University Hospitals Birmingham NHS Foundation Trust

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Good

Our view of the service

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.