The Care Quality Commission
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  • NHS hospital

Royal Sussex County Hospital

Overall: Requires improvement read more about inspection ratings

Eastern Road, Brighton, BN2 5BE (01273) 696955

Provided and run by:
University Hospitals Sussex NHS Foundation Trust

Important: This service was previously managed by a different provider - see old profile

All Inspections

During an assessment of Maternity

Date of assessment: 26 to 27 February 2025.

The maternity service at Royal Sussex County Hospital (RSCH) forms part of University Hospitals Sussex NHS Foundation Trust maternity services which also includes Worthing Hospital, St Richards Hospital and Princess Royal Hospital. We assessed the maternity services to determine if they had made improvement since our last comprehensive inspection in 2021, when the service at RSCH was rated inadequate. We had also completed a focused inspection in 2022 which was not rated.

We carried out an unannounced assessment of the maternity services at Royal Sussex County Hospital. This assessment was in response to information of concern we received associated with risk within the service.

Following the focused inspection in 2021, we saw improvements, but the service was in breach of regulation 12: safe care and treatment in relation to triage processes and checks on lifesaving equipment. The service had made improvements and was no longer in breach of regulations in relation to this.

Although we saw improvements during this assessment (2025) the service remained in breach of regulations. The overall rating for the Maternity service has improved from inadequate to requires improvement overall.

At this assessment we inspected this service using our single assessment framework and looked at all the key questions and 33 quality statements.

Royal Sussex County Hospital provides obstetric and midwifery services along with community midwifery care. The service includes pre-conceptual care, early pregnancy care, antenatal, intrapartum and postnatal care. The maternity unit includes an early pregnancy unit, obstetric consultant-led delivery suite, maternity assessment centre (triage), and wards for antenatal and postnatal care.

Approximately 9,000 babies are born within the service each year RSCH accounts for 2,444 births reported from January 2024 to January 2025.

We visited the following areas as part of the assessment:

Postnatal and antenatal wards, triage and assessment areas, the early pregnancy unit, the theatre and recovery area and labour suite. We also looked at bereavement facilities, and outpatient areas including antenatal consulting areas and pregnancy scanning.

We spoke with 12 patients and 2 relatives/carers. We reviewed 8 patient records. We spoke with more than 35 staff which included: consultants, resident doctors, midwives including specialist and community-based midwives, matrons, senior leaders, maternity support workers, administration staff, pharmacists, housekeeping staff, and student midwives.

We rated this service as Requires Improvement. We found 5 breaches in regulations. The service was in breach of legal regulation(s) in relation to people’s safe care and treatment and governance.

The breaches related to appropriate management of risks including induction of labour and caesarean section delays, medicines management, safeguarding and the premises at Sussex House. We also found breaches in relation to the governance of the service. The breach was in relation to risks not being addressed in a timely manner, staff access to patient information, assurance through auditing systems, setting of targets and benchmarking processes. Staff could not easily access information in one place on mothers or babies to ensure risks are appropriately managed.

We have asked the provider for an action plan in response to the concerns found at this assessment.

We refer to women in this report, but we recognise that some transgender men, non-binary women and women with variations in sex characteristics (VSC) or who are intersex may also use services and experience some of the same issues.

During an assessment of Urgent and emergency services

Date of assessment 26th and 27th of February 2025

We carried out an unannounced assessment of the Urgent and Emergency Services at the Royal Sussex County Hospital, Brighton. This assessment was in response to information of concern we received associated with risk within the service.

We last assessed Urgent and Emergency Services in 2022 and rated the service as requires improvement.

The service was previously in breach of regulation 12 Safe Care and Treatment and regulation 10 Dignity and respect. Improvements were not found at this assessment, and the service remained in breach of regulations. The rating for Urgent and Emergency Services has been combined with ratings of the other services from the last assessments. The rating of Royal Sussex County Hospital remains requires improvement overall.

We assessed this service using our single assessment framework and looked at all the key questions and 24 quality statements. We visited the major assessment and treatment area, minor assessment and treatment area, mental health assessment area, ambulance arrival area, resuscitation area, patient assessment and triage, ambulatory emergency department and the urgent treatment centre (UTC). We spoke with 40 patients and relatives/carers. We reviewed 20 patient records. We spoke with more than 60 staff which included: leaders of all levels, nurses, doctors, allied health professionals, administrators, paramedics, estates staff, site coordinators, practice educators, health care assistants, GP’s, Emergency Nurse Practitioners, flow coordinators and pharmacy technicians.

We found 2 breaches in regulation in relation to safe care and treatment and privacy and dignity. People waited within the department for long periods of time, the department was overcrowded, and staff could not always track where each patient was. Staff could not always get emergency equipment to patients. Fire exits were blocked; no nominated fire officer and staff did not understand of the evacuation process. It was not possible to clean the floor of the temporary escalation area as there were too many patient trolleys.

People experienced long delays before being admitted to a ward. Seriously unwell patients could not be monitored safely in high dependency areas of the department due to overcrowding. People’s privacy and dignity could not be maintained, and staff could not regularly check the patients’ comfort, skin integrity or ensure patients had enough to eat and drink.

The trust operated local clinical governance processes under the urgent care and medicine triumvirate. A clinical policy group managed monthly meeting agendas. The Acute Floor Directorate oversaw clinical governance and submitted reports to the Divisional Governance Group. In turn, the Divisional Governance Group reported to the Quality Governance Steering Group (QGSG), which the Chief Nurse and Chief Medical Officer jointly chaired.

Following the assessment, we issued a letter of intent about possible urgent enforcement action under section 31 of the Health and Social Care Act 2008 and asked the provider for an action plan in response to the serious concerns found at this assessment. The CQC met weekly with the senior leadership team to monitor compliance with the action plan until June 2025.

During an assessment of the hospital overall

Date of assessment: 26 to 27 February 2025

The Royal Sussex County Hospital is based in Brighton and run by University Hospitals Sussex NHS Foundation Trust. The Royal Sussex County Hospital provides clinical services to people in Brighton and Hove. The hospital is a major trauma and tertiary center for specialist services and provides some specialist services for patients from across the wider Southeast region.

At this assessment we inspected 2 assessment service groups, Urgent and Emergency care and Maternity services. We rated Urgent and Emergency Care as requires improvement and Maternity as requires improvement. The ratings of Urgent and Emergency Care and Maternity have been combined with ratings of other services from the last assessment. Please see reports from previous assessments to get a full picture of the services at Royal Sussex County Hospital. Royal Sussex County Hospital has maintained the rating of requires improvement overall.

At the assessment of Urgent and Emergency Care we found 2 breaches in regulation in relation to safe care and treatment and privacy and dignity.

At this assessment of maternity services, we identified 5 breaches of regulations in relation to safe care and treatment and good governance.

1 to 3 August 2023

During an inspection looking at part of the service

Royal Sussex County Hospital is one of the hospitals of University Hospitals Sussex NHS Foundation Trust. Royal Sussex County Hospital provides clinical services to people in Brighton and Hove. The hospital is a centre for major trauma and tertiary specialist services and provides some specialist services for patients from across the wider South East region.

At this inspection we inspected the surgery and medical care core services at Royal Sussex County Hospital. We found that since the previous inspections in 2021 and 2022, improvements had been made to some aspects of surgical services which resulted in an improved rating. However, there were still improvements required to the surgical services. We found there was a deterioration in the quality and safety of the medical care services since their last inspection in 2019, resulting in a drop in their rating. The improvements in the surgery core service resulted in an improvement of the overall rating for Royal Sussex County Hospital. More detail about the findings and required improvements can be found in the surgery and medical care core service sections of this report.

5 October 2022

During a routine inspection

We carried out this unannounced focused inspection of surgery, focusing on the neurosurgical service at Royal Sussex County Hospital, because we had received information of concern about the safety and quality of the service. We did not rate the service at this inspection. The previous rating of inadequate for surgery services at Royal Sussex County Hospital remains the same.

During the inspection we spoke with staff including managers, nursing staff, theatre staff, medical staff of all grades and senior leaders. We observed the environment and reviewed documents and information provided by the trust as part of the inspection process.

19 December 2022

During an inspection looking at part of the service

We carried out this unannounced focused inspection of the childrens emergency service at Royal Sussex County Hospital because we received information giving us concerns about the safety and quality of the service.

How we carried out the inspection

We looked at 22 patient records, observed activity in the department, spoke with three members of staff and reviewed data provided by the trust.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

11 August 2022

During an inspection looking at part of the service

We carried out an unannounced focused inspection because we received information of concern about the safety and quality of the services.

We inspected the surgery core service, focusing on the upper gastrointestinal service.

We did not rate the service at this inspection. The previous rating of inadequate remains.

Following the inspection, we took enforcement action because the safety of the upper gastrointestinal service required significant improvement. Further detail can be found in the areas for improvement section of this report.

How we carried out the inspection

We carried out this focused inspection on 11 August 2022. During the inspection we spoke with 25 members of staff. This included managers, nursing staff, theatre staff, medical staff of all grades and senior leaders. We reviewed ten patient records and reviewed documents and information provided by the trust as part of the inspection process.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

26 April 2022

During an inspection looking at part of the service

We carried out this unannounced focused follow up safety inspection of maternity services and main theatres at the Royal Sussex County Hospital who are part of the University Hospitals Sussex NHS Foundation Trust on the 26th and 27th of April 2022 because, at our last inspection on the 26 September 2021 we issued a warning notice to make sure the trust made improvements.

Summary of concerns from the warning notice:

  • Lack of sufficient numbers of suitably trained staff to deliver safe services
  • Unsafe storage and administration of medicines
  • Unsecured and non-contemporaneous medical records
  • Poor assessment and response to risk
  • Poor governance processes
  • Infection prevention and control standards were not consistently applied across some areas.
  • The service did not have enough staff to care for patients and keep them safe.
  • Staff did not have training in key skills.
  • The service did not manage safety incidents well and did not always learn lessons from them.

We carried out this return inspection to review compliance to the warning notice issued on the maternity services and main theatres

This inspection has not changed the ratings of the location and our rating of surgical services remains the same.

In addition we inspected the core service of urgent and emergency care following some information of concern. We rated urgent and emergency care as requires improvement because:

  • Not all staff had completed all the trust mandated training in key and essential skills. Not all staff received appraisals.
  • The use of the environment did not always support keeping people safe. Patients were frequently accommodated in non-clinical areas. The use of the environment did not always enable staff to protect the privacy and dignity of patients. The environment of the short stay areas did not support effective care for patients accommodated there, which included patients with mental health illnesses. The environment posed an infection risk as it could not be cleaned effectively.
  • The service was not able to plan and provide care in a way that met the needs of local people and the communities served. The needs of patients in the local community with mental health conditions were not fully met. They were accommodated for lengthy periods of time in an environment that did not fully meet their needs and by staff who may not have the skills to care for the patient.
  • 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.

However,

  • Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well.
  • Staff provided safe emergency care and treatment and gave patients enough to eat and drink, and gave them pain relief when they needed it. Staff worked well together for the benefit of patients and key services were available seven days a week.
  • Staff could call for support from doctors and other disciplines and diagnostic services, including mental health services, 24 hours a day, seven days a week. Consultant rotas were arranged so there was consultant cover in the department 24 hours a day seven days a week
  • Staff treated patients with compassion and kindness and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • Staff felt respected, supported and valued by immediate leaders. They were focused on the needs of patients receiving care.
  • Staff were committed to continually learning and improving services. Staff expressed that their ideas were listened to and acted upon.
  • The service had collaborated with external NHS providers to support safe care and improvements to the service and for patients. This included working with the local mental health NHS trust and the local ambulance NHS trust.

28 September 2021

During an inspection looking at part of the service

We carried out this unannounced focused inspection of maternity and surgery because we received information of concern about the safety and quality of the service. 

Information of concern had been received from several sources about the maternity and surgery services across the hospital. This included staff whistleblowing, patient complaints and information from other regulatory bodies.

We asked the trust to send an anonymous staff survey to give all maternity and surgery staff to give them opportunity to share their experience of working at Royal Sussex County Hospital and to raise and share concerns in a safe and confidential way. The staff survey for was open to staff from 01 to the 15 September 2021. The anonymous results and staff comments have been used as evidence to support our report.

We inspected surgery and maternity and focussed on the safety and well led key questions as the information about the safety and quality we received related to these key questions.

We rated both maternity and surgery as inadequate in both key questions.

Our rating of services went down. We rated them as inadequate because:

The service did not have enough staff to care for patients and keep them safe.

Infection prevention and control standards and practices were not consistently applied across some areas.

Staff did not have training in key skills. Not all staff were up to date with emergency life support training.

The service did not manage safety incidents well and did not always learn lessons from them.

Leaders did not run services well or support staff to develop their skills.

Staff did not understand the service’s vision and values or how to apply them in their work.

Staff did not feel respected, supported and valued. Staff were not always clear about their roles and accountabilities.

However:

Staff have a good understanding of their responsibilities for safeguarding vulnerable people and could demonstrate their knowledge and awareness in this area. However not all staff had up to date safeguarding training.

Medicines optimisation was managed safely.

Staff assessed risks to patients and acted on them

Staff were focused on the needs of patients receiving care.

The service engaged well with service users and the community to plan and manage services.

Staff collected safety information.

University Hospitals Sussex NHS Foundation Trust was formerly called Western Sussex NHS foundation Hospital. It changed its name on 1 April 2021 when it acquired Brighton and Sussex NHS foundation Trust.

The trust has five hospitals – Worthing Hospital, St Richards Hospital, Royal Sussex County Hospital, Princess Royal Hospital and Southlands Hospital – which provide a full range of acute services.

When a trust acquires another trust in order to improve the quality and safety of care we do not aggregate ratings from the previously separate trust at trust level for up to two years. The ratings for the trust in this report are therefore based only on the ratings for Western Sussex NHS Foundation Trust.

Our normal practice following an acquisition would be to inspect all services run by the enlarged trust. However, given we were responding to concerns in the maternity and surgery core services we inspected only those services where we were aware of current risks. We did not rate the hospital overall. In our ratings tables we show all ratings for services run by the trust, including those from earlier inspections and from those hospitals we did not inspect this time.

How we carried out the inspection

During the inspection we spoke to 40 members of staff including maternity care assistants, administrators, nursery nurses, midwives, senior leaders, doctors and anaesthetists, health care assistants, medical students, doctors in training, nurses and allied health professionals. We attended four multidisciplinary meetings, reviewed 18 patients notes and ten prescription charts. We reviewed a variety of data and meeting minutes. Twenty staff have contacted the Care Quality Commission to share their views as they were not able to speak to us on the day of the inspection.  

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.