Hastings And Eastbourne: Hospitals 'Inadequate'

England's Chief Inspector of Hospitals, Professor Sir Mike Richards, has published his first report on the quality of services provided by East Sussex Healthcare NHS Trust.

Overall the trust has been rated as Inadequate.

The inspection took place in September 2014. Because of the longer than usual time between the end of the inspection and publication of the report CQC inspectors returned to the trust on 24 March to assess the progress the trust has made addressing the serious concerns we raised.

In most cases, a rating of Inadequate would lead to the Chief Inspector of Hospitals recommending that the trust be put in special measures. Early indications from this week’s inspection, which focused on those services that were judged in September to cause the greatest concern – maternity, surgery and outpatients – are that improvements have been made, although inspectors still have concerns about the leadership and culture of the trust. As a result, any decision on special measures will be deferred until he has considered in full the findings of the latest inspection.

Hear from Professor Edward Baker:

The Chief Inspector of Hospitals, Professor Sir Mike Richards , said:

“When we inspected East Sussex Healthcare NHS Trust in September, we were extremely concerned at the disconnect we identified between the senior team and the staff working on the frontline. We saw no sign of a clear vision and strategy and a lack of response to concerns raised by staff. We had specific serious concerns about maternity, surgery and outpatients.

“Our recent inspection indicates there have been improvements in important areas for patients, but I am still concerned about cultural and leadership issues at the trust. I will not be making a judgment about special measures until we have fully assessed the results of our most recent inspection.

“We, alongside our partners will continue to keep a close eye on the trust and will inspect again in due course to assess whether or not adequate progress is being made.”

During the inspection in September a team of inspectors and specialists including doctors, nurses, managers and experts by experience visited Eastbourne District General Hospital and Conquest Hospital at Hastings. The trust’s community healthcare services for children and young people were also inspected.

CQC rates trusts on five key questions that reflect the care that patients have a right to expect. East Sussex Healthcare was rated Inadequate for ‘Safe’ and ‘Well led’, ‘Requires Improvement’ for ‘Effective’ and ‘Responsive’ and ‘Good’ for ‘Caring’

The regulator also rates the individual hospitals run by the trust and the core services they provide. Overall inspectors rated Conquest hospital as Inadequate, although medical and critical care were rated as Good. Improvements were required for accident and emergency, children’s services and end of life care. Surgery and maternity were both rated as Inadequate.

Eastbourne District General Hospital was rated Inadequate overall, although critical care was rated Good. Surgery and Outpatients were both rated as Inadequate and accident and emergency, medical care, children’s services and end of life care requiring improvement. Full reports are available at http://www.cqc.org.uk/provider/RXC

Our inspectors found that there was a worrying disconnect between the trust’s most senior managers and frontline staff.  Staff were concerned about how change was implemented, low morale, bullying and harassment and a number of staff came forward to raise serious concerns with CQC about the culture of the trust and the care being delivered.

At Conquest Hospital, inspectors found that although maternity staff were caring, the service was poorly managed with inadequate staffing.  Staff were working long hours without breaks and with little support and this was reflected by a high level of absence through sickness. Managers were trying to maintain a good service under trying circumstances.

Inspectors found every service to be caring and compassionate, with staff at all levels committed to providing good patient care and frustrated when they felt they could not achieve this. Patients commented positively about the staff providing the care.

Hear from Dr. Andy Slater, the Medical Director of Strategy:

The inspection team identified ten areas for improvement including:

The trust must improve the relationship with its staff, specifically the culture of the organisation, so that people feel able to speak up.
There must be a review of the culture within the organisation especially the perceived allegations of bullying.
The trust must work to improve relationships with the population it serves; specifically relating to their concerns about service changes, including the changes to the maternity services.
The way medicines are managed in clinical areas must be improved.
Changes within the outpatient services must be reviewed to ensure that they meet the needs of patients.
Waiting times for outpatient appointments must be reviewed to meet the government’s referral to treatment waiting times.
Ensuring there are sufficient staff to meet the needs of the service.
Overall, inspectors identified several areas of outstanding practice, including:

Clinical leadership and consultant presence in critical care.
The introduction of a handheld electronic system for recording patients‘ observations
Nurse-led discharge - an effective and efficient approach to patient discharge 

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