Worthing Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We rated well-led as good. We assessed a limited number of quality statements in the well led 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. We identified breaches of regulation relating to good governance. Staff described a poor culture, felt senior leaders were not focused on patient care and did not listen when staff escalated safety concerns. However, the service had a defined management structure with clear lines of accountability and most staff described a supportive culture at local level. Staff and leaders had worked hard to improve partnerships with key organisations to support care provision and joined-up care.

This service scored 86 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff told us that the culture at department level was supportive, and that staff were willing to speak up, but told us that senior managers did not listen when staff escalated safety concerns. Staff from the ED spoke about invested clinical leads who would battle on behalf of staff to get things done and they felt supported by leads at this level. However, staff from both the ED and Bluefin ward spoke to us about staffing and lack of funding. Staff told us that they felt leaders were not willing to spend money on making the department safer. An example given was when the nursing team in ED were told they needed another member of staff to meet RCN guidance, they thought this would be a funded post, however they had to move staff around and change shift patterns in order to meet the standard without additional staff input. Staff told us this made them feel devalued and had put pressure onto already burnt out staff.Following the assessment, the trust told us that an additional 1.3 WTE post was funded for the overnight shift. The two nurses overnight were supported by adult nurses with additional competency and training.Significant changes to the paediatric ED areas to accommodate building work were due to start. Staff told us they had been disappointed to not be made aware earlier of changes that would affect the waiting area and general flow in their department. Some staff we spoke with had not been informed of the length of time these building works would take.

There was a management structure with clear lines of accountability. However, there was no operational manager at the site for ED, and staff felt this was inequitable compared to other ED sites across the trust. The matron post was vacant on Bluefin ward.

We spoke to several consultants who informed us they had written two formal joint letters to senior leadership to share their concerns about paediatric ED and the risks to patients if staffing and processes did not change. The consultants told us they had never had formal acknowledgment or feedback to their concerns. There was frustration that they had not had feedback and felt they were not being listened to and described feeling disempowered. hey described the management of CAMHS patients was a particular concern. Staff told us they felt let down and that patients were not getting enough care. At the time of the assessment, there had been no formal acknowledgment to the letters sent. However following the assessment, the trust made us aware that a meeting was held with the Chief Medical Officer and the Chief Nurse to discuss these concerns with the consultants. We requested the actions taken following these letters from the trust, but only received a copy of the letter from November 2023 and no actions following this. The letter highlighted a group of consultant paediatrician's concerns about high numbers of children and young people with complex mental health needs. They described the ward environment as non-therapeutic for this cohort of patients and the detrimental impact on other patients whose care they say is compromised and on the nursing team resulting in problems with recruitment and retention. They concluded that they would no longer accept this group of patients if they had no physical health need.

We were sent the staff survey results for Bluefin ward, we did not receive the paediatric ED staff survey results. Only 50% of staff agreed that “When errors, near misses or incidents are reported, my organisation takes action to ensure that they do not happen again” which was worse than the divisional average of 67.4%. There was an action plan to address issues identified on the survey results but this result was not included.

There was a freedom to speak up policy at the trust and the trust had also recently adopted a new independent listening service called ‘The Guardian Service’. This was a service available 24/7 and was provided by an external company.

We spoke to senior nursing staff who told us that they had raised concerns and that they received support from their direct management but that further up the leadership chain they were not being heard. They described how the impact of what they were saying was diluted as it went up through the leadership structure and that the issues were not being heard or acted on.

Staff at all levels described a supportive local team, however, they felt they were not listened to by the senior leadership team.

The senior leadership team acknowledged the staff survey results and that some staff felt that they were not being heard. They had rolled out listening events in other departments and told us that they were hoping to do this for paediatric ED and the childrens ward.

There was a freedom to speak up policy at the trust and the trust had also recently adopted a new independent listening service called ‘The Guardian Service’. This was a service available 24/7 and was provided by an external company.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The senior leadership team told us that risk was managed at trust level, and that the single biggest risk was the workforce, with more jobs than people with gaps in senior nursing roles. They planned to fill the majority of vacancies internally with the rest being sent out to advert, however staff in Bluefin ward told us that the matron post had been vacant for over a year. Following the assessment, the matron post had been filled, following the changes made to the clinical operating model that was ongoing at the time of our assessment.

There was a divisional performance dashboard which monitored various indicators, which included ED performance against trust and national targets, cancer waits and referral to treatment times (RTT). These were also discussed at the divisional board meetings which also monitored risks and complaints. Incidents were managed by the trust under the Patient Safety Improvement Response Framework (PSIRF) methodology, and incidents would be referred to the PSIRF meeting to decide whether it met the criteria for an investigation or after action review (AAR). An AAR forum with divisional representation would then review the actions, where it would be then sent to the Quality Governance Steering group for any learning to be shared. Some of the key documents and standard operating procedures we reviewed were not dated or version controlled. An example of this was the Standard Operating Procedure (SoP) for the nursing management of the paediatric department overnight which had no date effective from or date due to be reviewed by.During the on site assessment there was no evidence of progress against the action plan developed by the trust following the CQC Mental Health Act reviewer’s assessment in November 2023. They found children under 1 to 1 supervision had self-harmed and left the ward areas in the 4 weeks prior to assessment. This meant that children and young people with mental health needs were not always receiving safe care on Bluefin Ward.

Following the on site assessment, we saw evidence that the trust had formulated an action plan following the CQC MHA review assessment in November 2023. An external audit company had been commissioned to review compliance with the MHA, the results of which had not yet been published.

Patients did not express any comments about how the service worked with local communities, however we were aware of patients often experiencing long delays for CAMHS assessments.

There was a divisional performance dashboard which monitored various indicators, which included ED performance against trust and national targets, cancer waits and referral to treatment times (RTT). These were also discussed at the divisional board meetings which also monitored risks and complaints. Incidents were managed by the trust under the Patient Safety Improvement Response Framework (PSIRF) methodology, and incidents would be referred to the PSIRF meeting to decide whether it met the criteria for an investigation or after action review (AAR). An AAR forum with divisional representation would then review the actions, where it would be then sent to the Quality Governance Steering group for any learning to be shared. Some of the key documents and standard operating procedures we reviewed were not dated or version controlled. An example of this was the Standard Operating Procedure (SoP) for the nursing management of the paediatric department overnight which had no date effective from or date due to be reviewed by.

We obtained feedback from system partners, who confirmed that there had been work to improve relationships and examples of collaborative working included jointly creating a standard operating procedure. However it was felt that there was often still a mis-match between expectations from each partner. The work that the local NHS trust provided at the hospital was not a commissioned service and was maintained through an ’informal’ understanding.

The Joint Standard Operating Procedure for the care of Children and Young People attending ED with a mental health need and/or admitted to an acute paediatric ward, with a mental health need had been produced between the trust, the local mental health NHS partnership trust and the local council. It had not yet gone through the full approval process and was awaiting approval and ratification. The procedure set out the aim for the organisations to work collaboratively together for the best possible outcomes for patients experiencing mental health concerns.As this was not yet fully implemented or embedded at the time of our assessment, staff could not be assured the patient was being assessed and treated in the most appropriate area of the unit and this could lead to a delay in treatment or discharge.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.