Birmingham Children's Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well led is rated as good. This meant children and young people’s needs were met through good organisation and delivery.

We looked for evidence of an inclusive and positive culture of continuous learning and improvement, based on meeting the needs of people who used services and wider communities. Leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

There was a shared direction and culture managed by capable, compassionate and inclusive leaders. Staff felt safe to speak up. There was good governance and close working with partners and the community.

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 Well-led.

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

There was a shared vision, strategy, and culture. The vision, values, and strategy had been developed through structured planning. Staff and leaders demonstrated a positive, compassionate, listening culture that promoted trust and understanding between them and people using the service. The culture was focused on learning and improvement and there was a mutual trust and respect between the leadership and staff.

The service had a people’s inclusion and experience group called the GROW surgery group. GROW stood for Great communication, Recognition for everyone, Our teams and Welcome everyone. They met monthly, for staff to get involved and shared their experiences for planning for the future of the division.

The surgical division worked together to plan services, whilst also improving workforce satisfaction through an approach known as the ‘pillars of surgery’. This included enhancing the patient pathway by moving low complexity procedures out of theatres, moving general anaesthetic use to sedation where clinically appropriate and reviewing the pre-admission process. Intended outcomes included increased theatre capacity for more complex surgery and a reduction in cancellations on the day.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience, and credibility to lead effectively.

There was a clear management structure which staff understood and were able to identify their leaders. Staff were given the opportunity to develop leadership qualities and develop their roles. All senior nurse leaders, managers and all staff knew their job roles and understood the accountability requirements.

Many staff we spoke with had opportunities to undertake further qualifications and develop or extend their roles within the service. Some staff were actively involved in partnership and working groups, contributing to initiatives aimed at reducing costs or improving clinical and operational practice.

Staff consistently told us they felt valued in their roles and able to contribute to service development. We also noted that some senior staff had been with the service for a long time, which supported continuity of care for patients and contributed to a stable, experienced, and consistent workforce.

Staff told us ward managers and senior nurse leaders were supportive, and they could speak to them regarding any concerns they had.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff were encouraged to speak up and to raise concerns. Leaders promoted the value of speaking up. The trust had a dedicated Freedom to Speak Up Guardian (FTSU). The Guardian’s role was to support workers to speak up when they felt they were unable to in other ways. Information about speaking up was easily accessible on the trust’s intranet. The staff had a good understanding of what the Guardian’s role was. Staff told us they would approach them if they felt it was needed but would generally approach their line manager in the first instance for support and guidance.

Freedom to Speak Up Guardians reports fed into the board level report. They fed back that request for listening sessions had doubled but contacts from mental health services had decreased, indicating positive impact from the targeted support being offered to staff. Leaders were supportive of this role and encouraged staff to engage with FTSUP for support.

There was a good culture of speaking up where staff felt safe to raise concerns without fear of detriment. Concerns were handled sensitively and confidentially and mindful of people’s rights and responsibilities.

The service valued diversity in its workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. The service had a diverse staff team and staff felt there was good teamwork and a positive culture around equality, diversity and inclusion.

There was a commitment to supporting equality, diversity and inclusion through peer-to-peer networks. These included staff networks including an ethnic minority staff group, disability networks, LGBTQ+ groups, as well as support from the freedom to speak up team, clinical psychology team, and chaplains.

The trust completed equality, diversity, and inclusion reports, including the headline reports for the Workforce Race Equality Standard and the Workforce Disability Equality Standard.

The service leaders had clear responsibilities, roles, systems of accountability with governance arrangements that were mostly effective. Staff used these to manage and deliver good quality, sustainable care, treatment, and support. Staff acted on the best information about risk, performance, and outcomes, and shared this securely with others when appropriate.

We attended the morning planning meeting for theatres; the meeting was well organised and attended by the appropriate staff. Due to some cancellations of elective surgical lists on this day, leaders discussed the other lists for the day and the utilisation of theatres. Staff explained that this decision had been made due to long term sickness.

There were meetings to monitor the performance of the service and track trends or themes against finances. We saw minutes from the last 3 meetings. Issues discussed included sickness absence, referral to treatment rates and performance. Action plans were developed and monitored. There were a range of meetings to cover governance, quality and safety. Minutes recorded covered a range of key topics. This included, for example, patient safety reports, staff vacancies, infection control, health and safety, and mandatory training compliance. Incidents were discussed to determine how learning and changes were to be implemented.

The service had a risk register. The risks were dated from when they had been identified, and how the service was mitigating the risks. One of the top risks was that the audiology room not sound proofed and long audiology waiting lists. The service had plans to mitigate these risks and address the waiting lists.

The service had a clear governance structure. The managers operated effective governance processes throughout the service and with partner organisations. They had structures and systems of accountability, so all levels of the management knew and understood their roles and responsibilities.

The service reviewed hospital data for learning from deaths, and a review was undertaken for every child death. The patient safety panel met monthly to identify actions and shared learning from these reviews with the departments in the service and across the wider trust.The service leaders had clear responsibilities, roles, systems of accountability with governance arrangements that were mostly effective. Staff used these to manage and deliver good quality, sustainable care, treatment, and support. Staff acted on the best information about risk, performance, and outcomes, and shared this securely with others when appropriate.

We attended the morning planning meeting for theatres; the meeting was well organised and attended by the appropriate staff. Due to some cancellations of elective surgical lists on this day, leaders discussed the other lists for the day and the utilisation of theatres. Staff explained that this decision had been made due to long term sickness of a member of staff.

There were meetings to monitor the performance of the service and track trends or themes against finances. We saw minutes from the last 3 meetings. Issues discussed included sickness absence, referral to treatment rates and performance. Action plans were developed and monitored. There were a range of meetings to cover governance, quality and safety. Minutes recorded covered a range of key topics. This included, for example, patient safety reports, staff vacancies, infection control, health and safety, and mandatory training compliance. Incidents were discussed to determine how learning and changes were to be implemented.

The service had a risk register. The risks were dated from when they had been identified, and how the service was mitigating the risks. One of the top risks was that the audiology room was not sound proofed and long audiology waiting lists. The service had plans to mitigate these risks and address the waiting lists.

The service had a clear governance structure. The managers operated effective governance processes throughout the service and with partner organisations. They had structures and systems of accountability, so all levels of the management knew and understood their roles and responsibilities.

The service reviewed hospital data for learning from deaths, and a review was undertaken for every child death. The patient safety panel met monthly to identify actions and shared learning from these reviews with the departments in the service and across the wider trust.

The service understood the duty to collaborate and work in partnership, so services worked seamlessly for people. Staff shared information and learning with partners and collaborated for improvement.

The service worked well with outside agencies. These included key relationships with the local authority, police, and mental health services. This was to provide care which was joined up and supported people to be safe and live well in their community. There were good relationships with the rest of the trust’s services, where services overlapped or were co-dependent. The service worked well with other local NHS trusts, community services, local schools, and local charities.

We saw minutes from monthly meetings held with other trusts to discuss speciality cases such as injuries caused by burns.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for people. Staff actively contributed to these discussions.

Areas we visited displayed posters giving details of the quality improvement work for the area. This allowed staff to give feedback on improvements and understand changes being made to their wards.

Wards and surgical areas had local improvements projects which were on going. These included:

• Pre- and post-operative care information leaflets with QR code access to digital guidance
• Creation of a ward mascot to deliver education to families, to encourage patients to mobilise after cardiac surgery, improve patient recovery and help prepare patients and their families for discharge.
• Cardiac dental care workstream
• Anxiety clinics to improve the preparation for children undergoing surgery.
• Anaesthetics feedback project to look at how anaesthetic trainees receive feedback, to enhance patient outcomes and experience.

The service had a programme of projects to drive improvements and provided regular updates and outcomes. For example, the patient safety team led projects to proactively improve the design and use of PEWS, including the embedding of Martha’s Rule principles. The impact of this was that increasing numbers of parents anonymously reported they felt able to raise concerns with clinical staff. There was project to reduce the number of patients who did not attend for appointments to improve department efficiencies.

To address the challenges within the surgical service, a number of initiatives had been introduced to support staff, improve communication, and drive service improvement. Monthly staff meetings were established to provide updates on the theatre staffing situation. A monthly newsletter was launched to keep teams informed about the current position and the actions being taken to improve services. Chief officers had provided weekly oversight and support to divisional colleagues to help drive and sustain service improvements.

The patient safety team had led work to improve the detection and prevent extravasations. Extravasation occurs when intravenous (IV) fluid or medication leaks out of a vein into the surrounding tissue. This can cause local injury and, in some cases, serious tissue damage. This had resulted in a 33% reduction in extravasations reported over 2-years post rollout, especially amongst the moderate and high-risk harm patient categories.