Queen Elizabeth Hospital Birmingham

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

At our last assessment we rated this key question as good. At this assessment the rating remains good. This meant people's outcomes were consistently good, and people's feedback confirmed this. Patients were involved in the assessment of their needs. Staff gave people clear information about their care and treatment needed to support both their physical and mental health. Patients received co-ordinated and effective care and treatment from members of the multidisciplinary team. Staff supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff routinely monitored people's care and treatment to continuously improve it. People's views and wishes were considered when their care was planned.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

Assessments considered the person's health, care, wellbeing, and communication needs, to enable them to receive care or treatment that had the best possible outcomes. Staff attended daily care planning meetings and there were individual emergency co-ordinators for all core specialties including neurology, cardiac and liver services. Co-ordinators reviewed staffing and surgical procedures to ensure patient flow was effectively managed.

Records were up to date and showed comprehensive assessments undertaken leading to effective ongoing care.

Patients were involved in the assessment of their needs, and support was provided where needed to maximise their involvement. They were given information and advice about their health, care and support to enable them to be as well as possible, physically, mentally and emotionally.

Staff assessed patients' pain using a recognised tool and gave pain relief in line with individual needs and evidence-based guidance. Patients were prescribed pain relief to take home when they were discharged on the day of surgery.

People's care needs were routinely reviewed. Regular multidisciplinary meetings were held to discuss patients and improve care. Staff collaborated across healthcare disciplines and with external agencies. Teams worked closely together to meet patient needs. Patients' care pathways were reviewed by relevant consultants.

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.

The trust's systems ensured staff in surgery services were up to date with national legislation, evidence-based good practice and required standards. For example, the trust's intranet contained a comprehensive range of up-to-date policies and standard operating procedures which reflected current practice. Care, treatment and support were delivered in line with legislation, standards and evidence-based guidance.

Staff gave people clear information about their care and treatment needed to support both their physical and mental health. People felt their expectations and needs were considered during decision-making.

Staff made sure patients nutrition needs were assessed and met in line with current guidance. The menu offered to inpatients included patient choice with a range of diets and textures.

Staff worked well across teams and services to support people. Staff made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

When patients received care and treatment from members of the multidisciplinary team (MDT) it was co-ordinated and effective. All relevant staff, teams and services were involved in assessing, planning and delivering patient care and treatment and staff worked collaboratively to understand and meet patient needs. We observed good MDT working on ward THH5. There was a daily MDT meeting attended by consultants, physiotherapists and ward sisters.

Information was shared between teams and services to ensure continuity of care, for example when clinical tasks were delegated or when people were referred between services. When patients were due to move between services, all necessary staff and teams were involved in assessing the patient's needs to maintain continuity of care. Ward 728 had flow coordinators who supported the discharge of patients, booked district nurses, ensured medication to take home was prescribed by doctors, and arranged packages of care.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff focused on identifying risks to people's health and wellbeing early and to support people to prevent deterioration. Patients attended pre-operative assessment appointments where their suitability for surgery was checked. This included the completion of a health questionnaire, and an opportunity for the nurse to provide advice or refer patients on to other appropriate services if they required.

Patients were empowered and supported to manage their own health, care and wellbeing needs by staff who understood their needs and preferences. The service offered a 12-week programme of physical activity called `Be Active +' which gave patients a head start and a chance to improve their health and wellbeing. Qualified exercise professionals worked with individuals registered with a Birmingham GP and aged 14 and over, to design a physical activity programme to meet their personal needs and goals.

There was a Queen Elizabeth Hospital Birmingham heart and lung transplant support group for patients to share knowledge and get support following a transplant. Meetings were held monthly through online calls and face-to-face every 4 months.

Patients were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. A walk-in support service was available for patients following breast surgery. The support group offered psychological support and exercise classes for patients, their friends and their relatives.

The service routinely monitored people's care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service participated in relevant national and local clinical audits. These included the National Respiratory Audit Programme, Myocardial Ischaemia National Audit Project and the Royal College of Emergency Medicine: Care of Older People and Time Critical Medications. Most of the audits identified the service were performing in line although in some, above (worse than) the national average. For example, while joint replacement outcomes were within expected ranges, there were concerns with some of the outcomes. These included high hip fracture mortality (16.3% at Queen Elizabeth Hospital Birmingham compared to 10.2% at Brimingham Heartlands Hospital) and low compliance with surgery timing (26.5%). Strengths in patient outcomes were observed in pressure ulcer prevention (98.2 to 100%) and compliance with vascular procedures.

The latest mortality data was positive. The Standardised Hospital Mortality Indicator (SHMI), last published for the period October 2023 to September 2024, was below the risk-alert level of 100 at 94.07 indicating fewer deaths than would be expected. However, there were 2 mortality triggers in September 2024 where more deaths were observed than expected. This was for fractured neck of femur and Non-Hodgkin's Lymphoma. A review was underway for the first indicator and a learning review would be undertaken for the second.

Managers used information from the audits to improve care and treatment. There were effective approaches to monitor people's care and treatment and their outcomes. Audit data from the Health Quality Improvement Partnership indicated mixed performance across the trust, with strong compliance in some areas but variability in mortality rates, surgical timing, and data completeness.

National Safety Standards for Invasive Procedures (NatSSIPS) were available in the theatre department. NatSSIPS provided a framework to produce Local Safety Standards for Invasive Procedures (LocSSIPS). A thoracic surgeon led on NatSSIP 2 and held discussions on how it would be implemented across all 4 hospital sites with the governance team.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff understood the importance of ensuring that people fully understood what they were consenting to and the importance of obtaining consent before they delivered care or treatment.

Staff gained consent from patients for their care and treatment in line with legislation and guidance. All consent forms we reviewed during our assessment had been completed in their entirety.

People's views and wishes were considered when their care was planned. A patient record we reviewed showed the patient had consented to tissue donation for research purposes. We saw evidence patients could choose to opt in or out for their tissue to be used for future research projects including genetic studies and medical research.

Staff protected the rights of patients subject to the Mental Health Act and followed the Code of Practice. People felt supported by staff, who took time to explain treatment and decisions. Staff were sensitive and knowledgeable when giving updates to families. The service had effective systems and practices to ensure people understood the care and treatment being offered or recommended.

Staff received Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards training. They understood relevant consent and decision-making requirements. Staff knew how to access policy and advice on these topics. Managers monitored compliance with the MCA. Patients who lacked capacity were identified during the pre-operative assessment process.

Staff we spoke with demonstrated a clear understanding of the trust's resuscitation policy and `ReSPECT' documentation. The ReSPECT process created personalised recommendations for a person's clinical care and treatment in a future emergency in which they were unable to make or express choices.

The hospital treated young people over the age of 16 years and the trust policy followed the law in presuming the young person was able to provide their own consent for surgery. Staff would follow guidance if there were concerns about the young person's mental capacity to make their own informed decisions.