Brighton and Sussex University Hospitals NHS Trust rated Requires Improvement by Chief Inspector of Hospitals

England’s Chief Inspector of Hospitals has rated the services run by Brighton and Sussex University Hospitals NHS Trust as Requires Improvement overall following a Care Quality Commission inspection which rated them as such for safety, responsiveness and leadership, although they were rated Good for effectiveness and for caring.

Inspectors visited Royal Sussex County Hospital, in Brighton, Princess Royal Hospital, in Haywards Heath, and other sites operated by the trust across Sussex, in May to find that, while improvements were still required in a number of areas, significant improvements had been made in the six months since the last visit.

CQC rated Royal Sussex County Hospital as Requires Improvement overall. Inspectors rated the hospital as Requires Improvement for accident and emergency (A&E), medical care, surgery, maternity and family planning, and outpatient services. The hospital was rated as Good for critical care, children’s care and end of life care.

Inspectors also rated Princess Royal Hospital as Requires Improvement overall– as they did A&E and maternity and family planning at that site. All other core services at Princess Royal Hospital were rated as Good by inspectors. The full reports on each site and the overall trust are available here.

Inspectors found that all the services they inspected across the trust were caring and effective. Staff communicated with and supported people in a compassionate way, and patients and their families spoke highly of the care they had received. The senior leadership of the trust were found to be visible and effective and were delivering a significant programme of change and improvement, although work was needed to improve the effectiveness of leadership in some of the services.

The flow of patients from A&E through the hospital was affecting patient care and experience in a number of different departments and wards. Some patients were being treated on wards which were not specific to their condition, and discharge levels were too low to always meet the demand of patients requiring admission.

The trust was taking action to tackle some long standing cultural issues, including race equality, and there were signs that progress was being made. The trust was working on its vision, values and behaviours. Staff were aware of this and said it was making a difference.  The overwhelming majority of staff across the trust said that they were proud of the services they were delivering and of the support they received from colleagues and managers.

Inspectors also identified staffing issues, especially in medicine and surgery. High usage of temporary staff placed pressure on staff - who were not always able to attend training sessions - and meant that patients might not always have their care needs met. The trust had increased its staffing levels, had improved recruitment procedures, and vacancies were being filled much more quickly than previously.

Pressure on the A&E department at Royal Sussex County Hospital was significant, and some other aspects of the Brighton site were presenting significant challenges for care delivery.

Inspectors found a number of areas where the trust must improve, including ensuring that:

• Action is taken to improve patient flow within A&E and across the trust.
• Effective systems are put in place to ensure that urgent referrals are handled in a timely way.
• There is enough suitably skilled and experienced staff to meet the needs of all patients.
• All equipment used for patient treatment or care is regularly checked to make sure it is safe and fit for purpose.
• Discharge planning and arrangements allow people to leave hospital as soon as they are ready to do so, continuing to work with local partners and stakeholders to do so.
• Care planning and delivery on the obstetrics and gynaecology wards meets people’s individual needs.
• Patient dignity is maintained in A&E.
• Trust culture supports staff to work in an environment where they feel supported to raise concerns, where the risk of bullying and harassment is assessed and minimised, and where any issues regarding staff relationships and behaviour are addressed to promote a better environment for staff and patients.

CQC identified several areas of outstanding practice, including:

• Care for patients living with dementia, which was very good at both acute hospitals. Staff had worked hard to provide people with a safe and stimulating environment, awareness had been raised through a trustwide campaign, and a new care pathway had been launched.
• Critical care teams at both acute hospitals, which were strong, committed and compassionate, and received overwhelmingly positive feedback from the public.
• Staff awareness of and engagement with the work that was being done in the trust on values and behaviours.

CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“When we inspected the services run by Brighton and Sussex University Hospitals NHS Trust, we found that – across the board – staff were working hard to deliver compassionate care to people using trust services.

“We found, however, that improvements were required in a number of areas.

I know that there is a significant change programme underway, and we saw that senior managers have a clear understanding of the challenges facing the trust.

“While the new hospital buildings may in time resolve some of the infrastructure issues, these will not rectify the cultural issues that some staff told us about. The trust must focus on these issues as a matter of priority over the coming months.

“We were very pleased at the enthusiasm and openness our inspection received from the trust and its staff. We will return in due course to check that the improvements we have requested have been made.”

Head of Hospital Inspection, Mary Cridge, who led the inspection team said;

“Our inspection found that this was a trust that was tackling some difficult issues with energy and focus. The trust was aware of its challenges and had clear and credible plans in place.

“Although there is a great deal of work to be done to make the improvements that are needed they have already come a long way. Staff are proud of the services they are providing for their patients and patients are receiving care, treatment and support that achieves good outcomes.”

An inspection team which included doctors, nurses, hospital managers, trained members of the public, CQC inspectors and analysts made an announced visit in May. Inspectors also returned unannounced in June.

CQC inspectors will return to the hospital in due course to check that the remaining improvements required have been made.

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