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 reviewed 4 quality statements for the key question effective. We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support, and treatment reflected these needs and any protected equality characteristics, ensuring people 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.

Care planning did not consistently involve patients or reflect what mattered to them. Routine clinical tools and documentation were often delayed due to workload pressures. Missed or undocumented medication administration posed risks, especially for time-sensitive drugs like insulin and antibiotics. National standards and evidence-based practices were not consistently applied during high-capacity periods. Patients experienced long waits in temporary escalation areas due to bed shortages.

At the last assessment we rated effective good at this assessment our rating went down to requires improvement.

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 plan and deliver people’s care and treatment with them, including what was important and mattered to them.

They did not have good systems for ensuring they kept standards up to date and embedded for the service. There was a main audit programme for ensuring compliance with evidence-based practice and assessment documentation. Results for these audits were among the lowest across the trust.

Staff did not always complete routine clinical tools promptly due to pressures in their workload. Documentation did not always show what medicines patients had received and when. This was a risk as antibiotics and time sensitive medications like insulin were not given when due.

Consultants reviewed clinical guidelines and ensured they were updated. We reviewed the last 3 meeting minutes of the consultants’ meetings and saw that guidelines were allocated to consultants to be reviewed and updated, progress was monitored and reported. At the time of the assessment 46 out of the 73 guidelines had been updated and approved by the trust board. Clinical guidelines were easily accessible via the hospital intranet. However, these may not reflect best practice due to 27 guidelines waiting to be updated and approved by the trust board. Although the department was overcrowded and patients were not always in the most suitable area their treatment plan followed national clinical guidance.

Documentation for the department was a combination of paper and electronic documentation. We reviewed 20 patient records during the assessment. Staff completed care plans that included care needs. However, not all risk assessments were completed. For example, pressure area care or allergy status, next of kin details, naming labels, and mental capacity assessments. This meant that staff did not have all the necessary information to keep patients safe.

The department had vending machines which stocked a variety of food and drinks. Patients were also offered sandwiches and hot drinks periodically during the day. Hot food was not always available unless the patient had been in the department for more than 12 hours. We observed housekeeping staff offering patients food and drinks. In the temporary escalation areas, there were no tables to put water jugs or serve a patient food. Patients who needed assistance to eat and drink waited a long time for a member of staff to have time to help them.

The evidence showed some shortfalls. The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Plans for transfers, referrals and discharge did not consider patients individual needs, circumstances, ongoing care arrangements and expected outcomes. Patients who needed admission remained in the major’s temporary escalation areas and staff monitored them while waiting for a bed to become available in the hospital wards. This meant that patients had to wait long periods of time in the department and did not always receive the care they needed.

The Urgent Treatment Centre (UTC) was in a modular building staffed by GP’s and Emergency Nurse Practitioners (ENP). It was operational between 8am and 11pm 7 days a week. Staff at the UTC told us they felt removed from the main team and were not invited to participate in safety huddles. Staff felt they could be more effective. Patients could be treated and discharged within their area, and they were underutilised and could improve patient flow significantly.

Staff had access to medical speciality teams across the hospital and contacted them to review suitable patients. However, staff did not always have access to the information they needed. The trust used different electronic patient records in some departments which meant medical staff on the wards could not access the information they needed to review and plan care. Doctors told us that at times vital information was missing which led to delays in care.

Once patients had been reviewed by a medical speciality team they became the responsibility of that medical team, with the ongoing support of the emergency department staff. For example, any investigations ordered by the speciality medical team whilst the patient remained in the emergency department, stayed the responsibility of the emergency department to follow up. This meant it added to the workload of staff working within the emergency department.

Patients experienced delays in medical reviews and treatments in the emergency department (ED). However, the medical teams worked collaboratively to review patients waiting in ED by including them in their regular ward rounds but due to the volume of patients to be reviewed often waited a long time.

Staff looking after patients attending with a mental health illness liaised with the psychiatric liaison service run by the local mental health trust. There were significant flow issues with long waits due to mental health bed availability. Staff communicated and escalated concerns when needed with the local mental health trust and gained advice from the psychiatric liaison team, but a lack of flow meant that patients experienced long waits in environments not suitable for their needs.

Multidisciplinary safety huddles happened at regular intervals during the shift. During the assessment we attended safety huddles and noted they were well attended by all disciplines on duty at the time. Risks and issues were discussed in real time and dynamic risk assessments used to flex the staffing according to the risks within the department. These huddles were also used to share positive information such as praising staff and improving metrics such as patient length of stay with the department.

Each shift had an Emergency Physician in Charge (EPIC). The EPIC is a senior clinician responsible for overseeing the overall functioning of the emergency department. They held a daily safety briefing for staff which ran to a planned agenda which included Urgent Treatment Centre usage, incoming ambulances, and resuscitation area capacity.

Clinicians had access to multidisciplinary support to review patients once in the department. We saw multidisciplinary teams working in the department that included, a pharmacy link, integrated discharge team, admission prevention team, mental health liaison services with the local mental health trust, social care teams, urgent community response team, homelessness team, and a virtual ward team.

Clinical nurse specialists attended the department when a patient was referred to their care and we saw staff liaising with them to ensure patients had the most appropriate care.

Staff’s ability to work together as a team within the department was limited due to overcrowding. Staff understood their roles and responsibilities within the department and department managers had oversight of the status of the department in terms of risk while on duty and documented the risk every shift. This form was used to track peaks of activity and inform the leadership team when reviewing incidents and risks in management meetings.

GPs had direct access to acute medicine and frailty teams and the on-duty consultant carried a phone which could be accessed by primary care and ambulance services when needed.

Staff used a computer system to share patient information with other health and care providers. Staff told us it was suitable and GP discharge letters were created and sent within 24 hours of attendance at the department electronically to the GP practice. This ensured that the GP was aware of the patient attending the emergency department and the outcome.

The evidence showed some shortfalls. The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Although there were appropriate referral pathways there were significant delays and blockers on the pathway. This was due to the issues with patient flow throughout the hospital and overcrowding in the department.

Staff carried out a programme of repeated audits to check improvement over time. Clinical educators supported the department in completing, reporting, and sharing outcomes of audits to help improvement. The performance of the department in the audit programme was below the standard expected but there were improvements made in some areas.

We reviewed records of risk improvement meetings. For example, preventable venous thrombus embolism was discussed with an agenda of the number per department, risks and mitigations, success stories and learning. Learning from these meetings were shared via newsletters and team meetings.

We attended part of the emergency department team day. This happened every 6 weeks. There were 12 members of the nursing team attending, there was excellent participation by all members of the team and a high standard of teaching. Learning from complaints and incidents was discussed on the team day.

The department contributed data to three Royal College of Emergency Medicine (RCEM) quality improvement audits (QIP). These were mental health, care of older patients and time critical medications.

Between January and November 2024, the trust recorded rates of unplanned re-attendance within 7 days remained above the national average. The rate peaked in March 2024 at 10.48, compared with the national average of 9.04, reflecting increased pressure during the winter months. Despite elevated rates the trust had not taken action to lower this figure.

The evidence showed some shortfalls. The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Findings from the July 2024 Consent and Capacity Audit. identified that staff demonstrated low compliance below 70% in accurately reviewing expiring legal authorisation records for mental capacity assessments. This shortfall impacted patients’ ability to make informed decisions about remaining in hospital to receive care. In response, the trust implemented a policy change in September 2024, moving from recommending to mandating the use of the mental capacity assessment form for all formal assessments.

Despite this area of concern, the audit reported high levels of compliance in several key areas. Staff consistently identified impairments, completed paperwork accurately, and applied the Deprivation of Liberty Safeguards appropriately. They also maintained clear records of advocacy involvement, respected advanced decisions, and effectively identified risks and care needs. All these areas achieved compliance rates above 80%.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Patients reported that they understood their care in relation to consent.

When patients could not give consent, staff made decisions in their best interest, considering the patients’ wishes. However, some records we reviewed did not have mental capacity assessment documented clearly.

Staff used patient education leaflets produced by an external provider. These were used alongside the trust's own materials to improve the patient consent process. Most leaflets were provided in different languages.