Royal Sussex County Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that women and communities were always at the centre of how care was planned and delivered. We checked if the health and care needs of women and communities were understood, and if they were actively involved in planning care which met these needs. We also looked for evidence that women could access care in ways which met their personal circumstances and protected equality characteristics.

At our last inspection we did not rate this key question. At this assessment, the rating for responsive was good. This meant women’s outcomes were consistently good, and women’s feedback confirmed this. We assessed 7 quality statements.

Women were involved in decisions about their care. The service provided information women could understand. Women knew how to give feedback and were confident the service took it seriously and acted on it. The service worked to reduce health and care inequalities through training and feedback. Women were involved in planning their care and understood options around choosing to withdraw or not receive care.

However, the service did not always make sure that people could access the care, support and treatment when they needed it.

This service scored 71 (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 a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Women were either referred to maternity services by their general practitioner (GP) or could refer themselves to the hospital. Staff advised women to self-refer before the end of their ninth week of pregnancy to ensure they went through the necessary screening processes.

Women deemed low risk could choose to birth at home or in the hospital labour ward. There was no Midwife Led Unit (MLU) at RSCH although women could be cared for at St Richards Hospital which did have an MLU.

The service had a specialist midwife who would see women who were choosing to birth outside of recommended guidance. For example, multiple births at home. These women were advised about recent guidance and the options available. The team tried their best to support women to make considered decisions. Consultant input could be sought and staff described a good team approach, with the woman’s wishes being the focus.

Women had access to a birthing pool which had recently been refurbished and had integrated lighting to create a calm atmosphere. The pool was available on a first come first served basis.

Birthing rooms on labour ward were made to feel as homely as possible with beds moved against walls and monitors stored outside of rooms to make them less medical. Birthing balls, music and dimmed lighting could all be used to create a calming atmosphere. Staff told us this helped to contribute to normalising birth.

The service maintained one to one care 100% of the time in the past 12 months. This was sometimes achieved by redeploying midwives from other parts of the service, for example the postnatal ward or home birth service. Recent changes in staffing and structure have meant there has been an improvement and that redeploying staff from other areas has reduced.

The service flagged patients who were known to have a learning disability on admission. Details of the specific reasonable adjustments that they may need were recorded. People living with a learning disability were initially assessed using the standard nursing assessment tools. A further learning disability specific risk assessment tool was then used.

Staff routinely used pregnancy and delivery plans to address the mental health and emotional wellbeing of patients. This included past mental health issues and the involvement of specialist teams if required. Mental health issues were part of risk assessments that were frequently undertaken.

The trust provided some specialist services for maternity these included, practice development midwife, perinatal mental health midwife, breastfeeding team, bereavement midwifes and safeguarding midwives.

A teenage pregnancy specialist midwife was in post; their role was to offer extra support and education to younger people who were pregnant. This included ensuring single rooms being offered to younger mothers and parents being able to stay with them at all times.

The service catered for bariatric (high body mass index) patients with wider chairs in the department and beds which could hold patients up to 220lbs. If a further weight limit was needed, a suitable bed from other areas of the hospital could be requested. We also saw specialist equipment in theatres for bariatric use.

The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Women were given a named midwife and contact number on booking, and a named consultant if admitted or considered higher risk. Women told us they could access antenatal and postnatal appointments at a time that suited them and their partners, and staff were pro-active in ensuring this.

Staff could access emergency mental health support 24 hours a day, 7 days a week for women with mental health problems and learning disabilities.

Dedicated triage midwives assessed any risks and signposted women to the most appropriate place for their care, this provided easier access for women to the right maternity care at the right time. This included advice during the antenatal and postnatal periods.

There was a dedicated home birth team. The homebirth team would stay with the women throughout the birth even if the patient was transferred into the hospital setting. We saw a strong collaborative workforce which allowed community and hospital midwives to work effectively both in hospital and in the community. However, at times when there were issues with staffing levels, the leadership team took the decision for the homebirth service to be temporarily stopped. This was to promote safety, by deploying staff to the main hospital wards.

Specialist midwives identified and supported women with specific support that included the needs of the local community. For example, the refugee service, drug and alcohol support and teenage pregnancy. There was a proactive approach to understanding the needs of different groups of people and delivering care that met their needs.

The maternity diabetes service was a multi-disciplinary team (MDT) service jointly run with obstetricians and a Band 7 midwife, with diabetes doctors, specialist nurses and dieticians. The trust also recently held a diabetes education morning.

The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Community midwives identified patients who would need interpretation services at booking. Staff within the hospital were made aware before admission and interpreting services put in place. These were primarily face to face although if this was not available, telephone interpreter services could be accessed.

Staff had access to several relevant leaflets available throughout the maternity wards and departments. The leaflets had information on the back on how to access the information in different languages. Staff told us these were printed off as and when they were needed.

Women received information on mealtimes, medication rounds, and information on baby sleeping positions.

We reviewed the trust website which included a range of information for women and links to a various useful information. This included signposting to external support as well as contact details within the trust for specialist midwives and how to book appointments. Women could also access a virtual tour of the maternity unit.

The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

From January 2024 to February 2025 there were 36 formal complaints about maternity services at RSCH. The complaints involved poor communication, delays, mismanagement of labour, cannula management and care needs not being met. Four of the complaints remained open and were still being investigated.

The findings of the Maternity Services Survey 2024 showed that when women were asked if at any point during their maternity care journey, did they consider making a complaint about the care you received, the service scored 6.7, which was above the national trust average of 6.4, when compared with all other trusts in England.

Patients were involved in their complaints review and the head of midwifery reviewed all complaint responses as well as the initial complaint. Staff always arranged to meet with the complainant wherever possible to discuss their worries in person.

Staff we spoke with said complaints were always taken seriously. We reviewed recent complaints and found they had been responded to in a respectful way. We also heard about recent changes to practice following on from complaints, for example letting partners always stay in the department.

Complaints were discussed from across the trust. The service discussed their complaints and shared the learning from them in regular meetings including the divisional quality governance forum.

The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

The trust’s maternity dashboard showed an average of 71.8% of women receiving antenatal care at RSCH (from August 2024 to January 2025) saw a midwife for their booking appointment by 10 weeks.

The NHS guidance is for a first midwife appointment (also called the booking appointment) to be before the women is 10 weeks pregnant. This is because some tests may need to be done before 10 weeks.

The trust had audited the use of the triage system from October to December 2024. The medical team had seen 56% of women within 2 hours. It also showed that 8% of women waited over 4 hours. However, in 13% of notes there was no documentation of the time of the medical review. The trust had identified an action plan was needed to address the shortfall; however, this had not yet been developed.

The service has recognised concerns about waiting for induction of labour (IOL) and delays to planned caesarean sections. In response there was an updated guideline to be approved and an IOL discussion group had been formed to listen to concerns and explain emerging plans and next steps.

The maternity services in the main hospital building were accessible for wheelchair users via the main lift. However, there were concerns raised that women accessing the separate Sussex House building had to be moved via an uphill road with limited parking.

Women were given a discharge date when they were booked in for a planned caesarean section. This enabled women to plan discharge arrangements and family support if needed. Women we spoke with post caesarean section were aware when their planned discharge date was.

Staff had access to a telephone translation service for women whose primary language was not English. The trust policy indicated not use family and friends to translate. The service tried wherever possible to use face to face translation services, on the day of assessment we witnessed this in practice.

The postnatal ward and Special Care Baby Unit (SCBU) were located near each other allowing easy access. The department had put in measures to ensure women could spend as much time as they wanted with their newborn.

The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Tackling health inequalities was a key priority for the service and part of their clinical strategy. Staff told us about areas of deprivation within their population and the efforts made to include all women and families in the community. This had been particularly useful when providing antenatal care for refugee women housed in the local area.

National feedback identified that black women continue to experience inequalities in care and outcomes. The service used this feedback to help their engagement with black women locally. Leaders monitored outcomes and investigated demographic data to identify when treatment and outcomes differed for different groups of women. Equity in experiences formed part of divisional quality meetings and was part of the work that the Maternal and Neonatal Voices Partnership (MNVP) were involved in.

The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Women were supported to make decisions to improve their overall health. This included stopping smoking and making healthy eating choices.

The department worked with the MNVP to improve the future of the service by including women and their experience to direct future projects.

Women we spoke with felt that their future needs had been considered. The service had a proactive post birth support team that helped women who may need additional support post birth following any traumatic birth.