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Birmingham Heartlands Hospital

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

Inspection Summary


Overall summary & rating

Updated 27 September 2019

Birmingham Heartlands Hospital was acquired by University Hospitals Birmingham NHS Foundation Trust on 1 April 2018.

The medical care service at the trust provides care and treatment for ten specialities across four sites; Queen Elizabeth Hospital Birmingham, Birmingham Heartlands Hospital, Good Hope Hospital and Solihull Hospital. The trust had 1,579 inpatient medical beds across the four sites, with 462 of these beds based at Birmingham Heartlands Hospital.

We carried out an unannounced focused inspection of ward 29 (elderly care) at Birmingham Heartlands Hospital on 23 July 2019, in response to concerning information we had received in relation to the care of patients in this ward.

We did not inspect any other core service or wards at this hospital or any other locations provided by University Hospitals Birmingham NHS Trust. During this inspection we inspected using our focused inspection methodology. We did not cover all key questions or key lines of enquiry and we did not rate this service at this inspection. We inspected elements of safe, caring and well-led.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity.

During this inspection we;

  • Spoke with seven patients who were using the service and eight relatives.
  • Spoke with 12 members of staff including registered nurses, health care assistants, reception staff, medical staff, and senior managers.
  • Reviewed 10 complete medical and nursing care records relating to physical health.
  • Reviewed five additional patient records relating to observations and sepsis screening pathways.

Our key findings were as follows;

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The service had robust systems in place to ensure the safety of patients. this included risk assessments and monitoring of clinical outcomes.
  • Staff kept appropriate records of patients’ care and treatment.
  • The service prescribed, gave, recorded and stored medicines well.
  • Staff cared for patients with compassion.
  • Staff provided emotional support for patients to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • The service had managers with the right skills and abilities to run a service providing high-quality sustainable care.
  • Managers across the service promoted a positive culture that supported and valued staff.
  • The service was committed to improving services by learning from when things went well and when they went wrong.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Midlands Region)

Inspection areas

Safe

Updated 27 September 2019

Effective

Updated 27 September 2019

Caring

Updated 27 September 2019

Responsive

Updated 27 September 2019

Well-led

Updated 27 September 2019

Checks on specific services

Medical care (including older people’s care)

Updated 27 September 2019

We carried out an unannounced focused inspection of ward 29 (elderly care) at Birmingham Heartlands Hospital on 23 July 2019, in response to concerning information we had received in relation to care of patients in this ward.

We did not inspect any other core service or wards at this hospital or any other locations provided by University Hospitals Birmingham NHS Trust. We did not cover all key questions or key lines of enquiry and we did not rate this service at this inspection. We inspected elements of safe, caring and well-led.

Maternity

Requires improvement

Updated 13 February 2019

We rated the service as requires improvement overall.

We rated this safe and well-led as requires improvement and effective, caring and responsive as good because:

  • Managers across the trust did not always promote a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff did not always feel valued and supported for the work they did.
  • The service collected safety information, which was compared to national data. However, we had concerns about the robustness of the data shared with partner organisations.
  • Whilst staff demonstrated good practice with regards to hand hygiene, we saw the environment and equipment were not always visibly clean. Staff did not always complete emergency equipment daily checks. Surgical site infections were above the national average
  • There were effective processes for the reporting of incidents, Staff were aware of their responsibilities to report incidents and we saw learning from incidents was shared. However, we were not assured incidents were being graded appropriately.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. However, although we saw there was a trajectory and service leads were sighted on it, we saw not all guidelines had been recently reviewed. Risk assessments and plans of care were not always in line with local policies and were not always carried out by the appropriate staff.

However:

  • Staff kept appropriate records of women’s care and treatment. Handheld and inpatient records were clear, up-to-date and available to all staff providing care. Safeguarding records were up to date and easily accessible. Completion of cardiotography trace records was in line with trust policy.
  • Staff understood their roles and responsibilities regarding safeguarding vulnerable adults and children. Although medical staff compliance with safeguarding training was lower than the trust target, most staff had received appropriate levels of safeguarding training.
  • Staff with different roles worked together as a team to benefit women. Midwives, doctors, nurses and other healthcare professionals supported each other to provide good care. Multidisciplinary teamwork was evident throughout the unit.
  • Staff actively promoted improving women’s health by encouraging women to stop smoking, and increasing skin to skin and breastfeeding.
  • Staff understood and respected the personal, cultural, social and religious needs of women and those important to them. Women and their relatives we spoke with told us they were treated with dignity, kindness and respect.
  • Staff provided emotional support to patients to minimise their distress. Women, families and staff valued the bereavement service. Bereavement services and staff knowledge on supporting bereaved families ensured people received the physical and emotional care required.
  • The trust planned and provided services in a way that met the needs of local people. There were a range of clinics for both high and low risk women. The trust collaborated with partner organisations effectively. The service’s vision and strategy was in line with local and national priorities.

Surgery

Requires improvement

Updated 13 February 2019

We rated this service as requires improvement because:

  • We identified some concerns in relation to the environment in the operating theatres. The airflow exchange in parts of the operating theatres did not meet with Department of Health guidance. In addition, we found the contents of emergency trolleys used in the operating theatres were not always checked daily, which had the potential to impact on the safety of care.
  • Processes to ensure the safety of patients undergoing surgery were not always followed in theatres. In particular, we found variable compliance with the surgical safety checklist and premature completion of instrument checklists. The consistent use of these checklists is key to eliminating surgical errors.
  • The service had enough medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm. However, we identified concerns in relation to out of hours provision, the volume of general surgical emergency patients and the high use of temporary staff. This impacted on the timeliness of care and the pressure on medical staff out of hours.
  • Medicines were not always managed safely. We observed two occasions on a ward when a medicines trolley was unlocked and unattended. Storage areas were congested and we saw there were occasions when a medicine was missed due to staff being unable to locate it, or there were delays in obtaining a medicine from pharmacy. The temperature of refrigerators used for medicines storage on the wards were not monitored consistently and when they were above recommended limits, action was not always taken to report this to pharmacy.
  • Staff recognised incidents and reported them appropriately. Managers investigated incidents and action was taken to prevent recurrence. However, staff did not always receive feedback about incidents and lessons learnt were not always effectively communicated to staff, particularly in relation to learning from incidents on other sites.
  • Patient feedback about the quality of the food and choice was variable and some patients told us this affected the amount they ate.
  • Consent was obtained in line with legislation and when patients did not have the capacity to make specific decisions, the principles of the Mental Capacity Act were followed for surgical procedures. DoLS applications were submitted to safeguard patients when necessary. When patients were unable to consent to their care, staff were able to describe how they acted in their best interests; however, nursing documentation of mental capacity assessments and best interest decision making was not always completed.
  • We spoke to three patients on one ward who felt there was a lack of communication between departments which impacted on their ability to obtain information about the plan for their care.
  • Matron and manager support to individual wards and the operating theatres was variable.
  • There was little engagement or understanding of governance issues below band 7 level.

However:

  • The service provided mandatory training in key skills to all staff. Overall completion rates for nursing staff were above the trust target of 90% and all modules were above 80%. Overall completion rates by medical staff were below the target at 82% although completion of most modules was above 75%
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had a good knowledge of their responsibilities to report safeguarding concerns and make referrals. They were supported by the trust safeguarding team to do this.
  • The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection. Audits were completed to ensure staff adhered to national guidance.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Audits were completed to make sure staff followed guidance.
  • Staff assessed and monitored patients regularly to see if they were in pain. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Staff gave patients enough food and drink to meet their needs and improve their health. Patients had access to specialist advice and nutritional support as required.
  • Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them. Performance in national outcome audits was variable with good outcomes in the national vascular registry, national emergency laparotomy audit and the national bowel cancer audit for example, whilst performance in the national hip fracture database audit was below the national average.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance to provide support and monitor the effectiveness of the service.
  • Multidisciplinary team working was effective. Staff worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide coordinated care. We observed therapies staff were based on some wards and staff communicated well with each other.
  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff maintained patients’ privacy and dignity and showed concern about their welfare.
  • Staff provided emotional support to patients to minimise their distress. Patients were supported by ward staff and specialist nurses.
  • Staff involved patients and those close to them in decisions about their care and treatment. Most patients were aware of plans for their care and treatment and said they had been provided with the information they needed to help them make decisions about their care.
  • The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care
  • The service used a systematic approach to continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish. We found examples of discussion at specialty and divisional level to identify improvements to the quality, safety and effectiveness of care.
  • The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. Risks were clearly identified in the divisional risk registers.
  • The trust collected, analysed, managed and used information well to support its activities. Most records were paper based and when electronic systems were used, security safeguards were in place.

Urgent and emergency services

Requires improvement

Updated 13 February 2019

  • The service did not always have enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
  • The service did not always have enough medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. There was consultant cover in the emergency department for 14.5 hours a day, which did not meet 16 hours medical staffing cover as recommended by the Royal College of Emergency Medicine.
  • Staff identified and responded to changing risks to patients, including deteriorating health. However, the lack of patient information in other languages did not support patients and relatives to monitor signs of deterioration.
  • The emergency department did not always provide services in a way that met the needs of local people.
  • Patient care was not always managed well to take into account the needs of patients requiring urgent care. The trust mostly did not meet the four hour target for patients to be admitted, transferred or discharged within four hours of arrival into ED from April 2018 to September 2018.
  • Senior ED staff understood the local risks to the service. However, the service did not evidence they regularly reviewed and monitored all current risks.
  • The trust did not always collect, analyse, manage and use information well to support all its activities.

However:

  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Policies were easily accessible on the trust’s intranet; managers checked to make sure staff followed guidance.
  • 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 made adjustments for patients’ religious, cultural and other preferences.
  • Staff regularly assessed and monitored patient’s pain levels. Staff supported those unable to communicate by using suitable assessment tools and gave additional pain relief to ease pain.
  • Staff cared for patients with compassion. Staff treated patients well and with kindness despite the busy and challenging ED environment.
  • Staff involved patients and those close to them in decisions about their care and treatment
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
  • Managers across the ED promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff at all levels felt part of the ED team.
  • The service was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.