Source · CQC inspection

Royal Sussex County Hospital

Provider University Hospitals Sussex NHS Foundation Trust Type NHS Healthcare Organisation Region South East Last inspected 17 Dec 2025

Overall rating: Requires Improvement View full CQC report

Domain ratings

Five CQC key questions

Safe

Requires Improvement

Effective

Requires Improvement

Caring

Good

Responsive

Requires Improvement

Well-led

Requires Improvement

Current CQC assessment

Single Assessment Framework

From 2024 CQC rates services through ongoing assessments rather than comprehensive inspections.

Requires Improvement Assessed 17 December 2025

The service is not performing as well as it should and we have told the service how it must improve.

Date of assessment: 26 to 27 February 2025The Royal Sussex County Hospital is based in Brighton and run by University Hospitals Sussex NHS Foundation Trust. The Royal Sussex County Hospital provides clinical services to people in Brighton and Hove. The hospital is a major trauma and tertiary center for specialist services and provides some specialist services for patients from across the wider Southeast region.At this assessment we inspected 2 assessment service groups, Urgent and Emergency care and Maternity services. We rated Urgent and Emergency Care as requires improvement and Maternity …

Ratings by service

Maternity

Requires Improvement

Feb 2025

Urgent and emergency services

Requires Improvement

Feb 2025

Maternity

Requires Improvement

Jan 2025

Urgent and emergency services

Requires Improvement

Jan 2025

Regulatory breaches & enforcement

Current-framework "must do" equivalent

Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, stated verbatim in the CQC assessment.

Letter of intent Overall

Following the assessment, we issued a letter of intent about possible urgent enforcement action under section 31 of the Health and Social Care Act 2008 and asked the provider for an action plan in response to the serious concerns found at this assessment.

· 17 Dec 2025 · CQC source

Breaches identified (12)

Breach Safe

We found 2 breaches in regulation in relation to safe care and treatment and privacy and dignity.

Regulation: Regulation 12 (Safe care and treatment) · 17 Dec 2025

Breach Overall

Although we saw improvements during this assessment (2025) the service remained in breach of regulations.

· 17 Dec 2025

Breach Safe

The service was in breach of legal regulation(s) in relation to people’s safe care and treatment and governance.

Regulation: Regulation 12 (Safe care and treatment) · 17 Dec 2025

Breach Overall

The breach was in relation to risks not being addressed in a timely manner, staff access to patient information, assurance through auditing systems, setting of targets and benchmarking processes.

· 17 Dec 2025

Breach Safe

The service was previously in breach of regulation 12 Safe Care and Treatment and regulation 10 Dignity and respect.

Regulation: Regulation 12 (Safe care and treatment) · 17 Dec 2025

Breach Overall

Improvements were not found at this assessment, and the service remained in breach of regulations.

· 17 Dec 2025

Breach Overall

We found 5 breaches in regulations.

· 17 Dec 2025

Breach Safe

At the assessment of Urgent and Emergency Care we found 2 breaches in regulation in relation to safe care and treatment and privacy and dignity.

Regulation: Regulation 12 (Safe care and treatment) · 17 Dec 2025

Breach Safe

At this assessment of maternity services, we identified 5 breaches of regulations in relation to safe care and treatment and good governance.

Regulation: Regulation 12 (Safe care and treatment) · 17 Dec 2025

Breach Safe

Following the focused inspection in 2021, we saw improvements, but the service was in breach of regulation 12: safe care and treatment in relation to triage processes and checks on lifesaving equipment.

Regulation: Regulation 12 (Safe care and treatment) · 17 Dec 2025

Breach Overall

We also found breaches in relation to the governance of the service.

· 17 Dec 2025

Breach Overall

The breaches related to appropriate management of risks including induction of labour and caesarean section delays, medicines management, safeguarding and the premises at Sussex House.

· 17 Dec 2025

Earlier inspection findings

pre-2024 framework · 19 must-do 7 should-do

Must-do actions (19)

Legal requirements based on regulation breaches identified during inspection.

Must-do action 1 of 19

Must do

Safe

The trust must ensure that all ventilation recommendations associated with the external audit of general theatres are implemented.

Regulation: Regulation 12 (Safe care and treatment)

⚠ General theatres had recently failed an external audit on their ventilation. According to the ‘Health Technical Memorandum 03-01 Heating and ventilation of health sector buildings’ guidance, most clinical areas are required to have 6 air changes every hour.

Must-do action 2 of 19

Must do

Safe

The trust must ensure equipment in ward and theatre environments is moved or stored to a suitable location and avoids emergency exits being blocked.

Regulation: Regulation 12 (Safe care and treatment)

⚠ Corridors were cluttered, and storage was limited on some of the older wards we visited and in general theatre areas. Staff told us there was a continued shortage of storage space. Theatre doors had signs to avoid obstruction, but we saw theatre equipment was still stored there. Senior leaders said …

Must-do action 3 of 19

Must do

Safe

The trust must ensure equipment stored on wards does not inhibit cleaning in any way.

Regulation: Regulation 12 (Safe care and treatment)

⚠ Ward and theatre areas were visibly clean and had suitable furnishings but were not well-maintained for equipment storage. In older wards and theatres, we saw some areas were cluttered with furniture and we saw overflowing equipment cupboards, which did not allow for thorough cleaning.

Must-do action 4 of 19

Must do

Safe

The trust must ensure appropriate training, in line with guidance, is in place and completed by staff to support patients with learning disabilities, and autism.

Regulation: Regulation 12 (Safe care and treatment)

⚠ Clinical staff did not complete training on recognising and responding to patients with mental health needs, learning disabilities, autism and dementia. Records showed mandatory training did not include training about meeting the needs of patients with mental health needs, learning disabilities, autism and dementia. Since July 2022 it is a …

Must-do action 5 of 19

Must do

Safe

The trust must ensure that staff complete mandatory training in line with their role and that oversight of targets is effectively monitored.

Regulation: Regulation 12 (Safe care and treatment)

⚠ Training modules for mental capacity and Deprivation of Liberty Safeguards (DoLS) was not seen and mandatory training completion for learning disabilities and autism populations was very low. Medical staff had an overall completion rate for mandatory training across all modules of 85%, which was below the trust target of 90%. …

Must-do action 6 of 19

Must do

Well-led

The trust must ensure action is taken to improve their compliance with national waiting list targets, and that performance data for the trust can be separated to show site performance.

Regulation: Regulation 17 (Good governance)

⚠ People could not always access the service when they needed it. Operations for patients were cancelled at the last minute and there was continued evidence of long waiting times and repeated cancellations to surgical operations. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were …

Must-do action 7 of 19

Must do

Well-led

The trust must ensure that workforce data for the trust can be separated to show individual site performance.

Regulation: Regulation 17 (Good governance)

⚠ It was not possible to identify mandatory training compliance figures, vacancy rates, turnover rates, or sickness rates for Royal Sussex County Hospital. The surgical division was across both Royal Sussex County Hospital and Princess Royal Hospital and the staffing data was not separated into data for each individual hospital.

Must-do action 8 of 19

Must do

Well-led

The trust must ensure communication structures for staff are clear, easy to follow, and that there are feedback mechanisms implemented for staff who raise individual concerns.

Regulation: Regulation 17 (Good governance)

⚠ There were areas such as general theatres where the communication and feedback mechanisms between senior and local leadership were lacking. Some staff were very upset about not feeling heard and they told us they felt frequently ignored by senior leaders when they raised their concerns or received no response at …

Must-do action 9 of 19

Must do

Well-led

The trust must ensure cultural concerns in the theatre department are addressed, and action is taken to ensure this improves.

Regulation: Regulation 17 (Good governance)

⚠ Staff morale for the theatre services remained low and staff still faced frustrations associated with raising concerns and understanding actions taken by senior leaders. Culture for some areas we inspected was very low and needed immediate improvement. The culture in theatres was still poor. Not all theatre staff felt respected, …

Must-do action 10 of 19

Must do

Effective

The trust must ensure that staff in theatres are supported to work within their clinical competency and that there are suitable arrangements for monitoring this.

Regulation: Regulation 18 (Staffing)

⚠ The service made sure most staff were competent for their roles, but staff did express concerns that some staff were working beyond their clinical remit in theatres due to staffing pressures. A staff member shared an example from theatres where a new staff member was being pressured to take on …

Must-do action 11 of 19

Must do

Safe

The trust must ensure appropriate training, in line with guidance, is in place and completed by staff to support patients with learning disabilities, dementia and autism.

Regulation: Regulation 12 (Safe care and treatment)

⚠ Some clinical staff completed training on recognising and responding to patients with dementia, and the trust was in the process of rolling out training on learning disabilities and autism, however there were no additional training modules on mental health. The trust told us that they were introducing training on autism …

Must-do action 12 of 19

Must do

Safe

The trust must ensure equipment in ward environments is moved or stored in a suitable location and avoids emergency exits being blocked.

Regulation: Regulation 12 (Safe care and treatment)

⚠ Ward areas were generally clean and had suitable furnishings which were clean and well-maintained, however some areas were cluttered, making it difficult to clean. The acute medical unit (AMU) was clean but visibly cluttered with equipment such as hoists, mattresses and observation machines stored across the ward. There was a …

Must-do action 13 of 19

Must do

Effective

The trust must ensure the nutritional and hydration needs of patients are met. This includes establishing an effective system for patients to be supported by staff at mealtimes in order to maintain adequate nutrition and hydration. This also includes ensuring nutritional and hydration intake of patients is monitored and recorded consistently.

Regulation: Regulation 14 (Meeting nutritional and hydration needs)

⚠ Staff did not have a system to make sure patients had enough to eat and drink to meet their needs and improve their health. Staff did not use a ‘red tray’ system or equivalent to identify patients with swallow difficulties at a glance. Staff did not always fully and accurately …

Must-do action 14 of 19

Must do

Safe

The trust must ensure hazardous waste such as sharps materials are managed and disposed safely in line with current legislation and guidance.

Regulation: Regulation 15 (Premises and equipment)

⚠ Staff did not always dispose of clinical waste safely. We found three sharps bins on AMU that had temporary closures open and one bin had not been signed or dated. This was non-compliant with HTM07/01 safe management and disposable of healthcare waste 2013 DH.

Must-do action 15 of 19

Must do

Well-led

The trust must ensure improvements are made to governance systems and processes by conducting regular audits to assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activity. This includes auditing of the accuracy and quality of patient records, pathways and assessments.

Regulation: Regulation 17 (Good governance)

⚠ The service did not routinely audit sepsis or neutropenic sepsis care pathways. The trust told us that they did not complete records audits, which meant they may not have oversight of issues and quality of patient records. There were gaps in patient assessment and care delivery checking systems such as …

Must-do action 16 of 19

Must do

Well-led

The trust must ensure that patient record documents and systems are reviewed to ensure staff have access to patient information that is accessible, accurate and up to date across all electronic or paper-based records.

Regulation: Regulation 17 (Good governance)

⚠ Patient notes were comprehensive, however not all staff could access all notes easily. The trust had multiple ways in which to record patient notes, some electronic, and some paper-based. This meant you could not view a patient’s entire record at a glance. Trust staff told us they could not access …

Must-do action 17 of 19

Must do

Well-led

The trust must ensure that workforce data for the trust can be separated to show individual site performance.

Regulation: Regulation 17 (Good governance)

⚠ It was not possible to identify the vacancy rate, turnover rate, or sickness rates for Royal Sussex County Hospital. The medical division was across both Royal Sussex County Hospital and Princess Royal Hospital and the staffing data was not separated into data for each individual hospital.

Must-do action 18 of 19

Must do

Well-led

The trust must ensure they have an out of hours discharge policy to reduce risks relating patients when discharged out of hours.

Regulation: Regulation 17 (Good governance)

⚠ Managers and staff started planning each patient’s discharge as early as possible but sometimes patients were discharged out of hours. Data provided by the trust showed that between May and July 2023, 28 patients were discharged between 10pm and 8am. Discharging patients at unsocial hours can be confusing and disorientating …

Must-do action 19 of 19

Must do

Effective

The trust must ensure that persons employed must receive appropriate support, training, professional development, supervision and appraisal as necessary to enable them to carry out the duties they are employed to perform in relation to caring for patients with mental health illness, and dementia.

Regulation: Regulation 18 (Staffing)

⚠ We saw several examples of where managers had assigned healthcare assistants (HCAs) to one to one care or supporting patients with mental health needs or under section, typically when no registered mental health nurse was available. We did not see any evidence of HCAs having additional training in order to …

Should-do actions (7)

Recommended improvements to enhance service quality.

Should-do action 1 of 7

Should do

Caring

The trust should ensure that patients’ privacy and dignity are supported when being moved by following surgery.

Regulation: Regulation 10 (Dignity and respect)

Should-do action 2 of 7

Should do

Safe

The trust should review safeguarding arrangements in line with the intercollegiate guidance for safeguarding to ensure staff training is suitable for frontline staff.

Should-do action 3 of 7

Should do

Well-led

The trust should improve systems for monitoring induction compliance and oversight.

Should-do action 4 of 7

Should do

Responsive

The trust should ensure they monitor call bell wait times to ensure patients are not left for long periods of time when needing support from staff.

Should-do action 5 of 7

Should do

Safe

The trust should ensure they monitor staff compliance with high-risk pathways such as sepsis.