This post chronicling the demise of standards in East Sussex will not surprise any of the employees. The decline was sustained before the fall, and as yet another trust bites the dust, politicians will remain in denial about the cause. Local mismanagement will be blamed when it is impossible for any management team to meet both the quality/access, and financial imperatives. (With apologies to the Argus for full reproduction). The media seem unable to take the argument beyond the specific to the general..
On Friday 15th August Frank le Duc reported in the Brighton and Hove News: Brighton hospital trust in crisis
PATIENT safety has been put at risk due to a catalogue of failings at a major hospital trust which has been placed in special measures.
A damning report published today by the Care Quality Commission (CQC) brands Brighton and Sussex University Hospitals NHS Trust inadequate and makes the recommendation that it needs support to improve.
The main areas of concern include:
- Patients being treated in a corridor in A&E at the Royal Sussex County Hospital in Brighton, compromising their dignity and confidentiality and risking infection
- The old buildings at the Royal Sussex being overcrowded and cluttered with narrow corridors and inaccessible fire exits
- Staff from black and ethnic minority backgrounds saying bullying, harassment and discrimination were rife
- Staffing levels and the skill mix in emergency departments, medical wards, critical care and midwifery were too low
- Some emergency patients using beds in the operating theatre’s recovery area for up to three days with no appropriate toilets
- The trust reported seven “never events” in 2015 – including four incidents where surgeons operated on the wrong part of a patient’s body
The trust – which also looks after the Princess Royal hospital in Haywards Heath – was placed in special measures yesterday.Going into special measures will normally mean the trust would partner with a successful trust and an action plan for improvements put in place. A trouble shooter is normally brought in.
The trust board was criticised for its lack of ownership to resolve the issues and inspectors said there was a “disconnect” between the board and staff.
The report also highlighted the trust’s failure to hit its targets for A&E waiting times and for outpatient appointments.
The trust was said to be inadequate for safety, responsiveness and leadership, while its effectiveness and care needed to improve.
However its services for children and young people at the Royal Alexandra Children’s Hospital were rated as outstanding.
Patients also said they were treated with compassion and care.
Trust chief executive Gillian Fairfield said the failures were unacceptable and apologised unreservedly.
The issues raised have partly been due to the condition of some of the buildings at the Royal Sussex along with an increase in demand for services and delays in discharging patients ready to leave hospital.
Dr Fairfield said changes had already been made to improve services and significant progress had been made in many areas since she arrived in April.
She said: “There is a lot more to do and some of the improvements will take time and a lot of hard work to achieve, but we are determined to continue the improvement process we have started to get to a place where we are providing our patients with a standard of care that they rightly expect and deserve.”
CQC deputy chief inspector of hospitals, Edward Baker, said: “There was a distinct disconnect between the trust board and staff working in clinical areas, with very little insight by the board into the main safety and risk issues, and seemingly little appetite to resolve them.”Royal College of Nursing senior regional officer Sue Huggins said: “The nursing team will be devastated to receive this report and yet they remain dedicated to providing the best care they can as they are professionals.
“No patient should ever have to receive care in a corridor and patients deserve dignified care at all times.
“This isn’t a problem unique to Brighton but it is an indication that unsafe staffing levels mean the appropriate standards can’t always be met.”
SAFETY AND LEADERSHIP ARE INADEQUATE WHILE CARE NEEDS IMPROVEMENT
AMONG services looked at by CQC inspectors were accident and emergency, medical care, surgery and critical care, end-of-life care and outpatients.
Overall the Brighton and Sussex University Hospitals NHS Trust, which runs the Royal Sussex County Hospital and Princess Royal Hospital, was given an inadequate rating.
Individually, the Royal Sussex in Brighton was found to be inadequate and the Princess Royal in Haywards Heath requires improvement.
Safety, responsiveness and leadership at the trust were all found to be inadequate, while its effectiveness and care required improvement.When it came to safety, inspectors said the trust had reported seven serious incidents over a one-year period, which was attributed to surgery. Four of these were related incidents, where surgeons operated on the wrong part of the body.
Not all areas of the hospital met cleaning standards and the fabric of areas like the Barry and Jubilee buildings were was poor and posed a risk to patients, particularly with regard to fire safety.
Both buildings were overpopulated, overcrowded and cluttered with narrow corridors and inaccessible fire exits and flammable oxygen cylinders were found stored in fire exit corridors.
Patients waiting in a corridor area of the emergency department at the Royal Sussex, known as the cohort area, were not assessed appropriately and there was a risk of cross infection.
Inspectors said there was a lack of clinical oversight of these patients and a lack of ownership by the trust board to resolve the issues.
Although the trust had an up-to-date infection-control policy, there was an inconsistent approach to hand hygiene practice in some areas.
Inspectors also criticised the trust’s use of balcony areas to create additional bed spaces.
The operating theatre’s recovery area at the Royal Sussex was being used for emergency patients due to having to reduce the pressure in A&E.
Some patients had stayed there for up to three days, despite no appropriate toilet facilities or access for visitors and carers.
Patients’ privacy, dignity and confidentiality were compromised in the outpatients department, medical wards and emergency department, where inspectors found frail elderly patients without call bells, patients being examined without the use of privacy screens and medical history discussions in close proximity to other people.
Inspectors said staffing levels and the skill mix in emergency departments, medical wards, critical care and midwifery were too low to ensure patients received the care they needed.
Nurse staffing levels in the emergency department at the Royal Sussex fell below safe levels on more than 60 per cent of shifts.
In some areas the trust had systematically failed to respond to staff concerns about this.
When inspectors looked at effectiveness, they found staff generally followed national guidance for care and treatment and patient’s nutritional needs were generally met.
The percentage of patients whose operations were cancelled was consistently higher than the national average, and over the course of a year, 71 people waited more than 12 hours in A&E for a bed to become available on a ward, In some areas, like the cohort area in the Royal Sussex, patients did not always have easy access to food and water.The trust’s care also requires improvement, although staff were found to be caring and compassionate to patients’ needs and patients said they felt well looked after.
Children and young people at the end of their lives received care from staff who consistently went out of their way to ensure both patients and families were emotionally supported and their needs met.
The trust was also found to be inadequate over its leadership.
Staff in general reported a culture of bullying and harassment and a lack of equal opportunity and longstanding problems faced by black and ethnic minority staff did not receive effective board action.Inspectors said there was a clear disconnect between the trust board and staff working in clinical areas, with very little insight by the board into the key safety and risk issues of the trust and little appetite to resolve them.
The culture at the Royal Sussex was one where poor performance in some areas was tolerated and there was a problem with stability of leadership and several long-term vacancies of key staff.
Ward managers and senior staff reported they received little support from the trust’s human resources department in managing difficult consultants or with staff disciplinary and capability issues.
The relocation of neurosurgery intensive care from Haywards Heath to Brighton in June 2015 had been managed without appropriate planning and risk assessment and also lacked evidence of robust staff consultation.
The executive team failed on multiple occasions to provide resources or support clinical staff in critical care to improve safety and working conditions.
There were several areas of outstanding practice, including services for children and young people at the Royal Alexandra Children’s Hospital.
The play centre has an under-the-sea themed room with a bubble tank and interactive floor.
A virtual fracture clinic, where patients with simple breaks in their bones are given advice over the phone instead of having to come in was praised, and the care provided for patients who had suffered a stroke was said to be outstanding.
The trust says it has already made significant improvements since the inspection in April, including sorting out fire risks and redesigning the A&E area to include a new assessment unit for patients coming in by ambulance.
New ways to better manage emergency patients during periods of high demand have been drawn up and a 24/7 surgical assessment unit has been opened for patients referred by GPs, which has increased the number of patients that can be seen and critical care nurse staffing numbers have been increased.
IT WILL TAKE TIME FOR THE TRUST TO GET ITSELF BACK ON RIGHT TRACK
TODAY’S CQC report makes difficult reading for Brighton and Sussex University Hospitals NHS Trust but many of these findings cannot be described as surprising.
Issues about overcrowding and long waits in A&E, missed targets, concerns about patient safety, staffing levels and allegations of bullying and harassment, especially for people from black and ethnic minority groups, have been well documented.
However, the depth and scale of the trust’s problems and the enormity of the task ahead means it is going to take a while to get it back on track.
The trust has been in a state of flux for nearly a year with several changes at the top following the departure of former chief executive Matthew Kershaw at the end of last year to take up a position at another trust.
Amanda Fadero took over as interim chief executive for a couple of months before Gillian Fairfield arrived in April.
Since April it has seen a new interim chairman and other board members have also been replaced and it is hoped the new team will be able to repair the distinct disconnect the CQC found between the board and staff.
Some of the issues raised are an indication of cuts in NHS investment in general, with staff struggling to provide the best service possible for an ever-growing number of patients in an atmosphere of cost cutting and cuts in bed numbers.
Part of the problem are the delays in patients being discharged from hospital when they are ready to leave because of issues providing community beds and support in their own homes.
This has a severe knock-on effect on departments like A&E and can lead to cancelled operations and long waits for appointments.
The NHS in general is also suffering a national recruitment crisis, something which the trust is not responsible for, but this is also adding to its problems.
There are plans for the future, the £480 million redevelopment of the Royal Sussex will lead to a better environment for patients but that will not be finished for several years and improvements need to be made now.
Dr Fairfield has already brought in several changes and it is hoped the trust will be out of special measures as soon as possible.