Archived: Brighton and Sussex University Hospitals NHS Trust

Updated 8 January 2019

The trust has a history of long-standing and complex issues and was put into special measures for quality by the Care Quality Commission (CQC) following an inspection in August 2016. The current executive team were not in place at the time of that inspection. In October 2016, the trust was placed into financial special measures after it deviated from its planned savings targets. The trust exited financial special measures in July 2018.

Following the 2016 inspection an agreement between Brighton and Sussex University Hospitals NHS Trust, Western Sussex Hospitals NHS Foundation Trust and NHS Improvement was created.

The agreement included a partnership between the two trusts. The intention being that the chief executive and chair of Western Sussex Hospitals Foundation Trust would also carry out those roles for Brighton and Sussex University Hospitals from April 1, 2017.

The management contract between Western Sussex Hospitals Foundation Trust and Brighton and Sussex University Hospitals was that the trust would:

• Exit quality special measures
• Exit financial special measures
• Improve accident and emergency performance
• Improve culture
• Deliver 3Ts (Trauma, Teaching and Tertiary Care programme) building redevelopment on time and within budget

The trust was undergoing an extensive building programme at the time of our inspection as part of the 3Ts renovation project.

The trust was inspected in April 2017 within weeks of this agreement taking shape. Although we saw some improvement during the 2017 inspection the trust had not made enough improvement to exit quality special measure.

In October 2017, we conducted a focused, unannounced inspection to specifically review staff understanding of COSHH after CQC was notified of a patient death following a COSHH incident.

Updated 8 January 2019

Our rating of the trust improved. We rated it as good because:

• The trust had made huge improvements since the new executive team had introduced improved systems of working. The trust had a new strategy, vision and values which underpinned a culture which was patient centred. The ‘Patient First Improvement System’ had empowered front line staff by equipping them with the lean tools, methods and a structured process which had helped to build and promote a culture of continuous improvement across the whole trust.
• A new divisional structure had been created around the pre-existing directorate structure. This had strengthened the existing leadership and management arrangements of the clinical services.
• Quality was a ‘golden thread’ running through the trust Patient First Strategy. In all the interviews undertaken on inspection this was evident in the use of data both quantitative and qualitative and how this was triangulated and reported through the Quality Steering Group to the Quality Assurance Committee and the trust board.
• All staff we spoke with on inspection were clear about the trust's approach and priority to deliver high quality sustainable care to patients. Staff knew and understood the trust’s vision, values and strategy and how achievement of these applied to the work of their team. To support the roll-out of Patient First across the trust, a communications plan was developed and implemented. The plan was tailored to different audiences to best reach staff in different parts of the organisation. Staff spoke about feeling that the Patient First Strategy had given them the ability to all speak the same language.
• The board received holistic information on service quality and sustainability. There was a programme of board visits to services and staff we spoke with told us that that leaders were approachable.
• Staff felt equality and diversity were promoted in their day to day work. We spoke with the newly formed Black and minority ethnicity working group. The trust had held an event in May where over 200 members of staff had come together to discuss equality and Black and minority ethnicity issues and start the forming of a new strategy. The output of this meeting was three workstreams; communication, recruitment, and education. The group we spoke with told us that they had seen a dramatic change in the past 6-9 months. They described this as powerful, positive and feeling included in the strategy and change. Staff told us that although they had not always felt supported in the past since the new executive team had arrived they now felt confident that they could raise any concerns about staff behaviours towards them with their line managers, and they felt assured that their concerns would be listened to and acted on appropriately.
• Staff felt respected, supported and valued. The executive teams and divisional leaders told us how they felt that improving the experience and engagement of their staff was fundamental to delivering a culture of high sustainable care and trust strategic objectives.
• The trust’s Patient First Improvement System empowered staff to make improvements and to be listened to and respected. In areas where ‘Patient First’ had been introduced the level of engagement and motivation had significantly improved as staff felt empowered to make improvements in their work. This was evident both on CQC engagement events at the trust and on inspection.
• A clear framework set out the structure of ward/service team, division and senior trust meetings. Managers used meetings to share essential information such as learning from incidents and complaints and to act as needed. The trust had governance and management arrangements had been strengthened significantly since the management agreement with Western Sussex Hospitals Foundation Trust and NHS Improvement. These arrangements enabled all clinical and management staff to function in an effective and efficient manner through both line management arrangements and governance arrangements.
• The board had invited the Good Governance Institute (GGI) carry out a review of the trust’s quality governance structures, which resulted in 31 separate recommendations being made. The trust acted to address these issues and the Good Governance institute carried out a further review reporting on progress against these actions. A focus of this work has been to strengthen quality governance arrangements at divisional level.
• The trust had effective structures, systems and processes in place to support the delivery of its strategy including sub-board committees, divisional committees, team meetings and senior managers. Leaders regularly reviewed these structures. The trust reported regularly through its governance arrangements on progress against delivery of its strategy to the board, Trust Executive Committee and to other relevant committees. However, the structure needed more time to become fully embedded.
• The trust executive team had worked hard to roll out Patient First Strategy across the trust. They had done this in a structured way by considering which areas of the trust would benefit the most from the methodology and training. There was no doubt that areas who had imbedded Patient first had made the largest impact on improvement. Although we were impressed at the speed and spread of improvement the trust needed more time to embed this methodology across the whole trust.

Updated 8 January 2019

Updated 8 January 2019

Updated 8 August 2014

We found children and their families were cared for by caring and dedicated staff who were supported to acquire further skills and qualifications by their team leader and manager. Staff told us they had annual appraisal and we saw evidence of this. All staff had received safeguarding training and knew how to report the signs and symptoms of potential abuse. Staff were aware of the relevant safety policies for lone workers and the provider had made every attempt to maintain the safety of staff who were working in community settings. The Children’s Community Nursing Team had recently received a Best Practice Team Award from the trust. The national audit team visited on 22 May 2014 and gave positive feedback about the service that the Children’s Community Nursing Team provided to children and families in the Brighton and Hove area.

It was evident that the team leader and manager were supported by the wider children’s services and the overarching clinical governance framework provided by the Royal Alexandra Children’s Hospital. There was a strong commitment in the Children’s Community Nursing Team to promote the care and independence of children in the care setting of their choice (home) in the Brighton and Hove area.