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Provider: Western Sussex Hospitals NHS Foundation Trust Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 22 October 2019

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

We rated safe, effective, caring, responsive and well-led as outstanding.

We did not inspect all core services. The previous rating for those services we did not inspect were taken into account when working out the overall trust ratings for this inspection.

We rated well-led for the trust overall as outstanding.

The service managed patient safety incidents very well. Staff recognised incidents and reported them appropriately and could discuss the processes involved. Senior staff and leaders were well sighted on incidents and could provide details of specific events and the action taken to mitigate risk and prevent recurrence. There were both trust wide projects and objectives that focussed on safety and local ward and department targets; both were closely monitored to enable the trust to reach their goals. Outside of Patient First methodology, there was evidence that where unexpected occurrences happened (such as a listeria infection contracted from a catering company’s sandwiches), these were reacted to swiftly and effectively. Serious incidents were responded to appropriately; the trust showed a consistent and robust approach to the reporting and investigating of incidents. Timely actions were taken to mitigate risk and learning was embedded across the organisation.

The service used safety monitoring results exceptionally well and participated in the national safety thermometer scheme. Staff collected safety information and shared it with staff, patients and visitors. The trust used information to improve the service through their strategy and quality improvement methodology, Patient First. The trust aimed to reach a 99% score on the patient safety thermometer across all sites. The current score was 98.7 % harm free care.

The trust had a hospital standardised mortality rate (HSMR) of 92. Throughout 2018/2019 they have improved on this to move from the 28th centile nationally to being in the top 20% of trusts in England, in terms of HSMR.

The service-controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. Standards of hygiene and infection rates were monitored to identify any risks and infection rates were low.

Staff kept appropriate records of patients’ care and treatment. Multi-disciplinary, electronic records were clear, up-to-date and available to all staff providing care.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Specialist teams supported ward staff and patients in vulnerable circumstances. Staff were able to provide examples of where they had acted to protect vulnerable patients. The safeguarding team worked closely to identify future risks and ensure triangulation of all aspect of the service provision to ensure safeguarding concerns reported through routes, other than as safeguarding referrals by staff, were identified and acted upon. Safeguarding of people with mental health problems was a particular strength of the trust that had been developed following an incident three years prior to this inspection. The safeguarding team also fed into the Patient First Strategic objectives with areas such as noise at night being considered from a safeguarding perspective because reduced night time noise was seen to result in a reduced need for sedation of people with dementia and a consequent reduction of complications such as falls.

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. The trust had invested in recruitment to maintain and increase staffing levels to ensure ongoing patient safety and high-quality care. There was a strategic objective to reduce medical staff costs through the appointment of more permanent staff and the introduction of innovative support roles. Recruitment of staff was a major challenge to the trust. However, there were systems, including the use of a flexible workforce that ensured there was a match between staff on duty and patients’ needs. We did not identify any areas where staffing challenges impacted negatively on patient care. We did see that the recruitment of additional consultants to the critical care units had enabled better senior medical staff coverage of both the critical care unit and out of hours anaesthetic requirements for the rest of the hospital.

The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance through programmes of audit. Outcomes were generally very good and exceeded the national averages. There was a multidisciplinary and quality improvement approach to improving outcomes. Data was collated and broken down to ward and department level so that local staff knew their own data and could use it to benchmark their own service over time and against similar wards or departments. Ward dashboards were used to show visibly the ward or department performance over time when measured against the True North Objectives. Staff were aware of changes to best practice guidance and talked knowledgeably about recent changes to recommended best practice. The trust had committed to employing and supporting research and academic development in all professions and this was reflected in the staff engagement with published research and using evidence-based practice. One example of this was recently published research which suggested the optimal timing for repositioning people at risk of pressure damage was not two hourly turns as this increased the risk of shearing damage to skin. The trust had not changed their policy in light of this but had invested in hybrid pressure relieving mattresses and were following any changes to the recommendations closely.

The trust made sure staff were competent for their roles. There was a programme of mandatory training and staff had opportunities to develop their skills and gain experience and qualifications to help them do their jobs effectively. Staff education was a real strength of this trust and staff of all grades and disciplines were encouraged to take part in further training and gain additional qualifications. The trust offered Clinical Improvement Scholarships as part of their Clinical Academic Programme in collaboration with Health Education England. The programme aimed to support practitioners to combine their everyday clinical roles alongside development of their research, leadership and continuous improvement experience. Projects completed so far include a physiotherapist developing improved access to optimum care and follow up where women had experienced severe perineal or pelvic floor injury during birth and an occupational therapist working on a two-year collaboration within the trust to prevent the deterioration of elderly patient’s frailty scores.

Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. Electronic records were used effectively and there were electronic systems to ensure patients’ conditions were monitored. The effective use of a trust wide electronic patient observation recording system with an automatic escalation process and oversight by the critical care outreach team had significantly reduced the number of in hospital cardiac arrests by identifying patients whose condition was deteriorating at an earlier stage.

A number of IT systems were in use to monitor and improve care quality including:

  • A single results system for all GPs to access patient test results.
  • An internal single system for results which is used by over 3,000 clinicians
  • A clinical portal is being rolled out alongside other key developments such as e-Handover, self-check-in, and ‘watch list’ to improve, standardise and increase clinical effectiveness.
  • Electronic patient observation, electronic prescribing and medicines administration are all well embedded

Staff cared for patients with exceptional compassion. Feedback from patients and our observations confirmed that staff treated them well and with kindness. Staff at all grades and from all disciplines, including executive staff, were able to recount specific stories where staff had gone over and above the usual expectations to meet patients’ needs and preferences. We heard numerous stories including where a member of nursing staff had been told by a very unwell elderly patient that their dog had been put into kennels and they didn’t know what would happen to it. The nurse completed their shift and then drove around all the local kennels to find the dog and persuade the owners to let them take a picture. The nurse returned, in their own time, to see the patient with a photograph of the dog that they could keep beside their bed. The patient died peacefully, knowing their dog was safe and being well cared for.

Staff involved patients and those close to them in decisions about their care and treatment. Patients said they were given sufficient information and support to make decisions about their care and treatment. The needs and preferences of patients took priority over performance data. We saw examples of where acutely unwell patients requiring high levels of care and who were not expected to live, but who wanted active treatment, were admitted to the critical care unit regardless of the impact on mortality figures. There was a strongly upheld view from all medical and nursing staff that the patients’ wishes were respected and that their needs came first in all decisions.

Staff provided emotional support to patients to minimise their distress, and patients could access a member of a multifaith chaplaincy team to discuss spiritual matters.

The trust planned and provided services in a way that met the needs of local people. They worked collaboratively with other healthcare organisations and patient groups to identify and meet local needs. The trust had an active patient experience and engagement committee which included staff, stakeholders and governors.

Generally, people could access the service when they needed it. Waiting times from referral to treatment usually met government standards and met the current commissioning targets. The arrangements to admit, treat and discharge patients were in line with good practice. The trust had a comprehensive suite of daily reports, for patient level operational review, including trend analysis.

The accident and emergency departments performed highly against the national averages. Western Sussex Hospitals accident and emergency four hour target performance was 92% in April 2019, compared to a national average of 85%

The service took account of patients’ individual needs. There were specialist teams to support those with additional needs, for example those living with dementia or those in vulnerable circumstances.

The trust board had the appropriate range of skills, knowledge and experience to perform its role. Non-executive directors were exceptionally well informed and had a sound understanding of the Patient First Strategy. They had received training in quality improvement and were able to articulate how reporting to the board was underpinned through the methodology. They knew the detail that allowed effective strategic oversight and challenge; for example, the chair was able to tell us how they had been informed about a serious incident involving a third-party catering provider and what the action had been to mitigate further risk.

The trust had a senior leadership team in place with the appropriate range of skills, knowledge and experience. The executive team were supporting another NHS trust to improve. In the relatively short time they had leadership of the other trust, there had been significant improvements without having any detrimental impact on the services at Western Sussex Hospitals NHS Trust. We noted the converse to be true; staff at Western Sussex had more opportunity to take on additional leadership responsibilities and more staff from all disciplines had increased developmental opportunities.

The organisational values were embedded, and staff could give examples of how they guided them in their work.

The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community. The trust had recently reset its strategy, mission strategic objectives and these were well understood by staff.

The trust used a systematic approach to continually improve the quality of its services and protect high standards of care by creating an environment in which excellence in clinical care flourished. The trust collected, analysed, managed and used information well to support all its activities. The trust was assured of its data quality. Performance dashboards were produced so that progress against any key performance indicators could be identified and tracked. There was appropriate oversight and challenge to the divisions through a system of senior review.

The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively. Patients were involved in production of pathways of care and other initiatives. There were arrangements for staff to register concerns or to highlight areas of exceptional practice or achievement.

There was exceedingly high ‘buy in’ from staff across the trust to the Patient First strategy and methodology. Staff felt engaged and proud to work for the trust. Results of a pulse survey in June 2018 showed that 93% of staff recommended the trust as a place to work and 97% recommended the trust as a place to be treated. The level of engagement was such that a large team of staff, including the chief executive and chief nurse, completed a climb of Ben Nevis to raise funds for improvements to facilities for patients living with dementia.

The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation. The trust had designed its quality objective to support the overall aim of becoming a learning organisation. There was a strong culture of quality improvement with staff trained in and carrying out quality improvement projects. Quality improvement using the Patient First methodology was highly visible throughout the trust and was known by all staff.

The trust remained on trajectory to deliver an underlying surplus of £2.5m at the end of the financial year. Delivery of this surplus will enable receipt of an additional £11.6m of Provider Sustainability Fund (PSF) and marginal rate rule for emergency admissions (MRET) income achieving the year-end control total of £14.1million.

Inspection areas

Safe

Outstanding

Updated 22 October 2019

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

There were comprehensive systems to keep people safe, which took account of current best practice. All staff were engaged in reviewing and improving safety and safeguarding systems through regular safety and improvement huddles. People who used services were at the centre of safeguarding and protection from discrimination.

Innovation was encouraged to achieve sustained improvements in safety and continual reductions in harm through the Patient First methodology. Examples of this included

  • Being awarded the One Small Step Together award in recognition of the work to reduce surgical site infections
  • A 30% reduction in falls through the implementation of a ‘Bay Watch’ system.
  • Meeting the 10 standards required of the Clinical Negligence Scheme for Trusts in maternity.

There were clearly defined and embedded systems, processes and standard operating procedures to keep people safe and safeguarded from abuse, using local safeguarding procedures whenever necessary. These were reliable and minimised the potential for error whilst reflecting national, professional guidance and legislation.

The service had suitable premises and equipment. There was ongoing investment in equipment and the premises. Where there were historic shortcomings in the estates (such as the number of single rooms in the critical unit) these were known and being considered by the board as part of the estates master plan. There was no evidence that where there was a less than ideal environment that this impacted on patient safety.

Training was a strength of the organisation and the service provided mandatory training in key skills to all staff. There was also a programme of quality improvement training at various levels to ensure the sustainability and delivery of the Patient First strategy.

There was a genuinely open culture in which all safety concerns raised by staff and people who used services were highly valued as being integral to learning and improvement. The trust managed patient safety incidents very well. Staff recognised incidents and reported them appropriately. Staff showed awareness of incident management and could demonstrate systems to us. Staff at all levels and from all disciplines could describe learning from incidents.

Learning was based on a thorough analysis and investigation of things that go wrong. All staff were encouraged to participate in learning to improve safety as much as possible, including working with others in the system and where relevant, participating in local, national, and international safety programmes. Opportunities to learn from external safety events were identified. Managers investigated incidents and shared lessons learned with the whole team and the wider service through staff meetings and newsletters. This included wider learning across the organisation, especially if incidents were serious. When things went wrong, staff apologised and gave patients honest information and suitable support. The trust applied the duty of candour when required.

The trust had sustained an improvement in the level of deaths related to septicaemia, more than halving the observed rate since April 2017, providing evidence of effective staff support and training.

The provider has a sustained track record of safety supported by accurate performance information. There was ongoing, consistent progress towards safety goals reflected in a zero-harm culture. The service used safety monitoring results well. Staff collected safety information, and shared it with staff, patients and visitors. Data was used to drive improvements both locally on wards and across the trust. Performance was closely monitored, and action taken if themes or variance from the target trajectory were identified. All safety data was considered inside the Patient First framework and there was a commitment to holding steady to the key improvement objectives whilst maintaining sufficient flexibility to adapt to changing priorities.

Safety thermometer information and ward dashboards were used to drive local improvements. The number of patients who suffered no new harm during their inpatient stay at the trust was 98.7%, as reported to the board in July 2019.

The service managed infection risk well. Staff kept themselves, equipment and the premises clean and carried out checks and audits to ensure standards of hygiene were maintained and rates of infection were low. They used recognised control measures to prevent the spread of infection such as isolation procedures and screening programmes.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Specialist teams supported ward staff and those in vulnerable circumstances. There was evidence of a pro-active approach and continual horizon scanning to ensure future risks were identified and responded to, where necessary. There was very good multi-disciplinary working and sharing of responsibility with other local stakeholders. Across the trust over 95% of staff had completed the safeguarding children training at an appropriate level.

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. The trust experienced severe recruitment problems, especially with nurses. It used its flexible workforce to ensure staff numbers were safe. There were systems to ensure staffing met the needs of patients on a short and long-term basis. The trust was creative in exploring new ways of recruiting and retaining staff.

Effective

Outstanding

Updated 22 October 2019

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

There was a truly holistic approach to assessing, planning and delivering care and treatment to all people who used services. The safe use of innovative and pioneering approaches to care and how it was delivered was actively encouraged. New evidence-based techniques and technologies were used to support the delivery of high-quality care. An example of this was an award-winning model developed by trust staff that was used to train staff who had responsibility for managing complex airways by allowing accurately simulated cricoid pressure teaching and assessment.

The service provided care and treatment based on national guidance and evidence of its effectiveness. There were systems to check policies reflected national guidance and to ensure any new guidance was evaluated and changes to practice made if required. Managers checked to make sure staff followed guidance using audits and other checks. There was a strong commitment to learning and development with local wards and departments having clear systems for dissemination of changes to guidance.

The trust organ donation service was rated as gold in 2018/2019 NHS Blood and Transplant Service. The report from the service showed that the trust performed exceptionally well for the early referral of potential organ donors and also for a specialist nurse for organ donation involvement and presence when approaching families. The report showed no opportunities were missed to follow best practice during the reporting period.

People who were detained under the Mental Health Act 1983 (MHA) were empowered to exercise their rights under the Act. The provider supported staff to understand and meet the standards in the MHA Code of Practice, working effectively with others to promote the best outcomes with a focus on recovery for people subject to the MHA. There was a mental health strategy and good oversight of detained patients care through the safeguarding team. There was also good collaboration with the local mental health trust. Staff understood their roles and responsibilities in relation to the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care. Patients and staff had access to specialist teams such as psychiatric liaison services to support them with complex issues.

All staff were actively engaged in activities to monitor and improve quality and outcomes (including, where appropriate, monitoring outcomes for people once they had transferred to other services). Opportunities to participate in benchmarking and peer review were proactively pursued, including participation in approved accreditation schemes. High performance was recognised by credible external bodies. Outcomes for people who used services were positive, consistent and regularly exceeded expectations. The trust monitored the effectiveness of care and treatment and used the findings to improve them. They participated in all relevant national audits and compared local results with those of other services, so they could learn from them.

The service made sure staff were competent for their roles. Managers appraised staff’s work performance and staff found this helpful. There were opportunities for staff to develop their skills and experience and to gain additional qualifications. Staff had their competency formally assessed for specified tasks or to use certain medical equipment. Staff appraisal files showed that they had been offered comprehensive review that included a personal development plan, objectives and an assessment of how well the staff member demonstrated the values of the trust.

Consultant appraisal records confirmed that each consultant was able to meet the requirement for them to attend within 30 minutes when on call.

Staff, teams and services were committed to working collaboratively and found innovative and efficient ways to deliver more joined-up care to patients. There was a holistic approach to planning people’s discharge, transfer or transition to other services, which was done at the earliest possible stage. Staff of different kinds worked together as a team to benefit patients. They worked as a multi-disciplinary team meeting regularly to agree treatment plans with patients and to monitor progress. Patients had access to the full range of therapists many on a seven-day basis. In critical care, there was exceptional work joint working with staff from the specialist palliative care team, in the emergency department and with medical staff working in medicine and surgery. Improvement huddles and safety huddles at ward and department level were multi-disciplinary with an equal voice for all participants. There was also good ‘buy in’ from non-clinical staff and teams and they understood how their improvement work related to better outcomes for patients. A good example of this was how well the estates and facilities staff recognised that their work made a difference to patients and helped achieve the True North Objectives.

Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment via an electronic records system. All staff contributed to this record so could see what care was being provided by other health care professionals.

Caring

Outstanding

Updated 22 October 2019

Our rating of caring stayed the same. We rated it as outstanding because:

Feedback from patients, those who are close to them and stakeholders was very positive about the way staff treat people. People talked about staff that went the extra mile and said that their care and support exceeded their expectations. Patients and carers were engaged in service development and their feedback was used when setting True North Objectives. An example of this was a focus on reducing noise at night which came about because of feedback from the friends and family test.

A True North objective was that over 97% of patients would recommend the organisation as a place to be treated. The trust scored between 96.8% and 97.8% between June 2017 and May 2019. The data appears to be stable with only random variation over the whole period. This placed them in the top 25% of all trusts nationally. The outpatient’s departments also scored 97% compared to a national average of 93%. The emergency department scored a consistent 95% compared to an 87% national average. The friends and family test response rate was much higher than for comparable trusts which meant there was greater validity to the scores. The trust outperformed most comparable trusts.

The Trust supplemented the information received from the friends and family test with a more detailed inpatient survey carried out by patients on hand-held tablets. Ward and departmental leads received patient comments and question scores for all their surveys, which enabled them to celebrate excellence with their teams and to set local improvement goals, where areas were identified as being of concern.

Staff cared for patients with kindness and compassion. Feedback from patients, and our observations confirmed that staff treated them well and with kindness. We found many examples where staff made considerable efforts to ensure patients were treated well. There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Relationships between patients, those close to them and staff were caring, respectful and supportive. These relationships were highly valued by staff and promoted by leaders. Staff recognised and respected the totality of people’s needs. People’s emotional and social needs were seen as being as important as their physical needs. We were told about numerous examples where staff had acted in a particularly compassionate way; this included two, very unwell, elderly patients being admitted and cared for in adjacent beds, which were pushed close together, so that they could hold hands and continue to comfort each other.

Staff involved patients and those close to them in decisions about their care and treatment. Patients and their loved ones reported they felt involved in making decisions about their treatment and care options and were provided with the necessary information to enable them to make an informed choice.

Staff provided emotional support to patients to minimise their distress and we observed this in practice across the trust. Patients could access chaplaincy services to meet their spiritual needs. The vision and values of the trust were said to be enshrined in two words – ‘We care’ The chaplains reflected this in offering spiritual, pastoral and religious support to all patients, relatives, carers and staff. Chaplains and volunteers visited all the wards regularly throughout the week. They had time to listen and offer encouragement and support to patients and their relatives and carers during their stay in hospital. Whilst the chaplains were Anglican, as this was most representative of the population served by the trust, they could arrange visits and support from other religious leaders, if wished. They were also happy to provide support to patients and families of any faith or none.

We saw evidence and spoke with staff about a case that demonstrated the commitment to ensuring staff supported patients and families to understand their condition and the care options available to them. A patient who was due to have an emergency operation was assessed and their specific information fed into a predictive database. Sadly, the predicted risk of them dying was very high. The consultants involved sat with the patient and their family and walked through all the data and likely outcomes, which helped the patient and family have a better understanding of their condition. The staff felt that this predictive tool really gave them confidence to have difficult conversations and enabled them to support patients in their understanding and allow greater involvement in decision making. There were two further recent examples shared with us where the patient being supported had resulted in a decision not to operate and had enabled them to be managed comfortably and have time to spend with their families.

Responsive

Outstanding

Updated 22 October 2019

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

The trust planned and provided services in a way that met the needs of local people. The trust worked collaboratively with commissioners, patient representatives and other stakeholders to provide services which considered local priorities and population needs. This included work with the local mental health trust in improving provision for patients with both mental health and physical health care needs. It also included leadership of the trust taking on the challenges presented by leading an adjoining trust to improve tertiary services for patients from the Western Sussex catchment. The trust provided system wide leadership and was driving system wide improvements through expansion of their Patient First approach.

There were processes in place to allow for specific services to include patients, including those with protected characteristics, in developments. The Southlands Eye Clinic was an example where a patient user group was created to allow input from governors, charities and patient representatives.

An example of using feedback to improve the patient experience comes from the respiratory physiotherapy team who work with critical care outreach nurses to help deliver a patient support group for those that have experienced a long stay in critical care known as 'WRAPS' (Worthing relative and patient support). Their feedback was used to make changes on the critical care unit. For example, delirium and hallucinations are common in this patient group and many people reported a 'floating head'. This was found to be linked with a picture of a man's head on the packaging dispensing disposable glasses. The trust made changes and the glasses dispenser no longer had a picture of a head on the side to minimise distress and hallucinations.

People’s individual needs and preferences were central to the delivery of tailored services. The trust had guidelines for staff on caring for adult patients with a learning disability in the acute hospital. The aim of the guidance was to enhance communication between the patient, carers and health care professionals, highlight issues of consent and advocacy for people with a learning disability and ensure a high standard of care is provided throughout the patient’s journey.

There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.

The services are flexible, provide informed choice and ensured continuity of care. There was also a learning disabilities improvement collaborative with wide representation including the trust learning disability liaison nurse, four service users, representatives from the community trust and mental health trust, estates and facilities representative, carers group representatives and safeguarding adults team representative.

There were systems to support people living with dementia including specialist dementia nurses and modifications to clinical environments to make them more dementia friendly. Volunteers were used to support activities for people with dementia to reduce the stress of the clinical environment.

People could access services and appointments in a way and at a time that suited them. There was good oversight of the referral to treatment times. There was a comprehensive validation process whereby monthly review of patients exceeding the 18-week target were considered at care group level. This was supported at divisional and corporate weekly meetings where anomalies were tracked and rectified.

Cancer performance for June 2019 were compliant against all of the targets, with 85% of patients treated within 62 days. This was well ahead of the trust's recovery plan and in the context of continued significant increased demand. National average performance at the same time had deteriorated to 77.5%.

Technology was used innovatively to ensure people have timely access to treatment, support and care.

Complaint investigations were comprehensive and had senior oversight from a clinical perspective. All complaints were considered from a safeguarding perspective. The letters written to complainants were compassionate and addressed the complainant’s concerns, as far as possible. The trust staff worked hard to resolve concerns locally before they escalated into complaints.

Well-led

Outstanding

Updated 22 October 2019

Our rating of well-led stayed the same. We rated it as outstanding because:

The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care. Staff spoke highly of their leaders and talked about approachability, visibility and a shared commitment to providing excellent care and treatment for patients. There was good cross-site working that supported consistency of approach across the two acute sites.

The trust, and each division, had a clear vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community. The trust had set its vision and strategic objectives in collaboration with all stakeholders. All staff spoke about and framed all organisational performance and development around the Patient First strategy.

Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. The organisational values were well publicised and embedded within the trust with staff able to provide examples of how the values the informed their work. Staff were committed to upholding the primacy of the patients in all the trust’s dealings.

The trust used a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish. There was a culture of identifying and solving problems using a quality improvement methodology. There was a commitment to research activity with many active projects and published papers. The trust was the highest ranked general hospital in this field.

The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. There were systems to ensure risk registers were current, that risks were escalated and their management monitored. The board assurance framework ensured strategic risks were understood.

The trust collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards. The trust invested in IT and had robust security systems which had been resilience tested. The trust had systems to ensure that its data sources were reliable and produced comprehensive performance dashboards to monitor performance over time.

The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.

Assessment of the use of resources

Use of resources summary

Outstanding

Updated 22 October 2019

We rated the trust’s use of resources as outstanding because:

The trust had a well embedded ‘ward to board’ quality improvement programme ‘Patient First’ which drove continuous improvement across the trust and was reflected in the trust’s overall cost per weighted activity unit (WAU) benchmarking in the best national quartile, the trust’s reference cost index (RCI) being consistently below 100 and the level of investment made to improve services. The trust benchmarked well with other NHS providers nationally across all the key lines of enquiries and for operational standards while achieving an underlying surplus position. At the time of the assessment, the trust had built from its internal improvement approach and achievements to work collaboratively with lead commissioners and other organisations in its sustainability and transformation partnership (STP) to improve services for patients and address the system’s financial challenge. The trust board was also the trust board for Brighton & Sussex University Hospital NHs trust, a trust experiencing significant financial and quality issues.

Combined rating

Combined rating summary

Outstanding

Updated 22 October 2019

This is the first time that we have awarded a combined rating for Quality and Use of Resources at this trust. The combined rating for Quality and Use of Resources for this trust was outstanding.