The Care Quality Commission
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Birmingham Community Healthcare NHS Foundation Trust

This is an organisation that runs the health and social care services we inspect

Overall: Requires improvement read more about inspection ratings
Important: Services have been transferred to this provider from another provider
Important: Services have been transferred to this provider from another provider
Important: Services have been transferred to this provider from another provider

All Inspections

17 May 2023, 18 May 2023

During an inspection of Community health services for children, young people and families

Birmingham Community Healthcare NHS Foundation Trust provides community-based healthcare to people of all ages across Birmingham, covering a population of approximately one million people and a geographical area of 103 square miles across Birmingham, Sandwell, Dudley and Walsall. It also provides specialist rehabilitation services including regional rehabilitation services to assist people manage disabilities, and at Birmingham dental hospital for people of the wider West Midlands region, including Warwickshire, Staffordshire, Worcestershire, Shropshire and Herefordshire.

The trust provides services in people’s homes, primary care premises and community inpatient facilities. The trust provides care for people in over 300 locations and approximately 100 of these are managed by the trust.

The trust provides;

• Adult community services – including community nursing and therapy services, Early Intervention intermediate care teams and specialist community services for people with a long-term condition;

• Adult specialist and rehabilitation services – including 300 intermediate care beds, regional rehabilitation services and prison healthcare;

• Children & families – including universal and specialist community children’s services for Birmingham;

• Learning disabilities – services for adults with learning disabilities in Birmingham;

• Dental – tertiary and secondary dental services at the Birmingham Dental Hospital and community dental services for Birmingham, Sandwell, Dudley and Walsall.

At this inspection we inspected the community health services for children and young people in Birmingham. We inspected as we had received information about low staffing numbers particularly in the health visiting service.

We previously inspected this core service in January 2020 when we rated the service as Requires improvement overall, requires improvement for Safe, Effective and Well led, Inadequate for Responsive and Good for Caring. We told the trust it must make the following improvements:

• The trust must ensure that all health visiting teams have safe staffing levels to provide children and their families with the care, treatment, support and advice they need. Regulation 18 HSCA (RA) Regulations 2014 Staffing

• The trust must ensure that all staff are supported at work to reduce the stress they are reporting. Regulation 18 HSCA (RA) Regulations 2014 Staffing

• The trust must ensure it reduces the waiting times for children and families to access neurodevelopmental services for an assessment. Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment.

• The trust must continue to ensure it has effective governance systems and processes in place to identify, assess, monitor and mitigate risk within the children’s community services it provides. Regulation 17 HSCA (RA) Regulations 2014 Good governance.

We found at this inspection that these requirements have been met.

What people who use the service say:

Parents said staff were approachable, friendly and they were happy with support given. Parents had used the ‘Hub’ when they had concerns about their baby and had found the advice given useful.

Parents said that health visitors listened to them and were helpful in giving them advice.

Parents said the health visiting service had improved since they had their other children and they felt well supported.

Parents said that staff were very supportive, were amazing and brilliant.

Overall summary of this inspection:

  • The service had enough staff to care for children, young people and families to keep them safe.
  • Staff had training in key skills, understood how to protect children, young people and their families from abuse, and managed safety well.
  • The service managed and controlled infection and prevention risks well. [EN1]
  • Staff assessed risks to children, young people and families, acted on them and kept good care records.
  • Where staff gave medicines, these were managed 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 to children, young people and families in a holistic way.
  • Managers monitored the effectiveness of the service and made sure staff were competent.
  • Staff worked well together for the benefit of children, young people and their families, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff treated children, young people and their families with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided social, emotional and practical support to children and young people, and families.
  • The service planned care to meet the needs of local people and took account of people’s individual needs.
  • People could access the service in a flexible way.
  • Leaders ran the service well using reliable information systems and supported staff to develop their skills.
  • Staff understood the service’s vision and values, and how to apply them in their work.
  • Staff felt respected, supported and valued. They were focused on the needs of children, young people and families. Staff were clear about their roles and accountabilities.
  • The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • Staff in some offices did not know where the defibrillator was kept.
  • Staff did not always make it easy for people to give feedback.
  • Staff did not always have time to keep children’s and young peoples records up to date.

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.

13/01/20 - 26/02/20

During an inspection of Community health services for children, young people and families

Our rating of this service improved. We rated it as requires improvement because:

  • The health visiting service did not have enough staff to care for children and young people and keep them safe and staff did not always manage control of infection risk well.
  • The trust’s new models of planning and delivering care to meet the needs of local people had not been fully implemented and staff were not always aware of how these new ways of working could improve their planning and delivery of care locally.
  • People could not always access the service when they needed it and sometimes waited too long for treatment, in particular, children and families waited far too long for a neurodevelopment assessment.
  • Staff did not always feel respected, supported and valued by senior managers and were not always clear about their roles and accountabilities within the new models of planning and delivering care.

However;

  • Staff had training in key skills, understood how to protect children, young people and their families from abuse, and managed safety well.
  • Staff assessed risks to children and young people, 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, gave children and young people enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children, young people and their families, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff treated children, young people and their families 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 children and young people, families and carers.
  • Senior managers ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work
  • Staff engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually. They were focused on the needs of children and young people receiving care.

13/01/20 - 26/02/20

During an inspection of Community end of life care

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

  • The service had enough staff 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. 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, checked patients ate and drank enough to stay healthy, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information.
  • 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.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They 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.

13/01/20 - 26/02/20

During an inspection of Community mental health services with learning disabilities or autism

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

  • The service provided safe care. Clinical premises where patients were seen were safe and clean. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented plans of care informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood the principles underpinning capacity, competence and consent and managed and recorded decisions relating to these well.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • The service was easy to access and staff and managers managed waiting lists and caseloads well. The criteria for referral to the service did not exclude patients who would have benefitted from care. Staff assessed and initiated care for patients who required urgent care promptly and those who did not require urgent care did not wait too long to receive help.
  • The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

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

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.

15 May to 21 June 2018

During an inspection of Community health inpatient services

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

  • Patient risks were assessed and managed appropriately and incidents were managed and lessons learned as a result. Staffing levels were planned and managed to ensure patients and staff needs were managed safely.
  • Staff used evidence based interventions and best practice guidelines to ensure positive outcomes for those using the services. They regularly audited their practice and made changes when appropriate. 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 that patients should have their needs met based on their consent. They understood the principles relating to mental capacity and restrictions placed on the patient’s liberty. As such they ensured they practiced in their patient’s best interests.
  • Staff worked compassionately and displayed a caring attitude to those they worked with and those who were involved in patient care. Staff demonstrated a patient centred approach and were emotionally supportive which was relayed to us by those who used the services.
  • All services were delivered with the rehabilitation, wellbeing and comfort of patients at its heart. Patients found services accessible, adjustments were made and resources provided if required. All key stakeholders were involved to ensure everyone’s needs were met. Peoples’ views were encouraged and used to make changes to improve on accessibility and outcomes.
  • Leaders were efficient at managing resources and providing a supportive environment for staff. Staff were supported in their learning and development and there were opportunities to reflect and be supported in professional growth as well as staff wellbeing. Information was shared, staff engaged in service development and research. Governance arrangements were in place and staff understood their responsibilities. There was a culture of putting patients first and staff feeling they played a valuable role in contributing to positive outcomes.

However:

  • The service provided mandatory training in key skills to all staff but did not make sure everyone completed it. This meant the service could not assure itself that staff working in the inpatient units had the skills essential and necessary for the safe and efficient delivery of services.
  • Staff we spoke with understood how to protect patients from abuse, however, not all eligible staff had completed training on how to recognise and report abuse. The trust had not provided staff with child protection level 2 training as mandated in the safeguarding intercollegiate document. When we raised our concerns with the trust appropriate and timely action plans were put in place immediately.
  • There was work to be done on building the strategy, vision and values of the service. This was because of change in the direction of the organisation and new leadership.

15 May to 21 June 2018

During an inspection of Community health services for children, young people and families

Our rating of this service went down. We rated it as inadequate because:

  • There was a lack of a learning culture. Learning from lessons was not always shared to ensure action was taken to improve safety. Following a serious incident within the health visiting service, which occurred in April 2017, learning appeared to have been identified but there was no evidence it had been shared with staff within the trust.
  • There was a lack of understanding of the risks within the service. The trust’s serious incident investigations did not consider broader, systemic issues that may have contributed to an incident, so learning was limited.
  • We found risk management was limited across children, young people’s and family services. Risk assessment was not consistently undertaken to ensure those most vulnerable received timely and effective care and support.
  • Leaders did not always understand the importance of staff being able to raise concerns and appropriate learning and action was not always taken as a result. Concerns raised by staff about their colleagues were not always investigated or acted on which impacted on the care delivered to children. Some staff told us they felt fearful of raising concerns with their managers.
  • We found staffing levels inadequate to provide the level of service required across health visiting, children in care teams and therapy services. The trust was unable to respond effectively to ensure the risk of harm was being assessed and managed.
  • Health visiting teams did not meet the requirements of the healthy child programme or consistently undertake antenatal visits.
  • There was not always a clear approach to monitoring, auditing and benchmarking the quality of all services or the outcomes for people receiving care and treatment within the children, young people and families’ division.
  • Mandatory training compliance did not consistently meet the trust average target of 85%. Safeguarding training did not consistently meet the trust targets and was not in line with intercollegiate guidance.
  • The safeguarding children’s policy did not effectively support staff in the trust’s endorsement of the Birmingham Safeguarding Board (BSB) or the West Midlands protocols.
  • Staff did not adhere to Infection prevention and control best practice, national guidance and the trust’s policies across all children’s services.
  • Care planning was not consistently done and care plans not consistently updated across the service.
  • The service did not consistently achieve the trust target of 90% compliance with yearly appraisals for staff.
  • Staff compliance with Mental Capacity Act 2005 training was below the trust target of 85% for medical and dental staff.
  • The trust was not meeting the referral to treatment (RTT) target of 92% of patients being seen within 18 weeks of the referral within therapy and children’s development centres. Nor were assured that deterioration of the child was not occurring as a result.
  • Compliance with the Equality Act (2010) was ineffective: we found a lack of specialist training for staff to support transgender young people within the paediatric sexual assault service and a lack of information in languages other than spoken English, including medical advice and treatment plans.
  • There was no systematic programme of clinical and internal audit to monitor quality, operational and financial processes or systems to identify where action should be taken.
  • Although leaders understood the challenges to quality and sustainability, and could identify the actions needed to address them, they were not always aware of the performance of their teams.

However:

  • Medicine management was good across the service.
  • Staff across the service had good knowledge of how to safeguard people and what their responsibilities were.
  • Staff supervision was happening, including safeguarding supervision however this was not always consistently provided and undertaken.
  • Staff met the nutritional needs of children and young people, including specialist and non-oral feeds.
  • Competency assessments were undertaken yearly to ensure effective and safe care delivery by staff.
  • Staff were kind and compassionate when delivering care to patients and their families.
  • Staff provided support to patients and families in difficult and emotional situations.
  • Children and young people with additional needs and those with very complex needs were supported by school nurses and the complex care team to attend school.
  • Local team leaders were visible and approachable. Most staff felt supported by their line manager and local leaders.
  • The children in care team and complex care team engaged service users in the development of the services.

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.        

23-27 June 2014

During an inspection of Community health services for adults

Services we inspected provided safe, effective, caring, responsive and well led care. Staff understood how to keep people safe and how to report incidents or concerns. Equipment and facilities were clean and well maintained. Infection prevention and control practices were embedded in how staff worked.

Services were tailored to meet people’s needs and practice reflected national guidelines. Innovative working practices had been employed in many areas, such as pain management and podiatry services some of which had received national recognition.

Staff were polite, caring and compassionate. Practice was observed in a number of locations and disciplines and feedback from patients and families we spoke with was universally good.

Staff training was overseen at local and trust level. Some staff reported difficulty in training due to availability of courses, in particular manual handling training.

Patient feedback, complaints and incidents were analysed to identify themes or learning for individual or groups of staff. Learning from incidents at a local level was good, however we found that learning across departments was less well established. Never events had not been discussed in detail outside the area they occurred.

Local management in the services was good. There was an open and honest culture. Staff in some areas felt disengaged with executive level management, though understood their role and position in the trust but felt that they were not valued.

During the course of the inspection we met with 125 staff. These encounters consisted mainly of individual interviews or small groups of two or three staff within departments; we also conducted focus groups with larger groups of staff from mixed disciplines.

We spoke with 32 patients in a number of scenarios including clinics, home visits. We also received feedback from patients who had completed our comment cards.

23-27 June 2014

During an inspection of Community health services for children, young people and families

Services for children, young people and families were judged to be good. At the time of the inspection services were judged to be safe. Risk was managed and management plans were in place for most services to address concerns regarding expanding caseloads and complexity. There was a robust system in place for clinical safeguarding supervision and all staff reported receiving regular supervision.

Care was effective. The majority of care was evidence based and followed recognised and approved national assessment tools and guidance. There was good multidisciplinary team working within the trust and joint working across local services. There were examples of excellent multi-disciplinary working at Allen’s Croft Children’s Centre hosting awareness events in partnership with local and national organisations.

Care and treatment of children and support for their families, was flexible, empathetic, and compassionate. The trust promoted self-care to empower children and families. Services were committed to delivering care as close to home as possible. There were individual examples where services had learnt from complaints and feedback.

Staff were passionate and proud about the care they provided, there was clear peer support and they felt supported by their managers. Concerns were identified with the responsiveness of services, and some, for example occupational therapy and speech and language therapy were failing to meet the waiting time targets. There was also a need to bridge the gap for the transition from children’s to adult’s services.

Several children and families services had won awards for practice and innovation, most notably  the multi-agency team at Allen’s Croft Children’s Centre received a Nursing Times award for partnership working.

23-27 June 2014

During an inspection of Community health inpatient services

Community inpatient services had systems and processes in place to keep patients safe, and the majority of staff were aware of the systems. Feedback was variable amongst staff and across units. Risk and safety information was displayed on wards, and the majority of staff indicated that this was discussed at team meetings.

Wards were in a good state of repair, were visibly clean and the majority of staff followed appropriate infection prevention practices. Some concerns were identified with out of date stock and unsecured environments and storage facilities.

The quality of records varied, there were concerns particularly on the intermediate care units regarding the completeness of assessment and planning records. Staffing levels met the needs of the patients at the time of our inspection.

There was variation in the use of evidence based practice, and effective assessment and delivery of care across a number of wards and hospitals.

Pain relief and nutrition and hydration needs were assessed appropriately and patients stated that they were not left in pain. There was some measure of patient outcomes, and one ward was involved in a national study to measure effectiveness of care and patient outcomes.

Staff uptake of mandatory training was below the trust’s target in  the month of April 2014. We found that most staff had received little or no training in stroke care and national guidance in stroke rehabilitation was not always followed. The majority of staff received supervision but this was not the case for all staff. Multidisciplinary team working was good.

Staff were committed and hardworking. All of the patients we spoke with had a positive experience, felt their privacy and dignity was maintained and most patients said things were explained to them in terms they could understand. The interaction we observed between staff and patients varied though was mostly positive in nature. However in some areas, staff were task oriented and did not always provide a person centred care approach. Some patients told us that they had not been fully involved in drawing up their care plans.

Some community inpatient services were responsive to patient needs. Discharge planning had been reinforced using the Project Jonah (a trust initiative to hold daily multi-disciplinary meetings to facilitate effective discharge planning) approach, but we found not all areas had formally adopted this approach.

Staff felt supported and valued, and were clearly passionate about delivering good care. Staff views on the trust’s leadership and vision varied but services were well led at a local level in most areas. Not all staff had a clear understanding of the vision of the trust. In some areas, staff felt they were not engaged in decision making about their service and there was not effective two way communication streams.

23-27 June 2014

During an inspection of End of life care

End of life services were good within the trust, we identified some excellent care.  Staff demonstrated a level of compassion and willingness to ‘go the extra mile’ for patients and families. We saw that innovative work was undertaken by the service, where staff had identified areas where their input resulted in improved outcomes for the patients and or their families.

We found the service to be safe. The trust undertook via each division and department audits which enabled conclusions to be drawn about activities. Where improvement or learning was required this was undertaken and shared appropriately with staff and relatives if need be.

We found the service was effective at meeting the needs of the patients on an end of life care plan. The services were highly personalised and holistic. The trust had developed a tool called the Supportive Care Plan for use with patients with a life limiting disease to help them achieve this. Multi-disciplinary team working was used to good effect for patients. 

The end of life service was caring. We found evidence of a level of care which demonstrated excellence.  Staff anticipated patients and family needs. We found that other staff within the team worked to an equally high standard.

The service was responsive to patient needs. The trust understood the needs of its client base, ensuring for example that translation services were readily available to patients whose first language was not English.  We saw that religious practices informed staff interactions so not to cause offence and so they were able to offer advice with these customs in mind.

We found the end of life service to be well-led. At team level staff were well supported, line managers knew their staff well and effectively managed them. Information was shared about the individual services and the trust as a whole. Staff felt they were part of the trust and represented the vision and strategy of the service.  Senior management was effective; governance arrangements were in place to plan for service provision and ensured that actions were disseminated appropriately.     

23-27 June 2014

During an inspection of Community dentist services

The dental services directorate had an open culture and encouraged the reporting of incidents, accidents and near misses. However; staff highlighted concerns regarding the decontamination process and cleanliness and the management of cleaning at Birmingham Dental Hospital. The dental services directorate and the trust were aware of these concerns, had addressed some of them and continued to monitor these issues.

Dental services focused on the needs of patients to ensure their care was effective and in line with best practice. However; staff raised concerns with us regarding the IT system used to record patient information and notes in the combined community dental services. A working group had been established to address and improve the reliability, functionality and sustainability of the IT system.

Patients and their representatives were mostly positive about the care they had received. We observed that patients were treated with dignity and respect whilst receiving treatment. However, some told us they found it difficult to get an appointment or to contact the Birmingham Dental Hospital by telephone.

The dental services directorate was responsive to the needs of patients, including the needs of specific groups of patients with more complex dental care needs.

The trust’s dental services directorate was well-led. Staff told us they felt valued, listened to and supported in their roles and that managers, both within the dental service and the trust, were approachable and visible. Staff we spoke with and observed were passionate and proud of the care they provided to patients in the Birmingham Dental Hospital and combined community dental services.    

Other types of report

As well as standard inspection, intelligent monitoring and Mental Health Act Commissioner reports, there are other types of report that we have published under special circumstances.