The Royal Sussex County Hospital requires improvement, according to government inspectors.
The Care Quality Commission (CQC) delivered its verdict this morning (Friday 8 August), with accident and emergency (A&E), medical care, surgery, maternity and outpatient services all also said to require improvement.
The hospital was, however, rated good for critical care, children’s care and end of life care.
And Brighton and Sussex University Hospitals NHS Trust, which runs the Royal Sussex, was rated good for caring and effectiveness.
Inspectors found that the flow of patients from A&E through the Royal Sussex was affecting patient care and experience in a number of different departments and wards.
As a result some patients were being treated on wards which were not specific to their condition.
Bedblocking is also a problem. The CQC said: “Discharge levels were too low to always meet the demand of patients requiring admission.”
In the past year there has been almost a threefold rise in the number of elderly patients medically fit for discharge but occupying beds because there was nowhere else for them to go.
Inspectors found that staff communicated with people and supported them in a compassionate way. And patients and their families spoke highly of the care that they had received.
The CQC added: “The senior leadership of the trust were found to be visible and effective and were delivering a significant programme of change and improvement.”
The CQC also said that the trust was taking action to tackle some longstanding cultural issues, including race equality, and there were signs that progress was being made.
The trust was working on its vision, values and behaviours. Staff were aware of this and said it was making a difference.
The overwhelming majority of staff across the trust said that they were proud of the services they were delivering and of the support they received from colleagues and managers.
Inspectors also identified staffing issues, especially in medicine and surgery.
High usage of temporary staff placed pressure on staff – who were not always able to attend training sessions – and meant that patients might not always have their care needs met.
The trust had increased its staffing levels, had improved recruitment procedures and vacancies were being filled much more quickly than previously.
Pressure on the A&E department at Royal Sussex County Hospital was significant, and some other aspects of the Brighton site were presenting significant challenges for care delivery.
Inspectors found a number of areas where the trust must improve, including ensuring that
- Action is taken to improve patient flow within A&E and across the trust.
- Effective systems are put in place to ensure that urgent referrals are handled in a timely way.
- There are enough suitably skilled and experienced staff to meet the needs of all patients.
- All equipment used for patient treatment or care is regularly checked to make sure it is safe and fit for purpose.
- Discharge planning and arrangements allow people to leave hospital as soon as they are ready to do so, continuing to work with local partners and stakeholders to do so.
- Care planning and delivery on the obstetrics and gynaecology wards meets people’s individual needs.
- Patient dignity is maintained in A&E.
- Trust culture supports staff to work in an environment where they feel supported to raise concerns, where the risk of bullying and harassment is assessed and minimised and where any issues regarding staff relationships and behaviour are addressed to promote a better environment for staff and patients.
CQC identified several areas of outstanding practice, including
- Care for patients living with dementia, which was very good at both acute hospitals. Staff had worked hard to provide people with a safe and stimulating environment, awareness had been raised through a trustwide campaign and a new care pathway had been launched.
- Critical care teams at both acute hospitals, which were strong, committed and compassionate and received overwhelmingly positive feedback from the public.
- Staff awareness of and engagement with the work that was being done in the trust on values and behaviours.
The CQC’s chief inspector of hospitals Professor Sir Mike Richards said: “When we inspected the services run by Brighton and Sussex University Hospitals NHS Trust, we found that – across the board – staff were working hard to deliver compassionate care to people using trust services.
“We found, however, that improvements were required in a number of areas.
“I know that there is a significant change programme under way and we saw that senior managers have a clear understanding of the challenges facing the trust.
“While the new hospital buildings may in time resolve some of the infrastructure issues, these will not rectify the cultural issues that some staff told us about.
“The trust must focus on these issues as a matter of priority over the coming months.
“We were very pleased at the enthusiasm and openness our inspection received from the trust and its staff.
“We will return in due course to check that the improvements we have requested have been made.”
Head of hospital inspection Mary Cridge, who led the inspection team, said: “Our inspection found that this was a trust that was tackling some difficult issues with energy and focus.
“The trust was aware of its challenges and had clear and credible plans in place.
“Although there is a great deal of work to be done to make the improvements that are needed, they have already come a long way.
“Staff are proud of the services they are providing for their patients and patients are receiving care, treatment and support that achieves good outcomes.”
The CQC inspection team included doctors, nurses, hospital managers, trained members of the public and analysts. They made an announced visit in May followed by an unannounced visit shortly afterwards.
Inspectors will return to the hospital in due course, the CQC said, to check that the remaining improvements required have been made.