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 reviewed 3 quality statements for the key question Responsive.

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

At our last assessment we rated this key question requires improvement. At this assessment, the rating has remained requires improvement. This meant people’s needs were not always met through good organisation and delivery.

This service scored 50 (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 make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Patients said they did not feel at the centre of their care and treatment but told us staff did involve them in planning and making shared decisions about their care and treatment. In the CQC Urgent and Emergency Care (UEC) Survey 2024, in relation to the question, ‘were you involved as much as you wanted to be in the decisions about your care and treatment’, the department scored about the same as the national average.

Patients and their relatives told us staff always had good intent and wanted to help even when they were visibly busy.

Staff were not always able to respond to patient’s individual needs and preferences. Staff were meant to undertake risk assessments to identify specific needs such as nutrition, hydration, mobility, falls risk and frailty, but records showed that staff not always complete these.

Staff could not always make reasonable adjustments to help patients access the service due to overcrowding. The department had access to translation services including British Sign Language (BSL) to support patients, loved ones and carers with face-to-face interpreting and translation needs. There was a multi-faith room on the hospital grounds for staff and patients to visit.

Staff were sensitive to multi-faith and dietary needs for staff and patients and supported these preferences when possible. Hot food was not always available unless the patient had been in the department for more than 12 hours. The service offered sandwiches and drinks for a wide range of dietary needs, and we saw housekeeping staff offering these to patients.

We saw interactions between staff and patients attending with complex mental health needs to ensure they stayed settled in the department. Staff monitored risks associated with patients attending with mental health needs and they were cared for in a separate area of the department. They did this with the support of agency mental health nurses. However, their needs were not always met because the environment was not suitable for their mental health needs.

The department had a specialist palliative team for the department who could support patients at the end of their life and provide specialist care. Mental health support workers were available to support patients with dementia in the emergency department. However, dementia champions were not available in the department. Managers told us they planned to recruit dementia champions by the end of 2025.

The department had created a resource for patients living with a learning disability. For example: puzzles, soft toys, colouring books, and board games were available to help pass the time, although we did not observe this being used during the assessment. The learning disability liaison offered staff additional advice and support.

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

The service met the requirements of the ‘Accessible Information Standard’ by identifying, recording, highlighting, sharing and meeting the information and communication needs of people with a disability or sensory loss.

The department had 54 leaflets relevant to the department. These leaflets were created by their Carer and Patient Information Group. The group worked with medical staff to improve the quality of locally produced patient education, purchasing external sources of patient education, and ensuring input from patient representatives and the Equality, Diversity, and Inclusion team.

Leaflets were available in various formats and could be read aloud from electronic devices for sight impaired patients or translated using web browser functions. Translated leaflets could be printed and given to patients if requested. Staff could also use the translation service available on the trust intranet. Leaflets could also be adjusted for font enlargement and specifically tailored for braille.

Patients with hearing impairments had access to a hearing loop and British Sign Language signing was recently added to a short video shown on digital screens in the Emergency Department, called: Why am I waiting? In the CQC 2024 urgent and emergency care survey this trust scored 6.7/10 for hospital environment and facilities which was about the same as similar providers.

Records showed that 95% of eligible staff had received training in learning disability and autism in the 12 months before the assessment and 85% of eligible staff had received training in information governance.

We did not observe any care for patients with a learning disability during the assessment, but staff told us that patients or their carers could download a ‘This is Me’ document from their website. When completed it informed the staff of any adjustments needed when caring for the individual.

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

Patients could not always access care, treatment, and support promptly due to capacity constraints and patient flow across the hospital. Records showed that attendances had increased in 2024. The average total time in the department for admitted patients was higher than the national average in 2024. The number of patients waiting over 12 hours in the department had increased since May 2023. It was higher than the England average and continued to remain this way prior to this assessment.

Patients attending with mental health needs faced delays with a high breach rate of 38.6%, which increased distress and worsened their condition. However, this was often outside the control of the hospital as patients experienced delays waiting for a bed in a mental health hospital.

Demand for emergency services increased overall, with attendances rising by 7.5% in 2024 compared with 2022. During this period, the number of patients waiting more than 4 hours grew, and the trust regularly performed below the England average.

In January 2025, the trust recorded the third-highest number of Type 1 attendances resulting in admission, with a conversion rate of approximately 32%. The trust consistently performed below the national average for 4 hour wait times. It did not meet the aspirational target of 78%, which highlighted a gap in performance.

Performance for the percentage of patients treated within 60 minutes at Royal Sussex County Hospital improved in recent weeks, outperforming both the England and regional averages. However, average total time in the emergency department, both overall and for admitted patients, remained considerably higher than the national average throughout 2024.

Ambulance handover delays over 30 minutes increased at the trust between 2022 and 2024, reflecting ongoing challenges in hospital capacity and ambulance efficiency. The number of delays rose by 19%, from 7,624 in 2022 (excluding January to March) to 9,425 in 2023, and by a further 26% to 12,685 in 2024. This upward trend indicated a decline in performance.

There were concerns about patient flow and delayed handovers within the trust. From January 2023, the percentage of delayed handovers initially reduced, reaching its lowest point in February. However, figures fluctuated throughout the remainder of 2023. From November 2023 onwards, the proportion of delayed handovers began to rise again, with rates ranging between 40% and 50% from May to December 2024.

Bed occupancy pressures impacted patient flow. Between July 2023 and October 2024, there was a sustained increase in the percentage of patients who no longer met the criteria to remain in hospital. This indicated significant pressure on bed availability across the trust, contributing to delays in the department and affecting patient movement.

Patients told us about long wait times they had experienced whilst in the department. Particularly when waiting for admission to a ward. Staff and department leaders told us there was a lack of urgency in wider areas of the hospital to support the emergency department with these delays. The longest wait at the time of our assessment was 36 hours. This did not include patients with mental health needs who waited significantly longer. Patients and their families said that better communication from staff would have helped manage expectations and relieve any uncertainties they had.

Department managers and staff acknowledged that patients could not always access support and treatment promptly due to patient flow and capacity issues. Delayed discharges on wards for patients awaiting social care provision were partly responsible for this. Staff said patient flow issues had become normalised and that this was demoralising. They told us the temporary escalation area and waiting room areas were not safe for patients and posed a risk.

Leaders did not routinely declare critical incidents or escalate concerns related to demand pressures. They told us that safety huddles took place regularly to assess departmental activity and anticipated medical emergencies. However, they only declared a significant incident when the department reached the highest level of pressure. Managers used a colour-coded system to assess and declare the department’s status after each safety huddle. During our assessment, we attended several huddles and observed this process in practice. The scale included five colours: Green, Amber, Red, Purple, and Black, with Black indicating the highest level of demand. Department managers told us that Purple was the most frequently declared status and had become the norm. We reviewed daily shift reports from February 2025, which confirmed this pattern.

Service leaders did not utilise the Operational Pressures Escalation Levels (OPEL) framework level 4 when expected. Department managers told us they rarely escalated to OPEL 4 as intensive care bed capacity was always available to the hospital which was a needed criteria for the enhanced escalation level to occur.

Department managers told us that the oversight of the systems and processes outside of the department that monitored this escalation processes would benefit from review by executive leaders.

Department managers and staff were alert to discrimination and inequality that could disadvantage certain groups of people. Leaders were knowledgeable about the impacts of socio-economic deprivation which affected the local area.

The department complied with equality and human rights requirements, including avoiding discrimination, considering the needs of people with different protected characteristics, and making reasonable adjustments.