Brighton and Sussex University Hospitals NHS Trust was told on Friday by the Care Quality Commission (CQC) that it “required improvement”. Chief executive Matthew Kershaw, pictured below, gives Argus health reporter Siobhan Ryan his response to the findings of the inspection and what the next steps are.
SIOBHAN RYAN (SR): Do you feel the findings of the CQC report are fair?
MATTHEW KERSHAW (MK): The report is a fair and balanced assessment to where we are right now and we acknowledge and accept that overall Brighton and Sussex University Hospitals (BSUH) requires improvement.
There are a great deal of positives in relation to the ratings themselves – more than two thirds of the individual areas inspected were rated as good – and the open and honest way that we approached the whole inspection and are dealing with things today was also positively remarked on.
I also think our staff should be really proud of the fact the Care Quality Commission (CQC) rated us good overall for providing services which were caring and effective and gave special mention to a number of outstanding areas including those for patients with dementia, the critical care teams at both the County and Princess Royal and our children’s services.
SR: Pressures on A&E, particularly at the Royal Sussex, was an issue last year and are an issue again this year. What exactly is causing the problems?
MK: Pressure on A&E is not unique to BSUH, it is an issue in emergency departments across the country and there is not one cause.
The population is ageing and as well as living longer more people are also living with and managing multiple illnesses and conditions.
As a result emergency demand on all health and social care services, including hospitals, is increasing.
The CQC took great care to point out that the ‘inadequate’ rating we received for the responsiveness of the emergency department at the Royal Sussex was not about the standard or quality of care being delivered in that department but about efficiency – how quickly people are admitted into the hospital or treated and discharged home.
The national standard is that for at least 95% of patients this should be within four hours and that is not a standard we are consistently achieving.
SR: How can the trust realistically resolve these issues?
MK: We cannot resolve these issues on our own.
The CQC were also very clear that the rating given for responsiveness in the emergency department reflects on-going and complex issues some of which are not ours to resolve, ie the number and types of patients who come into the emergency department, the availability of and access to alternatives to A&E and the discharge of inpatients from our wards who no longer need acute hospital care to enable us to create the capacity needed to admit patients from the emergency department in a timely way.
There are lots of elements we need to do better and we have been working hard on these for some time and we are making progress.
But the flow of patients into, through and out of the hospital is as much about the health and social care services and support provided in the community as what happens in the hospital itself and those responsible are working positively with us to increase and improve these services as a real priority.
SR: The report highlighted the case of two patients staying more than 18 hours in the emergency department.
Although these were not technically official 12 hour breaches, it is still a long time. What needs to be done to stop this from happening again?
MK: Whichever way you look at it, that is too long to be in the emergency department and we are very sorry that some patients are waiting longer than they should.
To stop this happening we need to fix the whole system.
We need to work with those who provide healthcare outside of the hospital to ensure that there are lots of alternatives to A&E available 24 hours-a-day, seven days-a-week, and that everyone knows where they are and how to access them.
That way the services provided in the emergency department are only used by those who really need acute emergency care.
We need to ensure that the patients in the emergency department are seen quickly and either treated and discharged home within four hours or admitted to a bed in the hospital for further investigations or treatment if that is what they need.
And we need to ensure that once a patient no longer needs to be in an acute hospital bed the on-going care and support they need is readily available so that they can be safely discharged either to their usual place of residence or to another facility that could better meet their needs.
SR: What is the trust doing regarding staffing levels and recruitment?
MK: This year we have made an additional £3 million investment in our nursing workforce which includes money to increase our nurse to patient ratios and to allow our ward sisters and charge nurses to be freed to up to run/lead the ward and not be counted in those ratios.
Earlier this year the government published, for the first time, nurse to patient ratios for every ward in every hospital in the country and from that we can see that we are making steady progress towards achieving them.
We still have a high number of nursing vacancies but we are undertaking a massive recruitment drive to try and fill as many of these as possible.
We have made some significant changes to our systems for recruiting nursing staff in order to speed them up.
Since the beginning of 2014 we have recruited 381 new nurses and 162 new healthcare assistants across every area of our hospitals.
SR: The report highlighted serious on-going cultural issues within the maternity and family planning services. How is this being addressed?
MK: We have some long-standing cultural issues within the organisation, including some very specific issues relating to race equality, and the CQC were extremely positive about the progress which has been made on the work being done to address these.
For the last 12 months we have been running a programme called Foundations for Success which is about engaging the workforce to properly talk about and help design ways to address some of these long-standing issues.
The programme includes and has already delivered the development of a new five-year clinical strategy, the design and delivery of a new clinical structure to create groups of services (clinical directorates) which better mirror the way patients use the hospital and give those closest to the frontline more responsibility and authority.
It also includes a set of new organisation-wide values and behaviours which have been developed through a consultation process which included more than 700 of our staff.
The implementation plan for these, which will turn them from nice words on a page to the reality in which we expect our staff to operate, includes specific work on race equality and on how we will reward people who behave well and manage those who don’t.
SR: The report said the issues raised by the CQC have already been recognised and were being dealt with by the trust. What exactly is being done and when will people notice any improvements?
MK: Hopefully people are already noticing improvements.
The CQC said they could see very clear and positive progress had been made on the challenges highlighted during their last visit in December 2013.
Clearly there will always be more to do but we are not ignoring these challenges in the hope they will go away, or denying they exist.
We are talking about them openly and honestly and working with our staff and other relevant organisations outside hospital to ensure we keep making improvements.
SR: Can the trust reach a good or outstanding level?
MK: We were tantalisingly close to achieving good this time.
Overall there are 90 ratings within the report and of those 64 (or over 70%) were good, 25 were requires improvement and one was inadequate and we are already well on the way to addressing the issues which prevented us from getting an overall rating of good this time.
Our long-term ambition is of course to achieve outstanding but of the 29 hospital sites which have been inspected under the new CQC regime so far, none have been given an overall rating of outstanding.
So my honest response is we will be focusing our time and energy in the next period on achieving a good rating which we can maintain.
SR: What areas of the report were you particularly happy with?
MK: I am happy that we received an overall rating of good for providing services which are both effective and caring.
Even in the areas where we know there is work to do the inspectors found our staff to be caring and that they supported patients and their families in a compassionate way.
Our staff work very hard, in often difficult circumstances, and these ratings are a credit to them.I am also happy that the CQC found almost universal awareness of the work we are doing on developing our organisational values and behaviours.
They said, with only one exception, all the staff they talked to about this had been directly in this work, knew a colleague who had been, or were aware of the opportunities they had to engage with this work.
Engaging with more than 7,000 staff across different sites which are many miles apart is not easy but this work is so important and I am absolutely determined that we do it properly and well. Finally, I am pleased that the CQC also identified we have some outstanding examples of best practice in our hospitals. They talked about the care we provide for patients with dementia as innovative, creative and best in class; they found our critical care teams at both the Royal Sussex and Princess Royal Hospitals to be strong, committed and compassionate.