• Hospital
  • NHS hospital

Birmingham Heartlands Hospital

Overall: Insufficient evidence to rate read more about inspection ratings

Bordesley Green East, Bordesley Green, Birmingham, West Midlands, B9 5SS (0121) 244 200

Provided and run by:
University Hospitals Birmingham NHS Foundation Trust

Important: This service was previously managed by a different provider - see old profile

All Inspections

24-26 April 2023, 11 May 2023, 13 June 2023 and 4 July 2023.

During a routine inspection

Birmingham Heartlands Hospital is an acute general hospital in Bordesley Green, Birmingham. The hospital is part of University Hospitals Birmingham NHS Foundation Trust and is based on a large site in a purpose-built facility. Birmingham Heartlands Hospital provides a range of outpatient, inpatient and emergency care services for its local community. These include maternity services, services for children and young people, medical services and surgical services.

We completed unannounced visits of the Urgent and Emergency Department due to information of concern. We also completed a follow up to the Pregnancy Assessment Emergency Room within the hospitals maternity services.

8 February 2023

During an inspection looking at part of the service

Pages 1 and 2 of this report relate to the hospital and the ratings of that location, from page 3 the ratings and information relate to maternity services based at Birmingham Heartlands Hospital.

We inspected the maternity service at Birmingham Heartlands Hospital as part of our national maternity inspection programme. The programme aims to give an up-to-date view of hospital maternity care across the country and help us understand what is working well to support learning and improvement at a local and national level.

We will publish a report of our overall findings when we have completed the national inspection programme.

We carried out an announced focused inspection of the maternity service, looking only at the safe and well-led key questions.

University Hospitals Birmingham NHS Foundation Trust provides maternity services across Birmingham, Sutton Coldfield and Solihull. The Maternity department at Heartlands Hospital comprises of delivery suite including triage, postnatal and antenatal wards, day assessment unit, midwife and consultant led clinics, scanning services, a bereavement suite, as well as a maternity led unit, although this was not always able to accept patients.

This hospital is not rated.

We also inspected 1 other maternity services run by University Hospitals Birmingham NHS Foundation Trust. Our reports are here:

https://www.cqc.org.uk/provider/RRK

How we carried out the inspection

We spoke to 25 staff including senior leaders, matrons, midwifes, obstetric staff, specialist midwives, clinical governance and the patient safety team to better understand what it was like working for the service. We interviewed leaders to gain insight into the trusts group leadership model and governance of the service. We reviewed 11 sets of maternity records and 20 prescription charts across the trust. We also looked at a wide range of documents including standard operating procedures, meeting minutes, risk assessments, recently reported incidents and audit results.

We ran a poster campaign during our inspection to encourage pregnant women and mothers who had used the service to give us feedback regarding care. We received 7 feedback forms from women. We analysed the results to identify themes and trends.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

7 to 14 December 2022

During an inspection looking at part of the service

University Hospitals Birmingham NHS Foundation Trust is one of the largest teaching hospital trusts in England, serving a regional, national, and international population. In September 2016, the trust announced plans to merge with the Heart of England NHS Foundation Trust.

The merger by acquisition took place on 1 April 2018. The combined organisation has a turnover of £1.6 billion and provides acute and community services across four main hospitals:

• The Queen Elizabeth Hospital Birmingham

• Birmingham Heartlands Hospital

• Good Hope Hospital

• Solihull Hospital

The trust also runs Birmingham Chest Clinic, a range of community services and several smaller satellite units, allowing people to be treated as close to home as possible. The trust has 2,366 in-patient beds over 105 wards in addition to 115 Children's beds and 145-day case beds.

The trust operates 7,127 outpatients’ and 304 community clinics per week. The trust has over 20,000 members of staff.

We carried out a short noticed unannounced focused inspection of the Medical Assessment Unit as part of the medical care core service on 14 December 2022. We received information of concern about the safety and quality of the service.

Medical Assessment Unit Inspection: Overall service rating: unrated

During the inspection, we focused on our safe and well-led key questions to inspect Ward 22 and Ward 23 of which is the Medical Assessment Unit (MAU) and Same Day Emergency Care (SDEC). This is in the centre block within Birmingham Heartlands Hospital.

We did not have sufficient evidence to rate the overall service.

We rated safe and well led as ​requires improvement​ because:

The service did not have enough nursing and support staff to care for patients and keep them safe.

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

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

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.

Leaders did not always operate effective governance processes throughout the service.

Senior leaders were not always visible and approachable to staff on the wards and MAU.

Senior leaders did not ensure staff felt respected, supported, and valued and understood the service’s vision and values, and how to apply them in their work.

However;

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 safe care records.

Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.

Leaders used reliable information systems and supported staff to develop their skills. Leaders were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. All staff were committed to improving services continually.

Children's and Young Person's Inspection: Overall service rating: unrated

The children’s wards provide care for children and young people up to 16 years of age. The trust managed a large population with 115 children's beds and day care beds.

The paediatric services at the trust include children’s wards and the children’s assessment unit. The trusts high dependency unit and neonatal services are provided at Birmingham Heartlands Hospital and Good Hope Hospital. Outpatient services for children and young people are also provided at Birmingham Heartlands Hospital and Solihull Hospital.

The hospital was the centre providing community paediatric services across the trust. The community service provides support for children who care for children with a learning disability and attention deficit hyperactivity disorder, as well as school nursing and community nursing input.

The service had ongoing challenges due to an increased flow of children across all wards.

We carried out an unannounced focused inspection of children and young people’s services at Birmingham Heartlands Hospital on 7 December 2022. This was conducted as we received information of concern about the safety and quality of the service.

We did not have sufficient evidence to rate the overall service.

We rated safe as requires improvement and well led as good because:

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 cleaning records on ward 15 were kept up to date.

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

However:

The service had enough medical staff. Staff mostly had training in key skills, understood how to protect children and young people from abuse, and managed safety well. The service-controlled infection risk well. Staff assessed risks to children and young people, acted on them and kept good care records. They prescribed, administered and recorded medicines well. The service managed safety incidents well and learned lessons from them.

Staff provided good care and treatment to children and young people. Staff worked well together for the benefit of children and young people and advised them and their families on how to remain safe.

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 children and young people receiving care. 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.

7, 8 June 2021

During a routine inspection

Birmingham Heartlands Hospital is an acute general hospital in Bordesley Green, Birmingham. The hospital is part of University Hospitals Birmingham NHS Foundation Trust and is based on a large site in a purpose-built facility.

Birmingham Heartlands Hospital provides a range of outpatient, inpatient and emergency care services for its local community. These include maternity services, services for children and young people, medical services and surgical services.

02 December 2020

During an inspection looking at part of the service

Birmingham Heartlands Hospital (BHH) is part of the University Hospitals Birmingham NHS Foundation Trust which is one of the largest teaching hospital trusts in England, serving a regional, national and international population. The combined organisation has a turnover of £1.6 billion and provides acute and community services across four main hospital sites:

  • The Queen Elizabeth Hospital Birmingham
  • Birmingham Heartlands Hospital
  • Good Hope Hospital
  • Solihull Hospital

The trust also runs Birmingham Chest Clinic, a range of community services and a number of smaller satellite units, allowing people to be treated as close to home as possible.

The trust has 2,366 in-patient beds over 105 wards in addition to 115 children’s beds and 145 day-case beds. The trust operates 7,127 outpatients’ and 304 community clinics per week. The trust has over 20,000 members of staff.

At the time of our inspection, the trust was 10 months into the pandemic response to COVID-19 with over 450 COVID-19 inpatients. A number of changes to services and ward specialties had taken place since March 2020 in response to the emergency to ensure the trust was able to provide care and treatment as appropriate to the increasing number of COVID-19 patients. Throughout the pandemic, University Hospitals Birmingham NHS Foundation Trust has had a consistently high number of COVID-19 inpatients.

Concerns have been raised through enquiries and serious incident reporting about medical care services at BHH in relation to:

  • Discharge processes and communication
  • Venous thromboembolism (VTE) assessment and management
  • Incident reporting and sharing of learning including Never Events
  • Support, care and treatment for patients with learning difficulties
  • Staffing
  • Poor culture
  • Infection control procedures
  • Nutrition and hydration

These concerns led to a decision being taken to complete an unannounced (staff did not know we were coming) focused inspection on 2 December 2020. We inspected elements of our safe, effective, responsive and well led key lines of enquiry. The inspection was carried out by two CQC inspectors and one specialist advisor. During our inspection we visited eight wards and spoke with 36 members of staff including ward managers, registered nursing staff, healthcare assistants, medical staff and discharge co-ordinators. We reviewed 32 sets of records, including reviewing the electronic patient record. Following our inspection, we held a virtual interview with managers for the medical care.

Following this inspection, we did not re-rate all key questions inspected. We have only re-rated key questions where we identified a breach of regulation. Our rating of this location stayed the same. We rated it as requires improvement because:

  • The service did not always control infection risk well. Control measures to protect patients, themselves and others from infection were not always used. However, equipment and the premises were visibly clean.
  • Venous Thrombosis Embolism (VTE) risk assessments were not always completed on admission or by the time of the first consultant review. However, where indicated staff usually prescribed medicines to prevent the risk of a patient developing a VTE whilst in hospital within 24 hours of admission. Where VTE risk re-assessment was not indicated following the initial risk assessment, staff did not document this decision and the rationale for it on the electronic patient record. This meant staff may not be able to see the most up to date clinical information when reviewing the electronic patient record. VTE risk assessments were not always reviewed by consultants in line with national guidance.
  • The service did not always have enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. However, managers regularly reviewed and adjusted staffing levels and skill mix to mitigate risks.
  • Staff recognised and reported incidents. Managers investigated incidents. However, there were not consistent processes on all wards for sharing lessons learned with the whole team and the wider service.
  • Staff gave patients enough food and drink to meet their needs and improve their health. However, this was not always documented in patient records where required. They used special feeding and hydration techniques when necessary. However, staff did not assess risk of malnutrition for patients admitted to the acute medical unit who had been in more than 24 hours.
  • Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions. Medical staff took time to consult family when making important decisions about a patient care where they lacked capacity. However, we did not always see evidence mental capacity assessments had been documented where indicated in patients where a do not resuscitation decision had been agreed.
  • The service had systems and processes in place to safely discharge patients in a timely manner. However, we did not find these systems were always effectively implemented by staff. Discharge planning was not always commenced upon admission and completed in a structured way.
  • Governance structures were in place; however, they were not always effective throughout the service. Staff at all levels were clear about their roles and accountabilities, however, not all staff had regular opportunities to meet, discuss and learn from the performance of the service.

However:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • The service had systems in place to provide an inclusive service which took account of patients’ individual needs and preferences. Staff were aware of these systems; however, we did not see evidence of them always being implemented. Staff described making reasonable adjustments to help patients access services. They coordinated care with other services and providers.
  • Staff generally felt respected, supported and valued. They were focused on the needs of patients receiving care. However, some staff on wards where there had been significant changes did not feel supported by senior managers.
  • Leaders and teams generally used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact.

23 July 2019

During an inspection looking at part of the service

Birmingham Heartlands Hospital was acquired by University Hospitals Birmingham NHS Foundation Trust on 1 April 2018.

The medical care service at the trust provides care and treatment for ten specialities across four sites; Queen Elizabeth Hospital Birmingham, Birmingham Heartlands Hospital, Good Hope Hospital and Solihull Hospital. The trust had 1,579 inpatient medical beds across the four sites, with 462 of these beds based at Birmingham Heartlands Hospital.

We carried out an unannounced focused inspection of ward 29 (elderly care) at Birmingham Heartlands Hospital on 23 July 2019, in response to concerning information we had received in relation to the care of patients in this ward.

We did not inspect any other core service or wards at this hospital or any other locations provided by University Hospitals Birmingham NHS Trust. During this inspection we inspected using our focused inspection methodology. We did not cover all key questions or key lines of enquiry and we did not rate this service at this inspection. We inspected elements of safe, caring and well-led.

Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity.

During this inspection we;

  • Spoke with seven patients who were using the service and eight relatives.
  • Spoke with 12 members of staff including registered nurses, health care assistants, reception staff, medical staff, and senior managers.
  • Reviewed 10 complete medical and nursing care records relating to physical health.
  • Reviewed five additional patient records relating to observations and sepsis screening pathways.

Our key findings were as follows;

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The service had robust systems in place to ensure the safety of patients. this included risk assessments and monitoring of clinical outcomes.
  • Staff kept appropriate records of patients’ care and treatment.
  • The service prescribed, gave, recorded and stored medicines well.
  • Staff cared for patients with compassion.
  • Staff provided emotional support for patients to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • The service had managers with the right skills and abilities to run a service providing high-quality sustainable care.
  • Managers across the service promoted a positive culture that supported and valued staff.
  • The service was committed to improving services by learning from when things went well and when they went wrong.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Midlands Region)

8 October to 29 November 2018

During a routine inspection

Birmingham Heartlands Hospital was previously managed by Heart of England NHS Foundation Trust. On 1 April 2018 a merger by acquisition took place of Heart of England NHS Foundation Trust by University Hospitals of Birmingham NHS Foundation Trust. As such Birmingham Heartlands Hospital is now part of University Hospitals of Birmingham NHS Foundation Trust.

We have not taken the previous ratings of services at Heart of England NHS Foundation Trust into account when aggregating the trust’s overall rating. CQC’s revised inspection methodology states when a trust acquires or merges with another service or trust in order to improve the quality and safety of care, we will not aggregate ratings from the previously separate services or providers at trust level for up to two years. During this time, we would expect the trust to demonstrate that they are taking appropriate action to improve quality and safety.

At this inspection we did not inspect all eight core services, therefore we are unable to provide an aggregated location rating. We will return in due course to carry out inspections of those core services we didn’t inspect this time. We will then aggregate all of the core service ratings to provide overall key question and location rating for Birmingham Heartlands Hospital.

For an overview of our findings at this inspection please see overall summary above.