8 reasons University Hospitals Birmingham NHS Trust has been downgraded by the Care Quality Commission

The Care Quality Commission (CQC) has downgraded the NHS Trust, which includes the Queen Elizabeth and Heartlands hospitals

Queen Elizabeth Hospital Birmingham

University Hospitals Birmingham NHS Foundation Trust has been told to improve its services by the Care Quality Commission (CQC).

The CQC downgraded the trust from ‘good’ to ‘requires improvement’ following an inspection in June which identified concerns about the safety and responsiveness of services.

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The NHS trust sees 2.2 million people every year across its sites and its hospitals deliver more babies than anywhere else in Europe.

Which hospitals are managed by the NHS Trust?

The main NHS services that the trust manages are:

Birmingham Heartlands Hospital

Queen Elizabeth Hospital Birmingham

Solihull Hospital and Community Services

Good Hope Hospital in Sutton Coldfield

Birmingham Chest Clinic

Accident and emergency (A&E) wait times across Scotland have hit a record high for the third successive week

What did the CQC inspection look at?

The inspection covered urgent and emergency care at Good Hope Hospital, Birmingham Heartlands Hospital and Queen Elizabeth Hospital Birmingham.

It also assessed medical care at Good Hope Hospital, surgery at Queen Elizabeth Hospital Birmingham and the trust’s cancer services.

Inspectors also considered whether the trust was well-led, as leadership is a key driver of the quality and safety of care healthcare providers offer people.

Following the inspection, the trust’s overall rating moves from good to requires improvement, and its rating for being well-led moves from outstanding to good.

The trust’s ratings for whether care was safe and responsive to people’s needs move from good to requires improvement. It remains rated good for whether its services are effective and caring.

Heartlands Hospital Birmingham

Why did the CQC downgrade the NHS Trust?

1) At the time of the inspection, the emergency department at Birmingham Heartlands Hospital was under significant pressure, with extremely high numbers of patients attending.

2) Inspectors found patients waiting to be seen in the department were not always monitored effectively, and safety checks on equipment were not always completed.

3) Where lack of space in the department led to patients waiting outside on ambulances, appropriate steps were not consistently taken to ensure patient safety. This was despite staff raising concerns about the risks created by overcrowding.

4) Although the emergency departments at Queen Elizabeth Hospital Birmingham and Good Hope Hospital were performing better, urgent and emergency care staff across the trust told inspectors they felt that the trust’s leadership held them solely responsible for risk, issues and performance measures and did not appreciate these were part of a whole system.

5) Frontline staff also highlighted a lack of collaborative working across the trust to improve patient flow and help drive major improvements in patient experience and outcomes.

6) At Good Hope Hospital, medical care, which includes older people’s care, suffered from long-standing staffing pressures. It did not always have enough nursing and support staff with the right experience to keep patients safe from avoidable harm or always provide the right care and treatment.

7) Services across the trust had been impacted by staff sickness. Managers regularly reviewed and adjusted staffing levels and skill mix, however the number of medical and nursing staff did not always match planned numbers.

8) Additionally, inspectors identified issues with the safe storage of medicines, infection control and equipment.

Reports have highlighted claims of bullying at the highest level of the organisation.

Were there any aspects of healthcare at the NHS Trust that the CQC praised?

However, despite the pressure they were under, staff across the trust interacted with patients compassionately. They also worked collaboratively within teams to support good patient outcomes.

Inspectors also identified some outstanding practice, especially in Queen Elizabeth Hospital Birmingham’s cancer services. Its haematology department demonstrated European-leading therapies and shared its knowledge with other services.

Similarly, trailblazing work was underway on blood tests with potential to diagnose over 50 types of cancer.

What has University Hospitals Birmingham NHS Foundation Trust said about the CQC report?

Fiona Allinson, CQC deputy chief inspector of hospitals, said:

“Our inspection identified concerns regarding the oversight of risk and the steps being taken by the trust’s leadership team to support staff to mitigate this – particularly in relation to urgent and emergency care and surgical services.

“We also found variation in the extent to which staff felt respected, valued and supported to carry out their roles, with some staff telling us their concerns about patient care were not listened to or acted upon by the trust’s leadership.

“There were concerning disparities in processes and guidance across hospital sites since the acquisition of Heart of England NHS Foundation Trust in 2018, and some staff expressed concern about the impact of this on patient safety.

“However, despite the unprecedented challenges the trust faced throughout the COVID-19 pandemic, the workforce remained unwavering in its focus on the needs of patients.

“We saw that patients were treated with compassion and kindness, and there were some areas of good and outstanding practice – particularly in cancer services at Queen Elizabeth Hospital Birmingham.

“We continue to monitor the trust closely to support it where it must improve, and to help it sustain areas where it is meeting high standards for patients.”

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