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Birmingham Children's Hospital Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 14 November 2019

Our rating of services stayed the same. We rated it them as outstanding because:

  • Our rating for safe was good overall. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff completed and updated risk assessments for each patient and removed or minimised risks. The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
  • Our rating for effective was outstanding overall. All staff were actively engaged in activities to monitor and improve quality and outcomes. Opportunities to participate in benchmarking and peer review were proactively pursued. Staff were consistent in supporting people to live healthier lives, including identifying those who need extra support, through a targeted and proactive approach to health promotion and prevention of ill-health, and they use every contact with people to do so.
  • Our rating for caring was outstanding overall. Children and their families were truly respected and valued as individuals and empowered as partners in their care. Staff provided exceptional emotional support to children, families and carers to minimise their distress.
  • Our rating for responsive was outstanding overall. There were innovative approaches to providing integrated person-centred pathways of care that involve other service providers, particularly for people with multiple and complex needs. There was a proactive approach to understanding the needs and preferences of different groups of people and to delivering care in a way that meets these needs.
  • Our rating for well-led was good overall. Leaders had the integrity, skills and abilities to run the service. Leaders operated effective governance processes, throughout the service and with partner organisations. Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.

Inspection areas

Safe

Good

Updated 14 November 2019

Effective

Outstanding

Updated 14 November 2019

Caring

Outstanding

Updated 14 November 2019

Responsive

Outstanding

Updated 14 November 2019

Well-led

Good

Updated 14 November 2019

Checks on specific services

Critical care

Outstanding

Updated 21 February 2017

Safety was rated as outstanding because:

  • The Paediatric Intensive Care Unit (PICU) and high dependency unit (HDU) had clear, effective systems and processes in place within this service to promote safe and effective holistic care.

  • Staff understood their roles, responsibilities and was proud of how the service had developed, including participating in local, national and international safety programmes.
  • Learning was based on thorough analysis and an investigation into when things went wrong and when things went well.

Effectiveness was rated as outstanding because:

  • The policies seen were based on National Institute for Health and Care Excellence (NICE) and other relevant guidelines.
  • Staff participated in a wide range of clinical audits and were involved in research.
  • Care bundles and individualised care pathways were embedded in practice.
  • Patient outcomes were monitored and presented in the annual paediatric intensive care report, which included the international benchmark.
  • Staff received a structured induction with agreed development objectives, which were monitored with clear competencies developed by the education team within this service.
  • There was a holistic approach to assessing, planning and delivery of care delivered by the multidisciplinary team across this service.

Caring was rated as outstanding because:

  • The high dependency unit (HDU), Paediatric Intensive care Unit (PICU), supporting services including the post-acute care enablement (PACE) team and the transport team staff all demonstrated that they were fully committed to delivering high quality, individualised patient-centred care.
  • Children and their families were treated with compassion, dignity and respect. Parents stated they were positive about the care received by their children and felt involved and informed.

Responsive was rated as outstanding because:

  • The flow of children through PICU was managed effectively to avoid delays with discharges and manage capacity with the increased demands on this service. Safety huddles were held three times a day with extra huddles as demand necessitated.
  • The individual needs of the children were met with the use of individualised patient photographic folders with clear instructions relating to their individual position preferences.
  • Any delays with discharge were escalated at the earliest opportunity and the capacity managed with support from the hospital operational clinical site team.
  • Parents and families were supported during and after discharge from this service.

Well-led was rated as outstanding because:

  • This clinical service group had a vision and strategy for development of the service. All staff spoken to confirmed they were part of ‘team BCH’ and all staff knew the local vision.
  • Staff were able to raise concerns and were supported.
  • Leadership was visible and there was a keen sense of teamwork and a positive culture.
  • Research and implementation of findings was very strong with communication sheets contained within each patient family folder.
  • The staff worked well in engaging with the children and their families and external groups to seek feedback and support for the service.

End of life care

Outstanding

Updated 21 February 2017

During our inspection there were no patients at the hospital requiring end of life care, although there were some palliative care patients, therefore we have gained assurance from documents and interviews with staff.

Overall, we rated end of life care at Birmingham Children’s Hospital as outstanding, having safe, effective and well led as good.

  • There was a positive, transparent culture of incident reporting and learning from incidents. Sufficient numbers of appropriately qualified and trained staff were on duty to ensure patients were kept safe.

  • Staff used national guidelines and evidence-based treatment when looking after patients. The hospital took part in several national audits and staff were encouraged to carry out local audits. Results of audits were used to improve patients’ experiences and care.

  • Feedback from parents and patients about the care they received was consistently excellent. Parents, carers and patients we spoke with said staff “went the extra mile” and were “brilliant” or “excellent” and the care given was much more than they expected.

  • Patients and their families were treated with respect, dignity and compassion, particularly at the most difficult times, and bereaved parents were given genuine, compassionate care with clear emotional support if a child died. Staff displayed a great sense of pride in the end of life care provided at the hospital. Patients’ needs and those of families and other representatives of patients were considered throughout the process and following death. Parents were involved at every stage and were treated as individuals.

  • Patients were treated as individuals and different approaches were taken, when needed, to care for them in the most appropriate way. People from different cultures, backgrounds and religions were supported by staff and adjustments were made to accommodate their needs.

  • Leaders had an inspiring purpose and common focus to deliver the best possible care to the children in their care, and this attitude was shared by staff at all levels. Staff across all groups were proud of the organisation as a place to work and spoke highly of the culture. Many staff told us the hospital was “the best place they had ever worked” and said they “couldn’t imagine working anywhere else”.

Medical care (including older people’s care)

Outstanding

Updated 21 February 2017

Overall, we rated medical care at Birmingham Children’s Hospital as outstanding. Safe was rated good.

  • There was a positive, transparent culture of incident reporting and learning from incidents. Sufficient numbers of appropriately qualified and trained staff were on duty to ensure patients were kept safe.

  • Staff used national guidelines and evidence-based treatment when looking after patients. The hospital took part in several national audits and staff were encouraged to carry out local audits. Results of audits were used to improve patients’ experiences and care.

  • Feedback from parents and patients about the care they received was consistently excellent. Parents, carers and patients we spoke with said staff “went the extra mile” and were “brilliant” or “excellent” and the care given was much more than they expected.

  • Patients and their families were treated with respect, dignity and compassion, particularly at the most difficult times Parents were involved at every stage and were treated as individuals.

  • Patients were treated as individuals and different approaches were taken, when needed, to care for them in the most appropriate way. Staff supported people from different cultures, backgrounds and religions and made adjustments to accommodate their needs.

  • Leaders had an inspiring purpose and common focus to deliver the best possible care to the children in their care, and this attitude was shared by staff at all levels. Staff across all groups were proud of the organisation as a place to work and spoke highly of the culture. Many staff told us the hospital was “the best place they had ever worked” and said they “couldn’t imagine working anywhere else”.

Outpatients and diagnostic imaging

Good

Updated 21 February 2017

We rated outpatient and diagnostic imaging services as good.

The safety and responsiveness of the service was good because:

  • There were clear processes for the reporting of incidents.

  • Staff were encouraged to report incidents using the electronic incident reporting system.

  • We observed staff using appropriate hand washing techniques and personal protective equipment, such as gloves and aprons whilst delivering care.

  • Care was provided at flexible times to increase the accessibility of the service being provided.

  • The trust involved the Young Person’s Advisory Group when planning the delivery of outpatient and diagnostic imaging services.

There was an outstanding level of caring across all outpatient and diagnostic imaging services because:

  • When speaking to children, parents and carers they were continually positive about the care that was provided and the way that staff treated them.

  • People told us and we saw that staff made an extra special effort when they provided care. Staff were committed to empowering young people through providing them with appropriate information and support to enable them to make decisions around the care they received.

  • Children, young people and their carers told us that they were treated with compassion, dignity and respect.

  • We saw numerous examples of staff going beyond the remits of their role to overcome obstacles to ensure the needs of the child, family and carers were met.

  • We found strong local leadership in outpatient departments.

However, we also found areas requiring improvement in the well led domain, relating mostly to diagnostic imaging services:

  • We observed and staff told us that radiographers and radiologists did not work as a cohesive team.

  • The on call system for radiographers was not in line with trust policy with regard to compensatory rest for staff called out during on call shifts.

  • The trust wide appointment scheduling system had not been fully implemented in radiology.

  • Clinical staff in outpatient departments were performing administrative tasks due to a lack of administrative and clerical support. We observed that this was adding to the delays experienced by patients in the ENT clinic.

Surgery

Good

Updated 14 November 2019

Our rating of this service stayed the same. We rated it as good because:

  • The safe use of innovative and pioneering approaches to care and how it was delivered was actively encouraged. New evidence-based techniques and technologies were developed and used to support the delivery of high-quality care.

  • All staff actively engaged in activities to monitor and improve quality and outcomes. Opportunities to participate in peer review were proactively pursued, including participation in approved accreditation schemes.

  • Staff continually improved their skills, competence and knowledge to ensure high-quality care was delivered.

  • Staff were committed to working collaboratively and found innovative and efficient ways for patients to receive care quicker.

  • Practices around consent and records were actively monitored and reviewed to improve how children and young people were involved in making decisions about their care and treatment.
  • There was a strong, visible person- centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Patients, their families and staff had built up strong, caring, respectful and supportive relationships.
  • Staff always empowered patients to express their views and to realise their potential. Staff showed determination and creativity to overcome obstacles to delivering care.
  • The service was flexible, provided informed choice and ensured continuity of care. Staff found innovative ways to ensure, that as much as possible, patients were cared for in environments they were familiar with and by staff they liked.
  • There was a proactive approach to understanding the needs and preferences of different groups of patients and their families and to delivering care in a way that met their needs.
  • There was a compassionate, inclusive and effective leadership at all levels. Leaders demonstrated high levels of experience, capacity and capability needed to deliver excellent and sustainable care.

Transitional services

Outstanding

Updated 21 February 2017

Overall we rated the service as outstanding because:

  • There was a holistic approach to planning patient’s transition to other services, which fully reflected individual circumstances and preferences.

  • We found there was a real passion and commitment across multidisciplinary teams to deliver a patient centred and high quality service for young people and adolescents (patients) transitioning to adult care.

  • There was a transitional care policy for young people with long term conditions and/or disability (the policy) that encompassed the activities needed to support patients transitioning to adult care.

  • The was an Adolescent and Transition Forum (A&TF) to ensure the policy was implemented and Young Person’s Advisory Group (YPAG) which had the remit to support and monitor the use of the policy.

  • The progress on implementing transition pathways for individual specialties was varied. There were 36 specialities where transition arrangements were either in place and well established or some in the earlier phases of development. Progress was dependent upon the complexity and rarity of individual medical conditions.

  • There were a number of specialties participating in national research programs and used the outcome of these to develop innovative and pioneering approaches to high quality care for patients transitioning to adult care.

  • Patients received treatment and care according to national guidelines. Transition services obtained good quality outcomes as evidenced by a range of national audits such as the Royal College of Paediatric and Child Health (RCPCH) and the National Institute of Health and Care Excellence (NICE) as a basis to quality assure its transition services.

  • Transition services used the Department of Health ‘You’re Welcome’ self-review tool, ‘Quality criteria for young people friendly health services, 2011’ to monitor standards via the Commissioning for Quality and Innovation framework (CQUIN).

  • Feedback from patients and parents were positive, children and young people were treated with dignity, respect and kindness. Staff communicated with patients and their parents and provided information in a way that they could understand.

  • Transition clinical leads and champions felt valued and supported by their managers and received the appropriate training and supervision to enable them to meet patients’ individual needs.

  • There were a range of examples of transition plans. Specialties used innovative and efficient ways to deliver more joined-up care to patients transitioning to adult care. There was a holistic approach to planning people’s transition to other services.

  • The service involved other organisations and there were examples of the local community being integral to how services were planned and ensured that services met patient’s needs.
  • Transition teams had reviewed its framework and processes for governance to support patients transitioning into adult care.

  • Staff we spoke with, minutes of meetings, monitoring data and audit of transition pathways demonstrated the governance processes for transition services were in place for the majority of specialities.

  • There was a YPAG which was proactive in ensuring patients were involved in the development, design and delivery of services for children and young people.

  • There was an open, transparent culture with a clear vision and strategy for transition services which was led by a strong management team. Staff told us and we saw evidence that they were consulted and part of the development of the strategy, they were engaged and enthusiastic about the new developments within the transition service.

However we found:

  • Not all specialities used the trust’s documentation. Plans to support transition for the remaining 16 of the 36 specialities needing amending or further embedding.

  • A centralised approach to how information was shared with other external providers when taking over the care of patients transitioning to adult care was in the process of being developed.

  • Further work was needed to formalise governance processes so themes and areas of concerns specifically relating to transition could be identified and acted upon in a more timely and effective manner.

  • Through conversations with transition clinical leads and champions there was a development opportunity to create a better understanding and appreciation of the needs of adolescents transitioning to adult care.

Urgent and emergency services

Good

Updated 21 February 2017

We have rated this service as good. This is because:

  • There was a clear process for reporting incidents, staff knew how to report incidents and received feedback when they did.
  • We saw that lessons were learnt when things went wrong, actions were taken and practice changed as a result.
  • Paediatric early warning scores were recorded during the triage assessment which meant that each child’s condition was closely assessed and monitored.
  • Staff were trained, competent and followed evidence based practice and national guidance.
  • Staff contributed to a range of local and national audits including those led by the Royal College of Emergency Medicine (RCEM). The RCEM reviewed the submitted data and developed action plans with the findings.
  • Staff were kind, caring and compassionate towards children, young people, and their families. They were pleased with the level of care and treatment they received in the department.
  • The service had a plan in place to ensure services were delivered to meet patient needs over the winter period.
  • Patients with complex needs and learning disabilities were supported with specialist care.
  • An admission avoidance board updated attendees about alternative support available to them in the community which could mean they were seen quicker elsewhere.
  • The department mostly met the target for patients been seen and treated within 4-hours. Where the 95% target was not met, the departments was above the England average.
  • Staff were aware of the vision and values of the trust and felt the challenges of the department were understood and their commitment was valued and respected.
  • There was a clear strategy for the future of the service.

However we also saw that:

  • In the observation unit, children in the unit were without identification bands in place, which meant their identity, could be difficult to determine; two of which had received prescribed treatment. We observed the unit was left unstaffed for over five minutes.
  • There was limited space for medication preparation in the resuscitation area.
  • The waiting area was at times overcrowded and unkempt, with no domestic service to clean away the litter or attend to the public facilities.
  • There was limited information for parents and patients on how to complain if they were unhappy about the service.

  • The risk register did not correspond with the risks within the department with staff anxieties relating to major incidents not being acknowledged. We were not assured that all risks were being addressed.
Other CQC inspections of services

Community & mental health inspection reports for Birmingham Children's Hospital can be found at Birmingham Women's and Children's NHS Foundation Trust.