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We are carrying out checks at City Hospital. We will publish a report when our check is complete.

Reports


Inspection carried out on March 28-30 2017

During a routine inspection

City Hospital (formerly Dudley Road Hospital, and still commonly referred to as such) is a major hospital located in Birmingham, England, operated by the Sandwell and West Birmingham Hospitals NHS Trust, Serving a population of around half a million people.

It provides an extensive range of general and specialist hospital services. It is located in the Winson Green area of the west of the City. On the City site, there is also a Birmingham Treatment Centre (BTC) and a Birmingham Midland Eye Centre (BMEC).

We carried out an unannounced visit on the Medical Core service in February 16, 2017, followed by a short notice announced inspection in March 28-30, 2017, with another unannounced visit in April 6, 11-13 2017.

We have made judgements about six core services within City Hospital and rated each one individually.

Our key findings were as follows:

  • Incident reporting and shared learning needed to be improved across the organisation.
  • The trust held 10 quality improvement half days (QIHD) per year during which time staff shared learning and attended relevant training.
  • Robust application of the World Health Organisation’s (WHO) ‘five steps to safer surgery’ checklist was visually monitored on a daily basis.
  • The trust had made a vast improvement in the end of life care service since 2014 inspection.
  • We saw examples of positive multi-disciplinary working and staff told us this was consistently good across the trust.
  • Infection control had improved since the inspection in 2014, however, this varied across both sites. Mortuary staff were not following the trust’s infection control policy. We were not assured the service was protecting mortuary staff and the general public that visited the mortuary from potential health and infection risks, infection control training was not included in the mortuary mandatory training.

We saw several areas of outstanding practice including:

End Of Life Care:

  • The palliative and end of life care service integrated coordination hub, acted as one single point of access for patients and health professionals to coordinate end of life services for patients.
  • The service provided access to care and treatment in both acute hospitals and in the community, seven days a week, 24 hours a day.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

BMEC-Emergency Department

  • Increase availability of specialist medical staff and anaesthetists to minimise the risk that children, particularly those younger than three years of age, who attended department receive timely and appropriate treatment.
  • Robust policies and procedures are in place to manage the effective security of prescription forms at a local level.
  • The storage of fluids are tamper proof, in line with Resuscitation Council guidelines.
  • Patient records must meet standards for general medical record keeping by physicians in hospital practice.

Medicine:

  • Ensure compliance with the Mental Capacity Act (2005) is documented.
  • Ensure attendance at mandatory training is improved.
  • Take steps to reduce delays in the patient journey and ensure people are able to access care and treatment in a timely way.
  • Improve the consistency of multi-disciplinary processes and ensure the implementation of consultant led board and ward rounds.
  • Ensure patients have access to translation services when required.
  • Ensure governance structures are embedded and a structured approach is taken to the identification and management of organisational risk.

Surgery including BMEC:

  • Ensure measures are in place to prevent further Never Events to protect patient’s safety.
  • BMEC mandatory training targets for all clinical staff are met and recorded.

Children and Young People BMEC:

  • Improve local governance and ensure risks to the service are escalated, recorded, acted upon and reviewed in a timely manner.
  • Medical staffing meets needs of patients and the service.
  • Review the storage of emergency drugs and equipment for children and young people
  • Age appropriate facilities are provided with separation of adult and children waiting areas and treatment areas.
  • Mandatory training targets are met and recorded including paediatric life support.
  • A framework for staff to develop and demonstrate competencies to care for children is in place.

Outpatient Department including BMEC:

  • Resuscitation trolleys are locked and secured with tamperproof tags.
  • Patient notes are kept securely and confidentially.
  • Sharps bins and clinical waste are stored securely and safely.
  • Consulting rooms in BMEC protect patients’ dignity and privacy, and prevent people from overhearing conversations between staff and patients.
  • There are improvements with staff completion of mandatory training.
  • All staff that carry out root cause analyses are trained to do so.
  • The consulting rooms in the BMEC orthoptics department were large, and two or three patients underwent consultations at the same time, only separated by screens. Patients were able to overhear conversations between staff and other patients in the room. Staff told us they were not able to protect patients’ dignity and privacy due to the way the rooms were set up, but they had one single room they were able to use if patients expressed concern. We asked staff if they told patients about this facility and if staff offered it to patients for their consultation; Staff told us that the patients only used the room if they raised the issue

In addition the trust should:

Urgent and Emergency care including BMEC:

  • The trust should review cleaning schedules and include the windows above the minors’ area, which were not part of the housekeeping schedule and had not been cleaned for several months.

  • The trust should review action plans from national and local audits, in particular record keeping audits to improve the quality of patient records.

  • The trust should improve the communication of waiting times to patients, especially if electronic displays are not in use.

  • Look for ways to improve patient privacy in the department.
  • Improve the waiting area and provision of age appropriate toys and games for children and young people in the department.
  • Consider introducing an electronic flagging system for vulnerable patients, such as those living with dementia or a learning disability.
  • Consider participating in a wider range local and national audits in order to assess, evaluate and improve care of patients in a systematic way
  • Staff should routinely assess patients’ pain on arrival to the department.
  • Introduce a water dispenser in the BMEC ED waiting room to ensure vulnerable patients have quick access to water at all times.
  • Implement SLA’s with other trusts so that paediatric patients are kept safe at all times
  • Improve communication from executive colleagues regarding changes being proposed to the department.

Medicine:

  • Review the content of the emergency resuscitation trolleys and ensure security of the contents.

Surgery including BMEC:

  • Safety thermometer information should be displayed on the wards. Staff members should be aware of their ward scores.
  • Competencies for nursing staff working in surgical specialisms should be revisited after their initial competency ‘sign off’ stage.
  • Patients should be consented for surgery prior to arrival on the ward
  • Wider learning should be promoted through complaint trends being shared amongst all areas of the trust
  • Ensure all BMEC staff are aware of the duty of candour and when this would be applied, following a notifiable safety incident.
  • Ensure all BMEC staff can identify a deteriorating patient; and that this is recorded in a structured way in order to monitor the effectiveness of this.
  • BMEC service work towards minimising cancelled procedures due to lack of patient records.
  • BMEC staff to be fully aware of when patients may require a deprivation of liberty safeguard (DOLS) application in order to ensure patients that lack capacity to consent to treatment is provided with appropriate care.

Children’s and Young People BMEC:

  • That a strategy for services for children and young people is developed and embedded, and there is improved reporting about service plans and priorities.
  • Review the arrangements for data collection that is specific to children and young people such as the audit plan and reporting, training and development records.
  • Greater visibility and support of the children and young people service from the executive leadership team.

End Of Life care:

  • The service must ensure they are preventing, detecting and controlling the spread of infections, including those that are health care associated in the mortuary department.
  • The trust should ensure they have updated ‘Anticipatory Medication Guidelines’. We could not be assured staff were following the most up-to-date guidelines.

Outpatient Department including BMEC:

  • Staff working in the outpatients department have their competencies checked regularly and that this is evidenced.
  • Ensure that staff receive training to improve awareness of who the trust safeguarding leads are.
  • The layout of the consulting rooms in the BMEC orthoptics department did not always ensure patient’s privacy and dignity were protected.
  • Ensure all incidents are reported including those involving patient falls on the escalator in the Birmingham Treatment Centre.
  • Patients in the BMEC outpatients waiting area are kept informed of waiting times and late-running clinics.
  • Reassess the layout of the BMEC coffee shop seating area to ensure people can move about safely, and sufficient space is provided for people using wheelchairs.
  • All staff have annual appraisals.
  • There are chaperone notices in the outpatient’s department.
  • There is clear signage in the outpatient’s department.
  • Staff complete training to raise awareness and improve skills for working with people with learning disabilities.

Ted Baker

Chief Inspector of Hospitals

Inspection carried out on 14 - 17 October 2014

During a routine inspection

Sandwell and West Birmingham Hospitals NHS Trust is a provider of both acute hospital and community services for the west of Birmingham and six towns in Sandwell. Serving a population of around half a million people. There are two main acute locations; City Hospital and Sandwell General Hospital, on the City site is also Birmingham Treatment Centre. The trust also provides community services in the form of inpatients at Leasowes Intermediate Care and Rowley Regis Community Hospitals. Alongside other community services such as district nursing and community palliative care. All community services are offered in the Sandwell area.

We carried out this comprehensive inspection because the trust is known as an aspirational trust wanting to become a foundation trust. The inspection took place between 14 and 17 October 2014 and unannounced inspections visit took place between on 25 and 30 October.

Overall, this trust requires improvement. We rated it good for caring for patients and effective care but it requires improvement in being responsive to patients’ needs and being well-led. We rated the safe domain as inadequate.

Our key findings were as follows:

  • Staff were caring and compassionate and treated patients with dignity and respect.
  • Incident reporting shared learning needed to be improved across the organisation.
  • Infection control practices were good but with pockets of poor practice which needed to be addressed.
  • Medicines management was inconsistent. Pharmacy support was good and staff valued the input of the pharmacists. However, the safe storage of medicines was not as robust, which we saw across the trust. This was area in which the trust failed to meet its targets for 2012-2013.
  • The trust has consistently not met the national target for treating 95% of patients attending A/E within four hours.
  • Generally community services were good with the exception of safe which we rated as requiring improvement
  • We were concerned about wards D26 and D11 at City Hospital which was not meeting basic care needs for patients.
  • The trust had recognised that end of life care was an area for development for them the Bradbury Day Hospice
  • The mortuary on both sites had longstanding environmental issues which needed to be addressed.

We saw several areas of outstanding practice including:

  • The iCares service within the community and the diabetic service were outstanding and had received national recognition. Critical care services were good overall having both staff and patients feeling well supported.
  • The compassionate and caring dedication for end of life care with regard to a minor was rated as outstanding, especially how the service utilised the wider healthcare team to meet the needs of the individual. We were confident in a similar situation this level of support would be repeated.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • The trust must review the levels of nursing staff across all wards and departments to ensure they are safe and meet the requirements of the service
  • The trust must ensure that all staff are consistently reporting incidents and that staff receive feedback on all incidents raised so that service development and learning can take place
  • The trust must ensure that all patient identifiable information is handled and stored securely.
  • The trust must follow through from findings of safety audit data and follow up absence of safety audit data.
  • The trust must address systemic gaps in patient assessment records.
  • The trust must take steps to improve staff understanding of isolation procedures.

There were also areas of practice where the trust should take action which are identified in the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

January 2015

Inspection carried out on 24, 28 June 2013

During a routine inspection

This inspection was conducted by a compliance manager, seven inspectors and an expert by experience. We spoke with 30 people who were in patients, 2 relatives and 48 ward staff of various grades. In addition we spoke with a number of senior managers.

Everyone using the service that we spoke with told us that their privacy and dignity had been maintained during their stay in hospital. One person told us, “They listen to me and they shut the curtains to give you privacy when they do things.” We found that people’s privacy, dignity and independence were respected.

All the people that we spoke with told us that before they were asked for their consent, their care and treatment was discussed with them in a way that they understood. This included the risks and benefits of the treatment. One person said, “I’ve been given all the options of my care and treatment and given my consent.” At our last inspection we found that the trust did not always act in accordance with regulations in determining people’s capacity to make decisions for themselves. In addition we had received concerns that key decisions about people’s end of life care were being made, without discussion with relatives. We spoke with people and their relatives about this and we looked at records where these decisions had been made. We found that, there had been significant improvements in how these decisions were taken.

All the people who were in-patients and their relatives that we spoke with told us that their medical and nursing needs were being met. One person told us, “They really look after you, more than fit for purpose.” On all the wards that we visited, we saw that staff were generally caring and committed to their work. We found that people experienced care, treatment and support that met their needs and protected their rights.

All the people that we spoke with during the inspection told us that they were happy with the quality of service they received. One person told us, “I chose to come back here rather than to xx, as this is where my consultant is based. Nurses are great, they remembered me from the last time I was here, no complaints at all. It’s as comfortable and as good as it can be.”

At our last inspection we identified that complaints were not responded to in a timely manner, staffing ratios were not at a level that would enable a quality service to be maintained. In addition we had identified that appropriate systems were not in place to ensure that learning from incidents informed staff's practice. During this inspection we found that there had been significant improvements in this area. Whilst we acknowledge that there were on-going areas for improvements, such as staffing and completing the reorganisation of the complaints process, the trust had clear plans in place to support this. We therefore found that there was an effective system to regularly assess and monitor the quality of service that people received.

Inspection carried out on 27 September and 1 October 2012

During a routine inspection

During this inspection we looked at the care and treatment people experienced across the emergency department (ED) and the medical assessment unit (MAU). We spoke with twenty people using the service, four relatives, a carer and twenty members of staff this included nursing and medical staff as well as senior managers. We looked at seven sets of records for people using the service.

People felt that they were able to give their consent before being treated or examined. One person told us "Staff always ask before they do anything". We found that improvements were needed to show how the trust determined that people lacked the capacity to make some decisions for themselves.

People said that they received good care which met their needs. One person told us " I am happy with the standard of care". We saw that care was coordinated to ensure that people received safe care and treatment.

People that we spoke with felt they had received safe care. Staff knew how to report concerns about people’s safety and welfare should they need to. People we spoke with spoke highly of the staff. We found that overall staff received the training and support they needed to do their job.

Systems were in place to regularly assess and monitor the quality of service but improvements were needed to ensure findings influenced practice. Most people we spoke with said they did not know how to complain. However we found that there was a robust system in place for investigating complaints.

During an inspection to make sure that the improvements required had been made

We reviewed the progress the Trust had made since our review of compliance in July 2011.

We found that there had been a significant amount of work undertaken in order to address the large backlog of complaints. This work has now been completed and the Trust is able to respond in a timely manner to all people who contact their complaints department.

We spoke with people who were waiting in this backlog for a response from the Trust. They told us they had been contacted. They said “it has taken a while for them to contact me but once they did they were very helpful and progress has been made”. Another person said, “the people who contacted me were very clear with their information about what was happening, this made me feel that I was being listened to. I’m still waiting for resolution to my complaint but at least I know that someone is looking at my issues now”, and “my issues are not yet resolved, I’ve had so many problems trying to get a response from them that things only moved forward when I contacted the Chief Executive in person”.

We considered the statistical information the Trust sent to us following the last review of compliance. We also spent time speaking with the Trust's complaints and litigation manager and the head of the Patient Advise and Liaison Service (PALS).

Inspection carried out on 4 May 2011

During a themed inspection looking at Dignity and Nutrition

The majority of people told us that they were satisfied with the care and treatment they received at City Hospital. They said they have been treated with respect and that their privacy and dignity had been well protected. They said they were given information and had been involved in decisions about their care and treatment.

People told us that their nutritional needs and dietary preferences were mostly met. They gave mixed feedback about the quality and range of food. Those people, who required assistance with eating or drinking, were complimentary about the way staff supported them. Observations on the two wards we visited showed that staff were attentive when assisting people and they mostly did this in a patient and professional way.