St Andrew's Healthcare - Birmingham

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated well-led as requires improvement. At this assessment the rating has remained requires improvement.

Requires improvement: This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. We were not assured all leaders had the skills, knowledge and experience to perform their roles effectively. Staff felt respected, supported and valued but this had not been the case in the months leading up to this assessment. Teams did not always have access to the information they needed to provide safe and effective care. Most governance processes operated effectively. However, staff knew and understood the provider’s vision and values and how they applied to the work of their team. Performance and risk were managed well. Staff collected and analysed data about outcomes and performance and used this to identify improvements.

The service was in breach of regulation 17 Good Governance.

The provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care (Regulation 17(1)) Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 17

We have not awarded this service a score for Well-led.

Find out about when we will not publish a key question score and what we look at when we assess Well-led.

The service did not have a clear shared vision, strategy and culture across the different national divisions which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. However, they described how senior provider leaders had not engaged with them effectively before implementing changes to the way advocacy, social work and occupational therapy support was delivered at the hospital. Some staff described how these changes left them feeling unable to provide the level of care they aspired to. Other staff described how they felt unheard when they had challenged these changes.

A new Director of Improvement role had been established and staff felt this was a positive step in the right direction because they were beginning to feel listened to and to see improvements being made in the service.

Staff had not been given the opportunity to contribute effectively to discussions about the strategy for their service, especially how the service was changing.

Staff could explain how they were working to deliver high quality care within the budgets available. Some expressed that whilst positive changes were now being made to staffing and service delivery, the damage done previously had caused a negative impact on their wellbeing because some ward staff had been left feeling “burnt out” and 2 out of the 4 social workers had left, so replacements were being recruited when we carried out this assessment.

Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

We were not assured that all leaders had the skills, knowledge and experience to perform their roles. A new director of improvement role had recently been introduced to support the local leadership team. Staff were positive about the introduction of this new role.

A number of patients told us the hospital had recently employed a Director of Improvement and they felt this was a good thing because there had been quite a lot of positive change since the person started working there.

Leaders had a good understanding of the services they managed. However, they had been unable to advocate effectively for the hospital when the provider’s national senior management team insisted on implementing significant changes to the way the service was delivered.

Leaders were positive and proud of the work their staff did to provide high quality care for patients but had been unable to effectively challenge the wider organisational leadership.

Local leaders were visible in the service and staff told us most were approachable for patients and staff. However, staff told us that the provider’s national senior leadership team rarely visited the service.

Leadership development opportunities were available, including opportunities for staff to apply for leadership courses and to train for professional qualifications, for example in nursing.

People did not always feel they could speak up and that their voice would be heard.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs.

Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements.

Patients and carers were becoming involved in decision-making about changes to the service.

The provider had set up a Freedom to Speak Up process for staff to raise concerns. Staff told us they could also raise concerns such as racial abuse with the human resource department, and that this was a supportive and effective way to be heard.

Staff told us they were frustrated at not having been heard when they raised their concerns about the effect of significant structural changes. However, staff told us they were beginning to feel more positive since the recent increase to ward staffing numbers and the decision to reemploy more social workers.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

There were equality and diversity champions within the service e.g. LGBT+, carers and black workers.

Staff were able to apply to work flexibly e.g. flexible working agreements to account for personal circumstances such as caring responsibilities, health issues and flexible retirement options.

Managers put reasonable adjustments in place for staff members to help them carry out their role.

The provider undertook equality monitoring of staff within the service to ensure it is diverse in its make-up and representative of the patient group and global community.

The service did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Staff maintained and had access to the risk register at service level. However, staff concerns did not always match those on the risk register. For example, some night staff were still unable to take their breaks when we carried out our assessment but this was not included on the service risk register.

Staff did not have full access to the equipment and information technology needed to do their work. The information technology infrastructure, including the internet system, did not always work well and hindered staff ability to carry out some of their duties in a timely way.

Staff participated in local clinical audits. However, the audits were not always sufficient to provide assurance and staff did not always act on the results when needed. Audits of the environment had been recently updated with a clear action plan for improvements because some aspects of the environment had been neglected for a period of time.

Ward managers were responsible for the oversight of audit actions through their ward action logs. Whilst we identified shortfalls in recording of clinic room checks and in the administration of some controlled drugs, these had been captured through the provider’s pharmacy audits and actioned through ward action logs.

The service did not record if a complaint was upheld but we found each complaint was investigated and an explanation provided for the person making the complaint. The records clearly showed any learning that was identified as a result of each complaint but we saw no analysis to guide performance.

Mental Health Act paperwork for consent to treatment was stored both in paper files and electronically. The paper files we reviewed contained out of date forms.

There was a clear framework of what must be discussed at a ward, team and hospital level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. The provider shared safety alerts from the wider organisation and from national sources.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients.

Staff understood how to manage local risk, issues and performance and were being supported by new leaders and the commissioners to develop the framework.

The service had plans to deal with emergencies – for example, adverse weather or a flu outbreak.

Where cost improvements were taking place, they had until recently compromised staff wellbeing and patient care.

The service used systems to collect data from wards that were not over-burdensome for frontline staff.

Information governance systems included confidentiality of patient records.

Team managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care.

Information was in an accessible format, and was timely, accurate and identified areas for improvement.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Leaders engaged with external stakeholders – such as commissioners who provided close monitoring and support to the service.

Patients and staff were given the opportunity to meet in a regular online forum with members of the provider’s senior leadership team. These meetings were open to staff and patients from Birmingham and the other St Andrew’s Healthcare hospitals.

Staff were also given the opportunity to attend in person or online “Round Up” sessions which were held annually. The provider also held “Executive Question and Answer” sessions, from which they produced written summaries for people to read.

The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Staff had been unable to dedicate time and resource to continuous development work for some time because they had been short staffed and over stretched. They were now being given the time and support to consider, identify and develop improvement strategies. Some were embracing this which was leading to early signs of positive change at the service.

Staff had not routinely used quality improvement methods but were positive about being given the opportunity.

Local leaders had not been given the freedom to develop improvement strategies but this was changing and they were now advocating for how best to improve and deliver care.

The service had a number of staff who were passionate and willing to ensure the hospital improved and delivered great care for patients.

The service was closely monitored and supported by their commissioners who carried out regular safety and quality visits to the wards, providing constructive feedback for improvement. Commissioners attended weekly stakeholder meetings with hospital staff and kept up to date with patient progress.