Ratings for maternity and emergency care services at Royal Sussex County Hospital revised after inspection
Urgent care services downgraded as maternity shows improvement
The Care Quality Commission (CQC) has updated its ratings for maternity and urgent and emergency care services at Royal Sussex County Hospital, following inspections conducted in February 2024.
The maternity services, managed by University Hospitals Sussex NHS Foundation Trust, have been upgraded from inadequate to requires improvement overall. Whilst improvements were noted, the CQC stressed the need for further actions to ensure services meet the needs of women and babies effectively.
Conversely, urgent and emergency care services retained their requires improvement rating overall but saw declines in areas such as safety, which was downgraded to inadequate. New concerns about patient privacy and dignity have led to stricter measures being imposed.
New findings in maternity care
Inspection of maternity services identified progress, with safe and well-led ratings moving from inadequate to requires improvement. Caring and responsiveness are now rated as good. However, the effectiveness of care dropped from outstanding to requires improvement.
Issues highlighted include delays for elective procedures such as caesarean sections and induction of labour. October 2024 data showed 69 women experienced delayed start times for caesarean sections, with 20 delays ranging from one to three days.
Facilities design within the maternity unit also fell short of meeting the needs of women and babies, with only one dedicated obstetric theatre impacting service flow. Despite a successful pilot for a second theatre in July 2023, a permanent solution has yet to be implemented.
Other concerns include inconsistent staff awareness of baby abduction policies, absence of audit systems, and outdated guidance for staff that is not aligned with best practices or legislative standards.
Dr Andy Heeps, Chief Executive Officer of University Hospitals Sussex NHS Foundation Trust, welcomed the recognition of progress made in maternity services:
“I welcome the Care Quality Commission’s recognition of the progress made in our Brighton maternity services. I am pleased that inspectors highlighted the compassion and kindness shown by our staff, and the strong teamwork between doctors, midwives and other healthcare professionals.
“Since the inspection in February, we have acted swiftly to use the CQC findings to make more improvements. We introduced extra theatre capacity for elective caesarean sections to improve access and reduce delays, and we strengthened leadership with key senior appointments to ensure services are well managed and responsive.
“While the service has moved up a level overall to ‘requires improvement’, with upgrades in the ‘safe’ and ‘well-led’ ratings, we totally accept that we need to go further. We are continually talking with families and staff to understand what more we can do to provide the safest, most compassionate care for mothers, babies, and families across Sussex.”
Suzanne White, head of medical negligence at law firm Leigh Day, expressed concern about maternity care at the hospital:
"We remain deeply concerned about maternity care at Royal Sussex County Hospital. In our cases, both here and more widely, we have seen a culture where mothers and their babies are treated with a lack of empathy. Too often, mothers’ voices are ignored, and their concerns are dismissed. This culture is causing avoidable harm to mothers and their babies and it needs to stop.
"Once again, we have to stress that urgent action for improvement is needed."
Urgent care stays unchanged with new concerns
Urgent and emergency care services saw downgrades in safety, effectiveness, caring, and leadership ratings. Inspectors found people being treated in non-clinical areas such as corridors, which compromised privacy and dignity. Temporary escalation areas were deemed inappropriate for effective care, particularly for patients with worsening conditions.
Due to delays within the department, issues such as prolonged ambulance handovers and extended waits for admission persisted. On the day of the inspection, 11 patients had been waiting over 24 hours for a bed.
Inspection findings also revealed frustration among staff regarding the computer system used, which was described as unsuitable. A reliance on paper and digital systems posed communication risks, especially for referrals or transfers to departments using incompatible systems.
Staff also reported a lack of timely action after submitting safety concerns, leading many to stop reporting incidents altogether.
Dr Andy Heeps commented on the challenges faced in urgent care services and steps taken to address them:
“The challenges highlighted in the Care Quality Commission’s report on our emergency department are well known, and since the inspection in February we have taken significant steps to address them.
“These include opening a new Acute Medical Unit to help ease pressures, moving patients to other wards at an earlier stage where possible, and working closely with partners to introduce new ways of assessing and caring for people outside hospital - helping to reduce the need for vulnerable individuals to attend A&E in the first place.
“We've made progress, but we are under no illusions about the very real pressures facing the local health system. At times, these pressures can be difficult for both patients and staff, particularly in emergency care. Longer-term developments, including the £62 million Acute Floor Reconfiguration project, will further strengthen our ability to deliver safe, timely, and compassionate emergency care for our community.”
Actions by CQC
The CQC issued a letter of intent under the Health and Social Care Act 2008 to address concerns in urgent and emergency care. The trust was required to respond rapidly with an action plan to avoid enforcement measures.
Maternity services were found to breach regulations in five areas, including labour induction delays, safeguarding, and premises conditions. These issues, alongside other findings, reinforce the CQC's directive for focused improvements.
Amanda Williams, CQC deputy director of hospitals in Sussex, acknowledged teamwork improvements in maternity services but highlighted ongoing concerns. She said:
“During our inspection of Royal Sussex County Hospital, we found several improvements in maternity services. Women and people using the service told us staff treated them with compassion and kindness, and we observed strong teamwork between doctors, midwives, and other healthcare professionals.
“However, we also found new concerns around the effectiveness of the service. The design and environment of the maternity unit didn’t fully meet the needs of women, people using the service and their babies. There was only one dedicated obstetric theatre which impacted the flow of the department.”
Commenting on urgent care services, Williams noted gaps in safety and care provision:
“We found several concerns in the urgent and emergency department. Some people were being cared for in non-clinical areas, including corridors, which didn’t protect their privacy and dignity... Following our inspection, we made clear to the trust where immediate action was needed to improve safety in the emergency department and mitigate the risks identified.”
The CQC is working closely with healthcare leaders to ensure implementations are made to ensure safety for patients.