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 that 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.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant 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.

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

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.

Staff gave people clear information about their care and treatment needed to support their physical and mental health.

The trust's systems ensured staff were up to date with national legislation, evidence-based good practice and required standards. Treatment was based on guidance and recommendations from, among others the Royal College of Emergency Medicine, the National Institute for Health and Care Excellence (NICE) as well as the trust's own policies and guidelines.

The service participated in clinical audits which enabled staff to show care was being provided in line with national recommendations and best practice.

The trust kept its database of guidance up to date. Staff received information through safety briefings and newsletters to implement new guidance or changes to existing procedures.

The trust's intranet contained a comprehensive range of up-to-date policies and standard operating procedures which reflected current practice. It had guidance for staff around collaboration with multiagency teams and for delegation of clinical tasks to ensure the right people delivered evidence-based care and treatment.

Sometimes notes did not capture people's social circumstances which could be important information. While clinical assessments were usually done to a good standard, we were told that because of time constraints people's social circumstances were not always fully explored and documented. However, the patient notes we looked at were completed to a satisfactory standard.

Catering for patients was not ideal. Food and drinks could be provided to patients who were having long waits in the department. While some hot food could be provided using a microwave, overall catering facilities were poor as the department was not designed to have patients staying long enough to need food and drink. Hot drinks were not provided in the ambulatory areas because of the risks associated with hot liquids and overcrowding although the department was looking at ways of doing this. Food was available to children from the adult kitchen.

We saw pain scoring being used and this was modified, when necessary, by using tools suitable for children and those with learning disabilities or other communication needs. When we spoke to patients, they usually said they had been asked about their pain and provided with pain relief promptly.

The service worked well across teams and other services to support people. Staff worked well with other professions, other departments and other providers.

Most staff told us that within the department there were good relationships between nurses, doctors, ambulance crews and the professions allied to medicine. We saw staff working well together and most staff told us this was usually the case. We saw constant dialogue between the nurse in charge, the doctor in charge and the Hospital Ambulance Liaison Officer (HALO). Most staff reported good working relationships between nursing and medical staff. However, some nurses who worked in enhanced roles felt that their skills were not valued or understood by some doctors.

Once a patient had been accepted for speciality care and treatment, it was recognised they then became that speciality's responsibility. However, this was sometimes difficult to manage in practice as there would not always be easy access to the doctors from that speciality while the patient was still in the emergency department. Doctors from some specialities were dedicated to the department at busy times to review patients and facilitate their admission but there were sometimes tensions when staff felt other specialities could do more. However, it was recognised that these areas had their own pressures.

There was good multidisciplinary working for patients with mental health needs. For patients who presented in mental health distress staff spoke highly of the prompt and effective service provided by the Liaison Psychiatry Team which almost always saw patients within the 1-hour target.

There were pathways to refer people who were frail into the Same Day Emergency Care (SDEC) area where there were staff who had the specialised knowledge to care for them.

The HALO was provided by the ambulance service but funded by the trust and was at the department 24 hours a day. This worked well, was valued both organisations, and the HALO played a key role in supporting the rapid ambulance assessment area. The HALO role was often mentioned as having a positive impact on the department and we observed their role as liaison and advocacy between the department and the ambulance service was effective. During our visit, the inspection team found they were often the person we went to, to best understand what was currently happening in the department.

Staff in the children's department told us they had good relations with the medical staff from the hospital's children's ward. However, they were frustrated that emergency calls went to the paediatric registrar rather than the consultant, although the consultants did often attend.

Vulnerable patients were supported through support from specialist staff. The emergency department navigator told us they would check for vulnerable patients and identify any communication needs to inform the assessment nurse and take them to majors if their needs were high. They gave an example that occurred the previous week where a person with a learning disability was moved to majors, where it was quieter, and they were prioritised to be seen. The matron for the children's area told us overall awareness of the needs of autistic children and those with a learning disability had improved and there were less barriers to access to treatment. They said emergency department contacted the hospital's vulnerabilities team for support and linked up with the community team.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

The service routinely monitored people's care and treatment to continuously improve it. Staff ensured that outcomes were positive and consistent, and that they met both clinical expectations and those of people themselves.

The service routinely monitored people's care and treatment to continuously improve it. The service had participated with the Royal College of Emergency Medicine (RCEM) quality improvement programme (QIP). We saw the results for the 2022/23 audits and were told that they were still awaiting their results for the 2023/24 programme. These audits covered infection prevention and control, self-harm and the care of older people.

We saw evidence of local QIP audits which were variously associated with further work on the RCEM outcomes, trust programmes or departmental initiatives. Areas of concern were recorded and actions assigned to named members of staff. These were monitored through clinical governance mechanisms and reported in the notes of these meetings as well as newsletters.

A recent focus was patient experience in the department as the managers had recognised it was often poor, and this was reported in the CQC annual Urgent and Emergency Care Survey 2024. We saw that as a result there were several initiatives in progress to improve the patient environment.

Aside from audits to prompt improvement, there was programme to monitor compliance with standards. These included audits for safeguarding, sepsis, cleaning, controlled drugs, pain scoring and adherence to internal and external guidelines.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. Consent usually relied on verbal assent which was appropriate in the context of an emergency department.

There were suitable procedures and guidelines which were reflective of best practice and legislation. These covered situations where patients were unconscious or unable to consent for other reasons.

Staff were trained in obtaining consent and were able to articulate what they would do under different circumstances. The special considerations for children and their competence to make certain decisions were also implemented and staff who looked after children were suitably trained in this.

Patients with a reduced capacity to make decisions for reasons of their mental health or other circumstances were given capacity assessments and if best interest decisions needed to be made, they were. It was recognised that individual’s capacity changed over time and this was of particular importance in a department where patients might alter their state of consciousness or have their judgment affected by medicines or substance abuse.

When we looked at patient records, we saw, when necessary, mental capacity assessments had been carried out and recorded as had any best interest decisions. This record keeping was subject to audits.