Birmingham Heartlands Hospital

This assessment was conducted to follow up on concerns and breaches of regulation identified during our previous assessment published in August 2025.

We reviewed 15 quality statements across 4 key questions: Safe, Effective, Responsive, and Well-led. The ratings for these areas have been combined with those from the previous assessment to determine the overall rating. At our previous assessment we rated caring as good. We did not re-inspect caring during this assessment, but we did see many examples of caring and compassionate staff.

We refer to women in this report, but we recognise some transgender men, non-binary people, and people with variations in sex characteristics or who are intersex may also use services and experience some of the same issues.

We rated the service overall as good. Since our last assessment, the service had made significant improvements and was no longer in breach of regulations relating to premises and equipment and good governance.

Staff assessed and managed risks effectively, and there was evidence that learning, quality improvement and governance processes were embedded across the service. Staff demonstrated a strong commitment to continuous improvement and described taking a considered and sustainable approach to implementing change. There was a clear and shared vision for the future of the maternity service, which staff at all levels understood and supported.

We found a positive and supportive culture across the midwifery workforce. Staff told us they felt able to speak up and raise concerns, and consistently described senior leaders as compassionate, visible, approachable and responsive. Leaders had taken meaningful action to address cultural challenges and promote an open, inclusive and collaborative working environment.

However, we still found breaches in regulations relating to safe care and treatment and safe staffing levels. We identified some prescribing errors on medication charts and poor medicines management. Some medical records did not always contain sufficiently clear documentation of patient management plans, which could affect continuity of care. Triage by medical staff remained a problem for the department at night and weekends with doctors having multiple pressures on their time. The service did not have the capacity to deliver the service safely in the right place for women at all times due to restrictions around the environment and this impacted on flow. There were staffing gaps, but it was an improving picture.

We found improvements were needed within the medical workforce. There were some inequalities in training opportunities between trust-employed doctors and trainee doctors. In addition, some medical staff described a poor culture within the medical workforce, and a lack of support at times indicating further work was needed to strengthen teamworking and staff experience in this area.

In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward. Or, if we have requested an action plan, this will be requested upon publication of the final report.

This assessment was conducted to follow up on concerns and breaches of regulation identified during our previous assessment published in February 2024.

We reviewed 25 quality statements across the five key questions: Safe, Effective, Caring, Responsive, and Well-led. The ratings for these areas have been combined with those from the previous assessment to determine the overall rating. We refer to women in this report, but we recognise some transgender men, non-binary people, and people with variations in sex characteristics or who are intersex may also use services and experience some of the same issues.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to Regulation 12: Safe care and treatment, Regulation 17: Good Governance, and Regulation 15: Premises and equipment.

The governance systems had failed to identify and mitigate a number of significant concerns found at this assessment. There were delays to care received by women. Women and their babies were not always monitored in line with national guidance. Some patients in the operating theatre did not have the appropriate checks completed prior to and after surgery to ensure they were safe and did not come to any harm. Not all risk assessments were completed effectively, and some risks were not managed for women who experienced post-partum blood loss. There were some poor medicine practices and medicine errors. The second operating theatre was unsecured, and the environment was not entirely fit for purpose.

We issued the trust with a Section 31 Letter of Intent for Maternity Services. We gave the trust 48 hours to respond to us with actions in relation to our high-level concerns on patient safety. The trust responded within this deadline with an action plan and supporting documentation which provided evidence they understood our concerns and were working to keep women safe.

At our previous assessment in February 2023, we issued a Section 29A Warning Notice in relation to insufficient medical staffing to provide safe care and treatment in triage. We found on this assessment that while cover was provided between 8am to 8pm by doctors, women were still experiencing delays in triage, particularly overnight. The Warning Notice was met due to notable improvements in the service but with still some residual improvements needed.

However, we also found women were treated with kindness and compassion. Leaders and staff had a shared vision and culture based on listening, learning and service. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles.

Birmingham Heartlands Hospital is part of University Hospitals Birmingham NHS Foundation Trust which is one of the largest teaching hospital trusts in England. A merger in 2018 included the Birmingham Heartlands Hospital site.

The hospital's children and young people's service has 2 wards, ward 16 (which consists of the inpatient ward) and ward 15 which includes paediatric assessment unit (PAU). There was also a high dependency unit (HDU), children's outpatients for paediatrics, and transitional care for neonates. The children's HDU is a specialised area in the hospital that provides a level of care between a standard hospital ward and the intensive care unit. These wards accommodated children and young people from birth to 16 years of age. We also inspected the neonatal unit which included a neonatal intensive care unit, critical care and special care unit.

Children and young people were assessed on the PAU (ward 15) for further care and treatment to be identified. After, children would either be able to be treated on the ward or discharged home. The neonatal unit looked after new-born babies who needed extra support.

We carried out this assessment as the children and young people's service at this site had not been rated since the trust was established in 2018. This was a comprehensive assessment, and we assessed quality statements across safe, effective, caring, responsive and well led. We rated the service overall as good. However, the service has been rated requires improvement for safe. The other key questions of caring, effective, responsive and well-led have been rated as good.

A CQC team of 2 inspectors, 1 CQC senior specialist in People with a Learning Disability and Autism and 2 specialist advisors carried out the assessment. We spoke with 20 staff members including senior nursing staff, ward managers, sisters and healthcare assistants. We met with doctors and consultants, domestic cleaning staff, nurses and student nurses. Also, the lead for asthma, the transition lead, the diabetes team, safeguarding leads, and the mental health champion. We also spoke with staff from an external agency offering support to a young person on the ward. During the assessment we spoke with 10 patients with consent and some family members and carers. We reviewed 15 patient records.

The assessment included a member of the medicines team. The medicines team visited ward 16, the HDU and the neonatal unit. They spoke with 3 nurses, inspected clinic rooms and administration records and associated care records for 12 patients.

The Birmingham Heartlands Hospital emergency department is a type 1 trauma unit situated in Bordesley Green in south-east Birmingham. It provides urgent and emergency care to patients in the local area as well as northern and particularly southern Birmingham. In the 2023/24 financial year there were 150,000 attendances, approximately 400 per day with an average of 130 of these arriving by emergency ambulance.

The emergency department is 1 of 3 run by University Hospitals Birmingham NHS Foundation Trust, with the others at Good Hope Hospital in Sutton Coldfield, and Queen Elizabeth Hospital in Edgbaston.

We carried out this assessment of the emergency department on 4 and 5 March 2025. It was carried out to determine if improvements had been made following our previous inspection in 2023.

We inspected 25 quality statements across the safe, effective, caring, responsive and well-led key questions and have combined the scores for these areas with scores from the last inspection to give the rating.

At the previous inspection, we rated safe as inadequate. At this assessment, the rating improved to requires improvement. Responsive stayed the same at requires improvement. Caring stayed the same at good. Well led and effective improved from requires improvement to good.

Four of the 5 regulatory breaches from our inspection in 2023 had been met, but the requirement for all staff to have appraisals had not. Because of crowding in the department, and the lack of flow meaning patients were waiting a long time both in and to access the department, we have issued a regulatory breach.

There was a strong focus on safety by staff and leaders, but external pressures and the building's size and configuration limited their ability to control risks. Due to crowding in the department caused by the demand for hospital beds, the service was not able to manage patients risks safely at all times. The environment was not fit for purpose which had a significant impact on the safety of the department, and limited leaders' ability to make improvements. There were not always enough staff to care for patients particularly with the higher demand at times of crowding.

Care and treatment were delivered against recommendations and guidance from national bodies including the Royal College of Emergency Medicine and the National Institute for Health and Care Excellence. The department took part in audits to assess and monitor the effectiveness of treatment. Patient's consent was asked for and their capacity to consent was assessed.

People were treated with kindness, empathy, and compassion. Their privacy and dignity were respected as much as possible but because of the challenges of the environment they often had a poor experience. People were able to make their own decisions and be understood. Staff were generally supported but suffered stress due to the high-pressure working environment.

The service was in breach of the legal regulations relating to safe care and treatment due to long waits, crowding and lack of flow in the department. However, there was good person-centred care, listening to patient's experiences and learning from complaints.

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.