Updated 15 May 2023
University Hospitals Sussex NHS Foundation Trust provides clinical services to people in Brighton and Hove, parts of East Sussex and West Sussex. The trust came into existence as a result of an acquisition by Western Sussex Hospitals NHS Foundation Trust of Brighton and Sussex University Hospitals NHS Trust on 1 April 2021.
The trust is now one of the largest organisations in the NHS employing nearly 20.000 staff and serving a population of around 1.8 million people in Sussex. The trust runs 7 hospitals across Brighton and Hove, West and Mid Sussex and parts of East Sussex. The trust provides 24 hour accident and emergency and maternity services on 4 hospital sites, with Royal Sussex County Hospital in Brighton being a centre for major trauma and tertiary specialist services. The trust also provides specialist services for patients from across the wider South East region.
The Care Quality Commission (CQC) carried out 7 core service inspections in the past 18 months at University Hospital Sussex NHS (UHSx) Foundation trust. These included maternity, surgery (general surgery, upper gastrointestinal (UGI) cancer services, neurosurgery), and urgent and emergency care. In September 2021 we carried out focused inspections of the maternity services at St Richards Hospital, Worthing Hospital, Princess Royal Hospital and Royal Sussex County Hospital. These inspections found safety concerns raised by staff to CQC were valid. The ratings for all 4 maternity services went down. CQC took enforcement action by serving a warning notice that asked the trust to make significant improvements. We inspected the maternity services again in April 2022 and found the trust had complied with the terms of the warning notice. However, we asked the trust to make additional improvements by issuing requirement notices.
We also inspected the surgical core service at the Royal Sussex County Hospital in September 2021 because we received safety and leadership concerns from whistle-blowers. This inspection also found the concerns to be valid. The service was rated as inadequate. CQC took enforcement action and asked the trust to make significant improvement. We carried out another inspection to check on the improvements in April 2022. Our findings showed little improvement had been made. We took additional enforcement action and placed conditions on the trust’s CQC registration.
CQC then received concerns about the UGI surgical service from staff and other stakeholders. We carried out an inspection of the elective UGI surgical service in August 2022 and found serious safety and leadership concerns. This resulted in CQC urgently imposing conditions on the registration of the trust, suspending the UGI elective surgical service to protect patients from the potential risk of harm.
We have continued to receive concerns from staff about the safety of the surgical services at the Royal Sussex County Hospital. We have escalated these concerns to other key stakeholders to ensure there is oversight and support for the trust to make the necessary improvements at pace.
We inspected the emergency and urgent care services at the Royal Sussex County Hospital in April 2022. The rating for this service went down from good to requires improvement. We provided the trust with a list of actions they must and should take to drive the changes needed to improve the service.
Due to the ongoing safety concerns identified by our inspections and the contacts from staff, we carried out a well-led inspection. This was to review our concerns about the quality of the trust’s leadership, organisational culture and the lack of progress against the enforcement action taken in the surgical core service at the Royal Sussex County Hospital. At the same time, in response to concerns, we carried out a focused inspection of the neurosurgical service at Royal Sussex County Hospital.
CQC policy details that when a trust acquires or merges with another service or trust to improve the quality and safety of care, we do not aggregate ratings from the previously separate services or providers at trust level for up to two years. However, CQC can aggregate ratings at any time during that 2 year period if it is considered in the best interest of the provider and people using the service.
Following this current inspection, we have aggregated ratings, including core service rating, location/hospital ratings and the well led rating to give an overall rating for the trust. This has resulted in a deterioration in the overall trust rating.
CQC had contact with approximately 120 staff during the well-led inspection. Although this was a small proportion of the trust’s total workforce we found consistent trends and themes from these contacts. As part of the inspection process staff ‘drop-in’ sessions were arranged rather than traditional focus groups to ensure clinical areas were not depleted of high numbers of key staff during a widely recognised period of high demand and staffing pressures. A letter was sent to all staff making them aware of the various ways to contact CQC should they wish to share their experience of working at the trust drop- in sessions across the trust's sites to give staff opportunity to talk to the inspection team. 120 staff took this opportunity to meet with CQC and share their experiences. These themes and trend matched information CQC had received from members of the trusts staff in the 18 months prior to the well led inspection. We spoke with staff from all hospital sites. However, it is worth noting the majority of contacts came from the Royal Sussex County Hospital and Worthing Hospital locations. We continue to have repeated contact from staff who tell us feel unable to raise concerns through the trust’s own internal escalation processes.
CQC continues to work with system partners and key stakeholders to support the trust make the necessary improvements for patients and staff.
Trust wide
- Current communication and engagement methods were ineffective.
- Staff felt leaders were not visible and felt unsupported by senior leaders.
- Some staff did not feel respected, supported and valued.
- Staff reported low levels of satisfaction and high levels of stress and work overload.
- Not all staff felt they could raise concerns without fear of reprisal. Others experienced ‘concern fatigue’ from raising the same concerns repeatedly with no action taken.
- We found some examples of bulling and harassment.
- Staff were not able to identify the Freedom to Speak Up Guardian (FTSUG). Staff were unable to tell us how they would access the guardian or raise a concern.
- There was no substantively appointed guardian of safe working hours for the Royal Sussex County hospital and Princess Royal hospital from April 2022.
- Risk, issues and poor performance and behaviours were not always dealt with quickly enough.
However,
- The majority of leaders had the experience, capacity and capability to lead effectively
- There was improved collaborative working between the trust and the Integrated Care System.
- There was good collaborative working between local patient advocacy groups.
- The refreshed trust strategies appeared to be sufficient to improve quality for patients and staff.
- All staff were committed to continually learning and improving services.
Neurosurgery
- The service did not always have enough staff to care for patients and keep them safe. Shortage of radiography staff resulted in delays of surgical procedures.
- Some staff had not completed trust mandated training in key and essential skills. Some staff had not received appraisals.
- Staff did not always work well together for the benefit of patients. Some consultants did not engage with patient discharge processes or with sharing prognoses with patients.
- The environment and availability of equipment did not always support safe and effective patient care and treatment. There were incidents of surgery being delayed due to lack of imaging equipment. Lack of an emergency theatre capacity meant planned surgery was often cancelled to accommodate emergency cases.
- People could not always access the service in a timely manner. Some patients were waiting over a year for their planned surgery.
- Staff did not always feel respected, supported and valued. Some consultants did not demonstrate respectful behaviours.
However:
- Managers used local and national audits and reviews to monitor the effectiveness and safety of the service. They used the results to make changes and improvements to the service. Leaders supported staff to develop their skills. Most staff were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.
- Where safety incidents were reported, the service managed them well and learned lessons from them.
How we carried out the inspection
- We looked at information such as staffing numbers and rotas, staff training, clinical stack management.
- We looked at medicines management, checked equipment, medical devices and consumables.
- We reviewed information provided by the service following the inspection.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.
What people who use the service say
Most patients praised the care, treatment and support they received from the service. However, we also saw concerns about waiting times in the emergency departments, long waiting times for access to services and staff attitude.