• Hospital
  • NHS hospital

Good Hope Hospital

Overall: Insufficient evidence to rate read more about inspection ratings

Rectory Road, Sutton Coldfield, West Midlands, B75 7RR (0121) 424 2000

Provided and run by:
University Hospitals Birmingham NHS Foundation Trust

Important: This service was previously managed by a different provider - see old profile

All Inspections

24-26 April 2023.

During a routine inspection

Good Hope Hospital is operated by University Hospitals Birmingham NHS Foundation Trust. Good Hope Hospital predominantly serves the areas of Sutton Coldfield, North Birmingham and a large proportion of southeast Staffordshire. The catchment area is approximately 450,000 people.

Our inspection was focused on the medicine core service and Urgent and Emergency Care at Good Hope Hospital. The medical core service spans across 4 divisions at the trust (divisions 2, 3, 4, and 7) and the Urgent and Emergency Care was under division 2.

We carried out an unannounced focused inspection to follow up on the Section 29a Warning Notice which was issued following the full core service inspection of the medicine core service which we carried out in December 2022. We identified serious concerns within the staffing of the medical core service and gave the trust a notice to advise them that significant improvements were required. We gave the trust until 15 March 2023 to make these improvements.

We inspected Urgent and Emergency Care due to concerns which were raised. We identified serious concerns in relation to safeguarding knoweldge and practice.

At our last inspection in December 2022, we rated the medical core service as requires improvement overall, with inadequate in safe.

Following this inspection, under Section 31 of the Health and Social Care Act 2008, we imposed conditions on the registration of the provider in respect to the regulated activity; Treatment of disease, disorder or injury. We took this urgent action as we believed a person would or may be exposed to the risk of harm if we had not done so. Imposing conditions means the provider must manage regulated activity in a way which complies with the conditions we set. The conditions related to the medical wards at Good Hope Hospital as well as Urgent and Emergency Care.

9 February 2023

During an inspection looking at part of the service

Pages 1 and 2 of this report relate to the hospital and the ratings of that location, from page 3 the ratings and information relate to maternity services based at Good Hope Hospital.

We inspected the maternity service at Good Hope Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out an announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

University Hospitals Birmingham NHS Foundation Trust provides maternity services across Birmingham, Sutton Coldfield and Solihull. The Maternity department at Good Hope Hospital comprises of delivery suite, triage, postnatal and antenatal wards, day assessment unit, midwife and consultant led clinics, scanning services, a bereavement suite, as well as a maternity led unit, although this was not always able to accept patients.

This hospital is not rated.

We also inspected 1 other maternity service run by University Hospitals Birmingham NHS Foundation Trust. Our reports are here:

https://www.cqc.org.uk/provider/RRK

How we carried out the inspection

We spoke to 25 staff including senior leaders, matrons, midwifes, obstetric staff, specialist midwives, and clinical governance and patient safety team to better understand what it was like working in the service. We interviewed leaders to gain insight into the trusts group leadership model and governance of the service. We reviewed 11 sets of maternity records and 20 prescription charts across the trust. We also looked at a wide range of documents including standard operating procedures, meeting minutes, risk assessments, recently reported incidents and audit results.

We ran a poster campaign during our inspection to encourage pregnant women and mothers who had used the service to give us feedback regarding care. We received 7 feedback forms from women. We analysed the results to identify themes and trends.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

13 and 14 December 2022

During an inspection looking at part of the service

Medical Care at Good Hope Hospital - Overall rating: Requires improvement​

Good Hope Hospital is operated by University Hospitals Birmingham NHS Foundation Trust. Good Hope Hospital predominantly serves the areas of Sutton Coldfield, North Birmingham and a large proportion of south east Staffordshire. The catchment area is approximately 450,000. The medical core service spans across 4 divisions at the trust (divisions 2, 3, 4, and 7).

We conducted an urgent, unannounced inspection of the full medical care core service due to a number of concerns raised by patients and their families around the care and treatment they had received. We also observed a number of serious incidents and safeguarding concerns in relation to the services provided by the medical core service.

Our rating of medical care at Good Hope Hospital stayed the same​. We rated it as ​requires improvement​ because:

The service did not have enough staff to care for patients and keep them safe. Compliance with some key training modules was low. The service did not always control infection risks well.

Staff did not always assess the nutritional risk of patients accurately which impacted on the support required. Concerns were raised over how staff worked together for the benefit of patients.

The service was significantly challenged due to demand which meant people could not always access the service when they needed it and in a timely manner.

The culture of the service had deteriorated and morale amongst staff was noticeably low. Staff did not always feel respected, supported and valued. There was variable feedback about the leaders who ran services.

However:

Staff understood how to protect patients from abuse, and managed safety well. Staff assessed most risks to patients, acted on them and kept good care records. They managed medicines well. The service mostly managed safety incidents well and learned lessons from them.

Staff gave patients gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff advised patients on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.

The service planned care to meet the needs of local people, and mainly took account of patients’ individual needs, and made it easy for people to give feedback.

Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

Staff used reliable information systems. Staff understood the vision and values, and how to apply them in their work. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Following this inspection, we issued the trust with a Section 29A Warning Notice as we found significant improvement was required in relation to safe staffing of the service. The Section 29A Warning Notice has given the trust until 15 March 2023 to make the significant improvements we have identified.

7, 8, 9, 10 June 2021

During a routine inspection

Good Hope Hospital serves North Birmingham, Sutton Coldfield and a large part of south east Staffordshire, including Burntwood, Lichfield and Tamworth. The catchment population is about 450,000. The hospital provides acute and general medicine and other specialist services including the Partnership Learning Centre, which is part-funded by the Medical School of the University of Birmingham. It has 430 beds.

02 and 09 December 2020

During an inspection looking at part of the service

Good Hope Hospital is part of the University Hospitals Birmingham NHS Foundation Trust which is one of the largest teaching hospital trusts in England, serving a regional, national, and international population. The combined organisation has a turnover of £1.6 billion and provides acute and community services across four main hospital sites:

  • The Queen Elizabeth Hospital Birmingham
  • Birmingham Heartlands Hospital
  • Good Hope Hospital
  • Solihull Hospital

The trust also runs Birmingham Chest Clinic, a range of community services and several smaller satellite units, allowing people to be treated as close to home as possible.

The trust has 2,366 in-patient beds over 105 wards in addition to 115 children’s beds and 145 day-case beds. The trust operates 7,127 outpatients’ and 304 community clinics per week. The trust has over 20,000 members of staff.

At the time of our inspection, the trust was 10 months into the pandemic response to COVID-19 with over 450 COVID-19 inpatients. A number of changes to services and ward specialties had taken place since March 2020 in response to the emergency to ensure the trust was able to provide care and treatment as appropriate to the increasing number of COVID-19 patients. Throughout the pandemic, University Hospitals Birmingham NHS Foundation Trust has had a consistently high number of COVID-19 inpatients.

Concerns had been raised through enquiries and serious incident reporting about medical care services at Good Hope Hospital in relation to:

  • Venous thromboembolism (VTE) assessment and management
  • Discharge processes and communication
  • Staffing
  • Incident reporting and sharing of learning including never events
  • Support, care, and treatment for patients with learning difficulties
  • Patient care and emotional support
  • Concerns around ‘do not attempt cardiopulmonary resuscitation’ paperwork
  • Concerns around staff culture
  • Infection control procedures
  • Nutrition and hydration

These concerns led to a decision being taken to complete an unannounced (staff did not know we were coming) focused inspection on two separate dates: 2 and 9 December 2020. We inspected elements of our safe, effective, responsive, and well led key lines of enquiry. The inspection team comprised two CQC inspectors and a specialist advisor who had expert knowledge in the medicine core service.

During our inspection we visited eight wards and spoke with 25 members of staff. This included medical staff, nursing staff between band four to seven, flow co-ordinators, ward clerks and ward managers. We also held two remote interviews with site and divisional directors.

We reviewed 202 sections of patient records. During the first day of our inspection, we reviewed ten records of current inpatients to explore venous thromboembolism (VTE) assessment and management, discharge processes and nutrition and hydration management. We reviewed 20 further patient records for the purpose of reviewing VTE management only. We also reviewed five records for patients already discharged. On the second day of inspection, we looked at 121 records specifically for the purpose of reviewing VTE management, 15 records for the purpose of reviewing nutrition and hydration and 16 ReSPECT forms. Please note that some of these records may have been for the same patients. In addition, we reviewed 10 records of discharged patients to review discharge management.

The medicine core service was last inspected in 2018 (the report was published in 2019). During the 2018 inspection, the service was found to be in breach of Regulation 18: Staffing due to not having the required numbers of nursing staff to keep patients safe.

During this inspection, we again found safety concerns in relation to nurse staffing. This was a breach of the Health and Social Care Act (2008) (Regulated Activities) Regulations: Regulation 18 Staffing. We also found evidence of a breach of Regulation 12: Safe Care and Treatment.

Following this inspection, we did not re-rate all key questions inspected. We have only re-rated key questions where we identified a breach of regulation.

During our inspection we found:

  • The service did not have enough nursing staff with the right qualifications, skills, training, and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels however this did not resolve the low numbers of registered nurses present on wards. Staff sickness rates and nurse vacancy rates were high. This resulted in some tasks being rushed, not enough staff to observe patients at high risks of falls, and some patients having to wait to be supported with eating meals. Ward staff did not have the capacity to meet the individual needs of all patients living with dementia.
  • Staff completed VTE risk assessments for each patient but did not always review these in line with the trust policy. Staff did not follow the trust policy consistently when discharging patients.
  • The service did not always control infection risk well. Staff did not always wear appropriate personal protective equipment as designed.
  • Not all staff could access patient records. Some assessments such as ReSPECT forms were not fully completed or updated.
  • Staff were not familiar with or aware of serious incidents or never events which had occurred across the trust.
  • Not all staff had received or updated training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards.
  • Staff did not all feel respected, supported, or valued by the wider trust.
  • Processes were in place to manage identified risks, however some actions such as those in relation to managing staffing, were not enough to mitigate the risk to patient safety.
  • Not all risk registers accurately captured risks to the service. Some actions such as those in relation to managing staffing, were not enough to mitigate the risk to patient safety.

However, we also found areas of good practice:

  • Staff were passionate about helping patients and wanted to have the capacity to do more.
  • Staff had training on how to recognise and report abuse.
  • Staff kept the premises visibly clean.
  • The design of the premises kept people safe.
  • VTE medicines were mostly prescribed in line with national standards.
  • Staff recognised and reported most incidents and near misses. Managers investigated local incidents and shared lessons learned with the local team.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service adjusted for patients’ religious, cultural, and other needs.
  • Patients with a learning disability could access the site based team to get support. Staff supported patients to choose food based upon dietary preferences.
  • Divisional leaders operated effective governance processes, throughout the service. Staff at senior levels had regular opportunities to meet, discuss and learn from the performance of the service.

22 August 2019

During an inspection looking at part of the service

We carried out an unannounced focused inspection at Good Hope Hospital on 22 August 2019. The purpose was to look at specific aspects of the care provided by radiology services at Good Hope Hospital, which was run by University Hospitals Birmingham NHS Foundation Trust.

Concerns were initially raised following a serious incident which occurred in the diagnostic imaging service which included the time taken to report on routine and urgent computerised tomography (CT) examinations, and the governance processes to ensure any backlog or delay in reporting was managed, escalated and resolved. The trust was given the opportunity to respond to these, however when satisfactory assurances were not received, the local inspection team decided to conduct an unannounced inspection.

Good Hope Hospital was previously managed by Heart of England NHS Foundation Trust. On 1 April 2018, a merger by acquisition took place of Heart of England NHS Foundation Trust by University Hospitals Birmingham NHS Foundation Trust. Consequently, Good Hope Hospital is now part of University Hospitals of Birmingham NHS Foundation Trust.

A rating has not been provided for this inspection as it focused on specific key questions and key lines of enquiry. It was carried out to assess whether there was significant risk of patient harm resulting from the concerns raised.

In diagnostic imaging services our key findings were:

  • There was no escalation of unreported scans due to lengthy delays, or a risk assessment process for patients waiting for their scan to be reported. We found no evidence of completed harm reviews for patients who had experienced lengthy delays in their scan being reported. However, staff responded to and acted quickly if patients deteriorated within the department. Patient records were not always up-to-date, or easily available to all staff providing care. Processes used by staff created a risk that scans could go unreported, and there was no appropriate risk assessment following the decision to migrate to a new patient records system. However, staff kept detailed records of patients’ care and treatment, which were stored securely.
  • Staff did not always recognise and report incidents and near misses, with variability in staff understanding around raising incidents related to delays in reporting diagnostic scans. While managers investigated incidents, local leaders were not always included throughout the entire process, and recommendations following investigations were not always implemented effectively. However, when things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured actions from patient safety alerts were implemented and monitored.
  • There were significant delays in images being reported for several diagnostic investigations, with limited action taken to address performance issues. Waiting times from referral to scan were generally in line with national standards and most people could access the service when they needed it.
  • The leadership team was not yet fully established or embedded within the service, and priorities and issues faced were not well managed. However, they had the skills and abilities to run the service. Leaders were visible and approachable in the service for patients and staff.
  • There were ineffective governance processes within the service. Staff at all levels were unclear about their roles and accountabilities. While staff had regular opportunities to meet and discuss the performance of the service, limited action was taken to address issues.
  • Leaders and teams did not always identify and escalate relevant risks and issues and did not implement actions to mitigate their impact. Risks were not always graded appropriately.
  • There were no clear responsibilities or robust arrangements for data management and audit across radiology information systems. While the service collected data, it was not analysed and no actions were taken to address concerns or improve performance. However, staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure.

Following this inspection, we told the provider that it must take some actions to comply with the regulations to help the service improve. We also authorised conditions to be imposed on the trust’s registration, as we believed patients may have been exposed to the risk of harm if they were not imposed urgently. Details are included at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Midlands Region)

8 October to 29 November 2018

During a routine inspection

Good Hope Hospital was previously managed by Heart of England NHS Foundation Trust. On 1 April 2018 a merger by acquisition took place of Heart of England NHS Foundation Trust by University Hospitals of Birmingham NHS Foundation Trust. As such Good Hope Hospital is now part of University Hospitals of Birmingham NHS Foundation Trust. 

We have not taken the previous ratings of services at Heart of England NHS Foundation Trust into account when aggregating the trust’s overall rating. CQC’s revised inspection methodology states when a trust acquires or merges with another service or trust in order to improve the quality and safety of care, we will not aggregate ratings from the previously separate services or providers at trust level for up to two years. During this time, we would expect the trust to demonstrate that they are taking appropriate action to improve quality and safety. 

At this inspection we did not inspect all eight core services, therefore we are unable to provide an aggregated location rating. We will return in due course to carry out inspections of those core services we didn’t inspect this time. We will then aggregate all of the core service ratings to provide overall key question and location rating for Good Hope Hospital. 

For an overview of our findings at this inspection please see overall summary above.