East Sussex Healthcare NHS Trust has been rated as “requires improvement” but must improve more before it can leave special measures, according to the Care Quality Commission.
Deficiencies in staffing levels in the emergency department and maternity services were impacting on patient care and experience, said the regulator in its latest report, which also warned that the “recruitment of staff remains problematic across the trust”.
“I remain concerned that performance within the emergency department is not as robust as it could be”
“The emergency departments faced staffing issues for both medical and nursing staff,” noted the report. “Nursing levels were regularly below that planned and access to paediatric trained nurses was not consistent.”
Meanwhile, in maternity, the report added: “Staffing levels within the day assessment unit were impacting on care and the ratio of staff to supervisory midwives was high, leading to reduced access to supervision. In addition, there were low numbers of band 7 midwives in the workforce.”
The trust was originally placed in the “special measures” regime for struggling service providers back in September 2015.
- CQC warns of poor staff engagement at Sussex acute trust
- East Sussex Healthcare rated ‘inadequate’ by hospital inspectors
At the time, inspectors were concerned by a “disconnect” between senior management and other staff, and said they saw a higher number of staff than expected who wished to remain anonymous.
Meanwhile, the inspectors found bad feeling among local stakeholders over the reconfiguration of services, which had seen consultant-led maternity and paediatrics centralised.
Following its most recent inspection in October 2016, the CQC said “significant improvements” had been made but recommended that it should remain in special measures for a further period of time.
“The improvements identified are fairly recent and not fully embedded”
Inspectors found that, while further work was needed, a number of improvements had been made at its two main sites – Eastbourne District General Hospital and Conquest Hospital in Hastings.
Both had previously been rated “inadequate” but, following the most recent inspection, both were now rated “requires improvement”.
Overall, the trust was rated “requires improvement” after the CQC visit. It was also rated “requires improvement” for being safe, effective, responsive and well-led, but as “good” for being caring.
The CQC said that, since the previous inspection in March 2015, the trust had made significant improvements in its services.
A new leadership team was in place, which was very visible, and the former concerns of bullying and lack of staff engagement appeared to have been tackled.
The organisational culture had transformed with staff on the whole positive, well engaged and feeling valued by the organisation. But, inspectors found further improvement were required.
Both accident and emergency departments were rated as “requires improvement”, but with poor staffing levels, poor record keeping and deteriorating performance against access standards.
“We will continue to focus on our key priorities – which include recruiting and retaining more permanent clinical staff”
The trust’s senior managers were relatively new and some improvements had only recently been introduced and were not fully embedded for the CQC to take a measured view of the improvements.
However, the CQC said its inspectors also saw several areas of outstanding practice at the trust.
There was positive engagement of staff in the outpatient department from management and a commitment to deliver high quality care and develop staff, said the regulator.
A recent maternity review was effective and considered the views of users alongside staff and had resulted in quick improvements to the service and a more positive culture among staff, said the CQC.
A dedicated multidisciplinary team had established a five year plan to establish an innovative rehabilitation care plan as part of an out of hospitals services transformation programme
This programme included staff from multiple specialties and enabled ED staff to work with colleagues from across the trust, and in the community, to develop future services.
The CQC praised innovations such as providing keepsake boxes for bereaved parents and using knitted comfort bands to reduce the risk of patients with dementia tugging at intravenous lines.
Sir Mike Richards
Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, said: “The improvements identified are fairly recent and not fully embedded. Continuation of this improvement must be seen as a priority for the trust.
“While the trust continues to make substantial progress, I remain concerned that performance within the emergency department is not as robust as it could be, and this is having an impact on the quality and timeliness of services for patients.
“While I appreciate the issues surrounding staffing, there are still delays in patients being transferred from ambulances to the emergency department,” said Sir Mike, who announced last week that he will retire in the summer.
“I feel optimistic that the trust will continue to improve, but it will require continued support for the foreseeable future,” he said. “That is why I am recommending the trust remains in special measures.
He added: “Compared to CQC’s last inspection in March 2015 there was positivity about the changes in culture within in the organisation. The concerted efforts by the leadership group have helped develop some significant improvements particularly in staff engagement.”
ICHP MD appointed - Dr Adrian Bull photo
Trust chief executive Dr Adrian Bull said: “I am very pleased that the CQC has recognised the progress that has been made since our last inspection. It is testament to the hard work and commitment of people across the organisation.
“We have a talented and professional workforce and the rating of ‘good’ for being caring is recognition of this,” he said. “However, we still have a lot of work to do to ensure we provide consistently high standards of care across all of our services.
He added: “In the coming year we will continue to focus on our key priorities – which include recruiting and retaining more permanent clinical staff; improving the management and flow of patients through our hospitals; reducing waiting times for investigations and planned surgery; further developing our community services; and achieving financial sustainability.”