Surrey and Sussex Healthcare NHS Trust, which runs East Surrey Hospital in Redhill and serves around 744,000 people across Crawley, Horsham, Reigate and the surrounding area, has lost its outstanding rating after inspectors found a breach of regulations in how the organisation is managed. The Care Quality Commission has issued the trust with a warning notice, demanding immediate improvements following an inspection of its leadership carried out in November last year.

The trust had held an outstanding rating since 2018, when inspectors praised a stable leadership team and a culture of openness across its services. That rating has now fallen to require improvement, a drop the regulator reserves for cases where it judges an organisation is not performing to the standard expected and must show clear evidence of change. The inspection focused specifically on the well led domain, the CQC's assessment of governance, culture and oversight at board level, rather than on clinical care itself.

Inspectors described concerns about levels of morale among staff and a reluctance among some employees to speak out. Amanda Williams, the CQC's deputy director of hospitals for the region, said the regulator's visit had exposed a disconnect between frontline teams and senior leadership. Staff described widespread burnout, feeling undervalued, and a disconnect between frontline teams and leadership, according to the findings shared by the CQC.

The report points to a governance structure that had not kept pace with the pressures facing the trust, leaving staff feeling unsupported at a time when demand on services remained high. Inspectors noted that while some improvement programmes were under way, the pace of change had not matched the scale of concerns raised with them. The warning notice gives the trust a defined period to demonstrate progress or face further regulatory action.

Andrew Hines, chief executive of Surrey and Sussex Healthcare NHS Trust, said the findings reflected the organisation as it stood at the time of the inspection rather than its current position. It's vital that our leadership reflects the experience of both our staff and our patients, and we welcome the CQC's report into our Trust leadership and culture as they were last November, he said. Hines pointed to changes made since the inspection, including a restructured executive leadership team and a board-overseen improvement programme covering staff support, freedom to speak up arrangements, equality and inclusion, and governance more broadly. He added that the trust aims to regain its outstanding status.

The trust has also pointed to more recent internal staff survey data, which it says shows higher participation and improvement in areas such as compassionate leadership and staff feeling able to raise concerns. Whether those figures translate into a stronger CQC rating will depend on the outcome of a follow-up inspection, the timing of which has not been made public.

The case fits a wider pattern that has emerged across NHS trusts over the past two years. Several other providers, including trusts in Sussex and the north east of England, have seen well led ratings fall sharply, often after periods of organisational change, financial pressure or unresolved concerns about staff wellbeing. Regulators have repeatedly linked weak governance at board level to poorer outcomes further down the chain, arguing that a disconnected leadership culture tends to surface first in staff survey results before affecting patient care.

For Surrey and Sussex Healthcare, the immediate task is to satisfy the CQC that the changes described by its chief executive are embedded rather than aspirational. The regulator has said it will continue to monitor the trust closely, and the warning notice means a further inspection is likely within a relatively short timeframe. Local health bodies, including Healthwatch groups covering the area, are expected to track the trust's progress alongside the CQC as it works to rebuild the reputation it held for the better part of a decade.

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