An unannounced, focused, inspection of the University Hospitals Sussex NHS Foundation Trust (UHSussex) was carried out during September and October at four of its hospitals; Worthing Hospital, St Richard’s Hospital in Chichester, Princess Royal Hospital in Haywards Heath and Royal Sussex County Hospital in Brighton.
The Care Quality Commission (CQC) inspection was undertaken 'in response to concerns received about the safety and quality' of the maternity services.
These included staff whistleblowing, patient complaints and information from other healthcare partners.
After the inspection, a warning notice was issued to the trust requiring it to take action to ensure significant improvements were made to staffing, training, governance and the overall culture of the services, to ensure the safe care and treatment of patients.
Surgery was only inspected at Royal Sussex County Hospital, the CQC said.
Following the inspection, the ratings for maternity services at Worthing Hospital and St Richard’s Hospital dropped from outstanding to requires improvement overall, and the overall rating for maternity services at Princess Royal Hospital dropped from good to requires improvement.
Surgery and maternity at the Royal Sussex County Hospital both dropped from good to inadequate overall.
'We fully accept there is more we can and must do'
UHSussex said it has has taken 'urgent action' to make improvements required by the CQC.
CEO Marianne Griffiths said: “We take the CQC’s findings very seriously. As soon as we received the inspectors’ initial feedback we acted immediately to make urgent improvements to ensure we continue to provide safe care.
“Hospitals all across the country have felt the strain of the pandemic and we are no exception. A combination of extraordinary levels of need for our services and high rates of staff absence related to Covid has left our staffing rotas extremely stretched and this pressure has led to many of the issues the CQC raised.
“We are doing everything in our power to tackle the underlying issue of staffing numbers. We have recently confirmed funds for 40 new midwives and obstetricians.
"We are also recruiting more qualified nurses from overseas and partnering with the Universities of Brighton and Chichester to train more nursing and medical staff to work in our hospitals.
“However, we fully accept there is more we can and must do, not just around staffing but also in making sure we are meeting required standards day in, day out and that we give our staff the support they need and deserve."
Bullying and harassment was reported
This was the first rated inspection since Western Sussex Trust merged with Brighton and Sussex NHS Trust in April 2021.
Nigel Acheson, CQC Deputy Chief Inspector Hospitals, said he is 'acutely aware' of the pressure that the NHS is under and 'how hard staff are working to provide good care for patients'.
He added: "So when staff are brave enough to raise concerns with us, we owe it to them, as well as to patients, to inspect services so there is transparency around the challenges being faced that can lead to increased support and improvement.
”Inspectors saw the impact that staffing shortages were having in both surgery and maternity at University Hospitals Sussex NHS Foundation Trust, with delays in patients accessing emergency surgery, and women in the maternity assessment unit waiting up to six hours to be assessed by a doctor."
According to the CQC report, bullying and harassment was reported by some staff and there was a 'perception that leaders were doing little to address concerns'.
After listening to staff about their experiences working in main theatres and recovery, inspectors had 'serious concerns about the culture amongst colleagues'.
Midwives also told inspectors that they had too many women to care for at one time in the antenatal, postal natal and triage area and they were 'frightened of missing a deteriorating woman or baby'.
The report continued: "Staff also told us they often did not have time during their shifts to report patient safety incidents and only reported what they considered to be serious incidents after their shift had finished.
"They told us they been instructed to stop reporting low staffing as an incident as it was a known risk.
"Staffing shortages are a national problem affecting the health and care system as a whole. However, while some other trusts have put steps in place to mitigate the impact of the risks posed by staffing shortages on patients and staff, this was often not the case at University Hospitals Sussex.
"We also found that not enough had been done to ensure that staff were listened to when they raised concerns, with the result that they described feeling unsupported and undervalued."
Not enough staff to care for women and babies to keep them safe
Inspectors noted that integration of the different hospital sites was still a 'long way from being complete'.
"This integration would have posed a significant leadership challenge, even without the wider difficulties currently faced by the NHS," the CQC report stated.
"We have highlighted areas for urgent local improvement, and the University Hospitals Sussex has developed a detailed improvement plan — but the trust will need also additional support from the wider system in order to overcome these challenges and ensure that its staff are supported to deliver safe, high quality care.”
Inspectors found, throughout the four maternity departments, that there was not enough staff to care for women and babies to keep them safe.
Staff were also not up to date with training in key skills.
"Women attending the triage service were not managed on the basis of risk," the report added. "Instead, individual risks were assessed in a subjective way.
"Midwifery leaders at Worthing Hospital and St Richard’s Hospital were visible and approachable in the department but staff could not always identify other members of the leadership team.
"The way in which they were having to work to support the service was having an impact on their capacity to lead and develop the service.
"Leaders at Princess Royal Hospital and the Royal Sussex County Hospital were felt to be far less visible and accessible."
UHSussex said it has now taken 'wide-ranging action' on the issues 'needing an immediate response' and has plans in place to address those that require a longer-term approach. Click here to read more.
Click here to read the full CQC report.