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CQC carried out a period of listening activity at Brighton and Sussex University Hospitals NHS Trust in December 2013 and January 2014. The report from that exercise, which informed our inspection in May 2014, is available below.

All reports

Inspection report

Date of Inspection: 5 July 2011
Date of Publication: 26 July 2011
Inspection Report published 26 July 2011 PDF | 154.43 KB

People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run (outcome 1)

Meeting this standard

We checked that people who use this service

  • Understand the care, treatment and support choices available to them.
  • Can express their views, so far as they are able to do so, and are involved in making decisions about their care, treatment and support.
  • Have their privacy, dignity and independence respected.
  • Have their views and experiences taken into account in the way the service is provided and delivered.

How this check was done

We reviewed all the information we hold about this provider, carried out a visit on 05/07/2011, checked the provider's records, observed how people were being cared for, looked at records of people who use services, reviewed information from people who use the service, talked to staff and talked to people who use services.

Our judgement

We had concerns relating to the environment which is not conducive to providing privacy and dignity to patients particularly on those wards providing care for elderly people like Jowers and Vallance in the Barry Building. These ward environments are particularly challenging for staff to be able to provide care to patients with the required levels of privacy and dignity.

There was no evidence of information being provided for patients regarding their pathway through A&E and what they could expect from the service provider.

Overall we found The Royal Sussex County hospital to be compliant with this outcome but to maintain this, improvements are needed.

User experience

People who use this hospital said that they felt supported by the staff to receive the care they need. They told us that wherever possible, every effort is made by the staff to help them maintain their mobility, independence and regain confidence to help them live independently when they are discharged. We spoke to many patients and were told that people felt able to express their preferences and that as far as practicable and in accordance with their wishes and individual care plans, people were enabled and encouraged to make choices about their daily lives.

During our visit we spoke with people attending the Accident and Emergency (A&E) and on a variety of wards who had been in the hospital between 2 days and 3 weeks and they told us they were generally very happy with the care provided. They said that they were called by their preferred names with some having a preference for a less formal first name to be used. We saw that staff were wearing name badges identifying their job titles. Patients told us that this was extremely helpful as they could not remember staff names and it was friendlier being able to address people personally.

General observations made by the inspectors throughout the day found that overall staff talked politely, respectfully and treated patients with dignity. Patients told us that they felt involved in their care and goal setting with staff working hard to make sure they were fully informed about their treatment and medication. We asked patients about their care and many of the people we spoke to told us that although they were confident that the doctors and nurses made the right decisions about their care and treatment, they were not always sure that they fully understood all the details. They said that when they asked or needed things explained in more detail the ward staff took time to explain things more clearly and were good at making sure people understood about their illness, their treatments and care. They also said that they were offered choices about many aspects of their daily living wherever practical. They said that staff were happy to do this even when they were busy.

Amongst the comments we received from patients were the following:

“Yes, I do feel that I am involved. Although they are obviously very busy, the doctors and nurses take the time to explain what is happening and I have been kept informed about how my treatment is going. They have told me I’ll be here for another 3 or 4 days’.

“The staff are always busy but very efficient. I am amazed at how well they all do their individual jobs. It is understandable, with the time it takes between one thing and the next that people sometimes have to wait. But the staff here are all friendly and very kind’.

“They have treated me as an individual as far as possible in this set up, in the circumstances”.

We also received positive comments from patients’ relatives, spoken with during our visit:

“I can’t fault the nurses – they are wonderful. They are always very helpful and explain what is happening. It can get very busy in here, as you can see, but the care is always there. They have time for everyone - I don’t know how they do it!

During our visit, we watched staff checking that people were okay, listening to patients’ needs and responding to any concerns. We saw that in the main call bells were placed on beds in easy reach of patients, although on Jowers ward several call bells were found not to be working leaving elderly patients having to attract the attention of staff for assistance.

Patients we spoke to in A&E told us that once they had registered at the reception area they had been asked to wait to be assessed by the relevant health care professional. They told us they had already been assessed as needing further treatment and or diagnosis and been asked to wait in a second waiting room. Patients told us that they had been informed what was going to happen next for example one person knew they were going to have an X-ray, ano

Other evidence

It is clear from discussions that we had with staff throughout the hospital that there is an emphasis and commitment to not only listening to patients but actively involving them in their ongoing care and treatment.

Staff appeared enthusiastic when they told us about procedures in place on the wards, including drawing curtains around patients’ beds, role modelling and acting as patients’ advocates, and said there was a high awareness of privacy and dignity on the wards for examinations. They said this was sometimes difficult given the restraints of the environment. Staff talked about a culture of respecting patients, and during our visit we observed that staff talked to patients respectfully, patiently and in a quiet friendly way. We saw that curtains were closed around patients’ beds when they were receiving treatment and care. Staff talked gently to patients, checking and asking permission before administering care. We observed that staff asked patients regularly if they were okay and if they needed anything. When asked they met patient needs quickly. We observed staff re-positioning patients with care when requested or prior to eating or drinking.

We spoke with a senior Matron who told us that amongst the new initiatives recently introduced on her ward was the ‘patient bedside handover’. This is carried out at the commencement of each shift and directly involves the individual patient regarding their assessed level of care and support. We were told that the handover will establish updated details of the patient’s condition, treatment and provision of personal care. It will also incorporate any outstanding actions and plan for the day ahead, including any scheduled operation, doctor’s review or discharge. It was explained to us that this is in addition to the conventional, office based, team handover, where confidential issues can be discussed. We were able to observe this nursing handover in practice during our visit to other wards.

While we were on Vallance ward we saw a computer on wheels on the ward, which staff told us was used on ward rounds to facilitate doctors accessing patients’ results and being able to input information at the bedside. The ward manager explained to us how patients were involved in consultant rounds, and that multi-disciplinary team feedback was always discussed with patients.

Other welcome developments that we were informed about included the appointments of a Dementia Care Link Nurse and an Older People’s Champion. This demonstrates good practice and should heighten awareness of dementia and related issues. It also enables staff, patients and relatives on the ward to have access to an identified nurse with specialist skills and knowledge, able to provide relevant support, guidance and training, as required.

Written information is made available for patients, relatives and staff both in main areas of the hospital and on the wards, including various notice boards. We saw examples of this including the Older People’s Champion Board and a notice board with contact details and useful information regarding dementia awareness and care. Information regarding chaperones, translating services and advocates was clearly displayed in the A&E departments.

However, through our discussions with staff it was evident that some of these positive initiatives are in danger of ‘losing momentum’. With the acknowledged increase in the number of elderly people requiring care services, including hospital treatment, it is important that the developments that have been introduced are closely monitored and associated improvements that have been implemented can be sustained. Staff we spoke with on various wards were often not aware of these specialists or told us they were only available on weekdays which provided a limited resource to patients, relatives and staff.

During our visit we spoke to a variety of staff who told us that they had received training in patient involvement, privacy and dignity and were fully awa