- NHS hospital
Midland Metropolitan University Hospital
Assessment report published 18 February 2026
Contents
Ratings - Urgent and emergency services
Our view of 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.
People's experience of this service
People told us they were looked after by kind and compassionate staff who gave the best care they were able to. They also told us they received good care and treatment.
However, many patients’ experiences in the department were that of their assessment and treatment being delayed and having to wait for prolonged periods in crowded and sometimes unsuitable places such as ambulances.