Birmingham Heartlands Hospital

Ratings - Maternity

• Overall

  Requires improvement

• Safe

  Inadequate

• Effective

  Requires improvement

• Caring

  Good

• Responsive

  Requires improvement

• Well-led

  Requires improvement

Our view of the service

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.

People's experience of this service

Women were mostly positive about the staff treating them with kindness and providing effective care and treatment. Most women felt staff made them feel safe and included them in decisions about their care and treatment.

Maternity and Neonatal Voices Partnership (MNVP) had spoken to people around concerns over communication, decision making, and support some had experienced. The MNVP action plan was created in response to CQC Maternity Survey 2022 data (published 2023) and continued to be an open action plan. The MNVP had supported the service to develop a birth reflections service.