Conquest Hospital

Updated 25 January 2023

We inspected the maternity service at Conquest Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out a short notice announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

The obstetric led unit at Conquest Hospital was part of the East Sussex Healthcare NHS Trust. The unit provides antenatal, postnatal, early pregnancy unit and obstetrics. Doctors were available 24 hours a day to perform epidurals for pain relief, assisted and emergency births. Women who had medical conditions, complications during their pregnancy for themselves and their baby were advised to give birth at the consultant led unit.

The unit had a 10-room delivery suite, 1 theatre and 2 recovery beds. There was 24-hour cover from obstetricians and anaesthetist to assist women. Elective caesarean section lists were on a Monday, Tuesday, Wednesday and Friday.

The postnatal ward has 3 bays of 4 beds, total 12 beds and 3 side rooms, total 15 beds. (4 postnatal beds are ring fenced where possible for transitional care).

The antenatal ward is co-located with the postnatal ward consisting of 8 beds in 2 bays. Induction of labour is undertaken in this area

The maternity day assessment unit has four beds for seeing women throughout each day. Triage was a telephone triage system and based within the Eastbourne midwifery unit based in Eastbourne Hospital.

From April 2021 to March 2022 there were 2937 births across all trust sites.

We did not rate this hospital at this inspection. The previous rating of outstanding remains.

We also inspected one other maternity service run by East Sussex Healthcare NHS Trust. Our reports are here: Eastbourne District Hospital, Eastbourne Maternity Unit: https://www.cqc.org.uk/location/RXC02

How we carried out the inspection

This maternity thematic review was a focused inspection; we inspected the domains of safe and well led using the CQC’s established key lines of enquiries (KLOES).

We visited all areas within the consultant lead maternity unit. We spoke with 11 women,15 staff members to understand what is was like working for the service, including consultants, anaesthetist, doctors, midwives, maternity care assistants and housekeepers.

We interviewed leaders to gain insight into the trust’s leadership and governance model of the service.

We reviewed 6 sets of patient care records. We also looked at a wide range of documents including standard operating procedures, meeting minutes, risk assessments and recently reported incidents.

After the inspection we requested further documentary evidence to support our judgements including policies and procedures, staffing rotas and quality improvement initiatives.

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.

Updated 6 June 2018

Our rating of this service stayed the same. We rated it as good because:

• Staff demonstrated good understanding of the different types of abuse and could tell us the process for reporting a safeguarding concern. Each area had a safeguarding champion who linked into the trust safeguarding team who ensured their area had the most up to date safeguarding information.
• In the majority of mandatory training topics, the medical department was meeting the trust target for mandatory training compliance.

• There was an improved culture of incident reporting, particularly the lower grade incidents such as bullying and harassment, showing staff felt safe to report these issues. Incidents were recorded on electronic systems that incorporated fail-safes about aspects such as duty of candour. Learning from incidents was shared across the department and staff received the outcome of the investigation following the incident they had reported.
• Staffing and patient acuity was monitored regularly throughout the day and staff moved to ensure a safe level of staffing and skill mix at all times.
• Risks to patients were assessed, monitored and managed throughout their admission. This included potential risks of being unwell, rapid deteriorating health and risk on discharge.

• The medical department used an integrated care pathway record, which was shared by doctors, nurses and other healthcare professionals. Records were clear, up to date and available to all staff providing care for the patients. The medical department audited records regularly and audits showed actions taken to improve any issues identified.

• Learning from incidents was shared across the department via cross-site departmental meetings, ward meetings and electronic communication.

• People’s care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. This was monitored to ensure consistency of practice.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff involved patients and those close to them in decisions about their care and treatment.
• All patients and relatives we spoke with gave positive feedback about the care they received on the unit. Staff maintained their patients’ privacy and dignity at all times.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
• We found evidence of a positive culture that promoted openness and inclusiveness, this included all levels of staff from band one upwards had a voice within the team.
• We found evidence of a cohesive leadership team who provided sufficient support to staff and had a good oversight of the medical division.
• Staff told us the leadership and executive team were supportive, visible and approachable.

Updated 27 February 2020

Our rating of this service improved. We rated it as good because:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it. Staff understood how to protect children, young people and their families from abuse and the service worked well with other agencies to do so. The environment had improved since our previous inspection all areas were visibly clean and equipment was well maintained.
• Staff completed and updated risk assessments for each child and young person and removed or minimised risks. Staff kept detailed records of children and young people’s care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
• The service had enough medical staff with the right qualifications, skills, training and experience to keep children, young people and their families safe from avoidable harm and to provide the right care and treatment. The service managed safety incidents well. Staff recognised and reported incidents and near misses.
• Staff provided good care and treatment, gave children and young people enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them and their families on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to children and young people, families and carers.
• The service took account of children and young people’s individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The service struggled with staffing numbers and staff did not always have the right qualifications, skills, training and experience to keep children, young people and their families safe from avoidable harm and to provide the right care and treatment.
• Staff did not always keep accurate records of medicines administered. There were no record of who held the correct patient group direction authorisations we could not be sure that they were being used safely and correctly in line with trust and national guidance.
• The trust did not submit data to the patient safety thermometer, however, the service was in the process of introducing a more formal method of reviewing continually monitoring safety across the division. Staff collected safety information however this was not formally shared with staff or patients.
• Although diagnostics, pathology and pharmacy provision were available at all times, there was no seven-day service for physiotherapy, occupational therapy and play specialists.
• There was not registered Mental Health nurse working within the department. The division had access to Child and Adolescent Mental Health Services (CAMHS) however there were pressures on the service meant children were not always seen or discharged in a timely manner.
• The service was not always able to deliver care in a way that met the needs of local people and the communities served.
• Staff were not clear of the formal process or guidance surrounding children missing appointments. Missing appointments for some children may be an indicator that they are at an increased risk of abuse.
• Although staff were aware of some changes within the department, we heard they were not always part of improvement plans. Staff we spoke with said they were not involved in the recent improvement to the playroom.
• The transition pathways from children’s to adults’ services was still not fully realised, although action had started to be taken to improve this.

Updated 27 March 2015

The intensive care service uses procedures to ensure patients receive safe and effective care. Clinical outcomes were monitored, and practice changed where required improvements are identified. Staff were caring and compassionate, working to maintain the privacy and dignity of their patients. However, some improvements were required in relation to bed management processes, to ensure that patients did not remain in the intensive therapy unit (ITU) longer than required, which can impact on privacy and dignity. Leadership on the unit is good, but a change to the clinical unit management team has led to a lack of discussion when it came to dealing with planning issues, such as the clinical environment.

Updated 27 February 2020

Our rating of this service improved. We rated it as outstanding because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information. Key services were available five days a week with reliable out of hours and weekend cover.
• Patients and relatives said staff went above and beyond, and the care received exceeded their expectations. Staff truly respected and valued patients as individuals. They treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service was tailored to meet needs of individual people and are delivered in a way the ensure flexibility, choice and continuity of care. There was a proactive approach to meeting the needs of those from different cultures or with complex needs. People could access the service when they needed it. The service made it easy for people to give feedback and made changes as a result of it.
• Leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care. Leaders supported staff to develop their skills and motivated them to succeed. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, valued, and were proud of the organisation as a place to work and spoke highly of the culture within the service. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service used innovative ways to engage with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The service did not keep their risk register updated.
• There were some issues with the structural maintenance of the hospital.
• The service did not have a major incident policy for the mortuary, although staff were developing one.

Updated 25 January 2023

Updated 27 February 2020

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available when required.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of and valued their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers and embeded this in the care they delivered.
• There was a strong visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind, compassionate and promoted people’s dignity. Staff provided emotional support to patients, families and carers to minimise their distress and recognise and respect the totality of people’s needs. Staff made adjustments to care and support that was highly individualised. Feedback from people who used the service and those close to them was always very positive
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Not all mandatory training requirements were completed by all staff.
• Not all staff received an appraisal in line with the trust target.
• Not all waiting times from referral to treatment were in line with national standards.
• In the main outpatient department there was no designated waiting area for patients on stretchers. Not all clinic areas had seating available for bariatric patients or those that had difficulty in sitting.
• The carpet in the medical outpatient waiting area was stained and unsightly.

Updated 6 June 2018

Our rating of this service stayed the same. We rated it as good because:

• We found that the surgical department was well led. There were appropriate leadership arrangements at all levels within the surgical department and staff felt supported by their managers. Managers, matrons, clinical leads and members of the executive team were visible and approachable. They were actively involved in safety huddles and governance meetings. Staff said they were listened to and senior managers understood and acted on their concerns.
• The cancellation rate of operations was lower (better) than the average for England. The service proactively monitored procedures and investigated all cancellations to ensure that it did not happen again.
• Care and treatment was delivered in line with current legislation and nationally recognised guidance. The clinical effectiveness team reviewed all newly published guidelines and ensured they were adapted into local policies.
• Conquest Hospital was committed to improving services by reporting, investigating and learning for concerns or incidents. The service had reported one never event between December 2016 and November 2017. Staff told us information was disseminated through safety huddles, communications books and meetings to ensure lessons were learned from incidents.
• Junior members of staff and students were supported throughout their training. Students were allocated and rostered with their mentor throughout their placement. Junior doctors spoke positively about the support they received in theatres. Each had a specific learning development plan and good contact with consultants.
• Patient records and clinical notes were completed. This included the World Health Organisation surgical safety checklist and five steps to safer surgery and risk assessments.
• Staff treated patients with compassion, dignity and respect at all times. Care plans were adjusted at the pre-assessment appointment to meet the needs of each individual.
• Risks were reported to the risk register. This was monitored twice a month at the risk and clinical governance meetings and action plans were implemented to reduce or remove the risk.
• The service had made improvements in the way medicines were prescribed, recorded and stored; this was in line with national guidance. Automated systems were in uses in most areas. We undertook a random check of controlled drugs in the anaesthetic room for theatre four. The controlled drugs book was accurately completed with no block signatures. The medicines in the locked controlled drugs cupboard were reflected in the book.
• There was multidisciplinary participation in all patient care. Patient records demonstrated input from physiotherapist, the medical team, surgical nurses, occupational therapists and specialist nurses. Nursing and operating department practitioners spoke of good working relationships with doctors. Staff of all levels were seen interacting positively with each other.

However,

• There was still a heavy reliance on temporary staff. There were 20 vacancies for surgery at the time of our inspection.
• Areas within the theatre environment created safety hazards and were in need of refurbishment. The service was aware of the hazards and these were monitored monthly at the risk register meeting. Minor improvement requests for works had been made by the service.

Updated 6 June 2018

The emergency department at Conquest Hospital has a four-bedded resuscitation bay, eighteen major cubicles/, a mental health assessment room, three minor injury assessment bays/cubicles emergency nurse practitioner bays, plaster room and eye examination room. There is a clinical decision unit connected to the emergency department by a corridor that has seven bed/trolley bays and is used to observe patients or await investigation results. A paediatric resuscitation bay, waiting area and a designated paediatric treatment cubicle are available. There is an x-ray facility in the emergency department.

The hospital does have an inpatients paediatric ward but not paediatric intensive care support. Children requiring intensive care are transferred to a specialist paediatric unit in London or Brighton. Children under the age of one year old after registering in the emergency department are sent directly to the paediatric ward. The department has a newly built primary care suite, which at the time of inspection was not fully functional. The future plan for the primary care suite is to develop a fit-to-sit GP and advanced nurse practitioner assessment service co-located in the emergency department.

Patients who go to the hospital with minor injuries or illnesses register with reception before a triage nurse assesses them. Urgent and emergency services were last inspected in 2016 when overall we rated it as requires improvement .We rated safe as inadequate, responsive, effective and well-led as requires improvement and good for caring.

Our rating of this service improved. We rated it as good because:

• Staff worked in a culture that empowered them to report incidents. Learning from incidents, including serious incidents, had improved since our last inspection. Staff confirmed they received feedback and learning from incidents.
• The service was delivered by staff that were competent, trained and supported by their managers, and in sufficient numbers, to provide safe and effective care.
• The service used local and national audits to identify areas of weakness, to develop improvement plans, and to increase the effectiveness and responsiveness of the department.
• The service worked with the local commissioners and other stakeholders to plan, deliver and further develop the urgent and emergency services to meet the needs of the local community.
• The median time from arrival by ambulance to initial assessment was consistently better than the overall England median over the whole of the 12 month period from December 2016 to November 2017.
• An audit demonstrated poor performance in the management of sepsis as a result the service developed an action plan. Recent audit data showed a marked improvement in the management of sepsis since the improvement plan was implemented.
• There was parity in the quality of care given to all patients who attended the department regardless of their health needs.
• Over the 12 months from January to December 2017, no patients waited more than 12 hours from the decision to admit until being admitted.
• Performance against national standards was showing an improving trend.
• Leaders across the directorate, and hospital had a strategy for the service, were visible, dynamic and supported their staff. Leaders understood the risks and challenges to the service.
• Care and treatment provided reflected evidence based practice and national guidelines.
• Consultants had clinical oversight and ownership of all the patients in the department.
• Staff were engaged, felt valued and were proud of their department. Staff safety and welfare was paramount to the leadership team.
• The mental health service provided had improved and the service worked in collaboration with the emergency department to ensure both physical and mental health needs of patients were met.
• Both staff and managers reported difficulties accessing child and adolescent mental health services, especially out of hours.

However:

• There was no information regarding how patients could make a complaint or comment. However, when this was highlighted to the leadership team immediate action was taken and information was displayed by the end of our inspection.
• There was no facility available for families to spend time with their deceased relative as recommended by the Royal College of Emergency Medicine guidelines. Families could spend time with a deceased relative in the resuscitation department or chapel of rest.
• The toilets in the department posed a risk to service users with a mental health illness. They contained a number of fixtures and fittings that could be used as ligature points. This was resolved shortly after our inspection after raising it with the department staff.
• Mandatory training compliance although better than our last inspection still required improvement.
• Out of date medicines were found within a fridge in the resuscitation unit and three out of date pieces of disposable equipment were found in the resuscitation trolleys.
• The department’s performance in the Royal College of Emergency Medicine was varied; however some of this audit were undertaken two years ago and may not reflect the improvements made.