Queen Elizabeth Hospital Birmingham

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

At our last assessment we rated this key question as good. At this assessment the rating remained as good. Leaders understood and embodied the culture and values of the workforce and the organisation. They had the skills and knowledge, experience and credibility to lead well. They demonstrated their integrity and honesty which was recognised by their staff. There was a clear system of governance and risk management based around delivering safe and good quality care and treatment.

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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

There was a shared direction for the service. The service had strategies which had been developed in line with the Queen Elizabeth Hospital Birmingham strategy. The `Building Better Lives' trust strategy 2024-29 had been developed through team-wide engagement sessions and included nursing, clinical and operational staff. The areas to focus on included strengthening and growing specialised services, boosting research, innovation, and education potential, integrating urgent and emergency care and enabling sustainable improvement.

Leaders ensured staff in all areas understood the vision and strategy and supported the vision, values and strategic goals and how their role helped in achieving them. Staff we spoke with were aware of the trust's strategic aim to always put the needs and care of patients first. There were visions and values which underpinned the strategy including developing staff and patient health and wellbeing.

Leaders acted to continually review and improve the culture of the service in the context of equality, diversity and inclusion. The service promoted equality and diversity in daily work and provided opportunities for career development. There were policies and processes in relation to inclusivity and fairness in diversity and equality.

Staff felt respected, supported, and valued. They were focused on the needs of patients receiving treatment and worked well together to ensure they achieved good outcomes for patients. Staff we met said they were positive and proud to work in the organisation.

We mostly observed positive relationships between medical staff and nursing staff, with the patient at the centre of the roles. However, we witnessed a member of staff exhibiting uncivil behaviour towards a colleague during our assessment. We raised this with the senior leadership team who said it would be addressed.

There was a newly introduced behavioural framework to educate and support staff. The trust had designed a 3-hour workshop called "How we behave at work matters" following the introduction of a behavioural framework for leaders of all levels across the trust. Following our assessment, leaders said there were plans to roll out the training between April and July 2025. The training would focus on the impact of behaviours on others and the role of leaders in role modelling good behaviour. Also, tools and techniques for offering constructive feedback when behaviours do not align to the acceptable behaviours in the framework.

Staff across various surgical areas told us culture had been an issue for several years but was now improving with changes to senior roles and structures.

Some, although not all staff, felt more confident to provide challenge. For example, staff in theatres told us about a situation where they had comfortably challenged a clinical intervention prior to sign in and the senior staff involved listened.

Managers introduced suggestion boxes to encourage staff to speak up and explored options of introducing more team meetings.

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. They did so with integrity, openness and honesty.

Staff felt supported and guided by their leadership team. The service had a senior leadership structure which included a clinical director, divisional head of nursing and a medical director who led the service. The leaders were available when they were needed and led by example. They were knowledgeable about the issues and priorities in the department and strived for change and improvement when needed. Staff told us leaders were approachable and visible across the department particularly within theatres following a change in leadership.

Leaders were visible and supportive. For nursing staff, matrons and ward managers provided local leadership. Staff were positive about their local leadership team and said they were visible and supportive. Matrons visited their clinical areas every day to ensure they were there for staff and accessible to anyone who required support.

Leaders had effective support and opportunities to develop and maintain their credibility and skills. The roles of staff and leaders were clear, and they understood their responsibilities and accountabilities.

Leaders were alert to any examples of poor culture that affected the quality of people's care and had a detrimental impact on staff. They addressed this quickly.

Staff received monthly newsletters which covered incidents reported, any safety issues, and provided information on new starters.

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

Staff and leaders acted with openness, honesty, and transparency. Staff were encouraged to raise concerns with their managers. The hospital had a freedom to speak up guardian and a network of champions who could be contacted 7-days a week. Staff had the opportunity to talk to the freedom to speak up guardian who addressed their concerns in a confidential, timely and respectful way.

Under the Freedom of Information (FOI) Act 2000, people had the right to request access to information held by the trust. Information was available on the trust’s website and patients were able to send a FOI request to the trust by completing an online form.

Resident and trainee doctors we spoke with said they felt able to challenge inappropriate behaviour from clinicians. They gave examples of when clinicians apologised when challenged about their behaviour.

Some relationships needed further work. There were 169 responses to the staff survey in theatres. This reported 69% of staff in theatres said relationships at work was strained, 37% had experienced bullying at work in the last 12 months and 50% of staff had seen incidents and near misses that could harm staff in the last 12 months. Senior staff within the department felt the results were concerning as they considered the culture within theatres was good. As a result, team leaders were asked to explore concerns especially around incidents with teams.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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

Leaders understood their responsibilities to their teams with supportive structures to provide good governance. They took ownership of risks relevant to the areas they managed and escalated these to the senior leadership and relevant committees.

The systems to manage current and future performance and risks to the quality of the service took a proportionate approach to managing risk. Although leaders had oversight on the performance for referral to treatment and carried out harm reviews on patients who experienced long waits, performance still needed to be improved. Similarly, there was generally lack of oversight around equipment used to deliver anaesthetics and the management of medicines.

There was clear management of risk. In 2024/25, the trust implemented a new system for the management of risks. Specialty teams held risks for their departments and regularly met with their governance lead to review risks and actions. The hospital's senior leadership team implemented monthly risk review meetings to consider the higher-rated risks, review compliance with trust policy and identify actions to address gaps.

Staff had time and resources to undertake effective governance and manage risk. There was a good range of accurate and timely data and information available to understand performance and quality and improvements were made as needed. Governance was used to learn, improve and innovate. Information was used effectively to monitor and improve the quality of care. Staff attended staff meetings where leaders shared audit results, health and safety information, information governance, amongst other timely topics.

Information held about patients was secure and protected. There were arrangements for the availability, integrity and confidentiality of data, records and data management systems.

Theatre clinical incidents were discussed during the weekly patient safety incident review group which was chaired by the deputy chief medical officer. The meeting provided a rapid assessment of all significant incidents including never events. Where required, staff directed immediate safety actions in addition to commissioning, tracking and reviewing incident investigations. There was a clear escalation process through the monthly quality and safety meetings reporting at the hospital risk/quality and safety meeting and escalated to the clinical delivery group.

The service had a monthly clinical dashboard review group where wards were invited to present action plans on both poor, and good performance. For example, a medical representative attended meetings and focused on missed anticoagulant medication to support identification of areas of good practice, and to help with identifying areas for improvement.

There was learning from avoidable death and where poor practice had been identified. The learning from death process was through a mortality review committee with a standing agenda to included Coroner's notices (Regulation 28 Prevention of Future Death reports); review of key statistics; and monitoring speciality mortality and morbidity reviews. We attended a meeting with the leadership team which clearly outlined the mortality and morbidity process. Each speciality had their own clinical lead who then reported to the deputy medical director for surgery.

Patient safety incident review group meetings occurred weekly chaired by a deputy chief medical officer. Information relating to incidents was shared through monthly band 7 staff meetings and through staff emails.

We reviewed several sets of minutes from meetings of surgical specialties, and they covered governance topics and identified actions required to improve patient pathways and care. The included waiting lists, avoidable harm, learning from incidents, and performance.

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.

Staff and leaders worked in partnership with key partnerships and organisations to support provision, service development and joined up care. Information provided after the assessment identified therapy leads regularly met with local care homes and the integrated care boards which covered the areas where the hospital operated to develop further pathways to support early discharge.

Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care. Pre assessment staff told us a shared care record system allowed staff access to GP records.

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 safe, effective practice and research.

Staff and leaders had a good understanding of how to make improvement happen. The approach was consistent and included measuring outcomes and impact.

Staff we met at surgical services said the culture of improvement was well embedded and they felt no barriers to making improvements and this was fully encouraged, although well-managed to ensure trust objectives were still achieved.

There was an active research, development and innovation (RD&I) team involved in and having completed many projects over the years. The RD&I department had a 5-year strategy covering 2025 to 2030. This was linked to the trust's strategy around `Building Healthier Lives' with 5 key objectives linked to the trust's 5 themes described in our Shared direction and culture section above. The department wanted to ensure:

• Every patient could participate in RD&I
• The team had a culture of continuous learning and development
• The trust was a centre for pioneering research and innovation
• Research reflected the demographics of the population
• All RD&I programmes were financially and environmentally sustainable

University Hospitals Birmingham supported a wide-ranging research and development infrastructure. It hosted several bodies within the National Institute for Health and Care Research (NIHR). The team provided support to other local research alliances including for cancer.

The trust board received the annual review of research and development for 2023/24 at its June 2024 meeting. The report described how the Department of Health and Social Care and NIHR recognised the challenges faced in supporting RD&I after the COVID-19 pandemic although recognising it remained valued and supported. The report to the board highlighted the achievements at the trust in the year and this included working within NHS England priorities which involved cancer research studies, some in very rare and highly aggressive cancers, and work in radiotherapy around rare brain tumours.

The RD&I team were working on over 1,000 active studies, had over 400 consultants and allied health professionals as principal investigators, and recruited between April 2024 and January 2025, over 6,000 patients.

Queen Elizabeth Hospital Birmingham had delivered over 1,850 clinical trials. It was one of only 2 hospitals in the UK to perform all 4 solid organ transplants such as heart, lung, liver, and kidney completing over 400 transplants annually.

A cardiac surgery improvement programme had been established to support the service increase the volume of surgery cases at Queen Elizabeth Hospital Birmingham. A cardiac improvement project group oversaw 6 project workstreams. They focused on, for example, quality and safety of the care of patients presenting to cardiac surgery services in a timely manner, capacity and demand modelling and recruitment, and retention to ensure appropriate workforce.

A same day emergency care surgical service (SDEC) had been developed in line with national guidance. The SDEC incorporated many of the surgical specialties, improving access to rapid diagnostics and more timely decision making for patients. The vision was that all surgical patients who could be diverted from the emergency department would be seen and treated by the surgical SDEC correct specialist care in the best environment possible. This was designed to reduce capacity pressure on the emergency department.