The Care Quality Commission (CQC) has announced the dates of a fresh full inspection of Brighton and Sussex University Hospitals NHS Trust (BSUH).
The trust, which runs the Royal Sussex County Hospital, in Brighton, was rated inadequate when it was inspected in April last year and subsequently placed in special measures.
A team of five inspectors carried out a “desktop review” to check the trust’s progress on Wednesday 25 January and Thursday 26 January.
Now the CQC has said that it will be back to carry out a full inspection on Tuesday 25 April to Thursday 27 April.
After the desktop review last month, the head of hospital inspections Alan Thorne wrote to the trust chairman Antony Kildare.
BSUH director of clinical governance Lois Howell told the trust board this morning (Thursday 23 February) that the feedback from the CQC was largely positive.
In the letter from the CQC the key findings were as follows.
Emergency department
• Increased medical ownership and enhanced medical and nursing leadership observed.
• Robust and controlled assessment of patients.
• Improved environment and design that provides greater support to patient flow.
• Performance against the four-hour standard remains a concern as does management of decision to admit timescales.
Recovery area
• Area had been maintained free of unplanned patients from April until (Friday) 16 December
• Since (Friday) 16 December records indicated that 55 patients have been placed in recovery either due to lack of an intensive care bed or from the emergency department.
• This resulted in medical patients being cared for by surgically trained staff.
• Outreach provision was not available after 8pm and therefore recovery staff are required to provide assistance to the anaesthetist.
• A clinical incident was completed by recovery staff for some inappropriately placed patients but not all.
• This may mean that the board is not sighted on the full number of inappropriate patients being cared for in recovery.
• The recovery area does not have facilities to support such patients in the department for extended periods nor their visiting relatives and carers.
Critical care
• Perceived divide between general and neuro critical care with neuro considered as less important. This may result in an impact on how valued staff felt.
• There was good evidence of ongoing training for neuro nursing staff.
• Belief by some senior staff within the department that the CQC report had led to staff being unreasonably dismissed.
• Staff we spoke to acknowledged the issues identified in the CQC report.
Fire safety
• All areas within the trust had competed fire safety risk assessments. In the Barry Building these were completed around the spring of 2016.
• Action plans had been competed for each area which included a significant number of actions, usually more than 30 and some of which were common across all assessments.
• We could not identify a co-ordinated approach to delivery of the plans or monitoring of completion of actions. However, we could see that some of the actions had been completed. The board sees risk assessment completion as the key performance indicator and this could mean that the board is not sighted on the degree of residual risk relating to fire.
• We could not identify the completion of any environmental risk assessments for clinical areas at ward level nor were local managers aware of these.
Risk management
• The trust had implemented a training programme to enhance staff understanding of risk and this had been attended by board members.
• Risk registers were of an improved format and there was a documented policy that guided escalation and management. We were unable to corroborate their use within the directorates.
• Performance management scorecards for directorates were comprehensive and standardised in presentation.
• Rapid improvement workshops had been initiated that were well considered in structure and inclusive in attendance.
Privacy, dignity and security
• Concerns relating to patient privacy and dignity in OPD (the Out-Patients Department) and emergency departments appeared to have been addressed.
• Records in both these areas were held securely and guarded privacy.
• Arrangements had been made for the safe and secure handling of prescriptions forms. Those for FP10s were being consistently applied but the arrangements for BSUH prescription forms was less embedded.
Staff engagement
• The trust had introduced a significant number of communications tools including newsletters, email messages, CEO messages, celebration of good practice and open forums.
• The trust had appointed a “speak up guardian” and has a staff “Connections” (helpline) initiative.
• The trust provided indication that nursing development opportunities were increasing and that leadership programmes had been introduced.
• The trust had very recently introduced “Working Better Together”, an initiative to combat bullying.
• When discussing these initiatives with a small focus group they were largely recognised by staff attending, although some were considered very new and in poster form. The BME Network did not recognise the availability of these initiatives.
• The trust did not measure and proactively publish the data (about) the equality of access to development initiatives.
• The BME network remained concerned about their reception at board level, citing non sign off of the WRES (Workforce Race Equality Standard) presented at board on (Thursday) 26 January as indicative. (During the feedback the board refuted that this was the approach.)
Human resource management
• The trust commissioned an external review of human resource management in April 2016 that included recommendations relating to documentation and leadership.
• The trust had reviewed, revised and updated all HR policies.
• Recommendations relating to senior leadership had not been completed, stalling due to planned change in trust management arrangements.
• Staff indicated that HR transactions were improved but concern was expressed over consistency of decision making.
The CQC said in its letter: “As we advised during the verbal feedback session, we consider that the documentation reviewed and corroboration in clinical areas and with staff to provide us assurance that we do not need to escalate our regulatory action against you.”
