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Provider: Surrey and Sussex Healthcare NHS Trust Outstanding

On 19 January 2019, we published a report on how well Surrey and Sussex Healthcare NHS Trust uses its resources. The ratings from this report are:

  • Use of resources: Outstanding  
  • Combined rating: Outstanding  

Read more about use of resources ratings

Inspection Summary


Overall summary & rating

Outstanding

Updated 18 January 2019

Our rating of the trust improved. We rated it as outstanding because:

  • Patient safety and the patient experience were the dominant thread running through the trust strategy and service delivery.
  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • There was an exceptional culture of data-driven continuous improvement and transformation at the trust, and this was supported by a comprehensive meeting structure and detailed performance reporting processes. The trust’s risk management policy, processes and tools were well designed, albeit there are areas where the format and content of risk registers could be improved.
  • We saw unmistakable evidence of sustained improvement achieved through investment in new facilities and increased capacity that resulted in enhanced effectiveness and responsiveness. This was due to a firmly-embedded and positive culture of openness and transparency, supported by a skilled, stable leadership and clear systems of control and governance.
  • Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The trust facilities and premises were accessible to patients and clearly signposted. Where there were limitations on space within waiting areas staff acted to mitigate risk and the trust was working to improve the environment. Signposting within the hospital had improved since our previous inspection.
  • The trust provided care and treatment in accordance with evidence-based guidance. Evidence-based systems were used for treating very sick patients. Staff were aware of clinical guidance for patients with specific needs or diseases. There was parity in the quality of care given to all patients who attended the department regardless of their health needs.
  • Staff provided care and treatment based on national guidance. Speciality clinics operating within the outpatient department followed relevant national guidance and participated in national and local audits.
  • Care was delivered by staff that were competent, trained and supported by their managers, to provide safe and effective care. The service provided regular training and development opportunities for staff. There were established developmental career pathways for different roles.
  • Patients were treated with compassion, kindness, dignity and respect, when receiving care. Feedback from people who used the service, those who were close to them and stakeholders was positive about the way staff treated people.
  • Staff felt confident they could raise concerns and report incidents, which were regularly reviewed to aid learning. Lessons learned were effectively shared and we saw changes implemented within the wards as the result of investigations.

  • Staff at all levels clearly and passionately described how they met patients’ needs and demonstrated a good awareness of protected characteristics including race, sexuality, and disability. We saw a variety of resources made available to staff to help them support these population groups. We saw flexibility, choice and continuity of care reflected in the service delivered. Staff were well supported by the mental health liaison team and the frailty and interface team.
  • The way the trust supported and encouraged innovation was a real strength. We saw good examples across the divisions and our observations were consistent with positive feedback we received from staff individually and at the focus groups.
  • The trust overall score for the National NHS Staff Survey was in the top 20% for the three years preceding the inspection. In some scores they ranked in the top 4 organisations nationally.
  • The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.

Inspection areas

Safe

Good

Updated 18 January 2019

Our rating of safe stayed the same. We rated it as good because:

  • The trust had arrangements to keep both adults and children safe from abuse which were in accordance with relevant legislation. Staff had received training, were able to identify children and adults who might be at risk of potential harm, knew how to seek support and worked with other agencies.
  • The trust ensured staff that were competent, trained and supported by their managers, to provide safe and effective care. The trust provided regular training and development opportunities for staff. There were established developmental career pathways for different roles.
  • Overall, staffing levels and skill mix was planned, implemented, and reviewed to keep patients safe always. Staff shortages were responded to quickly and adequately. There were effective handovers and shift changes to help ensure that staff managed risks to patients who used the service. Staff recognised and responded appropriately to changes in the risks to patients who used the service. Risks to safety from changes or developments to services were assessed, planned for, and managed effectively.
  • Medicines in outpatients were managed safely. Medicines and prescription pads were kept locked when not in use.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • Staff followed trust policies and best practice with regards to the department’s environment and equipment. Premises and facilities were presented to a high standard, visibly clean and suitable for their intended purpose. Infection control and equipment management were regularly monitored.
  • Records we reviewed demonstrated that the National Early Warning Scoring system was being used consistently and correctly.
  • There was evidence of a strong incident reporting culture and staff felt comfortable in raising concerns. These were investigated, learned from and used to prevent future recurrence.

Effective

Good

Updated 18 January 2019

Our rating of effective stayed the same. We rated it as good because:

  • The trust checked the effectiveness of care and treatment and used the findings to improve them. They took part in relevant local and national audits, and other monitoring activities such as service reviews, benchmarking, peer review and service accreditation. Staff shared up-to-date information about effectiveness internally and externally. Staff understood the information and used it to improve care and treatment and patients’ outcomes.
  • The trust made sure staff were competent for their roles. Staff had the right qualifications and skills to carry out their roles effectively and in line with best practice. Staff received prompt supervision and appraisals of their work performance and they had access to learning and development. The service had a clear and proper approach for supporting and managing staff when their performance is poor or variable.
  • Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. All staff had access to information they need to assess, plan, and deliver care to patients in a prompt way. When there are different systems to hold or manage care records, these were coordinated.
  • Staff understood and recognised that the deprivation of a person’s liberty only occurred when it was in that person’s best interest, was a proportionate response to the risk and seriousness of harm to the person, and there was no less restrictive choice that could be used to ensure the person got the necessary care and treatment. Staff used the Deprivation of Liberty Safeguards, and orders by the Court of Protection authorising deprivation of a person’s liberty appropriately.
  • There was a multidisciplinary approach to patient care. Staff, teams and services worked well to deliver effective care and treatment.

Caring

Outstanding

Updated 18 January 2019

Our rating of caring improved. We rated it as outstanding because:

  • People were treated with compassion, kindness, dignity and respect, when receiving care. Feedback from people who used the service, those who were close to them and stakeholders was positive about the way staff treated people.
  • Staff involved patients and those close to them in decisions about their care and treatment. Patients were satisfied with the information they had been given and was explained in a way they could understand.
  • Patients were given appropriate and timely support and information to cope emotionally with their care, treatment or condition. Staff communicated well with patients so they understood their care, treatment and condition.
  • Complaints were fully investigated and responses reflected this. There was clear evidence that learning was taken from complaints and that learning was shared with the complainant.

  • Staff at all levels clearly and passionately described how they met patients’ needs and demonstrated a good awareness of protected characteristics including race, sexuality, and disability. We saw a variety of resources made available to staff to help them support these population groups. We saw flexibility, choice and continuity of care reflected in the service delivered.
  • The trust coordinated care and treatment with other services and other providers. Facilities and premises were right for the services being delivered.

Responsive

Outstanding

Updated 18 January 2019

Our rating of responsive improved. We rated it as outstanding because:

  • We found patients’ individual needs and preferences were central to the delivery of tailored services. The trust had invested in facilities that led to innovative approaches to providing integrated person-centred pathways of care that also involved other service providers, particularly for patients with multiple and complex needs.

  • Individual patient crisis risk plans were developed by the mental health liaison team for use across the emergency department for those patients who needed it. This meant that staff had an engagement protocol for that patient which had already been approved by the mental health liaison team to meet their needs quickly and help avoid long emergency department admission.
  • Patients could access the service when they needed it, seven days a week. Services ran on time. Patients were kept informed of any disruption to their care or treatment. Trust performance for cancer waiting times was better than the operational standard and the national average in the most recent two quarters.
  • The surgery service worked closely with a national charity that were based in the hospital. When a patient was ready for discharge from the ward, the charity workers would offer a take home and settle service. This ensure that the patient got home safely and had the basics for the initial period back in their own home.

  • There was a noticeable reduction in the amount of ambulance turnaround times of over 60 minutes. Data showed during April, May and June 2018 95% of patients admitted, transferred or discharged within four hours of arrival in the emergency department.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff. It was easy for patients to complain or raise a concern and they were treated compassionately when they did so. There was openness and transparency in how complaints were dealt with. Complaints and concerns were always taken seriously, listened to, and responded to in a prompt way. The service made improvements to the quality of care as a result of complaints and concerns.

Well-led

Outstanding

Updated 18 January 2019

Our rating of well-led improved. We rated it as outstanding because:

  • We saw comprehensive leadership strategies in place, such as the SASH+ programme, which helped promote and sustain the desired organisational culture. We found a skilled, stable and highly visible senior management team that possessed a deep understanding of issues, challenges and priorities affecting their service.
  • All disciplines of staff had a shared focus and purpose to ensuring patients received the best possible care and experience. Staff morale was good, and staff were positive about the overall leadership of the trust.
  • There was a universally held view that the executive management team understood and owned the challenges faced by the emergency department and were focused on implementing system-wide change by holding all partners to account.
  • The trust had an effective process to find, understand, monitor, and address current and future risks. They escalated performance issues to the relevant committees and the board through clear structures and processes. We saw clinical and internal audit processes functioned well and had a positive impact on quality governance, with unmistakable evidence of action to resolve concerns.
  • The trust and service managed financial pressures so that they do not compromise the quality of care.
  • Staff understood candour, openness, honesty, and transparency and challenged poor practice. The service had mechanisms to support staff and promote their positive wellbeing. Behaviour and performance inconsistent with the values were found and dealt with swiftly and effectively, regardless of seniority.
  • The trust had systems and processes in place to engage with patients, staff, the public and local organisations to plan and manage services. Patients had been involved in service improvement activities within the department.