Worthing 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 rated effective as good. We assessed a limited number of quality statements in the effective key question and found areas of concern. The scores for these areas have been combined with scores based on the rating for the last inspection, which was good. The service was not in line with some clinical guidelines at the time of our assessment. Senior staff had worked hard to improve working relationships with system partners which supported some of the patient pathways. Staff from different specialities and roles worked together for the benefit of the patient. Staff assessed people, so the care and treatment provided met their needs. Staff worked together and with others when assessing people’s needs, however there were issues with sharing of information with staff not employed by the trust but involved in the patient’s care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff discussed people’s needs with them, and they were involved in how care and treatment was planned. They were confident they had been listened to and understood. Patients being discharged from the emergency department were provided with written and verbal information about contact with their GP, when to return and worrying symptoms to look out for. There were information boards with leaflets about the most common conditions readily available.

Staff used effective tools to support good clinical practice with people who had difficulties with communication. Staff assessed and acted on risks to patients of avoidable harm. Staff worked with other specially trained professionals to support people with additional needs

Records were up to date and showed assessments were undertaken leading to effective ongoing care. However, patients who had shared care and input from the local mental heath trust were at risk as patient notes were kept on separate electronic systems and staff could not see each other’s notes. This lead to a risk of staff not being aware of concerns each team had. This meant that sometimes the care was disconnected and not joined up.

Staff completed additional training such as the Oliver McGowan training which was designed to help staff be able to support patients with autism or a learning disability. Compliance with this training was again variable across the ward and paediatric ED but ranged from 76% to 100%.

The hospital participated in some national audits such as the National Paediatric Diabetes audit. The results from 2023 showed that the completion rate for key health checks for all patients with type 1 diabetes was 79.7%, which was slightly worse than expected when compared nationally. For the case mix adjusted mean HbA1c levels metric (this is an indicator of how well an individual’s blood glucose level is controlled over the preceding 6 to 8 weeks), the hospital was within the expected range.

Children and young people admitted for prolonged periods of time on ED had access to food and drinks.The trust told us that housekeepers visit daily to offer drinks to patients and carers. Hot food was available on the hospital site but not within the ED.

Staff from the emergency department told us about the benefits of having a paediatric emergency (PEM) trainee at the trust and how approachable they were. PEM trainees are recognised as a beneficial addition to paediatric emergency departments as cited in Facing the Future: standards for children in emergency care settings (2018) produced by the Royal College of Paediatricians and Child Health. We saw a play assistant using play as a therapeutic tool to help children feel at ease and to build good relationships during their stay in hospital. However the play specialist role was vacant at the time of our assessment, which meant the play assistant was having to manage the needs of the children’s ward and ED when needed without additional support. Several staff members raised concerns that there was no escalation plan for the paediatric emergency department. The trust provided us with a site-specific operational pressures escalation levels (OPEL) triggers document that detailed the general principles for ensuring patient flow at times of high need, however there was no specific guidance available for the paediatric ED.

The service was not in line with some clinical guidelines at the time of our assessment. Paediatric nursing cover did not match The Royal College of Paediatrics and Child Health (RCPCH) guidelines Recommendation 10: every emergency department treating children must be staffed by two registered children’s nurses on each shift. Following our assessment, an additional nurse was placed on the shift. However, the department was not given additional funding to ensure the extra nurse was provided. This meant that staff had to work together to ensure the second nurse was facilitated without support to do so from the senior leadership team. Staff told us that this had only been possible to achieve due to the collaborative team work within the department but had stretched the team, created additional stress and made them feel undervalued.

The service monitored compliance with some national standards and guidance. This included auditing monitoring of timelines of ED performance and ambulance handover times.The trust used the Paediatric Innovation, Education and Research Network (PIER) approach for recognising symptoms of deterioration. This included the PIER sepsis screening tool.

We requested national clinical audit results including benchmarking against other organisations but did not receive any data.

We did not collect the evidence to score this evidence category

The service worked closely with staff employed by the local mental health trust who provide Childrens and adolescent mental health Service (CAMHS). This is a service that assesses and treats young people with emotional, behavioural or mental health difficulties. Whilst the CAMHS team work closely with University Hospitals NHS Sussex, they are provided by a different NHS trust and therefore are not inspected as part of this assessment.

We saw good examples of staff from different disciplines working together for the benefit of the patient. We spoke to staff who were not based at the Worthing site permanently whether they had been made to feel part of the team and they felt they had.

We spoke to senior staff from the local mental health trust who provided feedback. They told us that they had regular engagement with the trust and that the engagement had improved.

The service had set up a mental health project group with the local NHS mental health trust and the local authority. This group met monthly to discuss key issues affecting the service and its mental health patients. We saw agendas and the relevant action plan resulting from this meeting but no formal minutes were taken.We were aware that the mental health trust had not formally been advised about the change of procedure for mental health patients to Bluefin ward and this meant that staff may not have full oversight of the patient pathway.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not collect the evidence to score this evidence category.

Staff told us that there were plans to create a dashboard through a trust information system on patients with mental health, but this was not in place at the time of our assessment. Staff told us about the struggles they had experienced with regular, targeted audits due to challenges with the electronic documentations system.

The service monitored some patient outcomes. Their emergency re-admission rate which was 4% over a 12 month period, although it was noted that not all of the readmissions directly related to the preceding admission. Some outcomes were not monitored, such as time waiting for patient to see the CAMHS team, or outcome of patients who self discharged prior to their assessment. Following the assessment the trust told us that the time of referral and the time seen by the clinician could be recorded on the electronic reporting system, however they were not planning to routinely audit this. Prolonged delays were escalated to the to the hospital senior management team and discussed on local area system calls.

Children, young people and their families were supported to make informed decisions about their care and treatment. We saw an example on Bluefin Ward where a parent was informed about an upcoming procedure, as the child was to young to provide consent themselves. Staff took time to ensure the parents wishes were taken into account and that they had enough information to make an informed decision.

Staff told us that consent training was included as part of the trust safeguarding training package.

Patient records that we looked at on site showed that staff clearly recorded consent in the children and young people's records.