CQC Downgrades East Sussex Healthcare NHS Trust: Urgent Care Falls

• The CQC downgraded urgent and emergency care at Conquest Hospital from 'good' to 'requires improvement' and maintained Eastbourne DGH's 'requires improvement' rating after February inspections.
• Conquest Hospital's overall rating dropped from 'outstanding' to 'good', while Eastbourne DGH's fell from 'good' to 'requires improvement'.
• Conquest Hospital breached four legal regulations, and Eastbourne DGH breached three, related to safe care, staffing, dignity, and management.
• Both emergency departments faced significant overcrowding and patient flow issues, leading to long waits and unsafe 'corridor care'.
• Mental health patients experienced inadequate support, with many leaving Eastbourne DGH without assessment, and national assessment standards were not met.

A primary driver of significant overcrowding in both emergency departments was identified as persistent issues with patient flow throughout the hospitals.

The Care Quality Commission (CQC) has issued a revised assessment of urgent and emergency care services at both Conquest Hospital and Eastbourne District General Hospital, operated by East Sussex Healthcare NHS Trust. Following inspections conducted in February, the CQC downgraded the urgent and emergency care rating at Conquest Hospital from 'good' to 'requires improvement'. Meanwhile, urgent and emergency care services at Eastbourne District General Hospital were once again rated as 'requires improvement'.

These service-level changes have broader implications for the hospitals' overall ratings. Conquest Hospital's comprehensive rating has shifted from 'outstanding' to 'good', while Eastbourne District General Hospital's overall rating has moved from 'good' to 'requires improvement'. The CQC has mandated that the trust submit detailed action plans for each facility, outlining immediate steps to rectify the identified deficiencies.

The CQC's findings highlighted significant regulatory breaches at both sites. At Conquest Hospital, the urgent and emergency care service saw its ratings for safety, caring, responsiveness, and effectiveness all fall from 'good' to 'requires improvement'. The 'well-led' domain experienced an even steeper decline, moving from 'outstanding' to 'requires improvement'. Inspectors identified four specific legal regulation breaches concerning safe care and treatment, staffing levels, upholding dignity and respect for patients, and the overall management of the service.

Eastbourne District General Hospital's urgent and emergency care service continued to be rated 'requires improvement' for its overall performance, as well as for safety, effectiveness, and responsiveness. The 'well-led' category was downgraded from 'good' to 'requires improvement', although the 'caring' aspect of the service maintained its 'good' rating. This facility was found to be in breach of three legal regulations, specifically relating to safe care and treatment, appropriate staffing, and the general management of the service.

Amanda Williams, the CQC's director of integrated care, noted that both urgent and emergency care departments were operating under immense, sustained pressure. This environment made it exceedingly difficult for staff to consistently deliver safe and effective care, despite their evident kindness and compassion, which was reflected in positive patient feedback. A primary driver of significant overcrowding in both emergency departments was identified as persistent issues with patient flow throughout the hospitals.

This overcrowding frequently led to extended waits for treatment or transfer to wards for patients requiring urgent care, increasing the risk of their condition deteriorating or experiencing prolonged pain. One critical example cited was a patient with a potentially life-threatening condition who endured a wait exceeding six hours for a scan due to delays in diagnostic access. Furthermore, staff often resorted to using temporary escalation spaces, sometimes referred to as 'corridor care,' to manage demand. These areas were not consistently safe, with patients sometimes lacking call bells and staff struggling to protect privacy and dignity, leading one individual to describe their care as 'undignified.'

Support for individuals with mental health needs was also found to be inadequate. The trust failed to ensure that patients received assessments from the mental health liaison team within the national standard of one hour. Notably, at Eastbourne, approximately 60% of patients presenting with mental health needs left the department before receiving an assessment.

While CQC inspectors acknowledged the capability and commitment of the leadership team, they concluded that leaders were not effectively identifying or managing risks. Crucially, they had not taken sufficient action to resolve long-standing issues, such as delays in securing access to specialist beds, which contributed to the overall system pressures. The CQC has clearly communicated its expectations for rapid improvements and has requested comprehensive action plans for both urgent and emergency care services.

These findings underscore the critical need for East Sussex Healthcare NHS Trust to implement robust strategies to enhance patient flow, ensure adequate staffing, and address the specific regulatory breaches identified. The required action plans are expected to detail how the trust will achieve immediate and sustained improvements across all areas of concern.

Compliance officers and legal counsel for NHS trusts, particularly those in urgent and emergency care, should review the specific CQC findings regarding breaches in safe care, staffing, dignity, and overall management. This case highlights the importance of proactive risk identification and robust action plans to address systemic issues like patient flow and mental health support, which can lead to regulatory downgrades and potential enforcement actions.

Source: Original reporting via Care Quality Commission