Our Quality Account - have your say!
Our priorities are grouped into three areas. The first group relates to patient safety, the second is patient experience, and the third is clinical effectiveness.
Please click on each of the titles below to learn more about our patient safety priorities, and then vote for which of the three you think we should prioritise. Once you have voted you will be taken to the next category.
Venous Thromboembolism (VTE), for example Deep Vein Thrombosis (DVT) and Pulmonary Embolisms (PE) are conditions in which blood clots form in the body. Patients who are identified as having the ‘suspected’ condition/s are streamed to the Same Day Emergency Care (SDEC) for assessment, diagnosis and treatment. An Incident occurred in 2022, where a patient wasn’t offered a second follow up USS Doppler scan as per NICE guideline recommendation which resulted in a serious incident. This triggered the need to ensure we have a local VTE diagnosis guideline that mirrors the guidance offered by NICE. Audits have been undertaken to assess our compliance with the NICE guideline, a significant proportion of the patients did not have their risk assessment completed (Wells Score) or did not have relevant tests completed (D-dimer).
There has been an increase in mental health patients attending acute care settings over the last three years. Between December 2022 and December 2024, the Trust saw 11,447 mental health attendances across Conquest Hospital and Eastbourne DGH.
Length of stay for these patients has increased as the availability of mental health beds has fallen, necessitating the admission of patients whose sole reason for attending is a mental health disorder into acute beds. Not only does this reduce the availability of beds for medically unwell patients, but it also places additional pressure on ward staff who often have to manage challenging behaviour, not infrequently associated with violence and aggression.
This has also necessitated an increase in security staffing and an additional temporary staffing cost as a result.
The current situation is suboptimal for all involved: clinical staff not specifically trained in managing mental health patients are increasingly being asked to do so, and this is not only challenging for the staff but is also less than ideal for the mental health patient, who often may receive care that is more focused on behavioural management and control than on therapeutic interactions.
This is compounded in cases where security staff are involved. Although the team does excellent work in treating mental health patients with respect and compassion, they are not clinical staff and as such are naturally focused on controlling the situation. It has also been anecdotally reported that some mental health patients find their presence intimidating due to their police-like appearance.
Other patients and members of the public are also at times adversely affected by the presence of mental health patients in acute care areas.
Overall, this presents a risk to the organisation that care may be suboptimal, and a subsequent risk that there may be a deterioration in the behaviour and wellbeing of mental health patients while awaiting mental health beds at ESHT.
Improvements to this area of care will require a multi-faceted approach: These will be delivered in stages…
Collaboration with the wards, local Mental Health Trust, Local Authority, voluntary, community and social enterprises (VCSEs) and other arm’s length providers:
Development of an Enhanced Care Team: Recruit and train specialised mental health professionals.
The pilot team at Eastbourne DGH will consist of x10 mental health clinical Support Workers at band 3 and x1 Band 6 mental health nurse.
The success of this pilot and lessons learnt will lead to the implementation of this template across the Conquest Hospital site.
There is also consideration to expand this service to the community settings at Rye and Bexhill Inpatient Unit to support patients who attend the service with a comorbidity of mental illness.
‘Front of House’ triage and initial risk assessment of mental health patients in the Emergency Department. This is aimed at delivering parity of esteem between mental health patients and others who attend the Emergency Department.
It will facilitate early therapeutic engagement and reduce the referral time to the Mental Health Liaison Team and the length of stay in the hospital. There is hope that this will enhance patient’s adherence to treatment, reduce complications and support emotional wellbeing of the patients/staff.
The Mental Health Outreach team, where appropriate, will provide specialised and focused care, leading to better mental health outcomes for patients. This includes quicker assessment, timely interventions, and individualised treatment plans as identified by the enhanced clinical framework. This intervention will lead to better overall outcomes for all.
Regulatory Compliance: The importance of providing quality mental health care within acute hospital settings has been emphasised by the national and regional healthcare regulatory bodies. Support for the concept of enhanced care teams in the UK can be found in various healthcare policy documents, and professional organizations (CQC reports, NICE guidelines, NHS Long-term Plan, Royal College of Psychiatry etc).
Stigma Reduction: The integration of mental health provision within acute hospitals helps reduce the stigma associated with mental health disorders. Patients will be provided with personalised care plans jointly developed by the Mental Health Trust and this will create a supportive stigma-free environment, leading to improvement in patients’ satisfaction and outcome.
Enhance Staff Competency: Devise care protocols in line with the enhanced care framework. Offer ongoing training and professional development opportunities for healthcare staff across the Trust to improve their mental health care skills. This will be achieved through the enhanced clinical framework.
Rolling Mental Health Training: Liaise with Sussex Partnership Foundation Trust to deliver rolling Mental Health training for all staff across ESHT as part of the Liaison Psychiatry / Paediatric Liaison Network (PLAN) standards. This will provide learning across Children, Adults, Older Adults, neurodiversity and Learning disabilities.
Mental Health E-Learning: Providing additional training to acute care staff via The Maudsley Hospital (London Psychiatric hospital) in de-escalation techniques and therapeutic interaction with Mental Health patients.
Infrastructure: Work with the Estates team and relevant authorities to endeavour to allocate space and resources for the Mental Health Outreach Team. Consideration for a Transfer and Assessment Facility (TAF) that will cohort suitable patients, accommodate the Mental Health Outreach Team and Mental Health Liaison Team to deliver safe and effective care as well as free up medical beds (x3 of this is required and there is a potentially suitable space at EDGH where the plaster room is currently housed).
Shared IT interface – clinical noting facility for the Mental Health Liaison Team and relevant ESHT staff to ensure seamless handover and updating of clinical information to expedite patient care. For example: updating risk assessments and access to historical risks when considering care /safety formulations. This conversation is ongoing.
Reduction in incidents of violence and aggression: With timely therapeutic engagements with patients, it is envisaged that the visibility of security personnel in clinical environment to manage disturbed patients’ behaviours will be reduced and only deployed as last resort and reviewed accordingly. This will in turn lead to:
Deconditioning is the decline in physical and mental functioning due to inactivity or bed rest. Deconditioning can in turn lead to longer lengths of stay in hospital which further exacerbates the issue. As we get older, we become more vulnerable. If a person over 80 years of age spends 10 days in bed, they may have 10 years of muscle ageing. Just 24 hours in bed may reduce muscle power by 2.5% and 7 days by 5-10% (NHS, 2017).
Data suggests that patients spend on average, 83% of the day in bed and 12% in a chair and that deconditioning is more prevalent than falls and pressure areas.
Whilst many acute inpatients experienced no harm, the harm reviews completed indicate that the majority of patients have experienced mild or moderate harm as a result of delays and extended length of stay. A third of patients have experienced severe harm.
There is increased awareness and recognition that more needs to be done to ensure timely discharge and improve hospital flow. Not only will this work reduce length of stay and free up beds for new admissions, but it will also improve the patient experience and provide ward staff with a proactive, patient focused process that is rewarding and motivating.
We are developing plans to reduce deconditioning through rehabilitation and reconditioning strategies. The ‘Eat Sleep Move Repeat’ Campaign is to raise awareness of the risks of deconditioning and provide support to patients to remain active during their stay in hospital. This also reduces the risk of patients losing independence and being able to be discharged home with less support required in the community.
Utilising ward staff but also recruiting ‘mobility volunteers’ from the community, the aim of this work is to increase patient physical activity and psychological stimulation, improve outcomes on discharge and to reduce potential for deconditioning and harms whilst an inpatient.
We have begun this work on pilot wards and plan to roll out to all wards across the Trust.
