Birmingham Women and Children’s NHS Trust rating falls after CQC inspection

Improvements will need to be made at the Birmingham Women and Children’s NHS Foundation Trust following inspections in June, July, August 2022 and October 2023.

The trust runs the Birmingham Children’s Hospital and Birmingham Women’s Hospital in Edgbaston.

The Care Quality Commission (CQC) carried out the inspection as part of its programme of ongoing check on the safety an quality of healthcare services with its inspectors visingt the following areas across the trust:

• specialist community mental health services for children and young people,
• child and adolescent mental health wards (CAMHS),
• community-based mental health services for adults of working age and
• mental health crisis services and health-based places of safety.

The inspection also looked at critical care and surgery at Birmingham Children’s Hospital. Following the inspection, due to concerns found within the specialist community mental health services and CAMHS wards, the trust was issued with a letter of intent telling them urgent enforcement action would be taken if significant assurances were not made. The CQC said that the trust responded to this and put in place ‘sufficient mitigation to reduce the risk to people using the services’.

Trust’s rating falls

Following the inspections, the trust’s overall rating has dropped from ‘good’ to ‘requires improvement’. Caring dropped from outstanding to good, responsive and well-led dropped from good to requires improvement, effective remained good and safe remained requires improvement.

The overall rating for mental health services at the trust dropped from requires improvement to inadequate.

However, inspectors were impressed by the level of care being provided at Birmingham Children’s Hospital which remained rated outstanding overall, as well as outstanding in the areas of effective, caring and responsive.

What was said about the inspection?

Lorraine Tedeschini, CQC’s deputy director of operations in the Midlands, said: “When we returned to Birmingham Women and Children’s NHS Foundation Trust, whilst we saw a continuation of exemplary care at Birmingham Children’s Hospital in critical care and surgery services, we saw a deterioration in the care being provided within the community based mental health services, which is why we took immediate action to ensure people are safe.

“Staff didn’t always review or complete risk assessments for each child or young person, including after an incident within the mental health service. For example, one young person’s risk assessment had not been updated since 2018 despite records stating they were at risk of self-harm and suicidal thoughts.

“It was concerning that staff weren’t continually monitoring children and young people on mental health waiting lists for changes in their level of risk in order to intervene if anything changed. “Due to those concerns, we told the trust we intended to take enforcement action if they didn’t make immediate improvements to how they are managing incidents at the service. The trust responded and took quick action to address our concerns in this area.

“We did also see several positive areas of work. Leaders ran acute services well using reliable information systems and supported staff to develop their skills. Staff told us they felt respected, supported and valued and were focused on people’s needs.

“The trust must also be commended for being outstanding across most areas in acute services at Birmingham Children’s Hospital. This is a great achievement and a sign of quality leadership and hardworking staff. We will continue to monitor the trust closely to ensure the necessary improvements are made to keep people safe in the areas we found concerns, and we will expect to see sustainable improvements the next time we inspect.”

What was found during the inspection?

Inspectors found the following during the inspection:

• In acute surgery services, staff did not always ensure that risks associated with the environment and equipment were consistently mitigated.
• Not all staff in Forward Thinking Birmingham (FTB) services worked well together for the benefit of patients.
• In specialist community mental health services for children and young people, children and young people sometimes had to wait long periods of time for their treatment.
• The FTB service was not well-led, governance processes did not ensure that procedures relating to the work of the service ran smoothly.
• In acute surgery services, care records were not always stored securely ensuring personal and sensitive information was protected. Staff in FTB services did not always understand the individual needs of children and young people who used the service.
• They did not always actively involve children, young people and their families in care decisions.
• FTB services did not always have enough nursing staff and support staff to keep patients safe,

What did the Trust do well during the inspection?

The report said:

• Managers mostly monitored the effectiveness of services and made sure staff were competent.
• Staff in acute services treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
• Staff felt respected, supported and valued, and were focused on the needs of patients receiving care.
• Most services planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
• Staff in the paediatric intensive care unit (PICU) assessed risks to patients, acted on them and kept good care records.
• The trust had a “Stop. Challenge. Change” tool which provided staff with a confidential system to report any incidents of discrimination, harassment or bullying.