined from outstanding to inadequate. How responsive and safe the trust is has also dropped from outstanding to requires improvement. Effective and caring remain as outstanding. This is the first time the trust has been rated for a well-led inspection since the merger in 2021.
The overall rating for Royal Sussex County Hospital has fallen from good to inadequate as has the hospital’s rating for safe and well-led. Effective remains good, caring remains outstanding and responsive remains requires improvement.
The overall rating for the Princess Royal Hospital has dropped from good to requires improvement as have the ratings for safe and well-led. Effective, responsive, and caring all retain their good rating.
How well-led both Worthing Hospital and St Richard’s Hospital has declined from outstanding to good, although both remain rated outstanding overall. Both hospitals also keep their outstanding ratings for being effective, caring and responsive and their good rating for safety.
Inspectors spoke to over 120 staff during the well-led inspection. A total of 118 staff raised a concern and two provided positive feedback. CQC has continued to receive contact from staff on a regular basis.
CQC have also recommended to NHS England that the trust should be given the highest level of support via their recovery support programme.
Deanna Westwood, CQC’s director of operations in the south, said:
“We carried out this inspection of University Hospitals Sussex NHS Foundation Trust in response to concerns raised with us around culture and leadership.
“At the time of our inspection we found staff on the front line doing their best to provide safe and effective care and treatment, despite significant pressures and a challenging working environment.
“However, staff and people using services were being let down by senior leaders, especially the board, who often appeared out of touch with what was happening on the wards and clinical areas and it was affecting people’s care and treatment.
“Staff told us they felt unable to raise concerns without fear of reprisal, so I want to praise those who were brave enough to come forward anyway, despite those fears. Speaking up in these circumstances isn’t easy but is incredibly important to give us an accurate picture of these services.
“We found a culture developing where safety concerns were normalised, and when a member of staff raised issues about this, leaders focused on an individual’s poor behaviours or performance issues, rather than any systemic failings. This had an impact on the organisation’s ability to address and learn from safety concerns.
“There was a clear disconnect between leaders and staff, leading to this poor and unsupportive culture. The board need to take ownership of this and work with staff to ensure their concerns outlined in our report are addressed.
“It’s also clear the trust needs help to ensure significant improvements in leadership are put in place to give them the support they need. The trust has been receiving support and oversight from key stakeholders after we shared our concerns with them. However, I am recommending to NHS England that the trust should be placed in segment four of the system oversight framework and receive additional support via their recovery support programme. This is the highest level of support that‘s offered and should give the trust the extra help needed to make the required improvements..
“At the time of this inspection the new chief executive had been in post for four months. The board know where they need to improve and we will continue to monitor services closely, including through future inspections to ensure this is rapid and widespread. If this does not happen, we will not hesitate to take further action to keep people safe.”
In neurosurgery services inspectors found:
- The service did not have enough staff to care for people and keep them safe.
- Staff did not always feel respected, supported and valued.
- Staff did not always work well together for the benefit of people. Some consultants did not engage with people using services including sharing information regarding their medical conditions.
- The environment and availability of equipment did not always support safe and effective care and treatment. For example, there were incidents of surgery being delayed due to a lack of imaging equipment.
Trust-wide inspectors found:
- Some staff felt their experiences of bullying and harassment went unaddressed because of the seniority of the staff allegedly carrying out the bullying and because they saw historical working relationships with senior executives as a deterrent to raising their concerns.
- Staff felt there was little point raising concerns because no action was taken when they did.
- Although the trust had responded to the cultural concerns in surgery at the Royal Sussex County Hospital, it has had a limited impact. Some consultants continued to display poor behaviours which meant a lot of staff felt undervalued, unsafe, and unsupported.
- Most staff did not know who the Freedom to Speak Up Guardian was, or how to contact them.
- Staff believed there was a culture of bullying and harassment which pressured them in to making unsafe decisions.
- Minority ethnic staff survey results showed they were more likely to experience poorer outcomes than their white colleagues.