Sussex Partnership NHS Foundation Trust

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• 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

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained the same. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. Governance processes were not robust. Teams did not always use the systems and processes available to ensure they delivered care that was of high quality.

We found the service in breach of regulation 17 as the Trust did not have robust governance processes in place that enabled staff to review the quality and safety of their service effectively and make improvements that were needed. The provider did not have good oversight of medicines management. However, staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff collected and analysed data about outcomes and performance.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Supervision and appraisals were aligned with provider’s vision and values and staff that we spoke with said that they tried to work in line with the values and visions of the organisation. Staff on Pavilion ward told us that they felt the culture on the ward had improved because they felt listened to by their managers.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in these services. There were posters throughout the service displaying the vision and values and staff that we spoke with were able to recall them.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. This included discussions at morning meetings, staff meetings, clinical governance meetings and during appraisal and supervision. Staff, patients, family and carers co-produced part of the strategy that related to suicide prevention.

Staff generally flet happy to work for the trust. For example, staff survey results for 2024 showed a high proportion of staff (87%) reported feeling trusted to do their job, around (79%) felt their managers took positive interest in their wellbeing, and a similar proportion reported having supportive flexible working arrangements.

Staff could explain how they were working to deliver high quality care within the budgets available. The managers on various wards told us that they could refuse an admission if there was concern that there would be a negative impact on existing ward acuity or if they could not meet the needs of the patient. However, managers told us they felt pressured by the bed management team to admit and discharge patients.

Leaders had the skills, knowledge and experience to perform their roles. Each ward had ward manager and matron/operations lead who were familiar with the patient group and were working towards implementing new clinical governance processes into practice. Leaders were supportive of the ward teams and aware of the need to assist them to carry out their roles effectively.

Leaders had a good understanding of the services they managed. They could explain how the teams were working to provide high quality care. Managers were committed to working towards improving both patient and staff experiences.

Staff told us leaders were visible in the service and approachable for patients and staff. Staff told us that they knew who the senior leaders were and that they sometimes walked the wards and encouraged staff and patients to approach them with queries or concerns. However, one staff member told us senior managers were not always supportive and visible on the wards; they did not always support staff, and staff did not feel valued. Two staff members told us they felt the executive team were detached from the wards and the staff team. One staff said they felt stretched and did not have an opportunity to get to know the patients well.

Leadership development opportunities were available, including opportunities for staff. There were leadership courses for managers and nurses, and support workers were encouraged to work towards senior roles.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. The provider had an OT that attended family and carer events and patients were able to feedback to them about the service. Feedback received was about restrictive interventions not being proportionate and patients being bored on the wards due to a lack of varied activities. Patients said they did not have free access to hot/cold drinks and fruits and snacks.

There was a freedom to speak up guardian (FTSU) to support staff to raise confidential concerns.

Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements. The feedback was reviewed and there was an action plan in place which identified areas of concern and plans to address these.

Patients and carers were involved in decision-making about changes to the service. Patients routinely raised issues and suggestions at the community meeting and staff documented these and provided “you said, we did” feedback on a weekly basis. These included patients requesting more gardening activities which had been referred to occupational therapy staff for development.

Patients and staff could meet with members of the provider’s senior leadership team and governors to give feedback. Leaders had an open-door policy and were visible on the ward for patients and staff to speak with them. Senior managers based themselves around different hospital locations so that they were visible and were available to talk to more people and receive feedback about services.

The service employed a diverse team of staff from international backgrounds. Employment practices promoted equality of opportunity. Staff did not raise any concerns about discrimination.

There were equality and diversity champions within the service. Staff were trained in equality and diversity.

Staff were able to apply to work flexibly by requesting working agreements to account for personal circumstances such as caring responsibilities and health issues.

Managers put reasonable adjustments in place for staff members to help them carry out their role. This included supporting staff to reduce their hours to maintain a better work life balance.

The provider undertook equality monitoring of staff within the service to ensure it is diverse in its make-up and representative of the patient group.

The governance system and processes in place were not robust enough at identifying, monitoring and mitigating risks that impacted on the quality and safety of patient care despite managers undertaking and participating in local clinical audits. Ward leaders did not ensure that blanket restrictions were appropriately identified, recorded and routinely monitored. This meant that patients were restricted unnecessarily from having access to food, drinks and other activities of daily living.

Managers on the various wards we inspected did not take a systematic approach to identify, record and challenge practices that may amount to blanket restrictions in relation to food and drinks. Local leaders did not routinely undertake reviews of what each of the blanket restrictions on the wards were to consider whether they were still proportionate.

The wards had identified ligatures, but these were not logged on their ligature risk assessment. For example, there was a pole in the middle of the garden on Amber ward which was not recorded on their risk assessment. Even though the provider had plans to level the tarmac in the garden of Amber ward to reduce the ligature risk it poses, they did not have a timeline or plan of when the work would happen.

The provider’s own oversight did not identify issues we had identified on our previous inspection such as the completion of physical health checks on admission and did not have robust oversight and assurances around medicines management.

We were not assured that managers on Amber and Falmer wards were auditing physical health monitoring. Managers did not have robust oversight of medicines management.

However, the service had recognised that restrictive interventions needed reducing and quality improvement projects had been set up for this.

There was a clear framework of what must be discussed at a ward, team or directorate level to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. There was a monthly clinical governance meeting attended by senior hospital managers divisionally, heads of directorate and directors. For example, staff attended monthly meetings to discuss themes on incidents and learning from the incidents. We saw a copy of a patient leaning bulletin in the nursing office on Rowan and Jade wards.

We observed a situation report (SITREP) meeting at Langley Green hospital safety huddle meeting where staff discussed information about patients’ safety. Managers discussed staffing levels and training across the hospital.

Staff participated in local clinical audits and completed several monthly audits on all wards. Some of the audits completed by staff focused on physical health, the National Early Warning Score (NEWS2), MHA, and observations.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. For example, staff supported patients to access the community mental health teams (CMHTs), crisis team, social services and GP.

Staff maintained and had access to the risk register at ward level. Staff at ward level could escalate concerns when required. We reviewed the risk register during the assessment and saw that it was up to date and contained relevant issues in keeping with the service and it was routinely reviewed and updated.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well and helped to improve the quality of care. Rowan, Maple and Jade wards had access to an electronic white board on which information about patients’ care plans and risk assessments, estimated discharge dates and 132 rights were displayed and updated. This helped staff to easily monitor updates including MHA section expiry dates.

The service had plans for emergencies including adverse weather conditions or flu outbreaks. Business continuity was a standing agenda item on the agenda for staff meetings.

Divisional Directorate leaders engaged with external stakeholders such as commissioners and Healthwatch. Commissioners routinely attended the wards to see specific patients about their care and treatment. The service ensured that they escalated notifications to commissioners following incidents or changes to a patients care and treatment.

Patients and staff could meet with members of the provider’s senior leadership team and commissioners to give feedback. Senior managers told us they visited the wards regularly and were readily available to patients and staff engage with them.

Staff were given the time and support for improvements and innovation projects which led to changes. Millview Hospital held a weekly quality improvement (QI) huddle which was led by a matron. The matron reviewed data which included reducing restrictive practice interventions, rapid tranquilisation and length of stay on the wards. Staff discussed ideas and career development in supervision, appraisal and at team meetings.

Staff told us about a Safewards project they were involved in. Amber ward had engaged in both Safewards and sleep hygiene projects. On Pavilion ward, the team were participating in a quality improvement project for reducing restrictive practices. On Jade ward the staff engaged in a quality improvement project which helped reduce restrictive practice by 70%.

Wards participated in accreditation schemes relevant to the service and learned from them. For example, Amber ward was recently part of Quality Network for PICU and submitted a request for accreditation but did not meet the standard following a review of the service and had to withdraw their submission. The service is working towards resubmitting their standards for accreditation.Pavilion ward was accredited with the RC.Jade ward was undertaking the RCP Accreditation Programme. Jade ward had their Peer review and was working towards successfully gaining full Accreditation.