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Provider: Sandwell and West Birmingham Hospitals NHS Trust Requires improvement

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

Reports


Inspection carried out on 4 and 5 September, 11 and 12 September, 18 and 19 September, 19 and 20 September, 9, 10 and 11 October

During a routine inspection

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

  • The Sandwell General Hospital and City Hospital were rated as requires improvement.
  • In many services, safe was rated as requires improvement and in six services well-led was rated as requires improvement.
  • Well-led for services for children and young people was rated inadequate.


CQC inspections of services

Service reports published 5 April 2019
Inspection carried out on 4 and 5 September, 11 and 12 September, 18 and 19 September, 19 and 20 September, 9, 10 and 11 October During an inspection of Community health inpatient services Download report PDF | 686.52 KB (opens in a new tab)Download report PDF | 6.09 MB (opens in a new tab)
Service reports published 31 October 2017
Inspection carried out on 16 February, 28, 29 and 30 March and 10 April 2017 During an inspection of Community health inpatient services Download report PDF | 391.39 KB (opens in a new tab)
Inspection carried out on 28-30 March 2017 and 10 April 2017 During an inspection of End of life care Download report PDF | 353.03 KB (opens in a new tab)
Service reports published 17 November 2015
Inspection carried out on 29 - 30 June 2015 During an inspection of Community health services for children, young people and families Download report PDF | 351.76 KB (opens in a new tab)
Inspection carried out on 28-30 March 2017

During a routine inspection

Sandwell and West Birmingham Hospitals NHS Trust is a provider of both acute hospital and community services for the people of West Birmingham and across six towns in Sandwell, serving a population of around half a million people.

Services are provided from two main acute locations, City Hospital (to the West of Birmingham)l and Sandwell General Hospital. On the City Hospital site there is also the Birmingham Treatment Centre (BTC) and a Birmingham Midland Eye Centre (BMEC). The trust also provides community services to include Adult services, End of life care, Inpatient services at Rowley Regis Hospital and Children and Young people services. For the purposes of this inspection we visited two community services; End of life care services and Inpatient services.

We inspected this trust using our comprehensive methodology in October 2014. At that time we rated the trust requires improvement overall, and we had particular concerns about Medical services, Surgery services and Outpatient and Diagnostic Imaging services across both City Hospital and Sandwell General Hospital sites. Since our last inspection, we have seen that the trust has made significant improvements in a number of areas, we saw some areas of outstanding practice, however there is still more work for the trust to do.

We carried out an unannounced visit to Medical service across both hospital sites on 16 February 2017, because we had concerns about safety and quality of care, followed by a short notice announced inspection on 28- 30 March 2017. This inspection included the following core services; Emergency Department (ED), Medical services, Surgery services, End of Life Care services, Outpatient and Diagnostic Imaging services and the Birmingham Midland Eye Centre. Following the inspection, we returned to carry out an unannounced inspection on 6, 11, 12 and 13 April 2017.

We made judgements about eight core services across acute and community,

Our key findings were as follows:

  • Incidents were reported, investigated, and learned from to improve safety and staff were committed to being open and honest with patients when things went wrong but this varied across both sites and core service.

  • The trust held 10 quality improvement half days (QIHD) per year during which time staff shared learning and attended relevant training.

  • Infection control had improved since the inspection in 2014, however, this varied across both sites.

  • Urgent and emergency care service trust wide met the RCEM standard of patients being treated within one hour of arriving.

  • The trust’s monthly average total time in ED for all patients was consistently lower than other English trusts and this was a stable position.

  • The trust held 10 quality improvement half days (QIHD) per year during which time staff shared learning and attended relevant training.

  • Robust application of the World Health Organisation’s (WHO) ‘five steps to safer surgery’ checklist was visually monitored on a daily basis.

  • The hospital routinely collected and monitored information about patient care and treatment and their outcomes.

  • There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.

  • Multi-disciplinary team (MDT) working was evident throughout the hospital.

  • The trust end of life care service had a holistic approach to patient care, care was tailored to meet patient’s individual specific needs. The service regularly reviewed the complex care needs of patients to promote coordinated, safe, and effective palliative and end of life care.

  • The mortuary on both sites had improved its environmental condition since inspection 2014

  • The trust provided access to care and treatment 24 hours a day, seven days a week.

  • An IRMER committee monitored, analysed and reported incidents in the diagnostic imaging department. All IRMER documentation was in place a vast improvement since inspection 2014.

  • We had concerns for ward D26 at city hospital around care and attitude of staff towards the patients.

We saw several areas of outstanding practice including:

  • The palliative and end of life care service ensured that patients and their families were involved in their care and their choices and preferences were upheld, including where they would prefer to be for their care and when they died.

  • The palliative and end of life care service integrated coordination hub acted as one single point of access for patients and health professionals to coordinate end of life services for patients.

  • The service provided access to care and treatment in both acute hospitals and in the community, seven days a week 24 hours a day.

  • The service reacted speedily to referrals by providing an urgent response team in order to meet patient’s needs quickly.

  • Staff went the extra mile to ensure patients received the right care in the right place at the right time.

  • Staff showed great compassion, empathy and an understanding of patient’s needs and preferences.

  • Newton 4 at Sandwell displayed a high-level person centred care approach. The staff on this ward were very enthusiastic and passionate about the care they delivered and the patients they served. There were a number of innovative practices developed on this ward, which included the breakfast therapy club to aid with patient rehabilitation, rewarded by the stroke association. The development and implementation of the JEL model for staff progression, the development of the delirium pathway and of the patient care bundles to aid patient progression and so patients could own their own goals.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

Sandwell General site

Emergency Department

  • The trust must take action to ensure storage and availability arrangements of emergency medicines required for resuscitation follow Resus Council Guidance and robust arrangements are put in place to manage the risk and ensure that medicines for resuscitation were protected from tampering.
  • The trust must take action to improve the standard of records completed by doctors when patients were admitted to wards from the ED compromised the clerking process and increased risk to patients.
  • The trust must take action to ensure patients in the ED receive treatment within one hour of arriving in line with the Royal College of Emergency Medicine (RCEM) recommendation.
  • The trust must take action to ensure there is a clearly agreed and resourced system in place for safely managing the condition of patients queuing on trolleys when the ED is very busy.
  • The trust must take action to ensure staff identify patients at risk of sepsis and follow the sepsis pathway in place.
  • The trust must take action to ensure doctors use the appropriate proforma in place for effective clinical pathways.
  • The trust must take action to ensure sufficient substantive registrar cover overnight for the safety of patients.
  • The trust must take action to ensure there is a designated appropriately safe room available within which to care for patients with mental ill health
  • The trust must take action to ensure the security and safety of staff working in the ED at all times.
  • The trust must take action to ensure unplanned re-attendance rate to the ED within seven days is reduced.
  • The trust must take action to ensure information about patients’ assessment and condition recorded by consultants and doctors is sufficiently detailed, precise and legible.
  • The trust must take action to ensure patients are admitted, transferred or discharged within four hours of arrival in the ED.

  • The trust must take effective action to mitigate the increasing risks to patients from overcrowding in the ED.

Medical Care service

  • The trust must ensure that all staff across medical services are up to date with basic life supporting training.
  • The trust must have assurance that the temporary staff being used are competent to fulfil the role.
  • The trust must ensure that resuscitation medicines and equipment are stored in a way to protect from tampering and that storage and availability is consistent across all areas within the medical service.
  • The trust must ensure that the guidance from the Resuscitation Council (November 2016) is being followed.
  • The trust provider must ensure there is sufficient storage for equipment on medical wards to avoid delay in relevant equipment being received by ward staff, and to avoid out of service and in service equipment being stored together.
  • The trust must ensure there is sufficient staffing and skill mix to meet safe staffing requirements on medical wards.

Surgery

  • Ensure measures are in place to prevent further Never Events to protect patient’s safety.

  • Ensure that records of care and treatment provided to patients are accurate and complete.

    Outpatient Department and Diagnostic Imaging

  • Ensure resuscitation trolleys are checked daily, medications and fluid bags are stored appropriately and trolleys are secure and tamperproof.

  • Ensure staff are up to date with their safeguarding mandatory training.

  • Ensure all staff undergo regular assessments to ensure they are competent and confident to carry out their roles.

City Hospital site

BMEC-Emergency Department

  • Increase availability of specialist medical staff and anaesthetists to minimise the risk that children, particularly those younger than three years of age, who attended department receive timely and appropriate treatment.
  • Robust policies and procedures are in place to manage the effective security of prescription forms at a local level.
  • The storage of fluids are tamper proof, in line with Resuscitation Council guidelines.
  • Patient records must meet standards for general medical record keeping by physicians in hospital practice.

Medicine:

  • Ensure compliance with the Mental Capacity Act (2005) is documented.
  • Ensure attendance at mandatory training is improved.
  • Take steps to reduce delays in the patient journey and ensure people are able to access care and treatment in a timely way.

  • Improve the consistency of multi-disciplinary processes and ensure the implementation of consultant led board and ward rounds.

  • Ensure patients have access to translation services when required.

  • Ensure governance structures are embedded and a structured approach is taken to the identification and management of organisational risk.

    Surgery including BMEC:

  • Ensure measures are in place to prevent further Never Events to protect patient’s safety.
  • BMEC mandatory training targets for all clinical staff are met and recorded.

CYP BMEC:

  • Improve local governance and ensure risks to the service are escalated, recorded, acted upon and reviewed in a timely manner.
  • Medical staffing meets needs of patients and the service.
  • Review the storage of emergency drugs and equipment for children and young people
  • Age appropriate facilities are provided with separation of adult and children waiting areas and treatment areas.
  • Mandatory training targets are met and recorded including paediatric life support.
  • A framework for staff to develop and demonstrate competencies to care for children is in place.

OPD including BMEC:

  • Resuscitation trolleys are locked and secured with tamperproof tags.
  • Patient notes are kept securely and confidentially.
  • Sharps bins and clinical waste are stored securely and safely.
  • Consulting rooms in BMEC protect patients’ dignity and privacy, and prevent people from overhearing conversations between staff and patients.
  • There are improvements with staff completion of mandatory training.
  • All staff who carry out root cause analyses are trained to do so.
  • The consulting rooms in the BMEC orthoptics department were large, and two or three patients underwent consultations at the same time, only separated by screens. Patients were able to overhear conversations between staff and other patients in the room. Staff told us they were not able to protect patients’ dignity and privacy due to the way the rooms were set up, but they had one single room they were able to use if patients expressed concern. We asked staff if they told patients about this facility and if staff offered it to patients for their consultation; Staff told us that the patients only used the room if they raised the issue.

Community Inpatients;

  • Review the process for assessing and documenting assessments in accordance with the Mental Capacity Act 2005.

  • Ensure patients are not deprived of their liberty for the purpose of receiving care or treatment without lawful authority, in line with Deprivation of Liberty Safeguards 2010.

  • Ensure that all staff have regard for the protected characteristics under the Equality Act 2010, and support patients in a way that is respectful and promotes their dignity.

  • The service must comply with the requirements of the Data Protection Act 1998, and ensure staff keep service user’s personal data safe and secure at all times.

  • Ensure risk assessments and safety reviews are considered and undertaken where changes to service provision is made.

  • Ensure risk registers are accurate, contemporaneous, and reviewed and update routinely, as required.

Ted Baker

Chief Inspector of Hospitals

Inspection carried out on 14-17 October 2014

During a routine inspection

Sandwell and West Birmingham Hospitals NHS Trust is a provider of both acute hospital and community services for the west of Birmingham and six towns in Sandwell. It serves a population of around half a million people. There are two main acute locations: City Hospital and Sandwell General Hospital; there is also the Birmingham Treatment Centre on the City site. The trust provides community services in the form of inpatients at the Leasowes Intermediate Care Centre and Rowley Regis Hospital, alongside other community services such as district nursing and community palliative care. All community services are offered in the Sandwell area. The Birmingham and Midland Eye Centre based on the City site is a specialist service which will be scheduled for a full inspection separately. Please note we did look at its outpatient department as part of the outpatient core service.

We carried out this comprehensive inspection because the trust is known as an aspirational trust wanting to become a foundation trust. The inspection took place between 14 and 17 October 2014, and unannounced inspection visits took place between 25 and 30 October.

Overall, this trust requires improvement. We rated it good for caring for patients and effective care but it requires improvement in being responsive to patients’ needs and being well-led. We rated the safe domain as inadequate.

Our key findings were as follows:

  • Staff were caring and compassionate, and treated patients with dignity and respect.
  • Shared learning from incident reporting needed to be improved across the organisation.
  • Infection control practices were generally good but there were pockets of poor practice that needed to be addressed.
  • Medicines management was inconsistent. Pharmacy support was good and staff valued the input of the pharmacists. However, across the trust, the safe storage of medicines was not robust. This was an area in which the trust had failed to meet its targets for 2013/14.
  • The trust had consistently failed to meet the national target for treating 95% of patients attending the accident and emergency (A&E) department within 4 hours.
  • Generally community services were good, but required improvement for safety.
  • We were concerned about wards D26 and D11 at City Hospital, which were not meeting the basic care needs for patients.
  • The trust had recognised that end of life care was an area for development for the Bradbury House Day Hospice.
  • The mortuary on both sites had long-standing environmental issues that needed to be addressed.

We saw several areas of outstanding practice including:

  • The iCares service within the community and the diabetic service. These were outstanding and had received national recognition. Critical care services were good overall, with both staff and patients feeling well supported.
  • The compassionate and caring dedication for end of life care with regard to a minor, which was rated as outstanding, especially how the service used the wider healthcare team to meet the needs of the individual. We were confident that this level of support would be repeated in a similar situation.

However, there were also areas of poor practice where the trust needs to make improvements.

Importantly, the trust must:

  • review the levels of nursing staff across all wards and departments to ensure that they are safe and meet the requirements of the service;
  • ensure that all staff are consistently reporting incidents, and that staff receive feedback on all incidents raised so that service development and learning can take place;
  • ensure that all patient-identifiable information is handled and stored securely;
  • follow through from findings of safety audit data, and follow up absence of safety audit data;
  • address systemic gaps in patient assessment records;
  • take steps to improve staff understanding of isolation procedures.

There were also areas of practice where the trust should take action, and these are identified in the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Use of resources

These reports look at how NHS hospital trusts use resources, and give recommendations for improvement where needed. They are based on assessments carried out by NHS Improvement, alongside scheduled inspections led by CQC. We’re currently piloting how we work together to confirm the findings of these assessments and present the reports and ratings alongside our other inspection information. The Use of Resources reports include a ‘shadow’ (indicative) rating for the trust’s use of resources.


Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Organisation Review of Compliance