Birmingham Children's Hospital

Updated 14 June 2024

Birmingham Women's and Children's NHS Foundation Trust is responsible for managing Birmingham Women’s Hospital, Birmingham Children's Hospital and Forward-Thinking Birmingham. It was created by a merger of Birmingham Women's NHS Foundation Trust with Birmingham Children's Hospital NHS Foundation Trust in February 2017. The trust is 1 of 5 trusts within the Birmingham and Solihull Integrated Care System. It has an annual turnover of £535 million, and provides a range of general and specialised services, including tier 4 children’s and young persons mental health services to young people up to the age of 25 years.

We carried out this unannounced inspection of the urgent and emergency care core service at Birmingham Childrens Hospital on 23 and 24 January 2024 because we received information giving us concerns about the safety and quality of the services. We did not look at any other services.

Our overall rating of the location went down. We rated them as requires improvement.

Updated 3 March 2023

Updated 21 February 2017

During our inspection there were no patients at the hospital requiring end of life care, although there were some palliative care patients, therefore we have gained assurance from documents and interviews with staff.

Overall, we rated end of life care at Birmingham Children’s Hospital as outstanding, having safe, effective and well led as good.

• There was a positive, transparent culture of incident reporting and learning from incidents. Sufficient numbers of appropriately qualified and trained staff were on duty to ensure patients were kept safe.

• Staff used national guidelines and evidence-based treatment when looking after patients. The hospital took part in several national audits and staff were encouraged to carry out local audits. Results of audits were used to improve patients’ experiences and care.

• Feedback from parents and patients about the care they received was consistently excellent. Parents, carers and patients we spoke with said staff “went the extra mile” and were “brilliant” or “excellent” and the care given was much more than they expected.

• Patients and their families were treated with respect, dignity and compassion, particularly at the most difficult times, and bereaved parents were given genuine, compassionate care with clear emotional support if a child died. Staff displayed a great sense of pride in the end of life care provided at the hospital. Patients’ needs and those of families and other representatives of patients were considered throughout the process and following death. Parents were involved at every stage and were treated as individuals.

• Patients were treated as individuals and different approaches were taken, when needed, to care for them in the most appropriate way. People from different cultures, backgrounds and religions were supported by staff and adjustments were made to accommodate their needs.

• Leaders had an inspiring purpose and common focus to deliver the best possible care to the children in their care, and this attitude was shared by staff at all levels. Staff across all groups were proud of the organisation as a place to work and spoke highly of the culture. Many staff told us the hospital was “the best place they had ever worked” and said they “couldn’t imagine working anywhere else”.

Updated 21 February 2017

Overall, we rated medical care at Birmingham Children’s Hospital as outstanding. Safe was rated good.

• There was a positive, transparent culture of incident reporting and learning from incidents. Sufficient numbers of appropriately qualified and trained staff were on duty to ensure patients were kept safe.

• Staff used national guidelines and evidence-based treatment when looking after patients. The hospital took part in several national audits and staff were encouraged to carry out local audits. Results of audits were used to improve patients’ experiences and care.

• Feedback from parents and patients about the care they received was consistently excellent. Parents, carers and patients we spoke with said staff “went the extra mile” and were “brilliant” or “excellent” and the care given was much more than they expected.

• Patients and their families were treated with respect, dignity and compassion, particularly at the most difficult times Parents were involved at every stage and were treated as individuals.

• Patients were treated as individuals and different approaches were taken, when needed, to care for them in the most appropriate way. Staff supported people from different cultures, backgrounds and religions and made adjustments to accommodate their needs.

• Leaders had an inspiring purpose and common focus to deliver the best possible care to the children in their care, and this attitude was shared by staff at all levels. Staff across all groups were proud of the organisation as a place to work and spoke highly of the culture. Many staff told us the hospital was “the best place they had ever worked” and said they “couldn’t imagine working anywhere else”.

Updated 21 February 2017

We rated this service as ‘requires improvement’ because we rated safe as inadequate. Effective and responsive and well led as requires improvement with caring rated as good.

• This service lacked clear identity, strategy and clinical leadership, which affected all aspects of care for neonates at this trust. Neonates could be cared for within any department of the hospital; we saw variation in the care babies received dependant on their location.

• This trust had two external reviews of their neonatal service dating back to January 2015 and January 2016 respectively.

• Nurse staffing levels did not meet national standards because of the increased number of babies on NSW requiring high dependency care.

• The trust did not collect adequate data on the quality and performance of neonatal care; this is a national standard. The trust was not fully using the gold standard of the neonatal network IT system to aid effective communication and care planning.

• This service did not always investigate serious incidents because of the lack of recognition of the severity or the potential harm to babies. Senior management lacked this understanding and therefore opportunities to learn from serious incidents were lost. Senior managers also lacked knowledge of risk register management.

• We found several concerns with the safety of the environment and equipment.

• The provision of neonatologists’ from the local maternity unit was not meeting the service level agreement of four hours neonatologist presence Monday-Friday. Senior management described the relationship between surgical paediatricians and the neonatologists’ as ‘unengaged’. Following the inspection we had information from the trust to demonstrate that improvements had been made.

• Mandatory training for registered nurses on the neonatal surgical ward fell below the trust target.

• Safeguarding children training for both nursing and medical staff fell below the trust target.

• Nurses working in neonatal care services require specialist training. There was no clarity on the number of staff required or eligible to complete specialist training, or which course they would be required to complete.

• All levels of staff lacked awareness of the full duty of candour process. Staff did not always recognise the seriousness of incidents and therefore missed opportunities to learn. This increased the risk of them not recognising when duty of candour applied.

• Staff were not aware of a missing child policy. A baby was abducted from NSW in July 2015.The policy was not a standalone policy but since our inspection, the trust said it was addressing this.

However:

• The trust was responsive to the concerns we highlighted following our inspection with immediate actions taken to address leadership and service issues and a strategic plan was made.

• There was a date set for public involvement to discuss the future of the service and to influence improvements.

• The neonatal surgical outreach team was responsive to the individual needs of surgical neonates and provided cross-organisational boundary care to meet these needs. This service had a clear strategy and demonstrated effectiveness of reducing cot days at the trust and out of region transfers.

• Staff were aware of how to report incidents and received some feedback.

• We observed good multi-disciplinary working between professionals.

• Parents praised the care that staff gave their babies and this shown in parent feedback and nominations for local awards. Staff demonstrated the trust values and described the culture as ‘team BCH’.

• The records we viewed met national standards for record keeping.

• The trust had a process in place for assessing and responding to deteriorating children with the provision of the PACE team.

Updated 21 February 2017

We rated outpatient and diagnostic imaging services as good.

The safety and responsiveness of the service was good because:

• There were clear processes for the reporting of incidents.

• Staff were encouraged to report incidents using the electronic incident reporting system.

• We observed staff using appropriate hand washing techniques and personal protective equipment, such as gloves and aprons whilst delivering care.

• Care was provided at flexible times to increase the accessibility of the service being provided.

• The trust involved the Young Person’s Advisory Group when planning the delivery of outpatient and diagnostic imaging services.

There was an outstanding level of caring across all outpatient and diagnostic imaging services because:

• When speaking to children, parents and carers they were continually positive about the care that was provided and the way that staff treated them.

• People told us and we saw that staff made an extra special effort when they provided care. Staff were committed to empowering young people through providing them with appropriate information and support to enable them to make decisions around the care they received.

• Children, young people and their carers told us that they were treated with compassion, dignity and respect.

• We saw numerous examples of staff going beyond the remits of their role to overcome obstacles to ensure the needs of the child, family and carers were met.

• We found strong local leadership in outpatient departments.

However, we also found areas requiring improvement in the well led domain, relating mostly to diagnostic imaging services:

• We observed and staff told us that radiographers and radiologists did not work as a cohesive team.

• The on call system for radiographers was not in line with trust policy with regard to compensatory rest for staff called out during on call shifts.

• The trust wide appointment scheduling system had not been fully implemented in radiology.

• Clinical staff in outpatient departments were performing administrative tasks due to a lack of administrative and clerical support. We observed that this was adding to the delays experienced by patients in the ENT clinic.

Updated 3 March 2023

Updated 21 February 2017

Overall we rated the service as outstanding because:

• There was a holistic approach to planning patient’s transition to other services, which fully reflected individual circumstances and preferences.

• We found there was a real passion and commitment across multidisciplinary teams to deliver a patient centred and high quality service for young people and adolescents (patients) transitioning to adult care.

• There was a transitional care policy for young people with long term conditions and/or disability (the policy) that encompassed the activities needed to support patients transitioning to adult care.

• The was an Adolescent and Transition Forum (A&TF) to ensure the policy was implemented and Young Person’s Advisory Group (YPAG) which had the remit to support and monitor the use of the policy.

• The progress on implementing transition pathways for individual specialties was varied. There were 36 specialities where transition arrangements were either in place and well established or some in the earlier phases of development. Progress was dependent upon the complexity and rarity of individual medical conditions.

• There were a number of specialties participating in national research programs and used the outcome of these to develop innovative and pioneering approaches to high quality care for patients transitioning to adult care.

• Patients received treatment and care according to national guidelines. Transition services obtained good quality outcomes as evidenced by a range of national audits such as the Royal College of Paediatric and Child Health (RCPCH) and the National Institute of Health and Care Excellence (NICE) as a basis to quality assure its transition services.

• Transition services used the Department of Health ‘You’re Welcome’ self-review tool, ‘Quality criteria for young people friendly health services, 2011’ to monitor standards via the Commissioning for Quality and Innovation framework (CQUIN).

• Feedback from patients and parents were positive, children and young people were treated with dignity, respect and kindness. Staff communicated with patients and their parents and provided information in a way that they could understand.

• Transition clinical leads and champions felt valued and supported by their managers and received the appropriate training and supervision to enable them to meet patients’ individual needs.

• There were a range of examples of transition plans. Specialties used innovative and efficient ways to deliver more joined-up care to patients transitioning to adult care. There was a holistic approach to planning people’s transition to other services.

• The service involved other organisations and there were examples of the local community being integral to how services were planned and ensured that services met patient’s needs.

• Transition teams had reviewed its framework and processes for governance to support patients transitioning into adult care.

• Staff we spoke with, minutes of meetings, monitoring data and audit of transition pathways demonstrated the governance processes for transition services were in place for the majority of specialities.

• There was a YPAG which was proactive in ensuring patients were involved in the development, design and delivery of services for children and young people.

• There was an open, transparent culture with a clear vision and strategy for transition services which was led by a strong management team. Staff told us and we saw evidence that they were consulted and part of the development of the strategy, they were engaged and enthusiastic about the new developments within the transition service.

However we found:

• Not all specialities used the trust’s documentation. Plans to support transition for the remaining 16 of the 36 specialities needing amending or further embedding.

• A centralised approach to how information was shared with other external providers when taking over the care of patients transitioning to adult care was in the process of being developed.

• Further work was needed to formalise governance processes so themes and areas of concerns specifically relating to transition could be identified and acted upon in a more timely and effective manner.

• Through conversations with transition clinical leads and champions there was a development opportunity to create a better understanding and appreciation of the needs of adolescents transitioning to adult care.

Updated 14 June 2024