Birmingham Children's Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective is rated as Good. This meant we looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on the latest evidence and good practice. Staff gave people information to support healthy living. They made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to patients to make decisions in people’s best interests where they did not have capacity.

At our last assessment we rated this key question good. At this inspection the rating remained good.

We have not awarded this service a score for Effective.

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

The service made sure children’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

Children, young people and their families said they were involved in their treatment decisions. We spoke with 15 children, young people and their families. They said as well as being involved in deciding about their care and treatment they received the information they needed to make their own decisions about their care.

Some patients had multiple health conditions alongside psychological and learning support needs. We reviewed several patient records where care planning was holistic and took account of all identified needs. This included patients with learning disabilities, epilepsy, and gastroenterological conditions. The electronic patient record clearly detailed the multidisciplinary teams involved in each patient’s care and the actions being taken to meet their individual needs.

Patients and their parents said they were confident their individual needs had been appropriately assessed and fully understood. Staff talked to patients and their parents about what reasonable adjustments they could make. One option was a private cubicle. In addition, staff could provide weighted blankets, ear defenders and earplugs and there was an option to make personalised timetables and schedules for children that might need them using pictures and symbols.

The individual needs of patients were recorded on the electronic patient record. This included identified mental health support needs, learning disability requirements, and safeguarding concerns, which were clearly flagged to support appropriate care. The staff told us they were passionate about supporting patients with additional needs including learning disabilities and autism, mental health and visual and hearing impairments. They offered support to patients, their carers, and ward staff, and were also responsible for monitoring and reducing restrictive practices.

The service had robust and comprehensive procedures for patients in need of mental health support. They had good partnerships with local mental health teams and support services.

We saw minutes from departmental meetings where self-harm amongst children and young people had been discussed. For example, types of self-harm injuries had been discussed, the need for an MDT approach and the latest guidance and learning.

Staff at the service had a good understating of the needs of children with attention hyperactivity deficit disorder (ADHD) and how it presented. The needs of children and young people were captured at pre-assessment and reasonable adjustments were made. For example, placing a child at the end of a ward where it was quieter or if a single cubical was required the patient could be admitted to an alternative ward.

The ward had communication aids which included booklets with pictures and simple words to prompt communication about how children and young people were feeling.

The service used ‘passports’ and different forms of communication aids with children and young people to enable them to express their wants, needs and wishes. The completion of these passports was voluntary, and the intention was that they followed the patient through their treatment journey, through various departments and hospitals if required. By completing the passport staff could understand a patient needs and wants, so patients did not have to repeat this during conversations with staff.

However, there was an inconsistent approach to the completion of these passports and staff were not always able to locate these on the electronic patient record. We fed this back to the service during our inspection. The service had not audited the use of hospital passports since September 2024, the audit had focused on the usage of hospital passports and any person-centred guidance such as positive behaviour support plans and one-page profiles for autistic and learning-disabled children and young people. The audit highlighted that the use of hospital passports had declined since 2023. In response to the 2024 audit findings, the service strengthened internal communications regarding the use and ordering of passports. This included featuring the topic in newsletters and adding it to the agenda of the Learning Disability and Autism Improvement Group.

Additionally, the internal intranet Learning Disability page was updated to include a dedicated hospital passport section for staff reference. During inspection, we discussed the use of hospital passports with the service, who reported a planned programme of audits to monitor improvement through to 2026.

The service had a family liaison support worker who did an initial check-in with new patients to understand any support needs. They gained an understanding of social and family histories, contacted schools if needed and local authority teams such as safeguarding. The family liaison worker also attended safeguarding meetings and multi-disciplinary team meetings as a link between the trust and the local authority teams. They were also trained to complete mental capacity act assessments.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards. Staff had access to up-to-date policies and procedures which enabled them to follow national guidelines and evidence-based practice. For example, the observation, monitoring and escalation policy was based on national guidance. Post-operative observations were in line with the Royal College of Nursing’s ‘standards.

The service took part in national audits. For example, the Epilepsy 12-point audit. Clinical pathways were based on best practice and national guidance. For example, children had access to an Epilepsy Specialist Nurse.

We saw evidence of effective multidisciplinary team working. These groups met on a regular basis to discuss clinical pathways, policies and procedures.

The service had a liver biopsy protocol, this was discussed during meetings we attended to ensure all staff were adhering to the protocol.

There was evidence-based care and treatment including pain management and specialised feeding techniques. Children, young people and their families told us pain had been managed well, and pain relief was given promptly when required.

Patient’s nutrition and hydration needs were met in line with current guidance. Food and fluid balance charts were regularly updated. Staff were able to request support from specialist feeding teams.

The service promoted the use of specialist area leads, for example, epilepsy nurses and play specialists. Staff with this specialist knowledge could offer additional up to date advice or support to other staff working with a patient with additional or complex needs.

We observed good working relationships between nursing and medical staff. They described collaborative and respectful interactions and a willingness to respond to each other’s needs. Most staff told us they felt supported by their immediate managers.

However, a significant number of medical staff told us that theatre cancellations had increased. They attributed this to a reduction in the availability of theatre nursing staff willing to undertake additional shifts following changes to bank staff pay rates. This was not an issue unique to this trust and had been raised as a wider local workforce challenge and was reflected in the service risk register. Cancellation data provided showed that cancellations due to unavailable staff accounted for 10% of the cancellations which was high in comparison to other areas.

Some staff groups felt there was a disconnect between the staffing and capacity needs identified by nursing and medical teams and the decisions made by senior leaders, particularly in relation to workforce availability and the cancellation of procedures. Staff told us they were able and confident to raise these concerns and propose potential solutions but did not always feel these were considered or acted upon. Staff recognised that procedures were sometimes cancelled to maintain patient safety staffing was short and that reasons were explained to them.

The service worked well across teams and services to support children and young people. Staff mostly made sure children only needed to tell their story once by sharing their assessment of needs when they moved between different services. However, the process for using hospital passports was not embedded or effective for all patients.

There were regular meetings weekly to discuss transplant patients. These meetings were attended by the teams involved in the patients care and meeting minutes showed good examples of multidisciplinary team working.

Effective multiagency working was clearly documented in patient records. The service had a mixture of staff, which included doctors, nurses, healthcare assistants, but also a play specialist. There were staff leading on mental health and for children and young people with learning disabilities and autism.

The service worked well with outside agencies, including the local authority, local safeguarding teams, social workers, mental health teams and local care teams who attended the service to support an individual child or young person.

The service supported people to manage their health and wellbeing.

Children, young people and their families could access information on healthy eating and accessing free vitamin supplements. We saw posters on noticeboards in the ward and family areas that gave health promotion information. There was also advice from local mental health teams on wellbeing and support for eating disorders.

The service had links with the local substance misuse teams and patients, their families or carers could request a referral for support.

The trust chaplaincy team offered spiritual support to children, young people and families. There was a multi-faith team offering religious and spiritual support.

The service monitored patient’s care and treatment to continuously improve it. Staff worked to provide outcomes that were positive and consistent, and they met both clinical expectations and the expectations of children and young people themselves. The service completed local and national audits to determine outcomes and improve practice where needed.

The service did a study of pharyngoplasty, a surgical procedure used to support speech and language development in children or young people with cleft‑related speech problems. The operation offered improved outcomes where perhaps previous procedures had not been as successful.

There had been an ongoing project to look at the link between the challenges for paediatric cardiac patients accessing dental care and the link between oral health and the risk of infective endocarditis (IE). The service had promoted a standardised referral pathway to support early dental screening, improved access to preventative treatments, and the maintenance of good oral hygiene for children at increased risk of IE.

The service was part of a national group that monitored the shortage of transplant surgeons. The groups aim was to drive the discussion around the shortages and meeting patient needs. For example, this included identifying areas in the country where surgeons where available when an organ became available for transplant and arranging the transfer of patient care.

The service took part in the congenital heart disease (CHD) peer review to improve safety and benchmark standards in paediatric cardiology. The results from this review were due following our inspection.

Locally designed audits were completed to monitor outcomes for children and young people. Outcomes for children and young people were mostly positive, consistent and met expectations, such as national standards. The service routinely monitored surgical site infection rates and had noticed an increase in bloodstream infections. The service initiated a thematic review alongside a comprehensive Infection Prevention and Control (IPC) audit.

The service took part in peer reviews, In September 2024, the burn care unit achieved 93% of the national standards in a peer review, with concerns noted regarding building refurbishment and a shortage of therapy staff. The service provided evidence following our inspection which confirmed funding had been secured for the refurbishment of the burn care unit in 2027.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. Consent was explained and patient notes that we reviewed on the electronic patient record showed that these were signed and dated. Consent was discussed again at different stages in the patient’s treatment and updated.

Parents and carers that we spoke with confirmed risks of procedures had been explained clearly and consent had been discussed and forms had been signed. Staff spoke with the children and young people before any care and treatment was started. They checked children, young people and their families understood what was to happen next. Staff were obtaining consent in line with legislation and trust policy. Staff understood how some children were able to give their own valid consent, should staff assess them as mature enough to fully understand what they were being asked. Staff understood ‘Gillick competencies’ which covered the legislation relating to consent for children.

A national working group had produced a consent form specifically for kidney transplant patients. The form detailed the risks of the transplant and was signed by the patient or parents or guardian, consultant surgeon and a consultant nephrologist (medical doctor who specialises in kidney care).

During our inspection the service advised us that following the implementation of the trust’s new electronic patient record system, a new programme of clinical audits was being introduced and was in the process of being embedded. This included planned audits of consent documentation to ensure compliance with governance and quality standards.