Updated 3 March 2023
Birmingham Women's and Children's NHS Foundation Trust is responsible for managing Birmingham Women's Hospital, Birmingham Children's Hospital and Forward Thinking Birmingham. It was created by a merger of Birmingham Women's NHS Foundation Trust with Birmingham Children's Hospital NHS Foundation Trust in February 2017.
The trust is one of five trusts within the Birmingham and Solihull Integrated Care System. It has an annual turnover of £535 million, and provides a range of general and specialised services, including tier 4 Children’s and Young Persons mental health services to young people up to the age of 25 years.
Birmingham Women’s Hospital provides specialist services to more than 50,000 women, men and their families every year from the city, the wider region and beyond. One of two dedicated women’s hospitals in the UK, the maternity unit delivering more than 8,200 babies a year. The hospital offers a full range of gynaecological, maternity and neonatal care. The fetal medicine centre receives regional and national referrals and is home to the West Midlands Regional Genetics Laboratory.
Birmingham Children’s Hospital is a specialist paediatric centre, caring for sick children and young people up to the age of 16. The hospital has a national liver and small bowel transplant centre. They are a nationally designated specialist centre for epilepsy surgery and host a paediatric major trauma centre for the West Midlands. Alongside a Paediatric Intensive Care Unit.
Forward Thinking Birmingham is one of the largest Child and Adolescent Mental Health Services in England, with a dedicated inpatient eating disorder unit and acute assessment unit for regional referrals of children and young people with the most serious of problems (Tier 4), and the Forward Thinking Birmingham community mental health service for 0-25 year olds.
Between 21 June 2022 and 11 October 2022, we carried out an unannounced inspection of two of the acute and the three mental health services provided by this trust as part of our continual checks on the safety and quality of healthcare services. We also inspected the well-led key question for the trust overall.
We inspected critical care and surgery at Birmingham Children’s Hospital and specialist community mental health services for children and young people, child and adolescent mental health wards and mental health crisis services and health-based places of safety; all part of Forward Thinking Birmingham. We inspected these services as our intelligence suggested there may have been a deterioration in the safety and quality of care provided.
Following this inspection, due to concerns found within the specialist community mental health services and on the child and adolescent mental health wards, we issued the trust with a Letter of Intent to take urgent enforcement action if significant improvement was not made. The trust took action and we received initial assurances that improvements were being made. We revisited the services between 10 and 11 October 2022 and found that significant improvement was still required in the quality of healthcare relating to management of risk due to issues with records.
We did not inspect any other services at Birmingham Children’s Hospital or Birmingham Women’s Hospital because our monitoring process had not highlighted any concerns. We will re-inspect these services as appropriate.
NHS England System Oversight Framework provides the framework for overseeing systems including providers and identifying potential support needs. The framework looks at five national themes: quality of care, access and outcomes, preventing ill health and reducing inequalities, finance and use of resources, people and leadership and capability.
Based on information from these themes, providers are segmented from 1 to 4, where ‘4’ reflects providers receiving the most support, and ‘1’ reflects providers with maximum autonomy. As of April 2022, the trust’s segmentation was 2.
Our comprehensive inspections of NHS trusts have shown a strong link between the quality of overall management of a trust and the quality of its services. For that reason, we look at the quality of leadership at every level. Our findings are in the section headed ‘is this organisation well-led’. We inspected the well-led key question between 9 and 10 August 2022. A financial governance review was also carried out at the same time as the well-led inspection, this was undertaken by NHS England. There was not a separate ‘Use of Resources’ assessment in advance of this inspection.
Our rating of services went down. We rated them as requires improvement because:
- We rated, safe, responsive and well-led as requires improvement and effective and caring as good.
- In rating the trust, we took into account the current ratings of services not inspected this time.
- Services that formed part of Forward-Thinking Birmingham (FTB) did not always provide safe care. FTB services did not always have enough nursing staff and support staff to keep patients safe.
- In the acute surgery services, staff did not always ensure that risks associated with the environment and equipment were consistently mitigated. Care records were not always stored securely ensuring personal and sensitive information was protected. The service did not always ensure safe systems were followed to prescribe, administer and store medicines. Children, young people and their families' individual care preferences were not always recorded to show these had been assessed and responded to.
- In acute and FTB services, action was not always taken to ensure risk assessments and risk management plans were consistently recorded for all relevant aspects of care and treatment. When risk assessments and management plans were in place, they were not always updated in response to changes to children and young people’s care needs.
- Not all staff in FTB services worked well together for the benefit of patients. Staff did not always work well with the psychiatric liaison team, who often referred adults to the crisis service.
- Staff in FTB services did not always understand the individual needs of children and young people who used the service. They did not always actively involve children, young people and their families in care decisions.
- In specialist community mental health services for children and young people, children and young people sometimes had to wait long periods of time for their treatment.
- The FTB service was not well led, governance processes did not ensure that procedures relating to the work of the service ran smoothly.
- In FTB services, staff could not always find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements.
- The acute services had enough staff to care for patients and keep them safe. Most staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Services controlled infection risk well. Staff in the paediatric intensive care unit (PICU) assessed risks to patients, acted on them and kept good care records. PICU staff managed medicines well. Services managed safety incidents well and learned lessons from them.
- Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers mostly monitored the effectiveness of services and made sure staff were competent. Most staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
- Staff in the acute services 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.
- Most services planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed.
- Leaders ran acute services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. Services engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
- The trust collected reliable data and analysed it. In acute services, 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. Data or notifications were consistently submitted to external organisations as required.
How we carried out the inspection
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.
What people who use mental health services say
Children and young people who used the mental health services told us they did not have a care plan and information about their treatment was not explained to them.
Children and young people said there were not enough staff and the staff member supporting them often changed. They said their appointments were cancelled due to staffing or they did not run to time. Children and young people said face to face appointments were not offered freely even if it is a preference.
Children and young people said access into the service needed to improve as they waited too long which often resulted in them reaching a crisis point. One person said they only received help after they had been in crisis and went to the local emergency department. People said they waited a long time to see the doctor.
Children and young people said they did not receive feedback about complaints they had made, other people did not know how to make a complaint and some people did not feel listened to.
A relative said they and their family felt listened to and were involved.
Some children and young people said staff were responsive and answered any questions they had, were lovely, polite and respectful. People said the care coordinators were consistently great. They told us that they had waited a long time but once they received the care it was very good, and they would be lost without the support they received.
Children and young people said the service was passionate about patient voice and co-production.
They said there was effective signposting to other services and charities and therapy and counselling sessions were very helpful.