Agenda item

36.1     The Committee considered an update report on University Hospitals Sussex NHS Foundation Trust (UHSx) Care Quality Commission (CQC) inspection reports. The CQC reinspected four of UHSx’s hospitals (including the Royal Sussex County Hospital (RSCH) in Brighton) in August 2023looking at Surgery and Medicine and published the reports in February 2024. The RSCH report showed an improvement from the previous report, with the overall rating upgraded to ‘Requires Improvement’. The safe and well-led domains were also rated as ‘Requires Improvement’.

36.2     The Committee asked what had led to the decline in UHSx’s hospitals ratings, in particular in the safety domain.

36.3     Professor Katie Urch, UHSx Chief Medical Officer, explained that the hospital ratings were not where they should be and recognised the need to improve in the safety domain, but clarified that hospitals were not inadequate or unsafe. While the majority of patients had a high quality of care, learning and change was needed. She explained that post-pandemic it was not uncommon for hospitals and Trust’s to see a decline in ratings given the suspension of normal services. Re-establishing services to the regular high level and documenting and demonstrating them effectively took time after COVID-19, and there had also been a significant turnover of staff. UHSx had also had a merger which created challenges as there were different documentation processes across hospital sites. Professor Urch emphasised that the CQC had reported that the care patients received was of a very high quality and safety level, but it was demonstrating that care and providing assurance to the regulator that had led to the decline in ratings.

36.4     The Committee asked whether the Trust would have progressed sufficiently to be considered ‘good’ under the CQC rating system by September 2024.

36.5     Prof Katie Urch explained that providing effective documentation of the level of care would not be instantaneous, but already work had gone in to ensure good practice was being shared and delivered across different hospital sites. There had been significant work behind the scenes to implement a system that improved staff feedback systems and allow the Trust to quickly learn about issues. The CQC was very clear that the care delivered on the ground was ‘outstanding’, and that was very reassuring for the Trust. Speaking about the Trust's Quality and Safety Improvement Programme (QSIP) timeline and implementation, Prof Urch said progress would not stop in September, but by then there would have been substantial improvements to how the high-quality care being delivered was evidenced. The Trust was confident that the bulk of the culture and safety change work would have been implemented by September, and then it would primarily be monitoring that those improvements were being embedded. However, it was difficult to say when the CQC rating might change as the scale and regulatory of inspections had changed.

36.6     The Committee asked for more detail on the police investigation at the RSCH, and how there could be assurance of current levels of safety given the investigation.

36.7     Professor Katie Urch emphasised that the police were investigating historical allegations between 2015-2021, and the Trust was completely complying with the investigation and being as transparent as it could be. The Trust could not comment in more detail given the ongoing investigation. UHSx had commissioned and conducted reviews into neurosurgery and general surgery and found that outcomes in these departments were not an outlier in national benchmarking statistics. Quality, safety and mortality meetings had all been reviewed by Prof Urch and that had given her high confidence in the team and how it reviewed itself. General surgery had slightly lower outcomes largely due to long waiting lists at the RSCH, and the Trust was exploring how to provide safe and timely care for elective patients at other sites to reduce this wait time.

36.8     The Committee asked for more information on how the Trust was reducing emergency department (ED) waiting times.

36.9     Professor Katie Urch noted that 76% of patients waiting less than four hours in ED was the target for the coming year, but that this was not currently being delivered, with the RSCH having the longest wait times. A challenge was that the ED had too many patients who should either be on a ward or discharged, but could not be because the hospital was full or care arrangements had not yet been made. There were therefore a lot of people who no longer needed hospital care which was creating longer wait times in ED. The Trust was spending £50m on expanding the ED floor at Brighton as it was currently too small, despite being adequately staffed. The programme is phased over the next three years with initial new developments, such as a new Surgical Assessment Unit, due to open later this year.

36.10   The Committee RESOLVED to:

1)    note the report; and

2)    receive an update report at an appropriate time.