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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

Reports


Inspection carried out on 16th to 17th October, Well Led 13th to 14th November 2018

During a routine inspection

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.


CQC inspections of services

Inspection carried out on 20 - 22 May 2014

During a routine inspection

East Surrey Hospital is the only hospital that forms Surrey and Sussex Healthcare NHS Trust. This hospital was an acute hospital and provided accident and emergency (A&E), medical care, surgery, critical care, maternity, children and young people’s service, end of life care and outpatient services, which are the eight core services always inspected by the Care Quality Commission (CQC) as part of its new approach to hospital inspection.

East Surrey Hospital had 650 beds and provided a wide range of inpatients medical, surgical and specialist services as well as 24-hour A&E, maternity and outpatient services.

We carried out this comprehensive inspection to Surrey and Sussex Healthcare NHS Trust as an example of a low-risk trust as determined by CQC’s intelligent monitoring system. The inspection took place between 20 and 22 May 2014 and an unannounced inspection visit took place between 6pm to 10.30pm on 6 June 2014.

Overall, this hospital is good but the outpatient service required improvement.

Our key findings were as follows:

  • Staff were caring and compassionate and treated patients with dignity and respect.
  • The hospital was clean and well maintained. The trust’s infection rates for Clostridium difficile and MRSA were within an acceptable range, taking account of the size of the trust and the national level of infections.
  • Patients whose condition might deteriorate were identified and escalated appropriately and the mortality rates for the hospital were within the expected range.
  • The vast majority reported a positive experience to us during our visits. The NHS Friends and Family Test showed the trust performed above the England average between November and February 2014. The A&E friends and family test was above the England average.
  • We found patients were supported to eat and drink, but we found a small number of patients on one ward who had dry mouths and did not have the appropriate documentation completed to indicate they had received mouth care.
  • Nurse staffing levels on the wards were generally satisfactory and staff, although busy, could meet the needs of their patients. There was some reliance on bank/agency or locum staff but this was very well managed and did not have any adverse effects on the delivery of care. The trust was actively recruiting more doctors but faced the same challenges that many trusts in England faced.
  • The maternity service was very busy but was providing good care to women with excellent facilities.
  • The trust consistently met the four-hour waiting time target in the A&E department. The flow of patients within the department was good and we did not witness any patient who had waited over four hours before a decision was made to admit them.
  • We found that patients who were placed in beds on wards that were not their specialism received safe care. There were good processes in place to track these patients and ensure they received the appropriate care and treatment.
  • Critical care services provided safe and effective care. The caring and emotional support as well as the leadership on the unit was exceptionally good.
  • Children received safe and effective care but the environment limited the ability to provide care to adolescents that was individualised to their specific needs. Staffing levels for children were safe and there was good leadership in place.
  • Patients received good quality end of life care. Staff were supported by a specialist palliative care team. Patient care was well managed and we found some excellent examples of care being delivered.
  • Outpatient services required improvement. Patients were treated with compassion, but many appointments were cancelled at short notice and because clinics were so busy, patients often had to wait a long time to be seen. Medical records were often incomplete because notes could not be obtained in time for clinic appointments.
  • Mortality rates were within expected ranges and there were no indicators flagged as being a risk or an elevated risk.
  • Medical records, medical secretaries and ward clerks felt they had not been listened to as much as they could have been and expressed concern about some of the changes that were taking place.
  • Without exception, clinical staff were proud to work for the trust and spoke very positively about the effective leadership within the trust. Staff recognised the significant progress the trust had made, particularly in the past two years. The commitment to the trust was exceptionally good.
  • The work the trust had done on major incident preparedness was good.
  • The trust was focusing on the performance of complaint handling and extra resources had been put into place within some of the divisions. We saw performance was improving and both clinical staff and the executive team were committed to this.

We saw several areas of outstanding practice including:

  • There was very poor mobile signal at the Crawley Hospital site. Relatives were given a bleep that meant they could be contacted if they left the clinical areas. This meant that people were not restricted to stay in one place for long periods of time and could be effectively contacted by staff.
  • The pre-assessment clinic at Crawley Hospital had been extended into the evening in a response to feedback and local demand.
  • We also visited one surgical ward where a patient who had a dementia diagnosis was being cared for. The circumstances around the admission meant that the patients spouse was also admitted to hospital at the same time. This caused anxiety for both patients, especially for the patient living with dementia. This ward identified a two bedded side room and ensured that both patients were kept together to alleviate the anxiety and distress of the rest of their admission.
  • We saw staff wearing “Ask me anything” badges. These badges encouraged patients and their loved ones to engage with staff to improve communication.
  • Staff (including the chaplain, catering and ward staff) had arranged for a patient near the end of life to have a “wedding” with a small party afterwards. The catering staff provided a wedding cake for the celebration. Although there wasn’t time for this to be an official marriage ceremony it was an example of staff working together to meet the individual needs of their patients.
  • The facilities provided for women in the midwife-led birthing unit were outstanding.
  • The care on the neonatal intensive care unit was outstanding. The staff team were committed to ensuring best practice and optimal care for the babies admitted to the unit.
  • We visited Woodland ward within the surgical directorate where we judged the leadership to be outstanding. We saw a very effective multidisciplinary approach to care delivery and consistent commitment to ensuring patients’ individual needs were met.
  • The trust has recognised that their location, close to a major international airport, increased the likelihood of girls presenting in the A&E department with complications of female genital mutilation. The safeguarding implications of this had been incorporated into the training programme.

There were however, also areas of poor practice where the trust needs to make improvements:

Importantly, the trust must:

  • Carry out a review of the outpatient service to ensure there is adequate capacity to meet the demands of the service.
  • Implement a system to monitor and improve the quality of the outpatient service that includes the number of cancelled appointments, waiting times for appointments and the number of patients that do not have their medical records available for their appointment.

In addition the trust should:

  • Review the training provided to clinical staff on the Mental Capacity Act to ensure all staff understand the relevance of this in relation to their work.
  • Ensure that a review of mouth care is undertaken so that staff are clear where this should be recorded in the patients care record.
  • Review the action taken to engage with medical secretaries, ward clerks and medical records staff to ensure these groups feel more included in decisions relating to their role.
  • Review the working environment for the medical records staff.
  • Continue to focus on improving the trusts performance on complaints handling.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Use of resources

These reports look at how NHS hospital trusts use resources, and give recommendations for improvement where needed. They are based on assessments carried out by NHS Improvement, alongside scheduled inspections led by CQC. We’re currently piloting how we work together to confirm the findings of these assessments and present the reports and ratings alongside our other inspection information. The Use of Resources reports include a ‘shadow’ (indicative) rating for the trust’s use of resources.


Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.