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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

Before people are given any examination, care, treatment or support, they should be asked if they agree to it (outcome 2)

Meeting this standard

We checked that people who use this service

  • Where they are able, give valid consent to the examination, care, treatment and support they receive.
  • Understand and know how to change any decisions about examination, care, treatment and support that has been previously agreed.
  • Can be confident that their human rights are respected and taken into account.

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

Throughout this hospital people are usually asked for verbal consent prior to an intervention by hospital staff. Explanations are given and most staff take time to ensure people really understand what they are consenting to.

Records do not always clearly document where people may lack capacity to give informed consent and record when decisions need to be made on their behalf.

Consent documentation is not always completed in accordance to policy.

Overall, we judge this hospital to be compliant with this outcome but to maintain this, improvements are needed.

User experience

We spoke to staff who were keen to tell us they were constantly aware how important it was to ask patients what they would prefer and if it was ok to do things. One nurse told us that “people deserve to be treated kindly and you need to ask if it’s ok”.

Patients told us that they were consulted about their care and treatment on a regular basis and that they receive personal care, from staff, in the way in which they wished it to be provided.

Amongst the comments that we received from patients were the following:

“Obviously the nurses are here all the time and, although they are very busy, they will always discuss and explain what they are going to do beforehand – like taking blood’.

‘I see the consultant or one of the other doctors every day. They are usually very good at explaining things like how my treatment is going or any changes to my medication’.

However, a couple of patients said that they didn’t always feel able to disagree with the treatment being proposed and felt they were not always listened to when they raised objections. This was largely due to feeling unsure about the treatment or believing that their opinions were not important or valued by some staff.

Other evidence

During our visit we observed patients being asked for consent prior to staff administering care. We saw and heard staff talking gently to patients telling them what they were going to do and asking if they were happy about it. It was apparent that throughout the hospital there was a culture of recognising the importance of the principles of gaining consent both verbal and at a more formal level when planning clinical interventions.

Throughout the hospital ward managers confirmed that up to date and accurate information regarding their care and treatment is provided to patients. We were told that in cases where a patient lacks capacity and is unable to give consent to treatment, there are various options available including a referral to an Independent Mental Capacity Assessor (IMCA). It was explained that this would often involve holding a multi-agency best interest meeting with the multi-disciplinary team. If it was then felt that a person did not have the capacity to make a decision, they might have a family meeting, and the multi-disciplinary team and family would make the decision. Ultimately, the consultant would be responsible for the decision.

In the majority of individual plans and records that we looked at during our visit, assessments were found to be full and comprehensive and incorporated physical, psychological, social and emotional needs. We also found evidence that MCA, psychological and Deprivation of Liberty (DOLs) assessments are undertaken and Best Interest meetings are held, as necessary.

We spoke to a consultant on Vallance ward who said that a significant proportion of patients on the ward are lacking in mental capacity, but this is not regularly documented. He said that if a patient has family then they would be involved in making decisions about their care, and that increasingly they are involving independent advocates. The multi-disciplinary team is also involved in making decisions, and social workers may be involved with this. He felt that awareness of mental capacity issues in the elderly care department is quite good, partly as a result of learning from incidents in the past.

We looked at patient records throughout the hospital but on Jower Ward we noted that important issues relating to patients treatment and conditions and options had not always been discussed fully with the patient and or their relative when it should have been. Some of the records we saw completed during June 2011 stated that discussions regarding consent issues would take place with the family at the weekend but no further entries had been recorded. It was therefore, not possible to establish if these discussions had taken place and not been recorded or if they had not taken place at all. Other records were not completed fully with counter signatures or in line with policy requirements. These concerns were raised immediately with the ward sister, matron and consultants responsible for the patients on this ward. An immediate review of all patient records on this ward was undertaken and the consultants instigated an instant strategy in place to address the shortfalls. Further measures were put in place to review procedures within other wards and throughout the trust to ensure that all consent documentation is appropriate, current and correctly documented.

The ward manager of Vallance ward told us that a patient is always assumed to have capacity unless there is a reason to think they may not. She said that everyone has the right to refuse treatment. We saw documented examples in a patient’s notes where the patient had declined pain relief, and also where the patient had refused to get out of bed to be weighed.

When we spoke with staff they were knowledgeable about the Mental Capacity Act and their responsibilities for gaining consent both verbal and written. We spoke to a nurse on Lewes ward who confirmed that she had received training in the Mental Capacity Act and consent. She told us that every patient has the right to