Birmingham NHS Trust told to 'make improvements' as bosses handed warning notice for staffing levels

The University Hospitals Birmingham NHS Foundation Trust has been told to 'make improvements' following Care Quality Commission inspections carried out in December.

An urgent, unannounced inspection was carried out on medical care services at Good Hope Hospital, after a number of concerns were raised by people and their families around the care and treatment they received.

Inspectors were also aware of a number of serious incidents and safeguarding concerns, information about these had been provided by the trust.

Following this inspection, the overall rating for medical care has remained rated as requires improvement.

But, CQC have served the trust with a warning notice as it needed to make significant and immediate improvements to its staffing levels in medical care at Good Hope Hospital.

Inspectors also carried out an unannounced focused inspection of the medical assessment unit (MAU) in medical care and the children and young people’s services at Birmingham Heartlands Hospital.

This was due to receiving information of concern about the safety and quality of services.

In medical care, the ratings for being safe and well-led remained rated as requires improvement.

As it was a focused inspection this service was not rated overall and also remains rated as requires improvement.

Children and young people’s services was rated as requires improvement for being safe and rated good for being well-led.

The overall rating for University Hospitals Birmingham NHS Foundation Trust remains as 'requires improvement.'

'We weren’t assured leaders were...reducing risks to keep people safe,' concerns raised by health inspectors.

Charlotte Rudge, CQC deputy director of operations in the Midlands, said: "When we visited University Hospitals Birmingham NHS Foundation Trust, we found staff working extremely hard under pressure, and treating people with compassion and kindness in all the services we visited.

“However, we weren’t assured leaders were appropriately managing priorities and issues, or reducing risks to keep people safe in medical care at Good Hope Hospital, particularly around staffing levels, which must be addressed as a matter of urgency.

“Additionally, across all the services we visited, there wasn’t enough nursing staff to keep people safe and to provide the right care and treatment. Although, managers regularly reviewed staffing levels and skill mix, they weren’t always able to adjust staffing levels to meet the needs of people on the wards. This impacted on staff morale, who were working incredibly hard but felt they couldn’t always provide the best care to people because of this.

“The staffing issues also meant waiting times and arrangements to admit, treat and discharge people from hospital were being impacted which could put people at risk and have a wider impact on the effectiveness of the local health and social care system.

“However, in children and young people’s services, we found staff completed and updated risk assessments and removed or minimised any risks to the children and young people using the service to keep them safe. Staff also identified and quickly acted when they were at risk of deterioration.

“Due to our findings, we have served the trust a warning notice primarily regarding staffing at medical care at Good Hope Hospital, so that they are clear about what changes must be made to improve people’s care and safety at pace. We will continue to monitor the service and return to check on the progress.”

At medical care at Good Hope Hospital:

• The service did not always control infection risks well.

• Staff did not always assess the nutritional risk of people accurately which impacted on the support required.

• Concerns were raised over how staff worked together for the benefit of people.

• The service struggled to meet demand, which meant people couldn’t always access the service when they needed it and in a timely manner.

• The culture of the service had deteriorated and morale among staff was noticeably low. Staff did not always feel respected, supported and valued.

However:

• Staff understood how to protect people from abuse, and managed safety well. Staff assessed most risks to people, acted on them and kept good care records.

At the medical assessment unit (MAU) in medical care at Birmingham Heartlands Hospital:

• The design of the environment did not follow national guidance and was unsuitable for caring for people, particularly more complex people overnight.

• The service did not have enough suitable equipment to help them to safely care for people.

• The service did not always manage medicines well. Medications were not always administered at the times that had been prescribed.

• Lessons learned from incidents were not always shared with the wider team.

However:

• Leaders used reliable information systems and supported staff to develop their skills. Leaders were focused on the needs of people receiving care.

At children's and young people’s services at Birmingham Heartlands Hospital:

• The service did not always have enough nursing staff with staffing levels regularly below planned levels to care for children and young people. This impacted the morale of some nursing staff.

• The service did not always ensure equipment was safely stored.

• The service did not always ensure personal protective equipment was worn in line with trust policies and guidance to prevent infections within clinical areas.

• The service did not always ensure medicines and controlled drugs were stored and disposed of safely within the high dependency unit.

However:

• The service-controlled infection risk well. They prescribed, administered and recorded medicines well. The service managed safety incidents well and learned lessons from them.

In response to the CQC's finding, Jonathan Brotherton, Chief Executive at University Hospitals Birmingham NHS Foundation Trust, said: “I would like to thank the CQC for their inspection; their findings have highlighted issues that we are working on to improve the care we provide for our patients, as well as the work we are doing to grow the support we provide for our workforce.

“Importantly, the inspectors noted that our teams are working extremely hard under pressure and we are pleased that it was recognised that our teams treat our patients with kindness and compassion. This is something that I would also like to echo.

“Our staffing levels, like much of the NHS, are challenged and we are continually working to address this. We have a strong programme of work to support values-led recruitment, with a clear commitment to bring more brilliant people into our organisation, to continue to provide excellent care.

“Whilst we accept that we do not always get things right, we are pleased that good leadership in many areas and a strong commitment to safety were acknowledged in the CQC’s report.

“We fully accept the CQC’s recommendations, which we are already working through, alongside those in the patient safety review. We are committed to working with the CQC positively and to provide any assurance that is necessary, as we do this work.”