Royal Sussex management rated inadequate after staff concerns ignored

More damning reports into Brighton hospital management mean the Royal Sussex is now deemed inadequate, a report published today says.

Short staffing means patient safety is being put at risk, and staff who raise concerns fear a backlash or simply being ignored, the Care and Quality Commission (CQC) says.

It has also downgraded the trust which runs the hospitals, University Hospitals Sussex NHS Foundation Trust (UHSussex), to improve staffing and ensure staff concerns are properly dealt with.

The CQC had already published reports into serious concerns with the hospital’s maternity, surgery and A&E departments were being run – with some non-urgent surgeries suspended last year.

Today, it raises fresh concerns about the neurosurgery department and children’s A&E at the neighbouring Royal Alex, both of which were inspected after concerns were raised.

Deanna Westwood, CQC’s director of operations in the south, said: “We carried out this inspection of University Hospitals Sussex NHS Foundation Trust in response to concerns raised with us around culture and leadership.

“At the time of our inspection we found staff on the front line doing their best to provide safe and effective care and treatment, despite significant pressures and a challenging working environment.

“However, staff and people using services were being let down by senior leaders, especially the board, who often appeared out of touch with what was happening on the wards and clinical areas and it was affecting people’s care and treatment.

“Staff told us they felt unable to raise concerns without fear of reprisal, so I want to praise those who were brave enough to come forward anyway, despite those fears.

“Speaking up in these circumstances isn’t easy but is incredibly important to give us an accurate picture of these services.

“We found a culture developing where safety concerns were normalised, and when a member of staff raised issues about this, leaders focused on an individual’s poor behaviours or performance issues, rather than any systemic failings.

“The trust has been receiving support and oversight from key stakeholders after we shared our concerns with them.

“However, I am recommending to NHS England that the trust should be placed in segment four of the system oversight framework and receive additional support via their recovery support programme.

“This is the highest level of support that‘s offered and should give the trust the extra help needed to make the required improvements.

“At the time of this inspection the new chief executive had been in post for four months. The board know where they need to improve and we will continue to monitor services closely, including through future inspections to ensure this is rapid and widespread.

“If this does not happen, we will not hesitate to take further action to keep people safe.”

UHSussex chief executive Dr George 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 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.”

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

“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.”

In the section of the report focusing on neurosurgery, inspectors found there were not enough staff, and sometimes surgery had been delayed because of a lack of equipment.

Staff did not always feel respected, supported and valued, and did not always work well together.

Some consultants did not engage with patients, including sharing information regarding their medical conditions.

The children’s A&E report is based on an inspection there in December. It also found the service didn’t have enough staff to care for patients and keep them safe and assessments weren’t always done on time.

However, it found staff did take action to safeguard patients from abuse, and to reduce the risk of avoidable harm to children with mental health illnesses.

On the day of the inspection, it was seeing 50% more patients than usual for December because of strep A.

Just days earlier, it had been reported that a 12-year-old Hove girl had died of the infection, the 16th child in the UK to do so – although there is no suggestion this is because of hospital delays.

Patients were waiting as long as 11 hours to see a doctor, and were not always assessed during long waits.

The report also said there was a lack of evidence staff always followed up if families left he department before seeing a doctor.

In August, non-urgent gastrointestinal operations were cancelled after an unannounced inspection found had failed to improve – with issues also blamed on short-staffing.

Inspectors spoke to over 120 staff during the inspection into how the trust is run. A total of 118 staff raised a concern and two provided positive feedback. CQC has continued to receive contact from staff on a regular basis.

The report said some staff felt bullying and harassment complaints were ignored because their complaints were about senior staff with relationships with top management.

Consultants at the Royal Sussex continued to behave in a way which made staff feel undervalued, unsafe and unsupported.

And minority ethnic staff survey results showed they were more likely to experience poorer outcomes than their white colleagues.