The Care Quality Commission (CQC) has found improvements in four services at Good Hope Hospital in Sutton Coldfield, following inspections in February and March.
Inspectors looked at maternity, medical care, services for children and young people, and urgent and emergency services at Good Hope Hospital, which is run by University Hospitals Birmingham NHS Foundation Trust. CQC carried out these inspections to follow up on findings and improvements the trust was told to make at previous inspections.
The overall rating for maternity has again been rated as requires improvement, while the rating for how well-led the maternity service is has improved from inadequate to requires improvement. The overall rating for medical care has improved from inadequate to requires improvement, while how well-led the medical care service is has improved from inadequate to good.
This was the first time CQC has inspected children and young people’s services at Good Hope Hospital. The overall rating, and the ratings for how effective, caring, responsive and well-led the service is, are good. How safe the service is has been rated requires improvement.
The overall rating for urgent and emergency care, and the rating for how safe the service is, have improved from inadequate to requires improvement, while how well-led the service is has improved from inadequate to good.
As CQC hasn’t inspected every service area since Good Hope Hospital has been run by University Hospitals Birmingham NHS Foundation Trust, there isn’t an overall rating for the hospital.
CQC found one breach of regulation related to person centred care in medical care, three breaches related to safe care and treatment in medical care, maternity, and in urgent and emergency services due to crowding and poor patient flow. CQC also found one breach related to good governance in maternity. CQC has told the trust to submit an action plan showing what action it is taking in response to these concerns.
Amanda Lyndon, CQC deputy director of operations in the midlands, said:
“During our inspection at Good Hope Hospital, we found leaders had improved their management of services leading to people experiencing care that better reflected their needs. The trust took a proactive approach to using learning and improving services, which was embedded across the areas we inspected. However, the trust has more work to do to make sure that people are being kept safe and staff have the tools they need to provide consistent support.
“For example, people and their families had positive experiences of receiving support from maternity services, and they felt comfortable raising concerns. However, it was clear that the service needed change, with delays in treatment, management of risk, and staffing levels affecting the quality of care.
“Children, young people and their families spoke positively about their experiences and care. Our inspectors saw staff treating people with dignity and compassion, and staff took a positive approach to learning and making improvements. However, staff didn’t manage some risks to children. Leaders didn’t always ensure there was a safe level of staffing, and staff needed to improve how they managed medicines.
“In medical care, the improvements in leadership are reflected in the service’s new well-led rating. Leaders were now more supportive and visible to staff, and fostered a better culture in the service which in turn had a positive impact on people’s care. However, leaders need to make sure staff get all the training they need to support people effectively. Staff needed to record information about people’s decisions on their care more effectively. They also needed to ensure they managed medicines safely.
“The trust had improved the leadership and culture of urgent and emergency care services. Staff continued to face challenges because of the high demand and pressure across the whole health and care system, but the trust had still made progress through improvements they had implemented.
“Overall, staff, leaders and people using services at Good Hope Hospital should be encouraged by the improvements we saw. We found many areas of good practice, and leaders should build on this by continuing to make improvements in the areas we have told them to.”
Inspectors found at Good Hope Hospital:
Maternity:
- Leaders didn’t always make sure there were enough staff to deliver safe care. On one shift, inspectors saw that out of a planned 14 staff on the delivery suite, only seven were available. Staff had to move between areas to keep people safe.
- Staff didn’t always manage the risks people faced safely and failed to always complete documentation and safety protocols.
- Staff didn’t report all safety incidents partly due to a change in the reporting system. When they reported incidents, staff and leaders investigated these thoroughly and identified learning opportunities and service improvements, but this was sometimes delayed due to staff being deployed
- However, staff groups maintained positive relationships with each other and worked closely together to support people in their care.
- Leaders had improved their management of the service, but they still needed to do more work to embed new processes and sustain change.
Medical care:
- Leaders failed to ensure that staff received relevant resuscitation training and no ward met the trust’s completion target.
- Staff didn’t keep records up to date on people’s treatment escalation and resuscitation decisions.
- The service didn’t always make sure medicines were managed safely or that they reflected people’s needs and preferences.
- However, staff learned from incidents to improve people’s experiences of the service.
- Staff treated people with kindness and compassion, while considering their individual needs and preferences.
- The service had a shared vision, strategy and culture which was based on transparency and equity and where staff felt they could speak up.
- Leaders were inclusive and embodied the culture and values of the organisation.
Children and young people:
- Staff didn’t manage some risks to children and young people well enough.
- Leaders didn’t ensure there were always safe levels of staffing. There were some concerns around how staff safely managed medicines.
- Staff kept records up to date which supported their colleagues to deliver effective care meeting people’s individual needs.
- Staff explained children’s treatment clearly, helping them understand the next steps in their care.
- Leaders investigated incidents and shared learning opportunities with staff to improve children’s experiences.
Urgent and emergency care:
- The emergency department was crowded during the inspection, and staff couldn’t provide people with the care and treatment they needed in reasonable time. People experienced long waits in the department and on the back of ambulances, causing frustration.
- The waiting area was small and served as the main access to the hospital, which made a crowded space feel even busier. This reduced people’s privacy and space.
- However, staff prioritised people’s safety. They had made the environment safer since the previous inspection.
- Leaders deployed more staff during busier times to help meet people’s needs.
- Staff delivered good care and treatment following evidence-based practice and people had good outcomes. Staff were kind, caring and compassionate.
- Managers provided strong leadership of the department and embodied the cultures and values of their workforce. They had improved oversight and risk management and fostered a positive culture.