Royal Sussex County Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that women and communities had the best possible outcomes because their needs were assessed. We checked if women’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring women were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

At our last assessment we did not rate this key question. At this assessment we rated effective as requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. We assessed 6 quality statements.

The service was in breach of legal regulation in relation to people’s safe care and treatment. The breach relates to review methods and measures to address changing practice.

Staff did not always have up-to-date guidance to follow legislation and current evidence-based good practice and standards. The trust did not effectively use benchmarking to ensure that outcomes were positive and consistent.

However, women were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Staff worked with agencies involved in people’s care for the best outcomes and smooth transitions when moving between services. They monitored people’s health to support healthy living. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people and took decisions in people’s best interests when they did not have capacity.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed some shortfalls. The service did not always ensure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed newborn risk assessments using recognised tools such as the Newborn Early Warning Trigger & Track (NEWTT2) tool to record observations and feeding.

The department does not currently audit NEWTT2 or Maternity Early Warning Score (MEWS) records as they staff could not add them to record electronically. We were told these needed to be added to the system before audits could be implemented. This meant the department had no assurance that they are completed in line with guidance.

Staff carried out observations for women in line with national guidance. Staff used a nationally recognised tool, the Modified Early Obstetric Warning Score (MEOWS) to identify women of risk of deterioration and escalated them appropriately. We reviewed 8 MEOWS records and staff had completed them correctly, although in one record the correct escalation process had not been followed as concerns had not been raised to senior staff in line with recommendations.

Leaders attended two cross site risk meetings each morning. Staff attended maternity huddles, which were held twice daily 7 days per week. We attended 2 huddles which were attended by midwives, midwifery support workers and doctors. Staff clearly communicated key information. Staff used the Situation, Background, Assessment and Recommendation (SBAR) tool to communicate important information about a patient's condition to their colleagues.

Staff highlighted women’s risk factors such as multiple births, reviews from neonatal teams and patients who required close monitoring due to high blood pressure. These meetings also included information on elective caesarean sections, possible emerging caesarean sections, induction of labour and any possible delays that these women may face. The team also identified women who required safeguarding referrals and discussed staffing levels in other areas such as the labour ward.

Midwives told us they also held mini huddles throughout the day if issues emerged. Staff found the huddles useful and said they helped them to problem solve if there were concerns about a woman’s observations or condition.

Staff carried out risk assessments for women using a standardised risk tool in line with national guidance. These included social assessment, risk assessment for blood clots and mental health assessment. Women’s communication methods were also included in initial assessments to ensure they could access the right care and communication.

Staff made referrals to consultant-led clinics for women with medically high-risk pregnancies. This showed staff were competent to assess and respond to patient risk, and there were reliable systems to support this.

The evidence showed significant shortfalls. Staff did not always have up-to-date guidance which followed legislation and current evidence-based good practice and standards. However, the service planned and delivered people’s care and treatment with them, including what was important and mattered to them.

A clinical and effectiveness team were aligning all guidance and policies in relation to maternity care, to ensure consistency trust wide. There was a clear process and audit of which policies and guidance that needed reviewing, however, there was still a significant back log.

In total there were still 78 outstanding documents that needed approval. Each document went through four separate approval processes, including medicines and consultant review. Staff reported conflicting pressures to be causing a delay. The trust aimed to have the piece of work finished before the end of 2025, however, staff felt more time was needed to complete the project.

Despite having completed an audit of the most important documents to be updated, we saw key policies had not been updated. For example, the obstetric haemorrhage guidance for post-partum haemorrhage (PPH) which were not updated or aligned across the trust. Staff currently use the University Hospital Sussex Obstetric Haemorrhage guidance which was out of date and was not aligned with the most recent National Institute for Health and Care Excellence (NICE) guidance. For example, using the correct dose of misoprostol and a flow chart which did not reflect the most recent safe actions and potions for management of PPH a major obstetric haemorrhage over 1 litre.

Despite the challenges to ratify and update policies the practice development midwives made use of noticeboards to communicate best practice guidance. For example, we saw noticeboards displaying best practice guidance for breastfeeding. Staff had access to guidelines on the trust’s intranet system. There were systems to communicate changes in national guidance through monthly newsletters, departmental alerts, during huddles and presentations to staff. On this assessment we saw this practice was in use.

Audits were not routinely undertaken or embedded within the department. We requested the departments audit schedule but the department did not have one. The department were not currently auditing sepsis cases meaning there is no data on number of cases or any action taken as a result of any increased numbers.

There were specific audits for required national audits, such as perinatal mortality, and Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK). The trust also undertook specific audits for CTG interpretation and use of ‘fresh eyes.’

The division were currently comparing governance data from workstreams related to patient experience, patient safety, risk management, past audits with poor outcomes, and changes from previous quality improvement efforts to implement a new audit schedule. However, at the time of assessment this work had not been completed.

Women were offered a choice of birthing locations and care throughout labour. Although there was no Midwife Led Unit (MLU) at RSCH, women could choose to give birth at St Richards Hospital MLU. We witnessed several discussions between staff about patient’s choice and how they could accommodate them, focusing on the women’s needs.

Staff documented and monitored growth from 24 weeks by measuring and recording the symphysis fundal height (a measurement taken during pregnancy to assess fetal growth) in line with current guidance. There was a clear escalation policy and pathway for any abnormal findings.

There was a breastfeeding room for women to use with breast pumps and a locked fridge to store breastmilk. If women wished to bottle feed, sterilisers were readily available. We saw noticeboards displaying best practice guidance for breast feeding.

We witnessed midwives and obstetricians emphasise the importance of fetal movements to women at each antenatal contact as a method of fetal surveillance. Staff also documented the detail of this conversation in patient records.

Women were given advice on signs of jaundice. The department ran a jaundice clinic from the post-natal ward.

The evidence showed a good standard. The service worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The service was supported by senior clinicians 24 hours a day. A consultant obstetrician was always on site and a senior manager on call from 5pm to 8am. The office had a whiteboard with the contact number of the on-call team who attended when asked to.

Staff could also access the mental health additional support team (MAST) for high-risk women and Juniper teams (for low-risk women) at all times. Staff told us they felt confident to seek assistance at any time of day and night.

Staff, including those in different teams, services and organisations, were involved in assessing, planning and delivering care and treatment. Care was delivered and reviewed in a coordinated way when different teams were involved in patient care.

During the morning risk meeting we heard staff ask if a patient had any existing appointments in different departments within the hospital. If the patient could attend, then the midwives supported them in this. For example, pre-booked scans and consultant appointments.

Staff we spoke to reported positive multidisciplinary working between midwives, midwifery support workers, paediatricians, consultants and other staff. Midwives told us they contacted consultants if they needed advice, for example, around risk assessments, and found most consultants approachable.

We heard examples of community midwives engaging with midwives and consultants on site.

Leaders worked with the local Maternity and Neonatal Voices Partnership (MNVP) to contribute to decisions about care in maternity services. A Maternity and Neonatal Voices Partnership (or an MNVP) is a group of parents, service users, maternity services, commissioners and the local maternity and neonatal system. They work together to review and contribute to the development and improvement of local maternity and neonatal care and ensure that service users’ voices are at the heart of decision-making.

Bereavement services had links with mental health teams (Juniper team) and external support agencies to support women following loss.

The trust offered ‘One stop’ clinics to women to support them if they were from refugee centres. There were also one stop clinics for drug and alcohol misuse families. This enabled women to attend with multidisciplinary input and access multiple services at once. The service also provided some multidisciplinary clinics such as consultant run specialist cardiac clinics.

We saw examples of external working between maternity departments in neighbouring NHS hospitals, for example seeking advice to reduce delay in placental histology being processed.

An infant feeding team were available to provide support with both breast feeding and formula feeding. They offered mothers one to one support in this area. Each bedside had an individual pack designed to support women with colostrum retrieval postnatally. Colostrum is the first form of breastmilk that is released by the mammary glands after giving birth. It is nutrient-dense and high in antibodies and antioxidants to build a newborn baby's immune system.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff offered women support to eat healthily, we saw posters with advice on lowering Body Mass Index (BMI) and healthy eating choices. Women were able to access mental health support with provision for pregnant women and mothers, with referral to psychiatric input if needed.

Specialist midwives offered support and advice to help women who were drug and alcohol dependent and supported women who were trying to stop smoking. Advice, referrals to other services and face to face meetings were offered. In the last 6 months figures showed that 55% of women who had booked in as being smokers were non-smokers at the time of birth.

The evidence showed some shortfalls. The trust did not effectively use benchmarking and targets to ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. The service routinely monitored people’s care and treatment.

There were 2,444 births reported from January 2024 to January 2025 at Royal Sussex County Hospital. Instrumental deliveries accounted for on average 9.3%. The trust did not set a target or benchmark these figures to check for outliers.

Women who underwent an induction of labour accounted for on average 26.98% of births from January 2024 to January 2025. The trust did not set a target, or benchmark these figures to check for outliers, identify any increases or trends in induction numbers.

Figures showed on average that 3.3% of women from January 2024 to January 2025 experienced third or fourth degree tears, this was slightly worse than the national average of 2.8%. It was reported that the total number of women with a blood loss of over 2500ml averaged 9.1%, the trust did not set a target or benchmark these figures to check for outliers.

The born before arrival (BBA) rates at the hospital from August 2024 to January 2025 were on average 1.1%.

Staff regularly audited fetal monitoring. We saw the recording of risk assessments related to fetal monitoring had improved from 59% to 89% in the 3 months before the assessment. Fetal Monitoring training was below trust target with 78.6% of midwifery staff having completed the training and only 55.1% of medical staff.

Required national audits were monitored and benchmarked with other trusts nationally. The service completed thematic reviews when data from national required audits fell below the lower limit or above the upper limit of a data set. Additionally, an annual report was written to understand the overarching themes from the previous year.

The trust took part in the 2023 Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries (MBRRACE) audit and their stabilised and adjusted stillbirth rate is 3.42 per 1,000 total births. This was around the average for similar trusts. The trusts stabilised and adjusted neonatal mortality rate was 2.07 per 1,000 live births. This was more than 15% lower (better) than the average for similar trusts. The stabilised and adjusted extended perinatal mortality rate was 5.50 per 1,000 total births. This was lower (better) than the average for similar trusts.

The service learned from neonatal deaths via a Child Death Oversight Panel. These were then presented to the Board through a series of meetings. Learning was also shared system wide via the Local Maternity and Neonatal System (LMNS) Quality and Safety Forum and the Board.

The evidence showed a good standard. The service told women about their rights around consent and respected these when delivering person-centred care and treatment. Staff knew how to support women who lacked capacity to make their own decisions or were experiencing mental ill health. They used personalised measures that limited patients' liberty.

Staff had access to mental health/deprivation of liberty safeguards (DoLS) guidelines on the trust intranet. Staff were able to talk about DoLS and how this would impact a woman on the unit. Staff were aware of their responsibilities under the Mental Capacity Act 2005.

We saw staff obtained and recorded verbal consent where appropriate, such as before a vaginal examination and written consent was recorded for procedures such as caesarean section.

Staff were seen fully explaining procedures and the associated risks of accepting the treatment or not.

The trust’s consent policy highlighted the duty to appoint an Independent Medical Capacity Advocate for patients when indicated by relevant codes of practice. The policy outlined the use of ‘Gillick competencies’ in relation to children. Gillick competence reflects a child’s increasing development to maturity and that parents cannot overrule the child’s consent when the child is judged to be Gillick competent.