Worthing Hospital

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• 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 rated responsive as good. We assessed a limited number of quality statements in the responsive 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 outstanding. People could not always access care and treatment in the department in a timely manner to meet their individual needs. Patients who attended the emergency department who needed admitting as an inpatient, experienced long waiting times in the department.

This service scored 82 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Children, young people and their families were involved in the planning and making shared decisions about care and treatment. Note we looked at showed that care plans were individualised and reflected children and young peoples physical, mental, emotional and social needs, and included input from play assistants and youth workers.

Staff told us that children and adolescents were no longer segregated on Bluefin ward and that this sometimes presented challenges when more complex patients needed to be admitted. Staff described some older patients using language that may not be suitable for younger children to hear. Staff managed this as best as they could and tried to ensure similar age groups were sited near each other. Upcoming development on the site meant that the paediatric ED was due to be moved to some of the adult ED areas with a temporary partition in between. Staff expressed a concern that children and young people may hear distressing sounds from the adult ED without a proper barrier between the two areas.

There was a dedicated breastfeeding room within the paediatric ED, however this was not always available as it was often used as an additional cubicle.Children and young people who remained in the dept overnight or for extended periods of time had access to shower facilities within the mental health area and the clinical decisions unit with the supervision of paediatric nurses, however this could compromise the dignity of a young patient who may be overwhelmed or intimidated by going onto these areas.

Children and young people had access to a youth worker who was committed to ensuring patients received care and treatment that understood the diverse health and social care needs of their local communities. Examples were given of the pressures of social media on adolescents and gang culture.

Staff we spoke with told us they felt that the staffing models were not equitable across all the trust sites. They gave examples of the Royal Alexandra Children’s Hospital in Brighton seeing less or equal acute patients than Worthing Hospital, but with a higher staffing template. Data provided from the hospital showed that whilst the Royal Alexandra Hospital had more attendances overall, Worthing Hospital had a higher number of acuity 1 patients per attendance (1.6% compared to 0.75% at RA).

We spoke with system partners such as the local NHS mental health trust who were aware of the needs of the local community and the pressures put on the system to meet this need. Issues such as lack of access to hospital data systems and patient notes were noted as a barrier to providing seamless care.

The trust and senior leadership team understood the diverse health and social care needs of their local community. They acknowledged that mental health presentation amongst children and young people had increased with 14% more presentations in the previous 6 months compared to the preceding 6 months. Since our last inspection, a dedicated children and young person’s mental health lead nurse had been employed and was working on a pilot with the aim of improving the service for patients and to help with children’s mental health needs and any arising issues .

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

People with mental health needs could not always access care and treatment in the department in a timely manner to meet their individual needs. Patients who attended the emergency department who needed admitting as an inpatient, experienced long waiting times.

It was possible for parents to stay overnight with their children on Bluefin ward as beds next to the children’s bed were available for them to rest or sleep on. These beds could also be moved to the paediatric ED for parents who were waiting in the ED with their children overnight. People could share their experience easily via the trust website or the patient advice and liaison team.

Staff worked hard to remove any barriers to access for patients. However staff from the paediatric ED did express their frustration that often patients who they felt would be better settled on the paediatric ward where there was play areas and enrichment were refused admission to the ward due to their mental health presentation.

The emergency department and paediatric ward was open 24 hours a day all year round. However processes did not support all patients, particularly mental health patients, to access care and treatment from the emergency department when they needed it. The trust told us that the four-hour performance target for mental health presentations has worsened considerably from 69% in July 2023 to 8.3% in July 2024. The trust attributed this decline in performance to the clinical decision to not admit patients with no physical health concerns to Bluefin ward.

Data provided to us from the trust showed that more than half (54%) of patients waiting for more than 12 hours in the ED were mental health patients.

There was no way of auditing the time patients that had been referred to CAHMS were waiting to be seen. The trust told us it had a “data quality issue” with the recording of this data.

The trust monitored the time to triage patients after presenting at ED with a target of 15 minutes or less. The trust told us in July 2024, the average time to triage was 11 minutes, which was better than the target.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.