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Provider: Birmingham Community Healthcare NHS Foundation Trust Requires improvement

Reports


Inspection carried out on 13/01/20 - 26/02/20

During a routine inspection

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

  • We rated the trust as requires improvement overall. We rated caring as outstanding, effective as good, and safe, responsive and well-led as requirement improvement.
  • We rated five of the six trust’s services as good and one as requires improvement. In rating the trust, we took into account the current ratings of the two services not inspected this time.
  • Although we recognised that the trust had made significant improvements and the board had improved many of its systems, including the vision, values and strategy, there was further work to be improved and completed. However, we were assured that the board and the trust was on a trajectory of positive change that would improve the experience of patients, families, the local population and staff.
  • Staffing levels of health visitors remained low and staff in these teams were carrying high caseloads. Morale remained low in these teams and staff did not feel that leaders effectively engaged with them. This continued to be a problem that was seen at the previous inspections in 2018 and 2019. However, the trust had improved governance arrangements to address these problems and were working with external stakeholders to recruit into these posts and had a clear trajectory of improving staffing levels up to and including 2021.
  • People could not always access the service when they needed it and did not always receive the right care in a timely way. Children and families were waiting too long for a neurodevelopmental assessment, including 147 weeks for the paediatric Attention Deficit Hyperactivity Disorder (ADHD) service, and 127 weeks for the paediatric physiotherapy service.
  • There was further work to embed IT systems across the trust to ensure staff were using them effectively to monitor and plan care to patients. Not all clinical information was kept in the same place and staff required further support to ensure care plans were used effectively and were up to date.
  • There was further work to engage with all staff groups to fully embed the vision and values of the trust. The staff survey in 2019 showed that less staff engaged with the process than in 2018, and although there were improvements in some areas of staff feedback there were areas that required immediate attention, such as equality, diversity and inclusion, and providing a safe environment for staff. Overall, the trust performed worse in the staff survey compared to comparable trusts nationally.
  • Although the experience of staff from a black, Asian and minority ethnic background had improved since 2018, there was further work to undertake to recruit into senior leaders roles, including band 8A and above.
  • Not all staff were following infection control practice in accordance with infection control standards.
  • There was a need to strengthen learning across the organisation to ensure it was shared across all front-line services.
  • We were not assured that opportunities were in place for the five divisions to learn from each other to drive development and opportunities of front-line services.
  • The trust did not have a defined quality improvement methodology however, we recognised that the trust had plans in place for improvement.
  • The trust did not always respond in a timely way to freedom of information requests.

However;

  • The service had enough staff in most services to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well in most services. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and in most services, did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Most staff understood the service’s vision and values, and how to apply them in their work. The majority of staff felt respected, supported and valued. Leaders had improved staff access to clinical supervision. Staff were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.


CQC inspections of services

Service reports published 27 May 2020
Inspection carried out on 13/01/20 - 26/02/20 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 13/01/20 - 26/02/20 During an inspection of Community health services for adults Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 13/01/20 - 26/02/20 During an inspection of Community end of life care Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 13/01/20 - 26/02/20 During an inspection of Community mental health services with learning disabilities or autism Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 27 May 2020
Service reports published 15 October 2018
Inspection carried out on 15 May to 21 June 2018 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 15 May to 21 June 2018 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Service reports published 30 September 2014
Inspection carried out on 23-27 June 2014 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
Inspection carried out on 23-27 June 2014 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)
Inspection carried out on 23-27 June 2014 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)
Inspection carried out on 23-27 June 2014 During an inspection of End of life care Download report PDF (opens in a new tab)
Inspection carried out on 23-27 June 2014 During an inspection of Reference: chsdentistry not found Download report PDF (opens in a new tab)
See more service reports published 30 September 2014
Inspection carried out on 13 June 2019

During an inspection looking at part of the service

Birmingham Community Healthcare NHS Foundation Trust delivers community-based healthcare services to the1.1 million residents of Birmingham. In addition, the trust provides universal and specialist services to 5.5 million people across 103 square miles of the wider West Midlands region, including Sandwell, Dudley and Walsall.

Over 100 clinical services are delivered from hospitals, health centres, clinics and peoples’ own homes.

We carried out an unannounced focused inspection of the children, young people and families’ service at Birmingham Community Healthcare NHS Foundation Trust on 13 June 2019, to review the assurances we had received relating to a Section 29A Warning Notice, particularly looking into caseload sizes and staffing levels within the health visiting service.

We did not inspect any other core services of Birmingham Community Healthcare NHS Foundation Trust.

We inspected using our focused inspection methodology, particularly looking at the safe domain. We did not cover all key lines of enquiry and we did not rate this service at this inspection.

This was a focused inspection to review evidence of assurance relating to the community health services for children and young people, particularly focussing on health visiting. It took place between 9am and 5pm on 13 June 2019.

We did not inspect the whole core service therefore there are no ratings associated with this inspection.

There were areas of poor practice where we told the trust they need to make improvements.

  • The service must ensure it reduces its health visiting caseload sizes to meet the trust target and work towards the national guidance.

  • The service must ensure it reduces its complex health visiting caseload sizes to meet the trust target.

  • The service must ensure cases involving potentially vulnerable children are handed over in a timely manner when they need to be.

  • The service must ensure that when risks are identified cases are correctly categorised when additional health visitor input is required.

  • The service must ensure that risks are always recorded and appropriate alerts are raised in care records.

  • The service must ensure that the system to maintain a duty health visitor is followed across the service.

  • The service must ensure that it has safe staffing levels.

In addition the trust should:

  • The service should ensure it assesses the impact the geographical working has had on its health visiting staff.

Following this inspection, we sent a letter raising our concerns. In response to our letter, the provider took some immediate actions to address the concerns we raised.

We told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with a Section 31 notice to the trust which is an ‘urgent notice of decision to impose conditions on their registration as a service provider in respect of a regulated activity’. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals

Inspection carried out on 15 May to 21 June 2018

During a routine inspection

Our rating of the trust went down. We rated it as requires improvement because:

  • We rated effective, caring and responsive as good. We rated safe and well led as requires improvement.
  • We rated well led for the trust overall as requires improvement. The rating for well led is based on our inspection at trust level. Taking in to account what we found in individual services. Ratings for other key questions are from combining ratings for services and using our professional judgement.
  • At core service level we rated effective, caring and responsive as good overall. We rated safe and well led as requires improvement. This meant we rated community inpatient services as good overall and community services for children and young people as inadequate overall. In rating the trust, we took in to account the current ratings of the core services not inspected on this occasion.
  • Community health services for children and young people went down from good to inadequate overall. The question of safety went down from good to inadequate. Effective went down from good to requires improvement. Caring stayed the same as good. Responsive stayed the same as requires improvement, and well led went down from good to inadequate. Mandatory training and safeguarding training were below target. The safeguarding children policy did not support staff effectively. Staffing levels and performance were not aligned to national standards. Staff did not adhere to infection prevention and control standards. Systems to secure investigation, audit and learning were inefficient. Care planning was inconsistent and referral to treatment waits were beyond the 18-week target for therapy and child development services.
  • Community inpatient services remained good overall. The question of safety went down from good to requires improvement. Effective, caring, responsive and well led remained good. Patient risks were assessed and managed appropriately and incidents were managed and lessons learned. Staffing levels were planned and managed well. Staff used evidence based interventions and best practice guidelines, auditing their practice. Teams were made up of staff from a wide range of disciplines to meet the needs of the patient groups they worked with. Staff were supported in ensuring they were reflective in their practice and identified learning and skills areas for improvement. Staff understood the principles relating to mental capacity and restrictions placed on the patient’s liberty. Staff worked compassionately and displayed a caring and patient centred approach. Patients found services accessible and stakeholders were involved to ensure needs were met. Leaders were efficient at managing resources and a supportive environment. Governance arrangements were in place and staff understood their responsibilities. We found areas for improvement relating to staff training and appraisals along with patient access to services.

Inspection carried out on 23-27 June 2014

During a routine inspection

We found that the provider was performing at a level which led to a judgement of Good. Services were safe, staff reported incidents and near misses and learning took place. The majority of services had sufficient staff though there were a number of vacancies across most teams, especially administrative staff, which were impacting on the delivery of services. Staff received suitable training and supervision.

Services were delivered using evidence based practice, and were delivered through multidisciplinary teams utilising care pathways. The majority of premises were fit for purpose and equipment was available for staff to access in the community.

Staff were caring and compassionate, and we saw some excellent examples of care especially in end of life services. The majority of services were responsive to the needs of patients, and there were innovative examples of care delivery. However there were some services, particularly in dental and children and family services where services were not as responsive as they should be.

The trust is well led, with an accessible and visible executive team, especially the chief executive and executive nurse. Governance systems and processes are in place and there is performance and quality management information available. Quality is high on the trusts agenda.