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.
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.