St Richard's Hospital

Updated 14 February 2024

St Richard’s Hospital is one of the hospitals of University Hospitals Sussex NHS Foundation Trust and provides clinical services to people living in and around Chichester.

At this inspection we inspected the surgery core service at St Richard’s Hospital. We found there was a deterioration in the quality and safety of the surgery service since the last inspection of surgery in 2016, resulting in a drop in their rating. The change in rating of the surgery services at St Richard's Hospital has affected the overall rating of the hospital which has dropped to requires improvement. More detail about the findings and required improvements can be found in the surgery core service section of this report.

Updated 20 April 2016

Overall we rated medical care services as 'Outstanding'.

This was due to the responsiveness of the service in the care of individual patients, coupled with a clear understanding of the needs of the population that used the service. Pathways were designed in collaboration with external stakeholders and community providers. The staff listened to feedback and acted on what they were told to fine tune services in the best interest of their patients. The trust executive and board had an exceptional understanding of what their service was and who their patients were. This approach was fed down so the directorate had a really good understanding of what they were meant to be providing and who the service was for - and created services that met the identified needs. Medical leaders focussed on getting the basics right and building on that to provide excellent care.

For example, there were exemplary provisions made for patients living with dementia across the whole hospital. We received very high levels of very positive feedback from patients and relatives who had used St Richard's Hospital. The 'Sit and See' scheme allowed staff to experience the hospital from a patient perspective.

Patients at risk of deteriorating were monitored and systems were in place to ensure a doctor or specialist nurse was called to provide additional support. The trust had an open culture and was prepared to learn from clinical incidents. Across the Division of Medicine there were enough medical and nursing staff to keep patients safe. The trust found it difficult to recruit new nursing staff; but was able to effectively fill gaps across the division by using bank and agency staff.

We found care was provided in line with national and local best practice guidelines. Clinical audit was undertaken and there was good participation in national and local audit that demonstrated good outcomes for patients. Patient morbidity and mortality outcomes were within expectations for a hospital of this size and complexity and no mortality outliers had been identified. The improvements in the care of patients with strokes was notable.

There was a good knowledge of issues around capacity and consent among staff.

Patients received compassionate care and were treated with dignity and respect. Most patients and relatives we spoke with said they felt involved in their care and were complimentary about staff. One person told us, “The staff are very, very kind and helpful. You just feel completely confident that they know their stuff." The Medicines division had good results in patient surveys with results indicating an improvement in patient views over the last 12 months.

The Medicines division were effective at responding to the needs of the community. The trust’s performance management team understood the status of the hospital at any given time. Bed availability was well managed. Elderly care pathways had been well designed to ensure elderly patients were assessed and supported with their medical and social needs.

The medical services were well led. Divisional senior managers had a clear understanding of the key risks and issues in their area. Medical areas had an effective meeting structure for managing the key clinical and non-clinical operational issues on a day to day basis. The hospital had a risk register which covered most key risks. Staff spoke positively about the high quality care and services they provided for patients. They described the hospital as a good place to work with an open culture. The most consistent comment we received was that the hospital was a “nice” place to work and staff enjoyed working in their teams.

Updated 20 April 2016

The children and young people’s service was rated 'Outstanding' because it had a strong, open culture of safety and developed reporting and learning from incidents and complaints. There was also strong governance and an effective assurance framework which resulted in a cycle of monitoring and improvement.

The children and young people who used the serviced experienced good care that resulted in outcomes that were generally above national benchmarks. Where there was underperformance, it was recognised and addressed through robust action. Staff knew how the service was performing in specific areas and were motivated to make improvements. Innovation and ownership of the service was strongly encouraged.

There was a culture of joint working and learning from others. This worked across the trust with examples such as 'Harvey’s Gang' (which the trust is justifiably proud of) and with other local providers and children’s agencies. The result of this was that children and families had a seamless journey through separate services, both internally and externally. Outcomes for very young children living in challenging circumstances benefited from this joint working.

Most importantly, the staff and leaders of the service were self-aware, they knew the limits of care they could provide safely, they understood the areas they needed to improve on and were working on these. They were very proud of their work and felt sufficiently comfortable in their position to share their pride widely and loudly to build on their strengths.

Updated 22 October 2019

Our rating of this service improved. We rated it as outstanding because:

The leadership team had ensured that recommendations from our last inspection had been acted upon. Improvements to services were noted by the team across the critical care unit on both sites.

Updated 20 April 2016

The overall rating for end of life care services for St Richard’s Hospital is 'Outstanding'.

The trust’s staff talked with enthusiasm about their proactive stance in getting people home to die if at all possible. This was supported by a strong rapid discharge policy that was sufficiently resourced to make it workable. The first national VOICES survey of the bereaved (2012) suggests that 71% of people wanted to die at home but that only 29% of people nationally who died in hospital felt they had sufficient choice about this. At the Western Sussex Hospitals NHS Foundation Trust, over 80% of people were supported to die in their preferred place of care. A strong culture of enabling rapid discharge supports people and their families in their desire to die in their home surrounded by the people they love and within a familiar environment that they retain more control over. The trust’s equipment library was a very good resource that enabled the rapid discharge of patients who wanted to be cared for at home in the last few days and hours of life.

A review of the data showed the trust had robust policies and monitoring systems in place to ensure it delivered good end of life care. However, it was the direct observation and conversations with staff, relatives and patients that made us judge the care outstanding. Individual stories and observed interaction provided assurance that staff of all grades and disciplines were very committed to the proactive end of life care agenda set by the board.

Staff provided a service that was caring. The specialist palliative care team (SPCT), mortuary and chaplaincy staff worked effectively and cohesively as a team to provide a seamless service. Most audits performed by St Richard's scored above England averages, which underpinned the rating given for this service. Feedback made directly to CQC, from relatives of people who had died at St Richard’s Hospital was overwhelmingly positive. They told us they, “could not have asked for more” and that staff in all areas of the hospital were caring, respectful and attentive. They talked about being involved and appreciated being supported to remain near their relative at all times.

The trust had prioritised the correct use of Do Not Attempt Resuscitation forms as a tool for engaging with patients and relatives about how they would like care to be delivered should there be an unexpected or expected but significant deterioration in the patient’s condition. Consultants had oversight of decisions made by junior doctors in consultation with family and we saw examples of clear challenge where a consultant was not content that sufficient thought had been given to the decision to withhold resuscitation that was requested by the relatives.

End of life care services were responsive. All teams worked hard to meet the needs of patients at the end of their life. There were some delays in discharges throughout the trust but these did not affect people needing end of life care where the trust managed to ensure that 79% of people were able to die in their preferred place of care.

The management structure, staff involvement and culture of the service were also outstanding. Staff feedback was exclusively positive throughout the inspection with all grades of staff supporting the trust focus on providing good end of life care. There was a positive vision for the future sustainability of the service.

Updated 29 July 2022

Updated 15 May 2023

Updated 22 October 2019

Our rating of this service stayed the same. We rated it as good.

Updated 14 February 2024

Updated 20 April 2016

Overall we rate the emergency department as 'Outstanding'.

This was because the trust had demonstrated a very responsive and hospital wide approach to meeting treatment time targets. The hospital met, and sometimes exceeded, the national target of seeing, treating, admitting or discharging 95% of patients within four hours, ending the year in the top 20 trusts in the country. Departmental leaders and staff had implemented highly effective systems to maintain flow and escalate problems as soon as there were indications of delays in patient flow.

There were clear arrangements in place to protect patients from abuse and avoidable harm. Medical and nurse staffing was at safe levels through effective recruitment and there were no 'No Events' or 'Serous Incidents' reported within the emergency department. There was a strong organisational culture of reporting errors and incidents. Incidents and complaints were investigated thoroughly, and lessons learnt were shared. Infection prevention and control practice was well established and staff followed the trust policy and national guidance.

Patients were efficiently assessed, monitored, and cared for to prevent or respond to deterioration in their condition.

Patients were asked about their wishes and supported to make decisions about their care and treatment. We saw staff consistently offered care that was kind, respectful, and considerate, whilst promoting patient privacy and dignity at all times. Staff supported patients promptly in managing pain and anxiety and we observed staff discussing treatment and pain management with patients in ways they could understand.

The 2014 Western Sussex Trust staff survey showed the numbers of staff experiencing physical violence was worse than the national average score for acute trusts. In discussion with the trust this was identified as a result of the large numbers of patients with advanced dementia. The trust had worked with staff to address the risks by introducing a new elderly care pathway so these patients had a reduced length of stay in ED and could quickly be transferred to a calmer ward environment or discharged to the familiar surroundings of their home.

CCTV was not installed within the paediatric area of the emergency department and doors were not locked, potentially allowing the public access with the risk of possible harm to children.