Sussex hospital trust leaders 'recognise how much work still lies ahead' after damning inspection report

The Care Quality Commission (CQC) has downgraded the overall rating of University Hospital Sussex NHS Foundation Trust from outstanding to requires improvement. It comes after an inspection between October and December ‘showed a decline in the care’ being delivered to people ‘across several key areas’.

In response, hospital leaders at the trust said: “We understand the challenges, we have made significant progress already, and we know there’s much more to do.”

The CQC report relates to seven inspections at the trust over an 18-month period – the most recent of which was just over seven-months ago, and looked at the ‘well-led’ domain. The trust’s overall rating has been changed from outstanding to requires improvement, while the ‘well-led’ domain was reduced to inadequate.

UHSussex chief executive Dr George Findlay recognised that, ‘like all NHS organisations’, the trust ‘needs to improve’ as it faces ‘challenges around staffing, fast-growing need for hospital services and recovery from the Covid-19 pandemic’.

He also highlighted the ‘significant positive changes’ that have taken place both before and since the latest CQC inspection in October 2022 – ‘including huge investment in better facilities, a new leadership structure, recruitment at all levels and a big effort to encourage a more open culture’.

Dr Findlay said: “When I took up this role just under a year ago, I commissioned an external review to give me a clear picture of where we stood as a newly formed trust – our strengths and our weaknesses. This review, and our improvement plans were shared with the CQC at the time of our well-led inspection.

“Everything the CQC is saying now chimes with what we already knew, and had committed to addressing right from the start.

“I’m extremely proud of the huge strides that colleagues have made, but we all recognise how much work still lies ahead. The seven months since this inspection have seen rapid progress – now we need to push on again.”

The University Hospital Sussex NHS Foundation Trust is responsible for seven hospitals in Sussex; Worthing Hospital; St Richard’s Hospital in Chichester; Princess Royal Hospital in Haywards Heath; Southlands Hospital in Shoreham-by-Sea as well as the Royal Sussex County Hospital, Royal Alexandra Children’s Hospital and Sussex Eye Hospital – all in Brighton and Hove.

The inspection was ‘in part prompted by whistleblowing concerns from staff’, a CQC spokesperson said.

Deanna Westwood, CQC’s director of operations in the south, said the inspection was carried out ‘in response to concerns raised with us around culture and leadership’. She said staff and people using services ‘were being let down by senior leaders’, adding: "Staff told us they felt unable to raise concerns without fear of reprisal.”

The trust highlighted a number of improvements made during Dr Findlay’s first year as chief executive. These included:

- A new leadership development programme to support leaders across the trust;

- A new clinical model to give strong leadership to clinical divisions and individual hospital sites;

- Trust-wide focus on making it easier for people to speak up and raise concerns, including stronger support for the Freedom to Speak Up service;

- Results from the anonymous monthly ‘Pulse’ staff survey show more people now feel confident that the trust would act upon concerns that were raised – up from 49 per cent in September 2022 to 58 per cent in March 2023, ‘closing in on the very best-performing trusts nationally’;

- £120m invested across all hospital sites (above and beyond the £500m Louisa Martindale Building and planned £48m redevelopment of A&E in Brighton);

- Weekly, structured sessions with frontline staff involving the whole executive team, and one or more executive team member spending time with frontline teams, every day

The trust said there has also been ‘strong progress in patient care’, including:

- A significant reduction in the number of people facing the longest waits for treatment – ‘now only just over 250 people’;

- Ambulance delays of an hour or more down to 3.2 per cent, from 9 per cent at the end of 2022;

- Waits of more than six weeks for diagnostics down by almost a third since late 2022;

- Strengthening performance for cancer waiting times, both for diagnosis, and treatment.

The CQC team visiting in 2022 also concluded that new strategies would ‘improve quality for patients and staff’; that the ‘majority of leaders’ had the experience, capacity and capability ‘to lead effectively’; most patients praised the care, treatment and support they received; the executive team had an appropriate range of skills, knowledge and experience and the new operating model ‘appeared to provide clear structures and evidenced multi-disciplinary leadership’ across hospital sites and divisions.

Dr Findlay said: “Right from my first day, the focus has been on facing up to our problems and giving our amazing staff the tools and support they need to do their jobs. None of the issues raised in this report are new to us, and that is why we were already addressing them.

“Much has changed since the CQC team was here, and that progress makes me confident for the future – delivering NHS care at the moment is really tough, making improvements is tough, but we have the plans and the people in place to do that."

In neurosurgery, services inspectors found:

- The service did not have enough staff to care for people and keep them safe;

- Staff did not always feel respected, supported and valued;

- Staff did not always work well together for the benefit of people;

- Some consultants did not engage with people using services including sharing information regarding their medical conditions;

- The environment and availability of equipment did not always support safe and effective care and treatment. For example, there were incidents of surgery being delayed due to a lack of imaging equipment.

Trust-wide inspectors found that:

- Some staff felt their experiences of bullying and harassment ‘went unaddressed’ because of the seniority of the staff ‘allegedly carrying out the bullying’ and because they saw historical working relationships with senior executives as a ‘deterrent to raising their concerns’;

- Staff felt there was ‘little point raising concerns’ because ‘no action was taken when they did’;

- Although the trust had responded to the cultural concerns in surgery at the Royal Sussex County Hospital, it has had a ‘limited impact’. Some consultants ‘continued to display poor behaviours’ which meant a lot of staff felt ‘undervalued, unsafe, and unsupported’;

- Most staff did not know who the Freedom to Speak Up Guardian was, or how to contact them;

- Staff believed there was a ‘culture of bullying and harassment’ which ‘pressured them in to making unsafe decisions’;

- Minority ethnic staff survey results showed they were ‘more likely to experience poorer outcomes than their white colleagues’.

In response, Adam Doyle, Chief Executive Officer of NHS Sussex, said: “We acknowledge the findings of the report and are working closely with the trust, the Care Quality Commission and NHS England to ensure the necessary improvements are made.

“We recognise the hard work and progress that has already been made to address many of the areas outlined in the report and will continue to support the trust to deliver the improvement plans that are in place for some of the other long-standing challenges that will take time to address, both across the organisation and in collaboration with system partners.”

Alan Boyd, chief executive officer of Brighton and Hove Healthwatch, said the latest CQC rating is ‘clearly disappointing’ for patients but ‘also all staff who work incredibly hard to ensure that patients receive excellent care’.

He added: "Of particular concern is that services at the Royal Sussex County are not considered to be safe although patients should be reassured that the care offered across the trust has been rated as ‘outstanding’.

"Healthwatch works closely with the senior management team at the trust and have been reassured by the actions that have already been put in place to deliver the required improvements.

"We need to support our trust as it continues its recover from COVID-19 and embeds change to deliver improvements and Healtwatch will be there to do this whilst offering critical challenge and championing the patient voice and experience.”

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