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Provider: Birmingham Women's and Children's NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 14 November 2019

Our rating of the trust went down. We rated it as good because:

  • Forward Thinking Birmingham was rated as requires improvement overall. Of the core services inspected in April, one core service was rated requires improvement overall and two core services were rated as good overall.
  • Birmingham Women’s Hospital was rated as good overall. Of the core services inspected in April, one core service was rated requires improvement overall and four core services were rated as good overall.
  • Birmingham Children’s Hospital was rated as outstanding overall, Surgery was inspected in April and caring was rated as outstanding.

Our full inspection report summarising what we found and the supporting evidence appendix containing detailed evidence and data about the trust is available on our website – www.cqc.org.uk/provider/RQ3/reports.

Inspection areas

Safe

Requires improvement

Updated 14 November 2019

Our rating of safe stayed the same. We rated it as requires improvement because:

  • Two core services at Birmingham Women’s Hospital and one core service within Forward Thinking Birmingham were rated as requires improvement for safe.
  • Three core services at Birmingham Women’s Hospital, the core service at Birmingham Children’s Hospital and two core services within Forward Thinking Birmingham were rated as good for safe.

Effective

Good

Updated 14 November 2019

Our rating of effective went down. We rated it as good because:

  • Four core services within Birmingham Women’s Hospital, the one at Birmingham Children’s Hospital and one within Forward Thinking Birmingham were rated as good for effective.
  • Two core services within Forward Thinking Birmingham were rated as requires improvement for effective.
  • Diagnostic Imaging is not rated for effective.

Caring

Outstanding

Updated 14 November 2019

Our rating of caring stayed the same. We rated it as outstanding because:

  • Surgery at Birmingham Children’s Hospital was rated as outstanding for caring.
  • Four core services at Birmingham Women’s Hospital and three core services within Forward Thinking Birmingham were rated as good for caring.
  • One core service at Birmingham Women’s Hospital was rated as requires improvement for caring.

Responsive

Good

Updated 14 November 2019

Our rating of responsive went down. We rated it as good because:

  • The core service at Birmingham Children’s Hospital, all core services at Birmingham Women’s Hospital and one core service within Forward Thinking Birmingham were rated as good for responsive.
  • Two core services within Forward Thinking Birmingham were rated as requires improvement for responsive.

Well-led

Good

Updated 14 November 2019

Our rating of well-led stayed the same. We rated it as good because:

  • Surgery at Birmingham Children’s Hospital, four core services at Birmingham Women’s Hospital and two core services within Forward Thinking Birmingham were rated as good for well-led.
  • One core service within Forward Thinking Birmingham was rated as requires improvement for well-led.
  • One core service at Birmingham Women’s Hospital was rated as inadequate for well-led.

Checks on specific services

Child and adolescent mental health wards

Good

Updated 21 February 2017

We rated child and adolescent mental health wards as good because:

  • We found Parkview clinic to be well managed and staffed by a happy staff team. Patients told us about many good experiences while they have been in the service. We observed a collaborative and inclusive team who worked well with patients.
  • There were processes in place to ensure safety when managing medications. Staff routinely carried out physical health checks. Carers told us they were kept informed about their child’s progress and we saw family therapy interventions carried out on the ward.
  • Staff within the service had a good knowledge of the patients in their care and staff across wards all worked well together. Staff were visible on wards and accessible to patients.
  • We found the leadership within Parkview clinic to be strong and innovative. The staff were team constantly striving to improve the service for patients and staff.
  • Staff had the opportunity to develop within their roles and give feedback on the service. Staff had regular team meetings and group peer supervision sessions. Staff were qualified, experienced and received appraisal however individual supervision was not routinely carried out and recorded.
  • Patient care records were clear, concise and well documented. Risk assessments and risk management were well recorded. Care plans were holistic and personalised and fully reflected patient views.

However:

  • Patients and carers told us that social activities were occasionally cancelled due to short staffing and this was disappointing for the patient. Patients also told us the food was not very good.

Mental health crisis services and health-based places of safety

Good

Updated 14 November 2019

Our rating of this service improved. We rated it as good because:

  • The service provided safe care. Clinical premises where patients were seen were safe and clean and the physical environment of the health-based places of safety met the requirements of the Mental Health Act Code of Practice. The number of patients on the caseload of the mental health crisis teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff working for the mental health crisis teams developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The mental health crisis teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.
  • Staff treated patients with compassion and kindness and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • The mental health crisis service and the health-based places of safety were easy to access. Staff assessed patients promptly. Those who required urgent care were taken onto the caseload of the crisis teams immediately. Staff and managers managed the caseloads of the mental health crisis teams well. The services did not exclude patients who would have benefitted from care.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

However:

  • Staff did not always accurately record information in relation to the Mental Health Act in the health based place of safety. This meant staff could not be sure how long a patient had been detained.
  • We found some medication errors relating to the disposal of controlled drugs, signage for storage of oxygen cylinders and archived prescription charts which had not been stored correctly
  • In the health based place of safety, it was not possible for staff to know if a fire alarm had been activated in the suite as there was no fire panel in that area.

Community-based mental health services for adults of working age

Good

Updated 14 November 2019

Specialist community mental health services for children and young people

Requires improvement

Updated 14 November 2019

Our rating of this service improved. We rated it as requires improvement because:

  • The number of patients on the caseload of the teams, and of individual members of staff, was high. Staff told us this could prevent them from giving each patient the service they needed. There were not enough staff to deal with the increasing levels of referrals or the backlog of patients waiting to be seen.
  • Staff turnover was high across the service, staff expressed feeling overwhelmed and overstretched, and their morale was low.
  • The service was not easy to access in a timely manner. Most patients had to wait a long time to get the help they needed because there were high numbers of patients waiting to access the service. The service was not meeting referral to treatment targets.
  • Consultation rooms where patients met with staff were not effectively soundproofed in two out of the four community hubs. The rooms were too hot and there were not enough consultation rooms to accommodate the needs of the service.
  • Records did not consistently evidence that patients had been supported to address their physical health needs or had been offered a copy of their care plan.
  • The service was generally well led and had improved since our last inspection. The governance processes ensured that procedures relating to the work of the service had improved in most areas. Managers’ understanding of pressures on the service, and on staff delivering the service, had improved. Measures had been put in place to deal with the pressures but these needed to go further and become embedded before significant improvement would be seen. High staff vacancies had persisted for long periods and showed only recent improvement. Staff were not given the right tools and support to work to an agile model. High waiting lists dominated activity across the service and staff used words such as “firefighting” to describe the culture they had grown accustomed to working in.

However:

  • Staff assessed and treated patients who required urgent care by referring them to the urgent care team or offering an urgent choice appointment. The criteria for referral to the service did not exclude children and young people or young adults who would have benefitted from care.
  • The service provided safe care. Clinical premises where patients were seen were safe and clean. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly, even though this may be by the urgent care team. Managers had much improved the way they monitored the waiting lists of patients waiting to access support. Staff assessed and managed risk well and followed good practice with respect to safeguarding. Mandatory training compliance had improved across the service.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. The recording of patient records to reflect this had much improved. Staff provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. A number of bank and agency vacancies were filled by staff who had been in post a long time. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood the principles underpinning capacity, competence and consent as they apply to children, young people and young adults. There had been improvements in the recording of capacity in patient records.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients, families and carers in care decisions.