Birmingham Heartlands Hospital

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

We reviewed the governance, management and sustainability quality statement from the well-led key question. As this assessment was based on risk, we did not complete enough quality statements to re-rate the whole key question, well-led therefore remained requires improvement.

There were governance processes in place for the service, however, these were not always deemed to be effective and consistent. Staff were aware of their roles and responsibilities and who they were accountable for.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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 medical division had a clear management structure. The division was split into care groups, such as respiratory, elderly care, acute and diabetes. Each care group had a management team which included a consultant, matron and a ward manager. Leaders delivered messages via team meetings, emails, ward safety boards, ward newsletters, ward WhatsApp groups, daily safety huddles at the beginning of each shift and initiatives, such as message of the week to ensure updates and learning was shared to as many staff as possible.

Staff spoke positively and passionately about the care and the service they provided. During our assessment, we saw leaders were present on the wards we visited. Staff said if they had a concern, they would not hesitate to raise it with managers. However, we observed an episode of blame towards a staff member during our assessment. Most staff we spoke with were aware of Freedom to Speak Up Guardians in the trust and knew how to escalate their concerns.

Each ward had a clinical dashboard which allowed managers to review ‘live’ data regarding the completion of risk assessments and care plans. These were reviewed at a monthly clinical dashboard review group. Evidence identified only 1 ward from medicine was invited to each meeting to present their results. One piece of evidence celebrated the success in achieving the target for a specific aspect of the dashboard whereas another item of evidence demonstrated a ward presenting their data in relation to challenges in meeting the target. There was no additional evidence to identify what actions were taken to drive improvements across the other wards or other dashboard elements.

There were processes in place to review risks within the service; however, these were identified not to be as effective as they could be. Within the evidence shared, there was minimal detail about the discussion of risks despite identifying there were a number of risks which required work on them but were yet to receive associated action plans. However, when reviewing the respiratory specialty risk register, there were no risks covering Ward 26 despite the issues raised in relation to the incident. A response from the trust had identified staffing constraints and lack of ability to provide close supervision of patients due to the ward being all single rooms as a risk and this was why the patient was only allowed on to the ward if their family and regular carers were involved. This was not evidenced on the risk register for the specialty. No risks were evidenced at all. Additional information provided by the trust identified the trust had undergone a change in the way in which each location was managed and this impacted the governance processes. There had been changes to the processes in place to oversee the risks for each location.

There were processes in place to feed into the patient experience group and ensure that relevant issues were raised, and actions identified to address the issues. However, the minutes provided did not evidence the update of the issues raised and actions taken.

Learning was shared with staff but the level of detail varied across different wards. Managers used a number of options to communicate with staff including team meetings, changes meetings, huddles and newsletters. Following the incident which occurred on Ward 26, there was evidence of a case review completed for learning purposes which involved all staff.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.