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.