Midland Metropolitan University Hospital

This assessment was carried out to follow up on the Section 29A that we issued in July 2024 following concerns and breaches of regulation identified during out previous assessment published in July 2024. It was a comprehensive inspection of the new maternity service since it had moved from City Hospital to the new Midlands Metropolitan University Hospital site.

We refer to women in this report, but we recognise some transgender men, non-binary people, and people with variations in sex characteristics or who are intersex may also use services and experience some of the same issues.

The service was in breach of the legal regulation relating to safe care and treatment, person-centred care and staffing. Key issues included delays in triage and care, poor flow in the departments, insufficient staffing levels to maintain safe care and lack of use of interpreters.

Despite these concerns, we observed improvements in the service’s culture since our last visit. We found women were treated with kindness and compassion. Leaders and staff were on an improvement journey and had the same shared vision. There was good support for staff from the middle management level and teams worked together well. The environment was clean and uncluttered and equipment checks were consistently completed. The teams had acted on concerns raised through data or from our last inspection to improve outcomes for women.

The service was receiving support from NHS England to drive improvements in safety and quality.

At our previous assessment in July 2024, we issued a Section 29A Warning Notice in relation to:

• Insufficient medical staffing to provide safe care and treatment in triage. We found on this inspection that while cover was provided for 12 hours a day by doctors, women were still experiencing delays in triage. The Warning Notice was met due to notable improvements in the service but there were still some improvements needed.
• The lack of checking and availability of emergency equipment. The Warning Notice was met as we found on this inspection these checks were consistently completed and there was a robust system for checking equipment.
• Not enough midwifery and nursing staff to provide safe care and treatment, and skill mix did not always follow national guidance. We found on this inspection there were still daily concerns with the staffing levels, and this caused delays to care daily for women. Recruitment had been successful and there were no vacancies at the time of the inspection, but the staff were all newly qualified Band 5 midwives, and this meant the skill mix was very junior. The Warning Notice was not fully met as there are still significant improvements needed to staff the departments.
• The Trust’s induction of labour guidelines did not meet national guidance. We found on this inspection that the guidelines had been updated in line with national guidance and the Warning Notice had been met.
• Routine enquiries around domestic abuse were frequently not completed and safeguarding concerns were not always accurate. We found on this inspection that the Warning Notice had been met. The routine enquiry question had been mandated and was therefore asked at every appointment and safeguarding records we reviewed were accurate.
• The trust did not adhere to guidance around the Birmingham Symptom specific Obstetric Triage System (BSOTS) in triage. We found on this inspection that the Warning Notice was met. BSOTS was adhered to, and women were assessed appropriately in triage.
• Women and birthing people did not always receive interpreting services as appropriate. We found on this inspection there was still work to be done to improve communication for women who spoke a different language. Staff’s use of interpreting services had improved but there were still instances where it was not used and women felt they had not received good communication. The Warning Notice was not fully met as there will still improvements needed to ensure good communication for all women and their families.

This assessment was carried out to follow up on the Section 29A that we issued in July 2024 following concerns and breaches of regulation identified during out previous assessment published in July 2024. It was a comprehensive inspection of the new maternity service since it had moved from City Hospital to the new Midlands Metropolitan University Hospital site.

We refer to women in this report, but we recognise some transgender men, non-binary people, and people with variations in sex characteristics or who are intersex may also use services and experience some of the same issues.

The service was in breach of the legal regulation relating to safe care and treatment, person-centred care and staffing. Key issues included delays in triage and care, poor flow in the departments, insufficient staffing levels to maintain safe care and lack of use of interpreters.

Despite these concerns, we observed improvements in the service’s culture since our last visit. We found women were treated with kindness and compassion. Leaders and staff were on an improvement journey and had the same shared vision. There was good support for staff from the middle management level and teams worked together well. The environment was clean and uncluttered and equipment checks were consistently completed. The teams had acted on concerns raised through data or from our last inspection to improve outcomes for women.

The service was receiving support from NHS England to drive improvements in safety and quality.

At our previous assessment in July 2024, we issued a Section 29A Warning Notice in relation to:

• Insufficient medical staffing to provide safe care and treatment in triage. We found on this inspection that while cover was provided for 12 hours a day by doctors, women were still experiencing delays in triage. The Warning Notice was met due to notable improvements in the service but there were still some improvements needed.
• The lack of checking and availability of emergency equipment. The Warning Notice was met as we found on this inspection these checks were consistently completed and there was a robust system for checking equipment.
• Not enough midwifery and nursing staff to provide safe care and treatment, and skill mix did not always follow national guidance. We found on this inspection there were still daily concerns with the staffing levels, and this caused delays to care daily for women. Recruitment had been successful and there were no vacancies at the time of the inspection, but the staff were all newly qualified Band 5 midwives, and this meant the skill mix was very junior. The Warning Notice was not fully met as there are still significant improvements needed to staff the departments.
• The Trust’s induction of labour guidelines did not meet national guidance. We found on this inspection that the guidelines had been updated in line with national guidance and the Warning Notice had been met.
• Routine enquiries around domestic abuse were frequently not completed and safeguarding concerns were not always accurate. We found on this inspection that the Warning Notice had been met. The routine enquiry question had been mandated and was therefore asked at every appointment and safeguarding records we reviewed were accurate.
• The trust did not adhere to guidance around the Birmingham Symptom specific Obstetric Triage System (BSOTS) in triage. We found on this inspection that the Warning Notice was met. BSOTS was adhered to, and women were assessed appropriately in triage.
• Women and birthing people did not always receive interpreting services as appropriate. We found on this inspection there was still work to be done to improve communication for women who spoke a different language. Staff’s use of interpreting services had improved but there were still instances where it was not used and women felt they had not received good communication. The Warning Notice was not fully met as there will still improvements needed to ensure good communication for all women and their families.

This assessment was carried out to follow up on the Section 29A that we issued in July 2024 following concerns and breaches of regulation identified during out previous assessment published in July 2024. It was a comprehensive inspection of the new maternity service since it had moved from City Hospital to the new Midlands Metropolitan University Hospital site.

We refer to women in this report, but we recognise some transgender men, non-binary people, and people with variations in sex characteristics or who are intersex may also use services and experience some of the same issues.

The service was in breach of the legal regulation relating to safe care and treatment, person-centred care and staffing. Key issues included delays in triage and care, poor flow in the departments, insufficient staffing levels to maintain safe care and lack of use of interpreters.

Despite these concerns, we observed improvements in the service’s culture since our last visit. We found women were treated with kindness and compassion. Leaders and staff were on an improvement journey and had the same shared vision. There was good support for staff from the middle management level and teams worked together well. The environment was clean and uncluttered and equipment checks were consistently completed. The teams had acted on concerns raised through data or from our last inspection to improve outcomes for women.

The service was receiving support from NHS England to drive improvements in safety and quality.

At our previous assessment in July 2024, we issued a Section 29A Warning Notice in relation to:

• Insufficient medical staffing to provide safe care and treatment in triage. We found on this inspection that while cover was provided for 12 hours a day by doctors, women were still experiencing delays in triage. The Warning Notice was met due to notable improvements in the service but there were still some improvements needed.
• The lack of checking and availability of emergency equipment. The Warning Notice was met as we found on this inspection these checks were consistently completed and there was a robust system for checking equipment.
• Not enough midwifery and nursing staff to provide safe care and treatment, and skill mix did not always follow national guidance. We found on this inspection there were still daily concerns with the staffing levels, and this caused delays to care daily for women. Recruitment had been successful and there were no vacancies at the time of the inspection, but the staff were all newly qualified Band 5 midwives, and this meant the skill mix was very junior. The Warning Notice was not fully met as there are still significant improvements needed to staff the departments.
• The Trust’s induction of labour guidelines did not meet national guidance. We found on this inspection that the guidelines had been updated in line with national guidance and the Warning Notice had been met.
• Routine enquiries around domestic abuse were frequently not completed and safeguarding concerns were not always accurate. We found on this inspection that the Warning Notice had been met. The routine enquiry question had been mandated and was therefore asked at every appointment and safeguarding records we reviewed were accurate.
• The trust did not adhere to guidance around the Birmingham Symptom specific Obstetric Triage System (BSOTS) in triage. We found on this inspection that the Warning Notice was met. BSOTS was adhered to, and women were assessed appropriately in triage.
• Women and birthing people did not always receive interpreting services as appropriate. We found on this inspection there was still work to be done to improve communication for women who spoke a different language. Staff’s use of interpreting services had improved but there were still instances where it was not used and women felt they had not received good communication. The Warning Notice was not fully met as there will still improvements needed to ensure good communication for all women and their families.

The Midland Metropolitan University Hospital (MMUH) opened on the 6 October 2024. The development of MMUH was to provide the chance to transform healthcare within their communities.

The new hospital would provide modern facilities to treat patients, and it would act as a catalyst for growth in the immediate surrounding areas. It signified an era of change in what was once the heart of the industrial West Midlands.

A collaborative partnership was underway between Birmingham City Council and Sandwell Metropolitan Borough Council, working with West Midlands Combined Authority, Homes England, the Canal & River Trust, and the trust to regenerate what was known as the Smethwick to Birmingham corridor.

The trusts ambition was to create positive change in the neighbourhoods surrounding MMUH. It would lead to better air quality and the reintroduction of more green space across the area. Midland Metropolitan University Hospital hope to provide a chance to help revive the area, supporting a healthy community for those who already live there and those who will choose to live, work and visit.

The trust had also recently secured funding, in partnership with education providers and others, to develop a learning campus onsite at MMUH. It aims to bring new learning opportunities and help them train the next generation of healthcare professionals from the communities they serve.

The surgery service was rated Good at the last inspection; however, this was at the previous location.

The surgery department comprised of: Surgical wards: A8 and B8. Trauma and elective orthopaedic ward: A7. Operating theatre department with 12 theatres and a recovery unit. Surgical assessment unit. Surgical Same Day Emergency Care.

We carried out this announced assessment on the 3 and 4 September 2025.We spoke with 28 patients and various visitors. We spoke with 40 members of staff. These included senior managers, all grades of nursing staff, healthcare assistants, domestic staff, consultant surgeons, anaesthetists, and other grades of doctors.

We inspected this service using our single assessment framework and looked at all the key questions and 33 quality statements. The main service provided by the hospital was surgery for adult patients.

There were effective systems to ensure that standards of cleanliness and hygiene were maintained. The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. The service made sure staff were competent for their roles. All staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

Patients told us they felt involved in their own care and treatment as staff took time to explain what was happening and why. We saw examples where staff had gone above and beyond what was expected to support patients. The trust planned and provided services in a way that met the needs of local people.The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

Managers and senior leaders had the right skills to perform their roles effectively. The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community. There was evidence of improved culture across the service and there was strong leadership. Staff told us they felt supported, respected, valued and were proud to work at the trust. The service was committed to improving services by learning from when things went well and when they went wrong, promoting training, research, and innovation.

The Midland Metropolitan University Hospital (MMUH) opened on the 6 October 2024. The development of MMUH was to provide the chance to transform healthcare within their communities.

The new hospital would provide modern facilities to treat patients, and it would act as a catalyst for growth in the immediate surrounding areas. It signified an era of change in what was once the heart of the industrial West Midlands.

A collaborative partnership was underway between Birmingham City Council and Sandwell Metropolitan Borough Council, working with West Midlands Combined Authority, Homes England, the Canal & River Trust, and the trust to regenerate what was known as the Smethwick to Birmingham corridor.

The trusts ambition was to create positive change in the neighbourhoods surrounding MMUH. It would lead to better air quality and the reintroduction of more green space across the area. Midland Metropolitan University Hospital hope to provide a chance to help revive the area, supporting a healthy community for those who already live there and those who will choose to live, work and visit.

The trust had also recently secured funding, in partnership with education providers and others, to develop a learning campus onsite at MMUH. It aims to bring new learning opportunities and help them train the next generation of healthcare professionals from the communities they serve.

The surgery service was rated Good at the last inspection; however, this was at the previous location.

The surgery department comprised of: Surgical wards: A8 and B8. Trauma and elective orthopaedic ward: A7. Operating theatre department with 12 theatres and a recovery unit. Surgical assessment unit. Surgical Same Day Emergency Care.

We carried out this announced assessment on the 3 and 4 September 2025.We spoke with 28 patients and various visitors. We spoke with 40 members of staff. These included senior managers, all grades of nursing staff, healthcare assistants, domestic staff, consultant surgeons, anaesthetists, and other grades of doctors.

We inspected this service using our single assessment framework and looked at all the key questions and 33 quality statements. The main service provided by the hospital was surgery for adult patients.

There were effective systems to ensure that standards of cleanliness and hygiene were maintained. The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. The service made sure staff were competent for their roles. All staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

Patients told us they felt involved in their own care and treatment as staff took time to explain what was happening and why. We saw examples where staff had gone above and beyond what was expected to support patients. The trust planned and provided services in a way that met the needs of local people.The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

Managers and senior leaders had the right skills to perform their roles effectively. The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community. There was evidence of improved culture across the service and there was strong leadership. Staff told us they felt supported, respected, valued and were proud to work at the trust. The service was committed to improving services by learning from when things went well and when they went wrong, promoting training, research, and innovation.

The Midland Metropolitan University Hospital (MMUH) opened on the 6 October 2024. The development of MMUH was to provide the chance to transform healthcare within their communities.

The new hospital would provide modern facilities to treat patients, and it would act as a catalyst for growth in the immediate surrounding areas. It signified an era of change in what was once the heart of the industrial West Midlands.

A collaborative partnership was underway between Birmingham City Council and Sandwell Metropolitan Borough Council, working with West Midlands Combined Authority, Homes England, the Canal & River Trust, and the trust to regenerate what was known as the Smethwick to Birmingham corridor.

The trusts ambition was to create positive change in the neighbourhoods surrounding MMUH. It would lead to better air quality and the reintroduction of more green space across the area. Midland Metropolitan University Hospital hope to provide a chance to help revive the area, supporting a healthy community for those who already live there and those who will choose to live, work and visit.

The trust had also recently secured funding, in partnership with education providers and others, to develop a learning campus onsite at MMUH. It aims to bring new learning opportunities and help them train the next generation of healthcare professionals from the communities they serve.

The surgery service was rated Good at the last inspection; however, this was at the previous location.

The surgery department comprised of: Surgical wards: A8 and B8. Trauma and elective orthopaedic ward: A7. Operating theatre department with 12 theatres and a recovery unit. Surgical assessment unit. Surgical Same Day Emergency Care.

We carried out this announced assessment on the 3 and 4 September 2025.We spoke with 28 patients and various visitors. We spoke with 40 members of staff. These included senior managers, all grades of nursing staff, healthcare assistants, domestic staff, consultant surgeons, anaesthetists, and other grades of doctors.

We inspected this service using our single assessment framework and looked at all the key questions and 33 quality statements. The main service provided by the hospital was surgery for adult patients.

There were effective systems to ensure that standards of cleanliness and hygiene were maintained. The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. The service made sure staff were competent for their roles. All staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.

Patients told us they felt involved in their own care and treatment as staff took time to explain what was happening and why. We saw examples where staff had gone above and beyond what was expected to support patients. The trust planned and provided services in a way that met the needs of local people.The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

Managers and senior leaders had the right skills to perform their roles effectively. The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community. There was evidence of improved culture across the service and there was strong leadership. Staff told us they felt supported, respected, valued and were proud to work at the trust. The service was committed to improving services by learning from when things went well and when they went wrong, promoting training, research, and innovation.

The Midland Metropolitan University Hospital is a type 1 trauma unit in Smethwick in the Black Country of the West Midlands. Attendance is around 350 patients each day but has peaks at around 460 at times of high demand. Average ambulance arrivals are around 120 vehicles each day. The numbers of patients needing resuscitation is similar to the rest of England but there is a marked increase in the proportion of patients classed as “major” rather than “minor” in their acuity, 76% compared to the England average of 45%.

We carried out this assessment on the 22 and 23 October 2025 and the team consisted of a lead inspector, a team inspector and a medicines inspector. We were accompanied by a senior nurse, an emergency department consultant and a paediatric nurse as specialist advisors.

This assessment was the first of the Emergency Department since the Midland Metropolitan University Hospital opened in October 2024 and so we looked at all key questions and quality statements. We followed up on issues raised through data and intelligence as well as information provided by staff and members of the public since the department had opened.

Because this was a new location, those regulatory requirements made in respect of the two emergency departments previously located at the Sandwell and City hospitals were not followed up, although any high-level themes were treated as intelligence for the inspection.

As a first inspection of a new location, we looked at all 33 quality statements across the safe, effective, caring, responsive and well-led key questions. We have rated the department as good overall, but the safe care and treatment of patients requires improvement and we have served the trust with breaches of a regulation in this regard.

During our assessment visit we visited all areas of the emergency department plus other areas relevant to the service provided such as the adjacent X-ray department. We also ensured patients who were being supervised by ambulance staff but were patients of the hospital were being kept safe and being well cared for.

During our assessment visit we spoke to 78 members of staff, 17 patients, 3 relatives and we looked at 29 sets of notes.

We found the department was good for all key questions except safe which was rated as requires improvement. This rating reflected a lack of compliance in updated safeguarding training for medical staff. Not all treatment was commenced in a timely manner due to pressures on the department from over-capacity. We were concerned about the visibility of patients who might deteriorate in the waiting area. There were failures to manage medicine stock safely and to give patients medicines on time. Although responsive has been rated as good, this was not without concerns around the persistent delays to care and treatment caused by demand exceeding capacity in the department and the inability to discharge or transfer patients out of the department. While we know much of this was outside of the department’s control, we have served the trust with a breach of a regulation due to considering the patient’s experience and the potential for harm notwithstanding this was recognised by the department’s leaders and always in focus. The breach of the regulation also covers the safe management of medicines and the failure to be compliant with safeguarding training.

However, there were strong processes, adherence to clinical guidelines and procedures together with a commitment to learning from incidents mitigated some of the risk and together with strong leadership and the caring and committed staff resulted in a good rating overall for the service.

The Midland Metropolitan University Hospital is a type 1 trauma unit in Smethwick in the Black Country of the West Midlands. Attendance is around 350 patients each day but has peaks at around 460 at times of high demand. Average ambulance arrivals are around 120 vehicles each day. The numbers of patients needing resuscitation is similar to the rest of England but there is a marked increase in the proportion of patients classed as “major” rather than “minor” in their acuity, 76% compared to the England average of 45%.

We carried out this assessment on the 22 and 23 October 2025 and the team consisted of a lead inspector, a team inspector and a medicines inspector. We were accompanied by a senior nurse, an emergency department consultant and a paediatric nurse as specialist advisors.

This assessment was the first of the Emergency Department since the Midland Metropolitan University Hospital opened in October 2024 and so we looked at all key questions and quality statements. We followed up on issues raised through data and intelligence as well as information provided by staff and members of the public since the department had opened.

Because this was a new location, those regulatory requirements made in respect of the two emergency departments previously located at the Sandwell and City hospitals were not followed up, although any high-level themes were treated as intelligence for the inspection.

As a first inspection of a new location, we looked at all 33 quality statements across the safe, effective, caring, responsive and well-led key questions. We have rated the department as good overall, but the safe care and treatment of patients requires improvement and we have served the trust with breaches of a regulation in this regard.

During our assessment visit we visited all areas of the emergency department plus other areas relevant to the service provided such as the adjacent X-ray department. We also ensured patients who were being supervised by ambulance staff but were patients of the hospital were being kept safe and being well cared for.

During our assessment visit we spoke to 78 members of staff, 17 patients, 3 relatives and we looked at 29 sets of notes.

We found the department was good for all key questions except safe which was rated as requires improvement. This rating reflected a lack of compliance in updated safeguarding training for medical staff. Not all treatment was commenced in a timely manner due to pressures on the department from over-capacity. We were concerned about the visibility of patients who might deteriorate in the waiting area. There were failures to manage medicine stock safely and to give patients medicines on time. Although responsive has been rated as good, this was not without concerns around the persistent delays to care and treatment caused by demand exceeding capacity in the department and the inability to discharge or transfer patients out of the department. While we know much of this was outside of the department’s control, we have served the trust with a breach of a regulation due to considering the patient’s experience and the potential for harm notwithstanding this was recognised by the department’s leaders and always in focus. The breach of the regulation also covers the safe management of medicines and the failure to be compliant with safeguarding training.

However, there were strong processes, adherence to clinical guidelines and procedures together with a commitment to learning from incidents mitigated some of the risk and together with strong leadership and the caring and committed staff resulted in a good rating overall for the service.

The Midland Metropolitan University Hospital is a type 1 trauma unit in Smethwick in the Black Country of the West Midlands. Attendance is around 350 patients each day but has peaks at around 460 at times of high demand. Average ambulance arrivals are around 120 vehicles each day. The numbers of patients needing resuscitation is similar to the rest of England but there is a marked increase in the proportion of patients classed as “major” rather than “minor” in their acuity, 76% compared to the England average of 45%.

We carried out this assessment on the 22 and 23 October 2025 and the team consisted of a lead inspector, a team inspector and a medicines inspector. We were accompanied by a senior nurse, an emergency department consultant and a paediatric nurse as specialist advisors.

This assessment was the first of the Emergency Department since the Midland Metropolitan University Hospital opened in October 2024 and so we looked at all key questions and quality statements. We followed up on issues raised through data and intelligence as well as information provided by staff and members of the public since the department had opened.

Because this was a new location, those regulatory requirements made in respect of the two emergency departments previously located at the Sandwell and City hospitals were not followed up, although any high-level themes were treated as intelligence for the inspection.

As a first inspection of a new location, we looked at all 33 quality statements across the safe, effective, caring, responsive and well-led key questions. We have rated the department as good overall, but the safe care and treatment of patients requires improvement and we have served the trust with breaches of a regulation in this regard.

During our assessment visit we visited all areas of the emergency department plus other areas relevant to the service provided such as the adjacent X-ray department. We also ensured patients who were being supervised by ambulance staff but were patients of the hospital were being kept safe and being well cared for.

During our assessment visit we spoke to 78 members of staff, 17 patients, 3 relatives and we looked at 29 sets of notes.

We found the department was good for all key questions except safe which was rated as requires improvement. This rating reflected a lack of compliance in updated safeguarding training for medical staff. Not all treatment was commenced in a timely manner due to pressures on the department from over-capacity. We were concerned about the visibility of patients who might deteriorate in the waiting area. There were failures to manage medicine stock safely and to give patients medicines on time. Although responsive has been rated as good, this was not without concerns around the persistent delays to care and treatment caused by demand exceeding capacity in the department and the inability to discharge or transfer patients out of the department. While we know much of this was outside of the department’s control, we have served the trust with a breach of a regulation due to considering the patient’s experience and the potential for harm notwithstanding this was recognised by the department’s leaders and always in focus. The breach of the regulation also covers the safe management of medicines and the failure to be compliant with safeguarding training.

However, there were strong processes, adherence to clinical guidelines and procedures together with a commitment to learning from incidents mitigated some of the risk and together with strong leadership and the caring and committed staff resulted in a good rating overall for the service.