PERFORMANCE: East Sussex Healthcare Trust has been recommended for special measures after its second Care Quality Commission inspection in a year found that staff “remained afraid to speak out”.

  • Inspectors found a “void” between “board perception” and the “reality of working at the trust”
  • Trust recommended for special measures after two 'inadequate' reports
  • CQC says there was “little public engagement” over recent reconfiguration of services

The conclusion is set out in an inspection report published today, alongside a catalogue of other CQC concerns about the trust, ranging from failures of public engagement, to data accuracy, to a high reliance on temporary staff.

Inspectors found there was a “void” between “board perception” and “the reality of working at the trust”.

At senior management and board level, managers spoke “entirely positively” about staff engagement and blamed “a few ‘dissenters’” for the negative comments inspectors heard. However, the CQC saw a “culture where staff remained afraid to speak out or to share their concerns openly”.

Some employees told the inspectors that relationships between management and staff “had never been worse”.

The trust was first inspected in September 2014 and was rated “inadequate”. However, the CQC said it could not take a decision on whether the trust should be recommended for special measures because six months had passed between the inspection and the report’s publication.

It has also been six months between the second inspection and the report’s publication. The CQC reinspected the trust in March.

In its report on this latest inspection, it says:

  • There “remained little public engagement in the wider benefits of” a reconfiguration of maternity and paediatric services, which took place last year. The trust had “failed to engage significant elements of the community” and inspectors saw no plan to address this.
  • There were delays to follow up appointments and the call centre for outpatient appointments was not “effective”.
  • There was concern about the accuracy of data and patient records were not securely stored in the outpatient department. Medical records were “often unavailable” or were in a “poor state of repair”.
  • There was a high reliance on agency staff in surgical services. Staffing in the emergency department relied “heavily” on locums, and nurse sickness levels were high.
  • Patients were left without food or drink for “excessive periods” because staff did not always follow fasting guidance.

The trust was found to be ‘inadequate’ in three areas including the quality of its leadership. It was rated ‘requires improvement’ for the responsiveness of its services, and ‘good’ for caring.

The trust had consistently missed the referral to treatment target over the past year. Patients in rheumatology were left waiting 48 weeks for an appointment and then struggled to get follow up treatment.

A senior member of staff told inspectors that consultants in rheumatology “refused” to see patients for follow up if they had their first consultation with a locum consultant. The report concludes this was “clearly detrimental to patient care”.

HSJ asked the CQC why the recommendation to place the trust in special measures had taken 12 months.

A spokeswoman for the regulator said placing a trust in special measures was a “big step” and it was “vital” that a “clear plan” was established to make sure the trust would benefit from the “extra support”.

Chief inspector of hospitals, Professor Sir Mike Richards, said: “It is clear from our most recent inspection that East Sussex Healthcare Trust has been struggling to deal with deep-rooted problems which have been having an impact on its core services. I am disappointed that the trust has made too little progress in dealing with the significant issues in the underlying culture which have been all too apparent for some time. 

“While I recognise that the trust has been working over the last few months to make further improvements I am chiefly concerned at the rate of progress since our inspection last year. The continuing disconnect between the trust board and staff is worrying, and I am sure lies behind the continuing poor performance.  

“I know there has been some improvement; I am aware of the renewed determination by the new senior managers to take more robust and focussed action. Despite these assurances, I do not feel the improvements we have seen are nearly enough to put to rest the concerns of the people who use the services or local stakeholders.”

Richard Sunley, acting chief executive at the trust, said: “We are very disappointed about the shortfalls the CQC has identified. We are sorry that we have let down people who use our services, our staff and colleagues and acknowledge we have not delivered the standards the people in East Sussex rightly expect from us.

"However, we welcome the additional support from the wider NHS that the CQC has recommended and are determined to make a new start. We are working hard to meet our ambitions to improve at pace and deliver excellence for the people we serve."

He added that improvements had already been made through increased staffing levels, investing in an electronic tagging system to track patient notes and reducing waiting times in outpatients departments.

He added: "I am pleased the CQC recognises our staff for delivering good, compassionate care and this is a strong position we will build from."

A spokesman for the NHS Trust Development Authority said: “We have received the CQC’s recommendation regarding East Sussex Healthcare.  We will consider and announce a decision in due course.”