Birmingham Heartlands Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed the learning culture, safe environments and safe and effective staffing quality statements for the safe key question. As this assessment was based on risk, we did not complete enough quality statements to re-rate the whole key question, safe therefore remained requires improvement.

Learning Culture: The service provided safe care and treatment. Learning from incidents was evidenced with outcomes of incident investigations and actions required to make improvements shared with staff throughout the service.

Safe environment: The design of the environment followed national guidance for safety. The wards were set out in single sex bays and side rooms. Staff carried out daily safety checks of specialist equipment to ensure they were in good working order. The service had suitable facilities and equipment to safely meet the needs of patients and their families.

Safe and effective staffing: The service did not always have enough nursing and support staff to keep patients safe and to provide the right care and treatment. The service had high vacancy rates which they were actively trying to recruit into. Managers mitigated risks of short staffing by using supernumerary staff and bank staff to support the teams.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they were encouraged to report incidents and received feedback from incidents they reported, and learning was shared from other incidents. All staff we spoke to told us they felt confident to speak to their managers about incidents and were supported to do so. We were told there was good wellbeing support if needed to ensure staff were mentally well at work. Wards had daily safety huddles where incidents and learning were shared with staff. Managers shared key information including actions for improvements within an encrypted social messaging group, newsletters and at team meetings. We saw a letter sent to all staff by the ward manager following an incident which detailed the findings and the actions needed to make improvements. Most staff we spoke with could recall recent incidents and the changes needed to drive improvement.

Staff shared key information to keep patients safe when handing over their care to others. We observed a handover and found it to be detailed and thorough.

Staff had a good understanding of the duty of candour and understood their responsibilities. Staff gave patients and families a full explanation and apology when things went wrong. We looked at 2 serious incidents for the service and both were fully investigated and the duty of candour was followed.

Staff understood the policy on complaints and how to handle them. Managers investigated complaints and identified themes. We reviewed 5 complaints and all were responded to appropriately and showed learning and changes made. Managers shared feedback from complaints with staff and learning was used to improve the service. We were told about a complaint where the communication at the end of a patient’s life was poor. The staff involved were booked onto communication training to ensure they improved their skills and learned from the complaint; this was also discussed in a team meeting.

There were processes in place for staff to follow when reporting incidents. Incidents were discussed as part of regular huddles and meetings, and where learning was required there were processes to follow for staff to ensure this was shared and embedded. Where serious incidents had occurred, staff formally undertook the duty of candour. Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 is a regulation, which was introduced in November 2014. This regulation requires the organisation to be open and transparent with a patient when things go wrong in relation to their care and the patient suffers harm or could suffer harm, which falls into defined thresholds. The duty of candour regulation only applies to incidents where severe or moderate harm to a patient has occurred. We reviewed 2 incidents where the duty of candour had been applied and found no concerns with how the service had completed this.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients could reach call bells and they told us staff responded quickly when called. We spoke with 7 patients, and they all told us they felt safe. One patient told us “The ward is excellent, the level of care is very high. I feel safe as the staff are professional and check in on me.”

Patients told us their risks were assessed. For example, they were asked if they wanted their bed rails up or down. One patient told us “I had the bedrails up when I had my surgery, otherwise I don’t keep them up”.

Staff told us the equipment was safe and they had access to suitable equipment to carry out their role. They told us they carried out daily safety checks and we saw these were completed consistently. The service had suitable facilities and equipment to safely meet the needs of patients and their families. Staff disposed of clinical waste safely.

Staff told us that when equipment was found to be broken, they removed it from the area, labelled it as faulty and logged this with the estates team. We were told beds and mattresses were checked each time a patient was discharged from the bed to ensure they were in good working order.

All staff received training on medical devices when they started within the trust. There were core trainers on the wards for specific equipment who trained staff in their ward area when required.

Managers were aware where the environment was not suitable and had plans in place to make improvements. The risk register highlighted that ward 18 had a poor environment with a plan in place for potential refurbishment.

The design of the environment followed national guidance. We saw the facilities and equipment were well maintained and used for intended purpose, stored securely, and used properly. All equipment we checked had an up-to-date electrical safety check.

The service did not always have enough nursing and support staff to keep patients safe from avoidable harm and to provide the right care and treatment. One staff nurse told us they often did not get their notes completed fully as they were always short staffed; this was reflected in the 9 sets of notes we reviewed. Another member of staff told us that it “feels unsafe some days”. All staff we spoke to said they were always short staffed and on ward 4, there were times when they had 12 patients to 1 nurse. Managers also told us they were short staffed daily. Staff told us staffing shortages was on the risk register and mitigations in place.

The service had high vacancy rate of 13% across the 6 surgical wards for nurses and 9.5% for healthcare assistants. There were a high number of vacancies within the areas we visited. There were 20 vacancies for staff nurses and 13 for healthcare assistants. Managers were taking appropriate steps to address vacancy gaps. This included an ongoing nursing recruitment programme including overseas nurses. Following a recent recruitment drive, a number of vacancies had been filled and staff were awaiting start dates. Managers used bank staff who were familiar with the service. We were told they did not often use agency staff. The wards mostly used agency staff for registered mental health nurses only. Between 26 February 2024 and 26 March 2024 a total of 2,348 hours were used for agency and only 19 of these were for registered nurses, the rest were for mental health nurses. Where there were shortfalls in staffing, managers escalated these to the site team and nurses were provided, where possible, from a bank of nurses used to support the wards when required.

Staff told us the service had a sickness rate of 4.68% for nursing staff within the last 12 months. Ward 17 had increasing sickness rates; in February 2024 it was its highest at 18.01%. Information reviewed after this assessment confirmed this.

During the onsite assessment we saw that actual staffing numbers did not always match the planned numbers. Both wards we looked at were reviewing their current establishment. We saw on 19 March 2024 on ward 4, they were 2 nurses short of their established numbers. We were told they should have 6 nurses and 4 healthcare assistants on in the day and mostly had 4 nurses and 3 or 4 healthcare assistants. The ward manager had a few international nurses who were awaiting their qualifications and they helped to bolster the nursing numbers by working supernumerary alongside the nurses. There was a structured plan for developing these nurses and completing their competencies.

There was a process in place to ensure wards were adequately and safely staffed at all times. Authority was given to managers in each area to take action when staffing had not reached or exceeded minimum staffing levels. When mitigation was not completed and all options exhausted such as the trust’s own bank, managers submitted requests for further support from external agency staff. The wards which were visited recorded low use of agency registered nurses, however, it was noted matrons were not restricting the use of agency for providing registered mental health nurses to provide support to patients. A standard operating procedure was provided to support managers in ensuring staffing within ward areas was safe.

There were processes in place for bank and agency staff to undergo a local induction. This ensured items such as identification badges were reviewed and important information about ward specific needs and policies were discussed. We reviewed a local induction checklist which ensured staff reviewed evidence of fit testing due to the high risk of respiratory infections on the ward. However, the documents provided were more aligned to provide local induction to bank and agency staff ‘booked’ through the usual staffing process. Where carers were provided for patients through regular contracts, the checklists did not explicitly state they were used for these staff members, despite the contact they would have with patients.

There were processes in place to support the involvement of carers in the patient’s admission. We reviewed the Standards for supporting carers document, version 2 which provided standards for the integration of carers and seeing them as equal partners in the care and treatment of patients. These processes appeared to mainly focus on carers that were not employed in the role of a carer (for example family and friends) and not necessarily in the similar situation as the incident which triggered this assessment.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.