Sussex hospitals inspection: NHS trust reveals how it plans to improve

A Sussex hospital trust has revealed an urgent action plan after being told it must make immediate improvements.

University Hospitals Sussex NHS Foundation Trust (UHSussex), which is responsible for hospitals across the county, has been given a warning notice and told it must make immediate improvements to its maternity and surgical services.

The Care Quality Commission (CQC) carried out an unannounced focused inspection of the trust’s maternity services during September and October at four of the trust’s hospitals; Worthing Hospital, St Richard’s Hospital in Chichester, Princess Royal Hospital in Haywards Heath and Royal Sussex County Hospital in Brighton.

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Click here to read more about the findings and how the trust's CEO responded.

Inspections were carried out at four of the trust’s hospitals; Worthing Hospital, St Richard’s Hospital in Chichester, Princess Royal Hospital in Haywards Heath and Royal Sussex County Hospital in Brighton.

More than 200 qualified nurses recruited

UHSussex said it has taken urgent action to make improvements, after being made aware of the wide-ranging concerns at the beginning of November.

The trust said it has already taken steps to address the issues raised and 'make sure it continues to provide safe care'.

A spokesperson said: "The CQC visited maternity services across the trust and surgery services at the Royal Sussex County Hospital in September.

The Care Quality Commission (CQC) carried out an unannounced focused inspection of the trust’s maternity services during September and October

"Its inspectors recognised the efforts of staff in the face of unprecedented pressure on services but identified a range of improvements needed.

"Most of the CQC’s concerns relate to staffing and demand pressures, as well as to the continuing impact of Covid-19. However, they also included specific issues around minimum standards and support for staff."

On staffing, the trust said it has recruited more than 200 qualified nurses from overseas this year, and has new funding for 40 extra midwives and obstetricians.

It is also carrying out daily reviews of maternity staffing, led by its chief nurse, 'to confirm it can provide one-to-one care for birthing mothers'.

Other actions included; reinforcement of infection prevention and control compliance, including weekly audits and a new escalation policy to manage theatre activity; the appointment of a director of midwifery; a clinically-led review and reduction in incident backlogs; engagement and listening events held for staff in surgery and maternity to hear and understand concerns; developing further workforce and wellbeing action plans; greater visibility of senior leadership; renewed focus on staff training and a review of and investment in the trust’s governance systems.

'We have moved quickly to make immediate improvements'

UHSussex chairman, Alan McCarthy, said: “The board takes the report very seriously and is fully committed to making the improvements needed to ensure we continue to provide safe care for our patients.

"Our staff across UHSussex have not wavered in their dedication to good and compassionate patient care and we are enormously grateful for their commitment.

"We have moved quickly to make immediate improvements and will continue to drive forward the actions needed in the other areas the CQC has identified.”

Layout of hospital 'did not ensure women and their babies were safe'

In the CQC report, which can read in full here, inspectors noted the findings for each individual hospital.

At Worthing Hospital inspectors found that staff morale was low and the workforce was exhausted.

The report added: "Staff were not completing daily and weekly safety checks in line with the trust’s policy, or national guidance.

"Staff did not always have time to report incidents and when they did, they did not always receive feedback. Opportunities to learn when things go wrong were lost.

"Leaders had the skills to run the service but had to take on additional clinical roles in order to support the delivery of safe care. This meant there was a gap in the leadership structure."

At St Richard’s Hospital, the design and layout of the premises 'did not ensure women and their babies were safe'.

"Records were not always clear and easily available to all staff providing care," the inspectors said.

"Staff did not always receive feedback from incidents across the trust.

"Leaders had the skills, but had to take on additional roles to run the service. This meant there were sometimes gaps in the leadership structure.

"Staff at all levels were clear about their roles and where they were accountable but they did not have regular opportunities to meet and learn from the performance of the service."

At Royal Sussex County Hospital, it was noted that not all infection risks were controlled well.

It was also found that leaders did not support staff to develop their skills.

The CQC report read: "Staff did not feel respected, supported and valued.

"Staff collected safety information, but this was not always accurate."

During the inspection of surgery, inspectors found that theatre lists often operated 'with fewer staff than required', adding: "Infection prevention and control practices were not consistently applied.

"Not all staff were up to date with emergency life support training. The service did not manage safety incidents well and did have the time to learn lessons from them.

"Mangers were not running services well in order to support staff to develop their skills.

"Staff did not feel respected, supported and valued and were not always clear about their roles and accountabilities."

However, inspectors found that, within maternity services, staff 'always investigated' poor outcomes 'in order to identify opportunities to learn'.

Doctors, midwives and other healthcare professionals were also praised for working together as a team to provide good care.

The report continued: "Staff treated women with compassion and kindness. Women’s individual needs were taken into account, and they were helped to understand their conditions.

"Staff provided emotional support to women, families, and carers. They felt valued by their immediate team members and told inspectors the emphasis on team working brought them pride.

"There was a collaborative and respectful relationship between medical and midwifery staff.

"Surgery staff were focused on the needs of patients receiving care.

"The surgery team engaged well with the community to plan and manage services."