Birmingham Women's and Children's NHS Foundation Trust

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Leaders at every level were visible and led by example, modelling inclusive behaviours. Leaders were knowledgeable about issues and priorities for the quality of services and could access appropriate support and development in their role. Leaders were alert to any examples of poor culture that might affect the quality of children’s and young people’s care and have a detrimental impact on staff and addressed this quickly. Staff and leaders actively encouraged staff to raise concerns and promoted the value of doing so. All staff were confident that their voices will be heard. There were clear and effective governance, management, and accountability arrangements. Staff understood their role and responsibilities. Staff and leaders were open and transparent, and they collaborated with all relevant external stakeholders and agencies. Staff and leaders worked in partnership with key organisations to support care provision, service development and joined-up care. Staff and leaders had a good understanding of how to make improvement happen. There were processes to ensure that learning happened when things went wrong, and from examples of good practice.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff said that managers had an open-door policy, were visible and interested in their wellbeing. Staff said they regularly saw senior managers including executives and they were responsive and supportive. Staff said executive team members acted on issues raised and the whole improvement process at Parkview had been led by executives. They said this had enabled them to have open and honest conversations about what did and did not work and had helped to have realistic timescales for improvements. Staff said that their wellbeing was prioritised, and managers said they had tried to create a culture where staff felt truly listened to. The recruitment, retention and wellbeing lead had led on a quarterly staff survey which included asking staff how they were feeling, their safety and what opportunities they needed to develop. This gave managers good qualitative information about suggestions and ideas from staff. They provided feedback to staff about what they were doing about their ideas through newsletters and on the rolling screen in reception. Staff told us they were given time to learn and develop. Staff said that training was accessible and if relevant to their job role they could attend specialist courses. Staff told us that morale had improved at Parkview.

Staff knew how to contact the Freedom to Speak Up Guardian and said they were easy to contact if needed. Staff said they would feel comfortable to raise concerns if they needed to and would not be victimised for doing so.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff told us about the regular audits that included risk assessments, care plans, training, and the environment. This cycle of audits had been developed as part of the Parkview quality improvement plan. Staff said there were daily operational meetings from Monday to Friday, so managers knew about the acuity of people on the wards, the risks, people’s dependency levels which determined how safe the staffing levels were. From this they could adjust staffing levels and told senior managers where they may need to have additional staff for shifts. This also meant they knew about incidents and how these were dealt with, and any learning was fed back to staff on the wards.

There was a clear improvement plan that identified the workstreams. This clearly detailed how improvements were to be made and who was responsible for doing so. The leads of these workstreams reported to the trust board and their partners and there were clear lines of accountability. Audits showed that where improvements were needed an action plan was created with nominated staff to action and clear timescales. This meant that it was clear how and by whom improvements were to be made. People told us of a data breach where information had been sent to the wrong family. The trust told us about this, and action taken to minimise risks with an apology to the family. The trust had also referred themselves to the Information Commissioners Office about this breach at the time the breach occurred, one month before the visit. We saw on Heathlands ward the names of people admitted to the ward on the outside of the office door including 1 person’s full name. We raised this with the trust who took immediate action to reduce this risk.

Managers said that the relationship with the West Midlands Provider Collaborative (WMPC) was good, and they were supportive. The senior Parkview Nurse Managers meet regularly with WMCPC Nursing leads for Quality and Care pathways. Managers had clear guidance on what issues needed to be reported to them which they did via a specific framework and process.. Managers said they were working with the WMCPC about reopening Ashfield ward, and they felt their views were listened to and respected. They had a plan in place, agreed with the WMCPC. The Ashfield reopening project group which included doctors, nurses, therapists, psychologists, facilities staff and managers met weekly to discuss workforce, resourcing, equipment, facilities, seclusion suite and the project risk register.

We attended the monthly quality improvement group meeting with partners where partners challenged and asked Parkview managers to provide evidence of improvements. Partners told us they could see improvements were being made and had renewed confidence in the service.

Managers told us how they had worked to improve quality at Parkview. They had reviewed the structures to see what needed to improve. They had reduced agency staff usage and improved staff sickness figures. They had clinical leadership on all wards and internal peer reviews and quality walkabouts identified what improvements were needed. Managers at Parkview told us how the trust executive team had been involved in and had supported the changes which included staff recruitment and retention at all levels. There was now an associate director of nursing, head of nursing and matron in post at Parkview. They attended handovers, went onto wards early in the morning to work alongside the night staff and observed practice. Managers had also improved the security arrangements and there was now 24-hour security cover. This had improved the management of keys and passes. A security group involving the Trust's Governance team oversaw the governance arrangements of security at Parkview. Managers told us how they had been successful in their application to ‘Hospital rooms’. Hospital rooms is an arts and mental health charity which commissions artists to create thoughtful, therapeutic, and creative environments in mental health units focusing on co-production with people who use the service. This will enable them to change the whole environment involving the young people.

We saw evidence of learning from people's observations not being completed or recorded in March 2024. In response to this the ‘Safe and supportive observations policy’ was reviewed and updated. This included the multidisciplinary team to ensure observation levels were clearly documented and discussed in handovers between shifts and the observation record sheet was updated so there was space to record. The Matron and the Governance lead complete spot checks and audits of people’s observation records to ensure staff were following the new policy.