Royal Sussex County Hospital

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We looked for evidence that people were treated with kindness, empathy and compassion. We checked that people’s privacy and dignity was respected and that they understood their experience of how they were treated and supported mattered. We also looked for evidence that every effort was made to take people’s wishes into account and respect their choices, to achieve the best possible outcomes for them.

We reviewed 3 quality statements for the key question Caring. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect. The service was in breach of regulation 10 dignity and respect.

This service scored 60 (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 shortfalls. The service did not always treat people with kindness, empathy, and compassion, or respect their privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect. Staff did not always provide care and treatment in line with peoples wishes and preferences. Patients could not have basic preferences when the department was busy.

Patients told us that staff were caring; however, they were very dissatisfied with the environment they received care in. They told us they were not informed about what was happening and often did not know what they could and could not do due to the number of patients around them. In the CQC 2024 urgent and emergency care survey this trust scored 8.3/10 for respect and dignity which was about the same as similar providers.

Staff communication in the temporary escalation areas was not private and could be overheard during private examinations. Staff were forced to discuss care about patients in front of others due to the number of people in the department and lack of space. This meant their confidential information could be overheard by others.

Family members understood the pressures staff were under and that they were doing their best. However, they told us staff rarely gave accurate information about what was happening with their family member’s care and that this was a major concern for them.

Staff did not always maintain people’s privacy. For example, staff delivered personal care in the temporary escalation area with privacy screens. Patients with limited mobility had to use commodes next to their trolley because of limited capacity. Staff set aside a small area for personal care which was difficult to access in peak times. Patients could access 1 toilet for wheelchair users.

Space was extremely tight in the temporary escalation areas and patients often had their personal space invaded by other patients. Family members saw this happening but understood the circumstances. We saw patients resting their legs onto their neighbour’s trolley when positioned close together.

The service did not give sufficient time for staff to develop trusting relationships with people, their families, friends and other carers. The lack of space meant that a patient’s family or friends were unable to sit anywhere when accompanying their relative or friend.

We saw staff made efforts to ensure that patients received compassionate support. Patients praised staff efforts, and we observed staff working very hard to deliver for patients in exceptional circumstances.

Staff collected feedback through the NHS Friends and Family Test (FFT) survey, which showed that 83% of patients rated their care as good or very good between December 2024 and March 2025. Despite the challenges identified during our assessment, staff continued to deliver good care to some patients. Patients praised staff, the speed at which they were seen, and the quality of care. However, feedback also highlighted concerns that aligned with our observations, including long waiting times, care in temporary escalation areas, and staff appearing overwhelmed. In the CQC 2024 urgent and emergency care survey this trust scored 7/10 for the overall experience which was about the same as similar providers.

The evidence showed some shortfalls. The service did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern, or distress.

Staff showed concern for people’s wellbeing in a caring and meaningful way. However, they could not always respond to people’s needs quickly enough to avoid any preventable discomfort, concern, or distress. For example, patients often waited more than 12 hours in the department and there were no washing facilities to allow them to freshen up if needed. Patients did not have continuous access to water or hot drinks.

Staff did not always answer call bells in a timely manner. Many patients in the major’s temporary escalation areas did not have a call bell to gain the attention of staff. This posed a risk to patient safety in the event of an emergency.

Some patients told us they had missed doses of time critical medications such as antibiotics as there were delays in prescribing medication. Patients told us the overcrowding and long waits were normal for this department and would avoid coming unless they were desperate and had no other option.

Other patients reported feeling frustrated but understood the situation. Patients told us that they could see staff were busy due to the number of patients. They knew that this had led to delays in care despite staff efforts. Family members who needed to leave their relative to find a member of staff found this challenging.

Department managers were visible and helped staff to deal with patients during busy periods. They fully acknowledged that patients were waiting for prolonged periods and had reported these concerns as risks on their daily reports and more widely on the risk register for the department.

The evidence showed some shortfalls. The service did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Patients did not receive safe, effective and person-centred care as the provider did not meet the wellbeing needs of staff. These included the facilities for safe working, such as regular breaks and rest areas. Staff reported feeling exhausted and not listened to by executive leaders. Staff reported that department managers tried to prioritise staff wellbeing but found this challenging due to the demands placed on the department.

In the 2024 NHS Staff Survey, the trust saw a slight increase in staff agreeing the trust takes positive action on health and wellbeing. However, this remained below the national average.

Medical consultants did not feel listened to. Consultants told us they felt isolated, and senior leaders expected them to solve issues such as overcrowding in the department themselves and they did not see a situation where things would improve. During the assessment resident doctors told us they had requested to be moved to a different department as the demands of the job plan adversely effected their mental health.

Nursing staff reported feeling that raising concerns did not have any impact on the situation they were facing. They described the situation as dangerous and the environment not suitable for to provide safe care.

Staff had allocated breaks and areas where they could take this. However, many reported missing their breaks and being unable to stop. They told us that despite their efforts, the demands of the department affected their emotional wellbeing.

Managers, and leaders acknowledged the feelings of staff and shared their frustrations. They aimed to work with them in a personal way and acknowledged the challenges faced. Department managers allowed staff space to speak freely when needed away from the busy department.

Trust leaders continued to work towards the wider Health and Wellbeing Strategy and acknowledged the efforts of their staff during our assessment. Trust leaders had met with medical consultants to better understand the challenges they faced but acknowledged that they were not able to resolve concerns.

The trust offered mental health and wellbeing support services including an external employee assistance programme and wellbeing resources that were signposted on the trust intranet pages.

The trust also provided a Staff Psychological Support Service (SPSS) which prioritised mental health and staff wellbeing through counselling, psychotherapy, and specialist trauma therapy. The SPSS delivered 23 Emotional Resilience and Stress Management preventative education workshops in 2024/25 to build self-awareness and coping mechanisms. Data provided by the trust did not show what percentage of staff from the emergency department had accessed the service.

The service did not have any Trauma Risk Management (TRiM) facilitators. Trauma Risk Management is a systematic, peer-led process used by the NHS to identify and support staff who have been exposed to a potentially traumatic event. However, 16 members of staff are booked to attend TRiM training in April 2025.

Staff told us that the department overcrowding, and heavy workload meant they could not always have protected time to debrief following traumatic care events. The department did have a practice development team who supported staff with their continued professional development.