University Hospitals Birmingham NHS Foundation Trust

Updated 29 August 2025

Although undertaken through our previous methodology, our last assessment of the well-led key question at trust level rated the organisation as inadequate. After an extensive improvement programme focused on culture, staff wellbeing and support, and governance effectiveness, this assessment has seen the trust rating improve to good.

University Hospitals Birmingham NHS Foundation Trust is one of the largest NHS teaching hospital trusts in England, serving a regional, national and international population. The population across the West Midlands Combined Authority area is now in the region of 2.9 million people and is one of the youngest and most ethnically diverse. The trust is the principal teaching hospital for the University of Birmingham.

The trust manages 4 acute hospitals and a range of community services. It employs around 24,000 permanent staff as the largest employer in the West Midlands. It provides 2,750 beds, sees around 360,000 people each year in its AEs and urgent treatment centres, and 310,000 people as inpatients. Two million people attend each year as outpatients. It’s annual turnover amounts to £2.4bn. The trust is managed by a unitary trust board made up of executive and non-executive directors. As a foundation trust it has a board of governors made up of public and staff representatives.

Each of the trust’s 4 acute hospitals, Birmingham Heartlands Hospital (BHH), Good Hope Hospital (GHH), Queen Elizabeth Hospital Birmingham (QEHB), and Solihull Hospital (SH) now have their own senior management structure under a hospital executive director. We visited all 4 hospital sites during this assessment and sat down in conversation with each of the senior leadership teams.

The trust also runs community services including renal dialysis units, an inpatient rehabilitation centre, and primary care health centres.

During our assessment we visited all 4 hospitals and undertook assessments of multiple service groups. This included

• Urgent and emergency care (AE) on 3 sites (BHH, GHH and QEHB)

• Services for children and young people on 2 sites (BHH and GHH)

• Medical care on one site (GHH)

• Surgery on one site (QEHB)

• Outpatients on one site (SH)

• Maternity services on 2 sites (BHH and GHH)

We also assessed the dialysis services at Runcorn Road Dialysis Unit and Castle Vale Renal Unit.

On our visits to the 4 acute hospitals we held focus groups for any members of staff to come and speak with us about their experiences. Together we met 510 staff at these focus groups and many other staff on our hospital services assessment visits.

We assessed University Hospitals Birmingham NHS Foundation Trust for leadership using our standard methods. This included interviews with staff across the whole organisation, including members of the trust board and senior clinical leaders; we used evidence provided by the trust and stakeholders; and used data and intelligence we hold about the organisation.

We assessed each of the 8 new quality statements for the trust and have reported on the excellent practice in many areas, as well as those that need to be improved.

The 2024 NHS Staff Survey, published shortly before our assessment, showed significant improvement in the views of staff, of whom 3,722 more staff responded than in our previous report from 2023 (which covered the 2022 staff survey, with the lowest response rate among the peer group of NHS trusts). In the 9 key leading indicators, although the trust was still below the national averages, the responses were all ‘significantly higher’ than the previous year. One key indicator was staff feeling enthusiastic about their job. In this measure, the result was only just slightly below the national average and had improved each year.

There was a clear shared direction, vision and strategy with the organisation aligned to all its plans and objectives. It was based on transparency and openness and understanding the challenges faced and for the future. There were capable, compassionate and inclusive leaders who led with integrity with patients at the centre of leadership values. They embedded the trust values and culture. There was commitment to equality, diversity and inclusion, and key indicators were showing improvement, although still with things to do. The diversity in the workforce was valued and recognised for its importance to the diversity of the local population. There was an exceptionally strong and committed group of staff networks who were having an impact on supporting their colleagues with a range of different needs, abilities and strengths.

There was an improved standard of governance including in systems of accountability, with the board being more able to demonstrate there was learning and sustainable change and improvement. Responsibilities were clear and supported the delivery of good quality and sustainable care, treatment and support. Although there was now a clear recognition in governance of learning and improvements, this needed to move to a stage where these changes and actions were evaluated for their success, remaining active rather than passive actions which were not continuously evaluated.

The trust’s performance against key clinical measures and standards had improved due to intense focus in some areas after the COVID-19 pandemic. But there were still areas of concern, particularly in the 3 AE departments around waiting times, crowding, and handover delays. A new surgical hub and new diagnostic facilities were beginning to see the waiting times for these procedures come down, although with more to do.

There was good partnership working and collaboration with health and social care stakeholders. The trust understood the duty to collaborate and work together in the best interests of patients and the community. There was focus on continuous learning and innovation. The trust was a leader in many areas of research and development with significant income from this work which was valued and often ground-breaking. The trust was making progress around environmental sustainability with some projects having major impacts in reducing carbon emissions.

However, there remained some staff who did not feel safe to speak up, as we reported at our last inspection. There was a dedicated and experienced Freedom to Speak Up Guardian team, but some staff still spoke of anxiety about being identified if they spoke up and it bringing detriment to their career. Some staff still spoke of bullying and intimidation, particularly some of the senior doctors. There were also concerns about financial governance and resilience in the finance team and delays in the finalisation of plans and accounts.

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.

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.