University Hospitals Sussex NHS Foundation Trust Also known as UH Sussex

On this page

• 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
• Environmental sustainability – sustainable development

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

In assessing this quality statement, we considered feedback from leaders, staff, people using the services and local system partners, as well as reviewing trust processes and survey results.

The evidence showed some shortfalls. Leaders did not always consistently demonstrate their commitment to compassionate and inclusive leadership. Not all staff felt there was a culture based on transparency. Not all staff felt respected, supported and valued. The trust had a new strategy, which had not been shared with staff at the time of our assessment.

Staff views on culture were varied. During our on-site assessments we spoke with a wide range of staff. We also reviewed information shared with us before and after the assessment. As part of the trust level assessment, we also carried out a staff survey. Locally staff described a positive culture and felt supported by the leadership within the areas they worked in. As part of our trust level assessment, we asked staff their opinion on ‘I feel comfortable raising concerns to my line manager’. Of staff who responded 71% agreed with this statement.

Some staff reported the executive team was not as visible as needed, which left departmental managers and staff feeling unsupported in addressing ongoing challenges. During our assessment of urgent and emergency care, managers had escalated and recorded risks related to overcrowding, unsuitable environments, staffing, infection prevention and control, and the use of temporary escalation areas. There was limited executive‑level action to acknowledge or address the severity and impact of these risks.

In feedback we received from staff before and after our on-site assessments, some described a culture of “fear and toxicity”. They felt that when concerns were raised about staff behaviour and/or patient safety, these concerns were “ignored” or “deflected”, and no action was taken.

Staff told us the executive team did not always behave in line with the trust’s values. We received feedback from staff about poor behaviours of the executive team, that were described as ‘problematic’. This included ‘eye rolling’, ‘gas-lighting’, and a reluctance to receive ‘bad news’ or that this would be ‘manipulated’. We heard of a bullying culture coming down from the board, and staff felt there needed to be more ‘civility in the building’, and that the executive teams should be role models and lead by example.

We received feedback from system partners who described the culture as “siloed”, “defensive”, and “hierarchical”. They felt the trust was not always transparent with them and were reluctant to have open conversations about the challenges. Partners told us that the trust had previously presented a more positive picture of its progress than was accurate. They felt this limited openness about the challenges and reduced opportunities for the organisation to receive support. Partners’ views expressed that this was changing gradually, and that the local NHS England team had funded a chief of culture and organisation role. This role was intended to support the defining, implementing, and nurturing of the trust’s culture to align with its strategic goals.

There was a lack of engagement between the trust and those officially representing staff, such as trade unions. During our interviews with staff representatives, they demonstrated a commitment to play a useful and meaningful role in the organisation. It was clear they were passionate about their role and had good working relationships with each other. They had excellent insight into a wealth of issues in the organisation and were aware of the drivers for change and success. They had worked hard to ensure the staff they represented had as much access to knowledge and information as was available. However, they told us told us that the leadership team did not always engage well with them. There was a lack of attendance at meetings, and they felt they were often “circumnavigated”, and were not as involved as they could be in helping to shape and influence the strategic direction of the organisation.

The NHS Staff Survey 2024 was completed by 8,191 trust staff, around 47% of the staff number. This was lower than the 2023 staff survey response rate of 50% and 2% lower than the national average compared to equivalent NHS trusts for 2024.

The trust scored worse than average for 8 of the 9 primary indicators in the survey and scores had declined in a number of important questions. These included, ‘care of patients is my organisation’s top priority’ (66.8%), ‘I would recommend my organisation as a place to work’ (51.68%), and ‘if a friend or relative needed treatment I would be happy with the standard of care provided by this organisation’ (54.99%), which were below the national average. The question ‘we work flexibly’ scored above the national average. Staff told us this supported a good work–life balance. They described their local managers as approachable when discussing flexible working and reported being satisfied with the range of flexible working options available.

However, staff did not think there was a strong emphasis on well-being at the trust. As part of our trust level assessment staff survey, we asked staff their opinion on ‘This organisation places a strong emphasis on well-being of staff’. Only 37% of staff agreed with this statement.

Out of the 13 indicators that related to staff morale we saw that 10 were worse than the national average. Only ‘I often think about leaving this organisation’, ‘I have a choice in deciding how to do my work’ and ‘I receive the respect I deserve from my colleagues at work’ scored better than the national average.

The trust had one of the lowest (5.6%) sickness absence rates in January 2025 compared with other trusts in Sussex. Between January 2024 and January 2025, we saw that peak sickness absences was in line with seasonal trends. However, on the staff survey 2024 we saw 44.9% of staff had felt unwell in the last year due to stress, 56.4% said they had come to work in the last 3 months despite not feeling well enough to perform duties and 48.2% felt worn out at the end of their shift, all were worse than the national average.

Not all staff were positive or proud to work at the trust. In our trust level assessment staff survey, 43% of staff agreed with the statement ‘I feel proud to work for this organisation’.

Leaders recognised examples of poor culture across sites, both current and historical, which had affected the quality of care and staff experience. The organisation’s merger during the COVID‑19 pandemic contributed to challenges in developing a unified culture and left a lasting legacy.

The trust’s People and Culture Committee developed an action plan in response to the staff survey. The ‘People’s Promise Priorities 2025-2026’ was presented at board in March 2025. The report highlighted the key indicators that scored worse than the national average. Although the results over time show improvement in most questions compared to previous years, it was noted by the trust board that the 2024 results had ‘plateaued’. Progress against the plan was monitored by the committee and reported every other month via a scorecard against each promise.

Staff understood the importance of equality and human rights in their work and could provide examples of where they had supported individuals with this. The trust had a ‘Workforce Inclusion Plan 2025 to 2026’ which set out their commitment to address inequalities for patients, the communities it served and staff and partners the trust worked with. However, staff did not always feel that the trust acted in a timely manner to address concerns.

The trust had recently developed a new trust strategy for 2025 – 2030, titled ‘Excellent care, Everywhere’. This was due to be implemented prior to our trust level assessment but had been delayed due to the NHS 10-year plan, to make sure that the new strategy and the plan aligned. This meant there was some uncertainty and a lack of clarity about future strategic objectives, within the organisation.

The strategy was developed in collaboration with staff, stakeholders and the local community, including governors, patient and carer groups, NHS partners and local authorities. It set out what the trust aimed to achieve for staff, the community and partners through six strategic ambitions. Each ambition was supported by detailed priorities. For example, ‘excellent care for our patients ‘included improving access and reducing waits for planned and cancer care; strengthening urgent and emergency care; developing centres of excellence; and improving fairness in access, experience and outcomes across Sussex.

The values of compassionate, inclusive and respectful were central to the strategy.

Before our assessment took place, the trust had undergone an independent review of its leadership. Our findings and feedback following our trust level assessment matched this report. During our interviews with senior leaders, they acknowledged the findings of the report were uncomfortable to read. They accepted the report in its entirety and were working on plans to address areas that needed improvement.

In assessing this quality statement, we considered feedback from leaders, staff, people using the services and local system partners, as well as reviewing trust processes and survey results.

Leaders understood the priorities and issues the trust faced but had not always taken appropriate action to resolve them. Some executives were visible and approachable in the service. Most staff reported a disconnect between the board and front-line services.

The trust was led by a unitary board. A unitary board is a single-tier board of directors composed of both executive and non-executive directors who should work together as one group. The trust board comprised of 8 executive directors including the chief executive and 8 non-executive directors, including the chair. The unitary board had a blend of longstanding and more recently appointed executives.

There had been several changes in the executive team. The chief executive resigned the week before the trust level assessment, with the deputy chief executive acting into the role. Since our 2022 inspection, the chief medical officer (2023), chief financial officer (2024) and a new chief operational role (2025) had also joined. As a result, the team was still developing how to work effectively together.

The executive structure was described as overly complex, unclear, and lacked psychological safety. This had resulted in the board not always acting in a unitary manner. This had led to staff feeling disengaged and disconnected from the leadership team. In our trust level assessment staff survey, 20.3% of staff agreed with the statement ‘overall, I think this organisation implements large-scale change well’. However, during our interviews, leaders described the staff working at the trust as “fantastic” and “truly astonishing”.

As an NHS foundation trust, the trust board was accountable to local people through a council of governors which represented the local community. The trust had 20 governors on its council: 11 public governors (with 1 vacant post), 4 staff governors (with 1 vacant post) and 5 appointed governors (representing volunteers, local authorities and universities). The council of governors appointed the chair of the trust board and its non-executive directors.

The executive directors were responsible for the day‑to‑day running of the trust. The chair and non‑executive directors provided advice, set the organisation’s strategic direction, and offered scrutiny and challenge that was informed by their experience in other public and private sector bodies. There was significant support available from system partners and key stakeholders to help the trust improve and deliver safe, effective care for patients. Leaders were passionate about the trust and worked to try to deliver good outcomes for patients despite the challenges they faced. The executive team held a range of individual portfolios covering areas including but not limited to quality, risk management, finance, procurement, health and wellbeing and equality, diversity and inclusion.

The trust had a senior independent director. They were an independent non-executive director, appointed by the board and responsible for providing a sounding board for the chair and served as an intermediary for other directors when necessary. During our interview, it was clear that they understood their role and responsibility.

There was a board development plan developed though the triangulation of information including skills review, appraisals feedback from chair or chief executive and an annual effectiveness review.

During our on-site assessments, staff spoke positively about their immediate line managers. Views on the executive team were mixed. Some staff felt the executive team understood local pressures and supported the vision for their areas, while others reported limited action at executive level to address risks and their severity. Staff acknowledged this could be challenging in a large organisation. In our trust level assessment staff survey, 21% of staff agreed with the statement ‘I have confidence in the executive team’.

Leaders told us they undertook regular visits to frontline services. These visits were intended to improve leadership visibility and ensured leaders were able to triangulate the information received through the trust’s governance systems, particularly in relation to staff experience. However, staff told us that they did not feel trust leadership were visible in the departments.

The chief pharmacist (CP) was currently on a leave of absence, and there was an acting CP in place. The CP was visible and accessible to all staff. Staff were provided with development opportunities which contributed to the effective succession planning of the pharmacy team.

Fit and proper person

Fit and proper person checks were in place for all directors in line with the requirements of the regulation. We looked at the personnel files of 6 members of the executive team. All files we looked at had completed the appropriate checks of directors’ suitability of their roles. All had received an annual appraisal in the last year.

In assessing this quality statement, we considered feedback from leaders, staff, people using the services and local system partners, as well as reviewing trust processes and survey results.

The evidence showed some shortfalls. The evidence we reviewed did not always demonstrate an open culture in which staff felt able to raise concerns, report incidents and suggest improvements. Staff did not always feel they could speak up and that their voice would be heard. Leaders were not always viewed as role-modeling good speaking up behaviours or listen to staff feedback and concerns.

Leaders were not always viewed as acting with openness, honesty and transparency. Staff did not always feel able to speak up within the trust. Staff did not feel that leaders would act to address concerns. We received feedback from staff both anonymously, before, after and during our on-site assessments that described “bullying”, “misogyny”, “paternalistic” and “toxic culture”. We were also told that whilst more experienced staff were felt able to speak up about issues, junior staff felt more ‘afraid’ to speak up due to being victimised.

Staff we spoke with on assessment told us there was not always a culture of speaking up within their departments. Some staff said they initially felt supported by managers when raising concerns, but this did not always lead to meaningful action or change.

The NHS Staff Survey 2024 showed that 56.4% of staff agreed with the statement, “I feel safe to speak up about anything that concerns me in this organisation”, which was below the national average of 60.3%. For the statement, “If I spoke up about something that concerned me, I am confident my organisation would address my concern”, 39.5% of staff agreed, compared with the national average of 48.2%.

In our trust level assessment staff survey, 41% of staff agreed with the statement, “I feel safe to report concerns without fear of what will happen as a result.”

There was a dedicated Freedom to Speak Up Guardian to the trust, and they had recently appointed a back-up Guardian to support them in their role. We found that this area has improved since our last inspection. Both worked on a part time basis but felt they felt they had enough time to do their role and be visible. When we met with the Freedom to Speak Up Guardian, we found them to be passionate and committed. They told us they visited different sites at least twice weekly. The trust ensured that staff were aware of the Freedom to Speak Up Guardian and had access to related policies to enhance their understanding and confidence in reporting concerns.

Between April 2024 and March 2025, a total of 248 cases were brought to the Freedom to Speak Up Guardian. When compared with similar trusts in the South-East region, the trust was the highest for the number of cases raised. The top themes were management issues, bullying, discrimination and inequality (often related to disability or race), systems and process. When a case remained open the Freedom to Speak Up Guardian would be in regular contact with the staff member until there was a resolution and the staff member was happy to close the case.

In our trust level assessment staff survey, 43% of staff agreed with the statement, ‘I feel confident raising concerns through the organisation’s freedom to speak up process’.

The chief people officer was the executive lead for freedom to speak up, who provided senior support for the speaking up Guardians, and was responsible for reviewing the effectiveness of the freedom to speak up arrangements. There was a designated non-executive director responsible for speaking up, who provided independent support for the guardians, ensured investigations were conducted with rigor and help escalate issues appropriately.

The chief people officer reported to the board, and they presented an annual report highlighting an overview of the themes emerging from staff speaking up to the Freedom to Speak Up Guardian. The board were made aware of lessons learnt and changes to practice encouraging improvement, which included developing leaders’ listening skills.

The evidence showed some shortfalls. Staff told us that leaders did not always act to continually review and improve the culture of the organisation in the context of equality, diversity and inclusion. They gave us examples of how leaders did not always act promptly to make it a more inclusive workplace. Discriminatory behaviour and unfair treatment were not always acted on.

Equality, diversity and inclusion were not always prioritised. Leaders acknowledged that further work was needed to strengthen the organisational culture in these areas and to improve the experiences of staff and the communities using services. The trust’s new strategy included a commitment to reset its core values to be compassionate, inclusive and respectful.

The People and Culture Committee maintained oversight on the trust’s developing cultural improvement work. The committee along with the board recognised that the interventions taken so far would take time to embed. There was an equality, diversity and inclusion team within the people’s services and patient experience teams, which included a focus on engagement with staff.

Staff felt that senior leaders did not reflect the diversity of the workforce. In March 2025, 3 board members (17%) identified as belonging to an ethnic minority group. This was higher than the local population (9%) but lower than the trust’s overall workforce (28%). Two executive directors (11%) did not disclose their ethnicity. The remaining 7 executive board members (39% of all board members; 78% of executive directors) identified as White. Among voting board members, 6 (35%) identified as White, 3 (18%) identified as belonging to an ethnic minority group, and 1 did not disclose their ethnicity. However, at the time of our assessment in July 2025, the CEO had left the trust, resulting in 6 executive board members who identified as White.

Discrimination from colleagues was a priority area for improvement for the trust, as well as career progression in clinical roles. The trust had a Workforce Inclusion Plan 2025-26. The trust’s People and Culture Committee approved the establishment of a Workforce Inclusion Steering Group as a sub-committee. Progress against this plan was reported every 2 months. The plan had 7 high impact actions which included, amongst others: upholds accountability (leaders checking workplaces for bias and leading by example); eliminates pay gaps (fair pay, equal opportunities, no exceptions) and dismantles discrimination (injustice at any level will be challenged).

Staff from minority ethnic backgrounds reported less positive experiences than white staff across all four WRES indicators. A higher proportion of minority ethnic staff experienced harassment or abuse from patients, relatives or the public compared with national findings. White staff at the trust also reported worse outcomes than white staff nationally. Overall, the data shows ongoing inequity in staff experience. For example, 53.68% of white staff felt there were equal opportunities for career progression (58.2% nationally), compared with 51.39% of minority ethnic staff (49.7% nationally). Reports of discrimination were 7.46% for white staff (6.69% nationally) and 14.13% for minority ethnic staff (15.72% nationally). These findings indicate that leaders need to strengthen action to ensure fair and inclusive working conditions for all staff groups.

However, in our trust level survey, 59.5% of staff agreed with the statement ‘in my experience, this organisation acts fairly towards staff regardless of ethnic background, gender, religion, sexual orientation, disability or age’.

The Workforce Disability Equality Standards (WDES) results from the 2024 NHS Staff Survey were worse for staff without a long-term condition or illness at the trust, indicating poorer experiences for staff with long-term conditions or illnesses. Results were worse than the national average for all 8 questions whether staff had a long-term condition or not. This indicated worse experiences for staff with long term conditions or illnesses at the trust when compared nationally.

The trust performed worse than the national average for 8 of the 7 WDES indicators. A third (32.35%) of staff with a long-term health condition experienced harassment, bullying or abuse from patients/service users, their relatives or the public in the last 12 months, reduced from 36.48% in 2023, this compared to 29.37% nationally (29.83% in 2023). The percentage of staff with a long-term health condition experiencing harassment, bullying or abuse from colleagues in the last 12 months was 25.39%, which was similar to 2023, this compared to 25.24% nationally (25.26% in 2023).

The trust showed average results, compared nationally, for colleagues with a long-term health condition experiencing harassment, bullying or abuse from managers in the last 12 months. This was similar to the results in 2023.

For staff members who indicated that they experienced discrimination on the grounds of their sexual orientation, the score was 7.36% in 2024, which was similar to 7.22% in 2023, compared with 3.67% nationally (3.96% in 2023). For those who experienced discrimination on the grounds of disability, scored worse from 8.72% in 2023 to 10.02% in 2024, this compares 9.12% nationally (8.91% in 2023).

The trust’s gender pay gap data shows that women make up a higher proportion of staff in both the highest‑paid (62.7%) and lowest‑paid (69.8%) quarters. Despite this, the trust continues to report a significant mean gender pay gap of 16.4%, meaning women earn around 84p for every £1 earned by men. The median gap is smaller at 1.4%, with women earning 99p for every £1 earned by men when comparing median hourly pay.

In terms of median bonus, the pay gap was 69.96%. This meant that women received 37p for every £1 men received. This was worse than the previous year, when the median bonus gap was reported as zero. The only bonus scheme used by the trust related to the clinical excellence scheme, which was available to consultants, where this was awarded rather than applied for as in the past.

This was monitored via the ‘Equality, Diversity and Inclusion Plan, including actions to address workforce equality standards’, which included actions to eliminate pay gaps. There were 5 actions relating to pay gaps. Two had been completed and 3 were outstanding or delayed.

Leaders did not all behave in a way that was in line with the values of the organisation in relation to equality, diversity and inclusion. Staff told us about a non-executive director who was not supportive of an initiative around Ramadan, where staff observing this were offered drink and fresh fruit when breaking their fast, and made divisive and discriminatory remarks.

Staff networks had been built to promote equality, diversity and inclusion. The trust had 7 staff networks. Each staff network had an executive sponsor, however, due to recent changes at executive level it meant not all the networks had an executive sponsor. Network leads told us they felt supported by their executive sponsors. However, they said some concerns they raised were not always escalated to the board. They also reported limited visibility of some non‑executive directors.

Network leads were passionate about their roles and the value of the networks. They worked well together and demonstrated a strong sense of collective ownership for equality, diversity and inclusion. However, they felt they were not always fully included in shaping ongoing organisational improvement.

They felt there was a disconnect between staff and executive leadership. For example, all network leads expressed their concern over the lack of communication following the high court ruling around single-sex spaces, to provide clarity for both staff and members of the public. Staff were left uncertain around this, including which toilets could be used. We heard examples of staff not wanting to drink at work for fear of being challenged on using the toilet, or transgender people being forced to use disabled toilets. The leads informed us an email was sent to clarify the position. However, this was sent 3 months after the ruling, and it was felt by staff this was due to pressure rather than through concern.

The evidence showed some shortfalls. Governance arrangements lacked clarity and were not always effective at all levels. They needed streamlining and strengthening to be more effective. The systems and processes for managing risk were not always effective.

There were not always effective governance and assurance processes and systems to support the delivery of good quality sustainable care and treatment. All levels of governance and management did not always function and interact effectively. This was highlighted through our most recent assessments of urgent and emergency care, and maternity, inspected in February 2025. We found significant concerns in these areas which should have been identified through the trust governance and assurance processes but were not.

The board assurance framework (BAF) set out the risks to achieving the trust’s strategic objectives and brought together information on organisational risks and priorities. All BAF risks had been reviewed and updated by the relevant executive leads and monitoring committees. Board papers were clearly linked to the BAF, showing which committee held oversight for each risk. The BAF identified 11 strategic risks. Each had an assigned executive lead and oversight committee. Nine risks were rated high and 2 moderate. Two of the highest‑rated risks related to maintaining safe, effective and compliant care, and developing a culture that supported the trust’s mission of delivering excellent care everywhere.

However, our review of documents and interviews with executive leaders showed that actions were not always taken to reduce risks or improve safety in line with strategic objectives. There was no clear consideration of the impact of known risks, risk validation and removal of risks from the risk register were not applied consistently.

Systems and processes in place to manage risk were not always effective. Leaders and teams used systems to manage performance, but at times this was not always effective. Risks were identified, with high‑level risks escalated with actions to reduce their impact. However, the trust’s response to mitigating and managing these risks varied across services and often lacked pace. For example, we looked at the trust risk register and saw that a lot of the risk scores were high, despite measures to mitigate the risk. During our interviews it was recognised that there was a need for clearer definitions of risks and better alignment between clinical and corporate risk. The risk systems were described as ‘clunky’ and ‘overly complicated’.

The trust did not consistently use accurate or comprehensive information to inform decisions about risk, performance, or patient outcomes. Our assessment of urgent and emergency care showed that significant improvements were required. In addition, communication about operational pressures within the department did not reliably reach executive leadership, and the point at which this communication pathway failed was not clearly defined.

The trust had an established process for collecting, analysing and escalating performance data to the board, structured around 6 overarching themes. The Integrated Performance Report identified the themes of focus such as: reducing patient safety incidents resulting in harm, reducing time spent in the emergency departments, improving theatre capacity, and improving scores for staff involvement. The trust had dashboards to monitor performance in key areas. The trust’s committee chairs provided a chair’s report to the board detailing the risks requiring escalation, the areas discussed by the committees and the decisions made. However, staff reported a reluctance within parts of the leadership team to receive ‘bad news’. Some also felt that difficult messages could be reframed or altered when escalated.

An annual report was produced and made publicly available each financial year. This included information on the trust processes for measuring performance.

The effectiveness of trust board and its committees were evaluated on a regular basis in line with the Code of Governance for NHS Provider Trusts. This independent review followed the same framework and headings as the CQC well-led quality statements. Following the most recent review it was identified that the trust needed to make improvements. We looked at this as part of our assessment and found similar concerns.

The trust had processes to ensure that people’s human rights were considered and safeguard people from abuse in line with legislation. The trust had relevant named leads for specific areas including safeguarding and mental health.

The trust had clear processes for staff to raise safeguarding concerns, set out in its policies and readily accessible on the intranet. Safeguarding alerts were managed by the safeguarding team, with information shared with external partners as required. We saw an increase in safeguarding incidents at Royal Sussex County Hospital and Princess Royal Hospital, rising from 59 reported incidents in 2023/2024, to 70 in 2024/2025. Reported safeguarding incidents for Worthing Hospital and St Richard’s Hospital remained about the same, with 62 incidents in 2023/2024, and 61 in 2024/2025. The increase in recorded safeguarding incidents reflected improved reporting.

Interviews with safeguarding leads showed the team worked hard to ensure safeguarding and people’s liberty remained central to service delivery.

The trust had a mental health lead and a mental health working group with representation form the local mental health trust. The chief nursing officer and the chief medical officer were the board leads for mental health.

There was some inter‑organisational working through the mental health pathway, but further improvement was needed to strengthen this, particularly across the patient pathways. During our on-site assessment of urgent and emergency care, we identified significant patient flow issues, with long waits linked to mental health bed availability. Staff escalated concerns appropriately to the local mental health trust and sought advice from the psychiatric liaison team. However, limited flow resulted in patients waiting in environments that were not suitable for their needs.

The chief nurse met weekly with the local mental health trust and the Integrated Care Board (ICB) to review patients in the trust requiring a mental health bed. There was, however, potential for wider board‑level committees to meet to support shared learning and joint improvement. This need was recognised, though it would require time and commitment from already very busy staff, and was seen as a future investment opportunity.

Information on how to complain was available on the trust’s website. A central complaints team managed the process, including receipt, acknowledgement, consent and registration on the electronic system. Investigations were carried out by locality managers with support from the central team, and all responses were reviewed by an executive. Divisions were responsible for acting on and learning from complaints.

The trust had a process for responding to complaints. In the 7 complaints we reviewed, responses were detailed and included an apology and summarised key issues, though not all were compassionate or reassuring. In our trust level assessment staff survey, 40% of staff agreed with the statement, ‘the organisation responds sympathetically when things go wrong’.

Between April 2024 and March 2025, the trust received 1,602 complaints, an increase from 1,221 in 2023/24. Nine complaints were reviewed by the Parliamentary and Health Service Ombudsman; 5 were upheld and 4 partially upheld.

The standard response target was 60 working days or an agreed timescale. Performance, between April 2024 and March 2025, improved from 54% to 60% of complaints closed within target due to strengthened processes. The main themes were waits and delays, communication and staff attitude. These were discussed at the Patient and Quality Assurance Committee, and learning was shared with divisions and teams for discussion at meetings.

The trust had processes in place to prevent and control infection (IPC). The board received an annual IPC report and quarterly updates. The chief nurse was the director of infection prevention and control (DIPC), supported by the deputy DIPC and a trust wide IPC nursing team, strengthened by IPC champions. Governance arrangements supported compliance with the National Infection Prevention and Control Manual for England.

The trust completed an IPC Board Assurance Framework (IPC‑BAF) to assess compliance against 10 domains and 54 key requirements. In 2023/24, the trust reported full compliance with 42 requirements, partial compliance with 6 and non-compliance with 2, both relating to ventilation. Partially and non‑compliant areas were monitored through the Quality Governance Steering Group for risk oversight.

Hospital-onset healthcare-associated infection rates were variable. Where increases occurred, these were reported to the board through integrated performance reports, along with actions being taken to address them.

Financial Governance:

There were processes to manage the financial resources and sustainability of the trust. The chief financial officer (CFO) had extensive experience in financial leadership. They had held financial leadership roles for many years and had joined the trust in autumn 2024 from a similar multi-site trust where they had been CFO for 4 years.

The trust’s financial position was a cause of concern. The Chair of the Finance Committee and the CFO both told us about the steps that were being taken to ensure that financial risks were identified, reviewed and managed effectively.

The Chair of the Audit Committee had retired just prior to the inspection. The Chair of the Finance and Performance Committee was an experienced senior leader with prior experience as an NHS board member. The non-executive directors we spoke with demonstrated their understanding of the complex leadership issues facing the trust.

As a large acute and specialist provider, the trust hosted a range of services for its integrated care system, and these were represented in its investment programmes. The trust had been successful in obtaining funding under the new hospitals programme. The trust was proud of the Louisa Martindale building on the Royal Sussex County Hospital site in Brighton and were taking steps in its investment programme to ensure best use was made of facilities. At the time of the assessment, the trust had received approval for the next stage of planning for investment in a cancer centre on the site.

External auditors had finalised the 2024-25 audit and had given a positive opinion on the accounts. Within the value for money opinion, the auditor had drawn attention to the challenges facing the trust. These included: the financial sustainability (noting the £30m out-turn deficit 2024-25; cash flow challenge; and that, as of the end of May 2025, only £12.1m of the cost improvement plan of £109m was fully assured); and the organisational governance through the single improvement plan had not led to improvements in culture metrics such as the staff survey.

The trust told us that it had agreed management actions to address the auditor’s recommendations.

Assurance for the delivery of the financial plan was overseen by the trust board and executive leaders. To provide greater assurance about the delivery of the financial plan, the trust had established a Financial Recovery Delivery Board under the chairmanship of the chief executive. Divisions had been set the challenge of delivering £50m of productivity savings with the balance being managed centrally. The risks of non-delivery of the plan were recognised as high, but the trust told us that it was on target to deliver its financial plan at the end of June 2025. To lessen risk, quarterly reviews of financial performance were being undertaken against a “stretch” run-rate ambition, and the executive team told us that it had developed a full suite of contingency options. There was significant level of risk in the financial plans and delivery will require the appropriate board appetite to address longstanding issues in order to deliver the plan the board has approved.

The evidence showed some shortfalls. The trust did not always understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Our interviews with senior leaders, observations and reviews of documentation showed the trust was committed to developing positive and collaborative working relationships with external partners. However, we were told this was not always consistent and could feel more directive at times rather than collaborative. The trust worked with multiple partners and communities to support healthcare delivery to meet the needs of people throughout Sussex. These included local authorities, NHS providers, hospices and voluntary organisations. For example, the chief nurse met regularly with the mental health trust through the Mental Health Quality and Strategy Group, discussing length of stay, mental health pathways, and environmental concerns. We also heard the trust worked with partners on targeted programmes, for example groups that focused on end-of-life care, discharge processes, and assistance for vulnerable people.

Partners gave mixed feedback about the trust’s approach to partnership working and engagement with communities. They reported positive collaboration when the trust initiated projects, but less consistency when partners led the work. Experiences also varied depending on which trust representatives were involved. Partners felt that more balanced and consistent collaboration would improve outcomes for people using services.

Partners told us the responsiveness of the board could be variable. It was felt the size of the trust often made it difficult for leaders to engage in the wider system effectively and maintain a visible presence. It was felt that as it was one of the largest providers in Sussex, the balance between the trust and system partners was not always even. There was a lack of focus on the actions needed to make improvements. Instead, this was externalised and the focus tended to be on what system partners could do to support improvements, rather than what the trust could do.

The trust strategy 2025 – 2030 had been developed in collaboration with the local community, staff and stakeholders. To ensure the strategy was community focused, the trust held ‘big conversation’ events and collected the views of more than 5,000 people through workshops and surveys and produced more than 12,000 pieces of feedback from people across Sussex.

We found staff in the emergency department worked effectively with the local ambulance service, demonstrating flexibility and responsiveness when notified of incoming trauma cases. They valued the information provided by ambulance crews and used it to facilitate detailed handovers, enabling safe and timely care.

The trust worked to have positive relationships with community and patient groups. During our assessment of maternity services, the service leaders spoke of great relationships with the local maternity and neonatal voices partnership (MNVP) and encouraged them to attend meetings on site. The MNVP had regular contact with maternity services leaders to make a difference to services provided to women.

The CQC coordinates national surveys annually to look the experiences of people using the NHS. We looked at the results for the adult inpatient survey, maternity survey, and the urgency and emergency care survey.

We reviewed the Adult inpatient survey 2024, based on 475 responses from people who stayed at least 1 night in the trust. The trust scored about the same as other trusts for overall experience, respect and dignity, kindness and compassion, leaving hospital, care and treatment, nurses, doctors, basic needs and hospital/ward environment. Areas rated somewhat worse, or worse than expected, were waiting to be admitted, information while waiting, noise from other patients and care available after discharge.

We reviewed the Maternity survey 2024, based on 281 responses from people who gave birth at the trust. The trust scored about the same as other trusts for labour and birth, staff caring for them, and postnatal care in hospital. The only area rated somewhat worse than expected was staff awareness of medical history during labour and birth. Further detail is available in our maternity assessment reports.

We reviewed the 2024 Urgent and emergency care survey for type 1 services. The trust received 324 responses and scored about the same as other trusts across all domains, including arrival, waiting, privacy, staff, care and treatment, tests, environment, leaving A&E, support at home, respect and dignity and overall experience. No areas were rated somewhat worse or worse than expected. Further detail is available in our urgent and emergency care report.

The trust encouraged patients and relatives to complete friends and family surveys. These surveys asked about their experience of care, if they would recommend the service to others and what the trust can do to improve patient experience. We saw for March 2025, 80% of patients in A&E, 92% of inpatients, 92% of maternity patients and 96% of outpatients responded ‘good’ or ‘very good’ to the question, ‘overall, how was your experience.’

The evidence showed some shortfalls. Processes were in place to support learning from incidents and patient safety alerts, but these were not always leading to timely improvement. Several known risks remained, and some incidents and investigations were not completed promptly, indicating a gap between recognising issues and taking effective action.

There was a process to deal with reported incidents. The trust had been early adopters of the Patient Safety Incident Response Framework (PSIRF) in 2023. This framework was introduced by NHS England to replace the serious incident framework with a focus on patient, carer and family involvement and emphasis on learning.

The trust had a team of 3 patient safety specialists. They worked as full-time patient safety experts providing expert advice. Incidents were monitored weekly at the Patient Safety Incident Response Group (PSIRG). PSIRG reviewed all reported unexpected deaths, new incidents graded moderate or greater harm and near misses. The group reported to the Patient Safety Group (PSG), which met every other month. The PSG monitored and provided assurance to demonstrate compliance with NHS England Patient Safety Strategy.

The trust had processes to learn from incidents and review patient safety alerts. However, these were not driving timely improvement, and several previously identified risks remained. In our trust level assessment staff survey, 57% of staff agreed with the statement, ‘this organisation encourages staff to report all concerns’.

Across our assessments of maternity and urgent and emergency care, staff understood what to report and how, but incidents were not always reported. Staff said they had stopped reporting all incidents because they saw little action or change in response to concerns. In maternity, not all staff were aware of PSIRF. We also found incidents that remained open and overdue investigations, indicating a gap between identifying issues and implementing actions to reduce risks.

There was limited oversight of action completion. The small patient safety team relied on divisions to monitor and follow up actions from incidents. As a result, multiple actions had not been updated or completed. For example, following a Never Event involving a retained foreign object, the trust confirmed that although procedures existed in theatres to prevent such events, equivalent safeguards were not in place across all relevant areas.

People who raised medicines‑related concerns were invited to the pharmacy to describe their experience at the start of the investigation. Learning from medicines incidents was led by the Medicines Safety Assurance Group and the medication safety officer, who reviewed themes and trends across incidents.

The trust had a Research and Innovation Strategy 2023 – 2028. The strategy was overseen by the Research and Innovation Strategic Steering Group. The chief medical officer was the executive lead. In 2023/2024 the trust recruited 7,500 participants into 124 studies. Research was linked to the trust’s new strategy.

The maternity service had introduced a ‘Living well’ app which allowed staff to suggest ideas for improvement and keep everyone up to date with progress and implementation. It also included a tracker to allow staff to say how their day was going and launched quick surveys to see where improvements could be made. The uptake had been slow at the start but audits revealed staff were more active in the month before our assessment.

The trust had launched the ‘Womble Project’ in January 2024. The project aimed to cut down on waste by using out of date and unused medical equipment in education settings, such as simulation training.

In the 2024 NHS Staff Survey, the trusts overall score of 5.48 for the question ‘We are always learning’ was similar to the national average. The trust scored worse than the England average for 1 of the 10 questions under this theme, and similarly to the England average for the remaining 9 questions. The questions “My appraisal helped me agree clear objectives for my work”. Only 29.4% of trust staff agreed with this statement. This was lower than then England average of 36.0%, and similar to the worst result of 27.3%.

The evidence showed a good standard. Leaders were aware of the trust’s impact on environmental sustainability. They were able to provide examples of where the trust had made changes to reduce the trust’s carbon footprint.

Staff and leaders understood the threat from climate change and were taking action to reduce the impact on the environment of healthcare activity. The trust and its staff had a genuine commitment to reduce the significant threat to the health of people who used services, their colleagues and the wider population. One of the ambitions in the trust’s new strategy linked to environmental sustainability.

The trust had a Green Plan, in line with national guidance and had undertaken a carbon footprint of all the trust’s activities to outline clear objective and targets for the future. The current version being 2021 – 2026 but was in the process of being reviewed and updated in line with the trust strategy. The Green Plan was required to include aims, objective and delivery plans for carbon reduction and sustainability. The plan was signed off by the trust board.

The current plan set targets for becoming a net zero provider. The plan was divided into 10 areas of focus which included, travel and transport, clinical, buildings and utilities, reduce, reuse and recycle and food, catering and nutrition. It included the area which accounted for the largest contributor of carbon emissions: supply chain and procurement, which includes medicines, medical equipment and other supply chain which accounted for 64% of the total carbon footprint breakdown.

There was a recognition of some key areas of work needed to be strengthened and some risks remaining to be mitigated satisfactorily. Between 2019/20 and 2023/24, gas heating emissions increased by 19%, electricity emissions remained unchanged, and business travel emissions rose by 4%. The rise in gas usage stemmed from the new boiler system at Royal Sussex County Hospital, with further increases expected in 2024/25.

The trust engaged with system partners on environmental sustainability. The trust sustainability lead engaged regularly with ICB sustainability teams and had close links with the Greener NHS regional lead. The lead also told us about their joint working at Worthing Hospital with the local authority towards decarbonising heat, to bring low-carbon heating and hot water to the hospital. To meet interim targets, the Green Plan Refresh outlined the need for emissions-cutting projects between 2028 and 2032, aiming to save around 30,000 tCO2e from the 2023/24 baseline. This would require major heat network and renewable energy efforts with public sector partners across Sussex.

There was appropriate governance in place to ensure performance against the targets and a board level lead for net zero. Leaders were aware of the trust’s impact on environmental sustainability. The trust evidenced key success in its environmental sustainability work. They were able to provide examples of where the trust had made changes to reduce the trust’s carbon footprint, which had been delivered as a result of the Green Plan. These examples included an investment in installing solar panels across the sites, a reduction of single use plastics, and changing the types of inhalers prescribed.

The trust promoted the ‘gloves off’ campaign which encouraged staff only to wear gloves when clinically indicated, linking into the environmental goal of reducing the number of gloves used and improve hand hygiene compliance.

The trust was proud of a number of initiatives; this included a network of 2,000 sustainability ambassadors. The ambassadors led on internal engagement on environmental and had come forward with ideas for consideration. The ambassadors had created sub workstreams in the departments they worked in, aimed at reducing the environmental impact from the ground up. For example, Green Admin, Green Pharmacy and Green ED. Each group set out clear objectives and aims relevant to their day‑to‑day practice and took forward projects focused on reducing paper use, promoting behavioural change in utility management, and increasing awareness of wider sustainability issues.