Birmingham Heartlands Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked people's care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work.

The service made sure children's care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them. The service planned and delivered children's care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based practice and standards. The service worked well across teams and services to support children and young people. Staff made sure children only needed to tell their story once by sharing their assessment of needs when they moved between different services. The service monitored care and treatment to continuously improve it. Staff ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves.

This is the first assessment for this service since the trust was formed in 2018. Effective is rated as good. This meant children and young people's outcomes were consistently good, and people's feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service made sure children's care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them.

Children, young people and their families said they were involved in their treatment decisions. We spoke with 10 children, young people and their families. They said they were involved in deciding about their care and treatment, and they received the information they needed to make their own decisions about their care.

We mostly saw good documentation in the children or young people's care plans and individual needs were identified. If a child or young person required reasonable adjustments or a `passport' because they had additional needs, this was identified in their personal care plan. However, there was an inconsistent approach to completion of these passports and staff were not always able to locate these on the electronic patient record. The care plans we reviewed included helpful levels of detail about how to care for the child or young person.

The service understood its responsibility to identify, record, flag and review reasonable adjustments for individuals to improve patients access to healthcare. The hospital's vulnerabilities team contacted the ward on a daily basis to see if they had admitted any new children or young people with complex needs who required additional support. The team were described as being strong advocates for any patient with additional needs including learning disabilities and autism, mental health, dementia and visual and hearing impairments. They offered support to patients, their carers, and ward staff, and were also responsible for monitoring and reducing restrictive practices.

There had been some missed opportunities to ensure the right reasonable adjustments were made for patients. Also to check that any restrictions placed on children and young people were proportionate and the last resort and followed the least restrictive principle. This should have been undertaken by the vulnerabilities team who were responsible for this. Not all staff understood the role of the vulnerabilities team and the system to refer cases to them was not fully embedded. A staff nurse told us "I'm aware of the vulnerabilities team, but not sure what they do."

Children, young people and their families' needs around translation were met. Staff assessed children and young people's needs when they first attended the ward. Where children or young people (or their families) did not speak English, staff used a translator to ensure they completed a full assessment. Information leaflets were available in many different languages to ensure children, young people and their families had the information they needed, and they could understand in relation to their care and treatment.

Trained staff supported children's mental health needs. The service had a nurse who was trained as a mental health champion who worked with other agencies to provide mental health support. They used appropriate plans to meet the young person's individual needs around their mental health.

There was support for grieving parents and families if needed through the bereavement service.

The service planned and delivered people's care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

There was evidence-based care and treatment including pain management and specialised feeding techniques. Children, young people and their families told us where needed, pain had been managed and pain relief was given promptly when required. The staff provided nasogastric tube feeding training to parents. They supported them to ensure they felt confident using the nasogastric tube when the child or young person went home. The service also provided support for new mothers who were struggling to breastfeed their babies, and the neonatal unit had a breastfeeding room. This support could take place at home, so the mother and baby were able to be discharged. Food and fluid balance charts were regularly updated where required.

Trained nurses supported new mothers who had been with the neonatal service with psychological support in the community once they had been discharged. They arranged to visit them at home and helped them with adapting to becoming a new mother and feeling safe at home without the nurses there for support.

Staff had access to up to date policies and procedures which enabled them to follow national guidelines and evidence-based practice.

We saw good working relationships between nursing and medical staff, staff felt supported by managers.

The service worked well across teams and services to support children and young people. Staff made sure children only needed to tell their story once by sharing their assessment of needs when they moved between different services.

Staff worked well together. There was good communication between doctors and the nursing team to meet the needs of the children and young people. Student nurses told us they felt supported by nursing and medical staff; they also told us they felt like they were learning and developing well.

Effective multiagency working was clearly documented in patient records. The service had a mixture of staff, which included doctors, nurses, healthcare assistants, but also a play therapist. There were staff leading on mental health and for children and young people with learning disabilities and autism.

The service worked well with outside agencies, including the local authority, local safeguarding teams, social workers, mental health teams and local care teams who attended the service to support an individual child or young person if they required additional support.

The service supported people to manage their health and wellbeing to maximise their independence, choice, and control. The service supported people to live healthier lives and where possible and reduce their future needs for care and support.

There were posters on display on the wards and the neonatal unit to promote healthier lives. For example:

• smoking in pregnancy advice and support
• information about measles
• managing preterm birth
• healthier eating
• sleeping plans to support new mothers
• information on the risk of nappy sacks
• safe bath times and how to bath your baby and child safely.
• sepsis awareness

Staff told us they spoke with children, young people and families about promoting healthier lifestyles.

The service monitored people's care and treatment to continuously improve it. Staff worked to provide outcomes that were positive and consistent, and they met both clinical expectations and the expectations of children and young people themselves. The service completed audits to determine outcomes and improve practice where needed.

The service was mostly providing good care for children and young people with diabetes but were below the national average. In the last audit for 2022/23 the overall health check completion rate was 83%, compared to 90.8% for England and Wales.

To improve outcomes, the service took part in a sleep apnoea study for neonate babies. The process was to wean babies off oxygen that was being delivered 24 hours a day. The Neonatal Community Outreach Team saw the parent and child at home and demonstrated how to carry out the pulse oximetry test. They then returned the following day to collect the machine and download the data. At the time of our assessment, 34 studies had been completed since August 2024; 11 failed and 23 passed. The failed studies were repeated every 4 weeks. Consultants reviewed results and provided action plans to share with the parents and families.

The service was improving outcomes for babies with intervention around winter viral infections. The service ran 2 respiratory syncytial virus (RSV) clinics each month between September 2024 and February 2025. RSV is a common cause of coughs and colds. RSV infections usually get better by themselves but can sometimes be serious for babies. A total of 39 babies received an immunisation jab helping to reduce the risk of RSV to babies.

The service completed the perinatal care bundle to reduce injury in premature birth. This was designed to improve outcomes for preterm babies. There was a clear plan of the key performance indicators to be actioned. These were all scored amber using the red, amber and green risk tool, so in the middle. The document identified key risks, areas for escalation, the progress from the last report, and what the service were doing well. The report highlighted successes and good practice, for example the attendance of staff at monthly drop in sessions and good feedback received from NHS England. The service had a clear picture of what needed to be done to meet these outcomes and when they had been completed.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service knew when any 16- and 17-year-old young people were placed on adult wards, as legally they were still classed as children. The service monitored this daily to provide support if needed to the children and the ward staff. Staff were in contact with the adult ward staff to ensure consent had been sought from the young person, and they felt happy and safe to receive care and treatment on an adult ward.

Consent was obtained effectively. Staff spoke with the children and young people before any care and treatment was started. They obtained verbal or implied consent and checked children, young people and their families understood what was to happen next. We saw consent was clearly documented in records. They showed consent had been discussed and given where relevant.

Staff were obtaining consent in line with legislation and trust policy. Staff understood how some children were able to give their own valid consent, regardless of their age, should staff assess them as mature enough to fully understand what they were being asked. Staff understood `Gillick competencies' which covered the legislation relating to consent for children.

Where consent could not be obtained, staff delivered care in the patient's best interests. The service would also ensure other professionals and family or carers were involved in the decisions of the child's or young person's care and treatment.