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.

There was a positive learning culture with staff managing incidents well. Learning from incidents was evident, including the incident which triggered this assessment. Staff knew what incidents required reporting and how to report them. When things went wrong, staff were aware of the principles of being open and honest and where required, implemented the duty of candour. The processes in place supported staff to report and learning from incidents.

Safe Environment: The design of the environment followed national guidance. Staff had access to enough equipment to enable them to complete their roles and equipment was regularly serviced and well-maintained. Our observations of patients in the care environment were positive, patients had access to their call bells, and when faults were reported, these were managed well and mitigation put in place to ensure patients remained safe.

Safe and effective staffing: There were processes in place to ensure the service had enough staff with the right training, skills and qualifications to keep patients safe from avoidable harm. However, during our onsite assessment and when reviewing additional evidence, we found staffing did not always meet the planned requirements.

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 mostly raised concerns and reported incidents and near misses in line with the trust’s policy. The trust had a clear incident management policy that explained how to report, categorise, and investigate incidents. Staff told us they knew how to follow this policy and who to contact if they had any questions or concerns. Healthcare assistants we spoke with on Ward 24 felt confident to raise concerns with the ward sister and when they needed to.

Staff understood the online reporting system and were comfortable using it. Senior staff gave an example of when a safer swallowing issue was escalated to a speech and language therapist and raised as an incident. There had been no never events reported for the service. However, an incident which triggered this assessment had been reviewed against the never event guidance and was deemed not to have met the classification.

Staff told us they were encouraged to drive improvement for the service. For example, following a specific incident on Ward 26, the service developed a document for enhanced observation. It required staff from care companies to complete hourly checks on patients. Senior staff had done a case study relating to a recent specific incident and intended to present it in a team meeting. The case study had been presented at the clinical dashboard review on preventing harm. The message was cascaded down to all wards at divisional level through band 7s and matrons. Learning from the incident was shared via message of the week.

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 a selection of incidents and complaints and found these had been investigated in line with the trust's processes and duty of candour letters sent to families for the incident and response letters which covered all relevant elements were completed.

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 told us they felt safe in the environment and had access to their call bells. When patients used their bells, they told us staff usually responded quickly to them. However, a patient on Ward 26 provided details of a time they used their call bell and had waited a significantly long time for a staff member to attend to them.

All staff told us they had access to suitable amounts of equipment to enable them to complete their role. Equipment was well maintained and regularly serviced to ensure patients were kept safe. Examples were provided by staff of how issues were managed well and in a timely manner when they raised concerns about items of equipment.

Staff told us they completed regular checks on bed spaces when patients were discharged home. This ensured items such as beds and mattresses were checked prior to the next patient being admitted, and if any faults were identified, staff escalated them immediately.

The design of the environment followed national guidance. Ward 26 was observed to be a ward containing only single en-suite rooms due to the needs of the patients who were admitted there. Equipment was observed to have been serviced, electrically tested and had details of when next checks were due.

Managers told us they accurately calculated and reviewed the number and grade of nurses and healthcare assistants (HCAs) needed for each shift in accordance with national guidance.

The service had reducing vacancy rates. Registered nurse vacancy rate was at 19.6% and HCA vacancy rate was at 12.9%. A trust wide HCA recruitment was planned in May 2024.

Staff absences were covered, when possible, with existing staff, staff from other wards or bank staff. In the event of sickness, staff made contact via WhatsApp groups, and we saw evidence of shifts being filled from 10am-6pm.

The service had increasing rates of bank and agency nurses. Information provided identified the total external agency staff hours used split between registered nurses and registered mental health nurses at 7,129.6 hours. Managers made sure all bank and agency staff had a full induction and understood the service. The service had a local induction checklist for bank and agency staff. Nurses in charge of wards or departmental team leaders ensured agency workers received an induction using the agency local induction checklist.

During our onsite assessment, we found the number of staff did not always meet the planned requirement. In addition to this, we also found additional staff were regularly required to provide additional, enhanced observation of patients due to risks identified through assessments. However, staffing did not always ensure this enhanced supervision was completed. Further evidence reviewed off site found the wards we visited did not always have the planned number of staff working. We reviewed the staffing rota from the 9 to 18 March 2024 on Ward 26. We found 8 shifts where a registered nurse or HCA short. We also found Ward 32 was meant to have 4 registered nurses and 3 HCAs working during the day, however there was a shortage of up to 2 staff members in 9 shifts, in the 2 weeks prior to our onsite assessment.

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 local induction of bank and agency staff ‘booked’ through the usual staffing process. Where carers were provided for patients through other routes, such as their regular contracts when in their usual residence, the checklists did not explicitly state they were used for these staff members, despite the contact they were or would have with patients.

The trust had a standard operating procedure for recording, monitoring and reporting nursing staffing levels which allowed matrons and the clinical site management teams to review planned versus actual staffing levels on a daily basis. They had the authority to move staff to ensure safe staffing levels were met across the organisation taking into account ward comments and patient acuity.

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.