Midland Metropolitan University Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This is the first assessment for this service. This key question has been rated good. This meant people’s needs were mostly met. However, we have recognised assessment and treatment were not always delivered in a timely way and patients were subject to increased risks. There was no information provided to patients about the time they might have to wait to be seen.

We have not awarded this service a score for Responsive.

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

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Assessments were carried out for all patients arriving in the department and these not only covered each patient’s condition, but other needs such as their mental health needs, social circumstances and any protected characteristics.

Patients were given the opportunity to be involved in planning and choices about the care offered to them in the department. Relatives and carers were involved with the patients consent. When patients were assessed as lacking mental capacity, capacity assessments were done and best interest decisions made. This was carried out in the context of emergency care where patients might be temporarily unable to communicate because of their clinical condition.

The department had specific clinical pathways to accommodate patients with particular needs. These accommodated, for example, patients who were elderly or frail and those who had specific conditions not necessarily related to their admission such as diabetes. Mandatory training for staff included caring for people with dementia, learning disability and autism.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The emergency department worked with other health and social care providers as well as commissioners to offer a service that met the needs of the local population. In our conversations, staff often spoke of the issues that challenged the department in the context of the hospital’s location and the people they served. We saw that complaints investigations considered health inequalities as root causes.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. However, there was no information about waiting times for patients.

The trust’s website gave information about what the emergency department was for and alternative services that could be used instead. The website was clear that the emergency departments at the Sandwell and City hospitals were now closed.

For patients arriving by foot, taxi or car the location of the department was well signposted and the children’s and adult entrances clearly differentiated. There was good signage within the department, and it was clear where toilets, food and beverages could be found.

However, there was no information available in the main waiting room about current waiting times. Several staff drew this to the attention of the assessment team and told us it meant patients were frequently asking questions about this. Staff believed this contributed to frustration and therefore to violence and aggression as well as interrupting their work. We were told that such a system was planned but reductions to the trust’s information technology department meant it was a low priority.

Staff ensured patients could obtain information on treatments, local services, patients’ rights and how to complain. Staff made information leaflets available in languages spoken by patients. Staff ensured carers and families were regularly updated about the patient’s progress.

The department used a bespoke patient flow intelligence tool (PFIT) that was used through a standard operating procedure to identify, in real time, barriers to patient flow and opportunities to get the system moving again. We saw this was an effective tool and it was used integral part of the department’s oversight and management.

The department made us aware of information derived from clinical and management systems to facilitate both the day to day running of the department as well as to plan how the department should be configured and managed. For example, we saw how clinical information had been used to plan staffing models and to model flow through the different zones when designing clinical pathways.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment, and support. Staff involved people in decisions about their care and told them what had changed as a result.

There was clear information for patients and relatives on how to make complaints. This was through material displayed in the department, throughout the rest of the hospital, and on the trust’s website.

There was a Patient Advice and Liaison Service (PALS) which supported patients to make complaints but also tried to address issues early on to get problems corrected for the patient’s benefit. Staff knew how to support patients to make complaints but would also try to fix the issue causing the concern.

Complaints were taken seriously. There was a process to investigate formal complaints and to understand and to implement lessons learnt. Action plans involved tasks such as improving training, addressing individual staff performance or revising processes and guidelines.

Written complaints were acknowledged within 48 hours, and it was aimed to provide a full response within 30 working days. When this was not possible complainants were told why and kept up to date. Over the 6 months before our inspection, there had been 30 complaints and 24 had been completed within 30 days, and we noticed response delays appeared to increase as the departments workload increased.

We looked at a sample of final responses to complaints, and they were investigated appropriately and patients given a suitable explanation. There was information provided as to how to contact the Parliamentary and Health Services Ombudsman if the complainant was not satisfied.

Apologies were made if necessary and the complaints process ensured that the legal Duty of Candour was met.

Learning from complaints was embedded in governance and oversight mechanisms and there were agenda items for complaints, often alongside incidents, in all the governance, management and staff meeting notes. Themes were discussed and there was a focus on identifying health inequalities through the themes in complaints.

The department staff bulletin that covered learning from complaints and we saw examples of “lessons on one page” (LOOP) documents that provided succinct descriptions of learning from complaints.

The service did not make sure that people could access the care, support and treatment they needed when they needed it. The service was open to people to attend when they needed it, but they were often subject to long waits. People did not always receive timely care and treatment in line with national performance standards which was an issue for many emergency departments at the time of our assessment visit. However, the department had well developed systems to recognise and respond to capacity challenges and thus to mitigate risk and harm.

The department was newly built with sufficient capacity to deal with the projected demand, but increases in demand meant the department was frequently crowded. This was mitigated by good design of flow and clinical pathways in the department, but these were not always enough as they could not change the underlying root cause of system pressures on emergency care in the local health economy.

There was a lack of available beds outside of the hospital, both in social and mental healthcare provision but also within the bed base of the hospital itself. Some patients who had no criteria to reside, which meant they were medically fit to be discharged, were held in the department awaiting arrangements for them to be moved. This sometimes meant patients had to be admitted onto wards in the rest of the hospital despite them not needing hospital treatment. Patients who needed to be transferred into the rest of the hospital for further treatment were also often held up in the department while waiting either for assessment by medical staff from the relevant speciality or waiting for a bed to become available. This meant the department was unable to meet the national standards set for time spent in the emergency department.

In turn this meant patients waiting for assessment and treatment in the department were subject to delays. Treatment cubicles and assessment areas were often full, and patients sometimes did not receive care in a timely manner because of the demands on staff. Patients waited a long time in the waiting room to be seen and sometimes patients had to be held on ambulances outside the department while waiting for space to be available for them to come into the department. This in turn affected patients in the community as ambulances were not available to respond to other calls.

During our assessment visit, no patients were being cared for in temporary escalation spaces such as corridors, despite the department being exceptionally busy. There were processes and guidelines to use these escalation spaces, but we were told they were avoided when at all possible.

Crowding meant some patients therefore did not always receive assessment and treatment in a timely way, they were subject to increased risk, and outcomes for some patients were poorer than they should be. This was a situation recognised by the department and these issues were explicitly noted in governance meetings and the department’s risk register.

There were clinical pathways to guide patients through the department, into the hospital as well as for transfer or discharge. These were well designed, well monitored and incorporated processes to effectively respond to emerging problems. This meant that the department was able to mitigate, to some extent, the demand challenges that it faced.

Other internal services reduced the pressure in the emergency department. There was an urgent care service located in a purpose-designed portable building operated by the trust. This worked well with clear pathways between it and the department, and it offered safe and effective treatment for those patients treated. There was a same-day emergency care (SDEC) facility located adjacent to the department for medical patients. It had its own staff and there were clear pathways between it and the main department. However, there was sometimes confusion as to how to admit patients who arrived for SDEC care through a referral from their GP.

The movement of services from the Sandwell and City hospitals to the MMUH had required a complete redesign of emergency care pathways. This had resulted in clear, well documented policies and procedures that not only gave clear guidance as to what was expected but also a platform for development. This was as changes were required through experience of what was working and what was not, as well as responses to the changing pressures on the department.

The department had a clear structure to monitor the department’s performance and to take action to deal with capacity and flow issues. This was defined through an overarching policy in which was embedded standard operating procedures. These covered ambulance assessment, triage, paediatrics, majors, resuscitation and ambulatory majors. There was an additional standard operating procedure that dealt with co-ordination between the department and the rest of the hospital.

There were systems for recognising when the department was coming under undue pressure, and there were mechanisms with which to respond. Protocols were aligned with the standard NHS Operational Pressure Escalation Level (OPEL) framework. Additional site meetings were initiated in consideration of the OPEL scores. System partners were involved as necessary with escalation to system responses and oversight by the integrated care board if the situation worsened.

Emergency department meetings and ‘huddles’ took place throughout the day against a fixed timetable, and additional ones were initiated through standard operating procedures triggered by information from the patient flow intelligence tool. Each meeting had a specific purpose and expected outcomes and was run against an agenda. The department engaged fully with the wider site meetings that oversaw flow across the wider hospital. Through these arrangements there was a clear rhythm to the day to day running of the department which promoted good team working both within the department and with the rest of the hospital.

Quality standards defined the expectation as to how specialities took patients out of the emergency department and the ‘Your Next Patient’ standard operating procedure was used to take suitable patients out of the emergency department onto wards. Improvement plans included work with specialties to better support the ED, although it was noted that medicine was seen as already well embedded and an approach to emulate.

The leaders in the department understood the current and emerging pressures and had processes and plans to improve flow. For example, there was a recognition there was a need to improve flow first thing in the morning, and this was enabled by promoting early cycles of ‘Your Next Patient’.

There was a programme of improvement work to further develop the department’s performance, particularly in the respect of enabling flow and therefore capacity. These considered streaming, processes, alignment of demand and capacity, flow into the rest of the hospital, and identifying patients discharge needs early in their hospital journey to reduce their length of stay. Efficient and effective same-day emergency care was a particular focus of this as was in-reach by specialities.

There was a streaming model that had been developed through piloting and testing in the 3 months preceding our assessment visit. This system was used to identify the sickest patients and ensure they received treatment quickly as well as to send other patients to suitable areas within the department, the hospital, and to also refer them to community services where that was the most appropriate option.

The department was falling consistently short of the of the national standard of 78% of patients having a decision about their onwards care within 4 hours. For the 6 months prior to our inspection was 60% on average with a lowest value of 53%, and the highest of 65% in July and August 2025. However, these failings were also seen at national and regional level, and the department was not an outlier in this regard. For patients spending 12 hours or more in the department, the lowest figures were around 3% in June, July and August but worsening towards the winter with 14% in November 2025. This showed the trust to be better than the national average and much better than the region.

Staff and leaders actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support, and treatment in response to this.

Staff demonstrated a good understanding of the people who used their services. For example, there had been exploration of the reasons many people from out of the area with mental health problems attended following detention by police in the city center. The department worked with local charities to understand the needs of diverse groups.

Staff completed equality, diversity, and inclusion modules as part of their mandatory training and these included working towards the standards for recently mandated training into learning disabilities and autism.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Patients and their relatives participated in discussions about their treatment plans and their future. This included when further treatment was no longer in the patient’s best interests. When we looked at patient records, we saw that any Do Not Attempt CardioPulmonary Resuscitation (DNACPR) decisions were discussed and recorded.

There were specialist link nurses available for people with complex conditions and the department worked with other specialties to ensure people had appropriate care and treatment plans.