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Provider: University Hospitals Birmingham NHS Foundation Trust Good

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Good

Updated 13 February 2019

Our rating of the trust stayed the same. We rated it as good because:

  • We rated safe, effective, caring and responsive as good and well led as outstanding.
  • We rated nine of the core services we inspected at this inspection good overall and eight as requires improvement.

Inspection areas

Safe

Good

Updated 13 February 2019

  • Controlled of infection risk was managed well, particularly regarding hand hygiene. They used control measures to prevent the spread of infection.
  • Services were assessed and responded to patient risk and took action to respond to the deteriorating patient
  • Records were mostly kept in line with national guidance.

Effective

Good

Updated 13 February 2019

Our rating of effective stayed the same. We rated it as good because:

  • All core services kept in line with trust standards for pain screening and treatment. We found staff ensured patients were provided with effective pain relief information, advice and medication.
  • We found core services provided care and treatment based on national guidance and evidence of its effectiveness, which staff demonstrated through their delivery of care

Caring

Good

Updated 13 February 2019

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

  • Staff cared for patients with compassion and mostly maintained patient’s privacy and respect.
  • Staff provided emotional support to patients to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care and treatment.

Responsive

Good

Updated 13 February 2019

  • Services were planned to meet the needs of the local population
  • Services were considerate and acted to meet the needs of patients such as those living in vulnerable circumstances.
  • Care and treatment was mostly coordinated with other services and other providers.
  • Patients knew how to give feedback about their experiences and could do so in a range of accessible ways, including how to raise any concerns or issues.

Well-led

Outstanding

Updated 13 February 2019

We rated it as outstanding because:

  • There was compassionate, inclusive and effective leadership at all levels. The trust had a senior leadership team in place with the appropriate range of skills, knowledge and experience.
  • The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
  • The trust collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards. The trust housed state of the art clinical informatics with an advanced electronic data system and was regarded as an exemplar for its clinical and non-clinical governance systems.
  • There were consistently high levels of constructive engagement with staff and people who used services, including all equality groups. The trust engaged and involved patients to shape services and culture.
  • Safe innovation was celebrated. There was a clear, systematic and proactive approach to seeking out and embedding new and more sustainable models of care. In September 2016, the trust was named as a Global Digital Exemplar trust as part of new plans to fast-track digital development and improve the digital skills of the NHS workforce.

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.