Brighton hospital trust remains in ‘special measures’ despite significant improvements

The main hospital trust for Brighton and Hove has made significant improvements over the past year, inspectors said, but it will remain in “special measures”.

Brighton and Sussex University Hospitals NHS Trust was inspected by the Care Quality Commission (CQC) in April – weeks after a new management team took over.

A year ago the trust, which runs the Royal Sussex County Hospital, was rated inadequate and placed in special measures.

The latest report, published today (Thursday 10 August), rated the trust as “requires improvement” – one grade up from inadequate.

The CQC said that inspectors “found significant improvements in services” and added: “Inspectors found there were areas of improvement in most areas which had been identified at the previous inspection.

“At the Royal Sussex County Hospital the CQC found that staff had clearly striven to deliver improvements in dignity and privacy within the outpatients department although the environment within the eye clinic still presented difficulties in delivering care in a confidential and dignified manner.

“Previously staffing levels and the skill mix in emergency departments, medical wards, critical care and midwifery were found to be too low to ensure patients received the care they needed.

“Although there were more doctors in the emergency department staffing levels and recruitment still remained a challenge.”

The trust recently said that it had almost 1,000 vacancies, including more than 400 unfilled nursing jobs.

He CQC said: “The trust has tried to address an organisational culture of bullying and harassment via leadership training and a staff initiative with a campaign backed by staff communications and new guidance and tools.

“Within the emergency department there was a new self-rostering approach to medical cover that had a significant impact on the department.

“This initiative allowed the department to provide round-the-clock medical cover without the use of temporary staff.

“The introduction of a clinical fellows programme in the emergency department had improved junior doctor cover and allowed better development opportunities for juniors.

“The CQC has told the trust it must ensure patients’ dignity and privacy is respected in the emergency department by ensuring there is enough space in holding bays, with proper screening, and by avoiding the use of mixed-sex accommodation.

“At the Princess Royal Hospital consultant cover had increased although there were still concerns regarding the provision of paediatric nursing and paediatric anaesthetist cover to the emergency department.

“Inspectors found the care of patients living with dementia was well developed on Hurstpierpoint Ward.

“Staff told inspectors that there had been an improvement in the management of poor behaviour, notably in the maternity department where a new code of conduct had been introduced.

“The CQC has told the trust it must review the current paediatric service in the emergency department and ensure there are enough staff to safely meet children and young people’s needs.”

The chief inspector of hospitals Ted Baker said: “I am well aware that our inspection of Brighton and Sussex University Hospitals NHS Trust coincided with the introduction of significant changes to the senior management which I hope will help the trust deal with the underlying problems we have found in the past.”

Professor Baker said: “I am pleased to note that we have already found real improvements have been made since our last inspection.

“All those involved in the delivery of that change should be given the credit for that work.

“However there still remains an extensive programme of change to be delivered and embedded.

“There is no doubt that the lack of consistent leadership has hampered the pace of change in the last 12 months.

“I am hopeful that the new joint working with Western Sussex Hospitals will provide a period of stability and clarity of leadership that will lead to sustainable change.

“For now I recommend that the trust remains in special measures. We will return in due course to check on further progress.”

The Royal Sussex was given an overall rating of requires improvement and the same rating for urgent and emergency services, medical care (including older people’s care), surgery and outpatients and diagnostic imaging.

Critical care was graded inadequate, maternity and gynaecology were good, services for children and young people were outstanding and end of life care was good.