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Provider: University Hospitals Birmingham NHS Foundation Trust Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 11 October 2021

University Hospitals Birmingham NHS Foundation Trust is one of the largest teaching hospital trusts in England, serving a regional, national and international population.

In September 2016 the trust announced plans to merge with the Heart of England NHS Foundation Trust. The merger by acquisition took place on 1 April 2018. The combined organisation has a turnover of £1.6 billion and provides acute and community services across four main hospitals:

  • The Queen Elizabeth Hospital Birmingham
  • Birmingham Heartlands Hospital
  • Good Hope Hospital
  • Solihull Hospital

The trust also runs Birmingham Chest Clinic, a range of community services and a number of smaller satellite units, allowing people to be treated as close to home as possible.

The trust has 2,366 in-patient beds over 105 wards in addition to 115 children’s beds and 145 day case beds. The trust operates 7,127 outpatients’ and 304 community clinics per week.

The trust has over 20,000 members of staff.

The trust had experienced significant challenges over the past 18 months due to the COVID-19 pandemic. The trust had treated over 14,000 COVID-19 positive patients, of those 2,830 were COVID-19 related deaths. Over 1,500 staff were redeployed from substantive roles to care for the most acutely ill patients and support staff in critical areas. Services had to be redesigned and moved at short notice.

At the time of our inspection, the number of patients admitted to the trust with COVID-19 had significantly reduced. Although throughout the three weeks of core service inspections, the number of patients admitted with COVID-19 had started to increase again.

We carried out an unannounced inspection of the following acute services provided by the trust:

  • Urgent and emergency care at Good Hope Hospital, Birmingham Heartlands Hospital and Queen Elizabeth Hospital Birmingham because we had concerns about the quality of services,
  • Medicine at Good Hope Hospital because we received information giving us concerns about the safety and quality of the services,
  • Cancer services because we received information giving us concerns about the safety and quality of the services. This core service is not aggregated to form the overall trust ratings.
  • Surgery (focused) at Queen Elizabeth Hospital Birmingham because we had concerns about the quality of services.

We also inspected the well-led key question for the trust overall.

We did not inspect several services previously rated requires improvement because this inspection was focused only on services where we had concerns. We are monitoring the progress of improvements to services and will re-inspect them as appropriate. Services previously rated as requires improvement and not inspected this time include:

Birmingham Heartlands Hospital

  • Medical care (including older people’s care)
  • Surgery
  • Maternity

Good Hope Hospital

  • Surgery

Solihull Hospital

  • Urgent and emergency services

Community Health Services

  • Community health services for children and young people
  • Community end of life care

Our rating of services went down. We rated them as requires improvement because:

  • We rated effective, caring and well-led as good and safe and responsive as requires improvement. Well-led is the overall trust-wide rating, not an aggregation of services ratings.
  • We rated two out of six services inspected as good, three as requires improvement and one as inadequate.
  • We have not taken the previous ratings of services at the Heart of England NHS Foundation Trust into account when aggregating the trust's overall rating. This is because we only inspected one core service at Birmingham Heartlands Hospital and two at Good Hope Hospital, therefore it would not be proportionate.
  • Patients were not always protected from harm. There were significant handover delays for patients arriving by ambulance and for those who self-presented to the department. Services did not manage medicines well. Not all staff had received mandatory and safeguarding training, however work was ongoing to improve this.
  • Individual needs were not always met. People could not always access the service when they needed it and received the right care promptly.
  • Staff did not always feel respected, supported and valued. Leaders did not always run services well and did not always manage risk effectively.

However:

  • Service generally provided care and treatment based on national guidance and evidence-based practice. Staff monitored the effectiveness of care and treatment. The service made sure staff were competent for their roles. Staff worked together as a team to benefit patients. Key services were available to support patient care.
  • Staff predominantly treated patients with compassion and kindness. Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.

How we carried out the inspection

We carried out this inspection on various days throughout June and July 2021. We visited areas relevant to each of the core services inspected and spoke with a number of patients and staff, as well as holding focus groups.

During the inspection we visited 10 areas for cancer services at Queen Elizabeth Hospital Birmingham, 13 for medical services at Good Hope Hospital, 13 for surgery services at Queen Elizabeth Hospital, four for urgent and emergency care at Good Hope Hospital, five for urgent and emergency care at Birmingham Heartlands Hospital and three for urgent and emergency care at Queen Elizabeth Hospital Birmingham.

We spoke with 210 staff members of various speciality and profession including, consultants, doctors, radiotherapists, nurses, healthcare support workers, pharmacists, patient experience, domestic staff and administrators.

We spoke with 56 patients throughout the departments and reviewed 95 patient records.

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.

Inspection areas

Safe

Requires improvement

Updated 11 October 2021

Effective

Good

Updated 11 October 2021

Caring

Good

Updated 11 October 2021

Responsive

Requires improvement

Updated 11 October 2021

Well-led

Good

Updated 11 October 2021

Checks on specific services

Community end of life care

Requires improvement

Updated 13 February 2019

For this inspection, we rated end of life care services as Good for safe, caring and responsive. We rated the service as Requires Improvement for effective and well led.

Overall, we rated the service as requires improvement because:

  • Patient outcomes were not regularly monitored and reviewed to ensure the end of life care service was meeting the needs of patients.
  • There were no audits to identify the ratio of cancer to non-cancer patients treated by the service.
  • The service did not monitor or audit patients preferred place of care or death. However, they did provide a rapid response team to support patients to be discharged.
  • Two of the five of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders we viewed were not completed correctly as they did not include a mental capacity assessment, despite stating the patient ‘lacked capacity’. We were therefore not assured that the Mental Capacity Act legal requirements were always implemented for people who had DNACPR orders.
  • There was no end of life care strategy for community end of life care services.
  • The trust did not have a specific strategy for end of life care which incorporated planning to meet the needs of the local population.

  • The trust did not have a service improvement lead for community end of life care services.
  • There was no end of life care regional steering group.

However:

  • Staff had a good understanding of how to protect patients from abuse and could describe what safeguarding was and the process to refer alerts.

  • Overall, we found the standards of cleanliness and hygiene were good and staff demonstrated a good knowledge of procedures for the management, storage and disposal of clinical waste, environmental cleanliness and the prevention of healthcare acquired infection.

  • Comprehensive risk assessments were carried out for patients and risk management plans

developed in line with national guidance.

  • We saw good examples of good multi-disciplinary working and involvement of other agencies and support services.

  • From to , the trust reported no never events in community health services for end of life care.

  • All patients, their relatives and care givers told us they were fully included in discussions around their plan of care.

  • There were systems in place to ensure that staff affected by the experience of caring for patient at end of life were supported. For example, members of the SPCT had access to a clinical psychologist based at the local hospice, through a self-referral system as well as a psychologist who provided clinical supervision to individuals or groups, as required.

Community health services for children, young people and families

Requires improvement

Updated 13 February 2019

This is the first inspection of this service. We rated it as requires improvement because:

  • Staff had not recognised or reported incidents which meant appropriate investigation and learning had not been undertaken.
  • Robust arrangements were not in place for administration of non-prescription and as required medicines.
  • Essential equipment to weigh children and young people was not available.
  • Whilst most of services had sufficient staff, long term staff absence within the learning disability nursing service had impacted adversely on children’s access to care and treatment.
  • There was a need to ensure transition arrangements between children’s and adults services met best practice.
  • The referral to treatment wait for the special assessment service, autism service and occupational therapy service had consistently exceeded the required waiting time and were not in line with good practice.
  • There was a need for greater insight and engagement from more senior managers within the trust to ensure safe, high-quality and sustainable service was provided.
  • Arrangements for governance and performance management did not always operate effectively.

However:

  • Staff went beyond expectations to treat children, young people and their loved ones with kindness and compassion.
  • Children, young people, and their loved ones were active partners in their or their children’s care.
  • The service provided mandatory training in key skills for staff and most staff had completed it.
  • The service monitored the effectiveness of care and treatment and used the findings to improve them.
  • Staff understood how to protect patients from abuse and had training on how to recognise and report abuse and they knew how to apply it.
  • Staff had the qualifications, skills and experience and ongoing training and their competence was monitored appropriately.
  • There was effective multidisciplinary working to provide high quality and effective care.
  • The service was responsive to the individual needs of children, young people and their families.
  • The service and its staff were committed to improving and developing services and learning when things go well.