We carried out this unannounced focused safety inspection of maternity services, provided by the University Hospitals Sussex (UHS), because we received information of concern about the safety and quality of the service.
Information of concern had been received from several sources about the maternity services across the trust. This included staff whistleblowing, patient complaints and information from other regulatory bodies.
University Hospitals Sussex provide maternity services at the Princess Royal Hospital, Royal Sussex County Hospital, St Richards Hospital and Worthing Hospital. This report focuses on our findings at Princess Royal Hospital.
We also asked the trust to send an anonymous staff survey to give all maternity staff the opportunity to share their experience of working at UHS and raise and share concerns in a safe and confidential manner. The survey was open to staff between 1 September and 15 September 2021 and at the Princess Royal Hospital there were 57 responses. The anonymous results related to the Princess Royal Hospital have been used as evidence to support our inspection.
This inspection has not changed the ratings of the location overall. However, our rating of maternity services went down. We rated them as requires improvement.
Overall, we rated safe as requires improvement and well-led as 'inadequate', we did not have enough evidence to re-rate the effective domain.
University Hospitals Sussex NHS Foundation Trust was formerly called Western Sussex NHS foundation Hospital. It changed its name on 1 April 2021 when it acquired Brighton and Sussex NHS foundation Trust.
The trust has five hospitals – Worthing Hospital, St Richards Hospital, Royal Sussex County Hospital, Princess Royal Hospital and Southlands Hospital – which provide a full range of acute services.
When a trust acquires another trust in order to improve the quality and safety of care we do not aggregate ratings from the previously separate trust at trust level for up to two years. The ratings for the trust in this report are therefore based only on the ratings for Western Sussex NHS Foundation Trust.
Our normal practice following an acquisition would be to inspect all services run by the enlarged trust. However, given we were responding to concerns in the maternity and surgery core services we inspected only those services where we were aware of current risks. We did not rate the hospital overall. In our ratings tables we show all ratings for services run by the trust, including those from earlier inspections and from those hospitals we did not inspect this time.
How we carried out the inspection
Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activities in maternity services. We carried out a focused inspection related to the concerns raised, this does not include all of our key lines of enquiry (KLOEs). We looked at KLOEs specific to the domains: safe, effective and well-led.
We visited clinical areas in the service including the central delivery suite, the postnatal ward, triage and the day assessment unit. We spoke with members of staff, including service leads, midwives (bands 5-8) obstetric staff (junior-consultant), consultant anaesthetists, maternity care support workers, student midwives and advanced neonatal practitioners.
We conducted a survey of maternity staff prior to the inspection. We observed the morning handover on the delivery suite and the postnatal ward. We observed the multidisciplinary ward round. We reviewed 10 sets of maternity records and 10 medicine charts. We also looked at a wide range of documents including protocols, meeting minutes, risk assessments, grading of recently reported incidents and audit results. Before our inspection, we reviewed performance information about this service.
You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.