Birmingham Women's Hospital

Updated 30 June 2023

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 Women’s Hospital.

We inspected the maternity service at Birmingham Women’s 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.

Birmingham Women’s and Children’s NHS Foundation Trust provides maternity services for the population of Birmingham and the surrounding areas. The fetal medicine centre receives regional and national referrals. The maternity department comprises of delivery suite, 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 birthing centre.

We did not review the rating of the location therefore our rating of this hospital stayed the same

This hospital is rated Good.

How we carried out the inspection

We spoke with 32 staff including senior leaders, matrons, shift leads, midwives, obstetric staff, specialist midwives, receptionists, cleaning contractors, clinical governance leads and safety champions to better understand what it was like working for the service. We interviewed leaders to gain insight into the trust’s leadership model and the governance of the service. We reviewed 8 sets of maternity and 17 medicine records. We also looked at a wide range of documents including standard operating procedures, meeting minutes, risk assessments, recent reported incidents as well as audits and audit actions.

We ran a poster campaign during out inspection to encourage pregnant women and mothers who had used the service to give us feedback regarding care. We received 2 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.

Updated 14 November 2019

• There were significant gaps in safeguarding processes and practices that were not effectively overseen by the senior team or by the trust safeguarding team.
• Incident-reporting processes were inconsistent; staff did not always recognise incidents and learning was not always shared or identified.
• Staffing levels were insufficient to meet demand and there was limited evidence the trust had a robust strategy to address this.
• Local safety systems were not fully functioning and there were gaps in risk assessments, documentation of staff training and equipment servicing.
• There was very limited auditing or benchmarking for radiology services, which reflected inconsistent senior leadership and persistent short staffing.
• Although patients spoke positively about the care they received, communication from staff was not always clear and consistent.
• Radiologists provided an on-call service to help provide urgent care and reduce waiting times for reports. However, the trust had no oversight of this system, which was unofficial and tenuous. Radiologists provided clinical advice and guidance in their own personal time and whilst on duty at another NHS trust.
• Senior leadership in radiology was not functioning. There was no senior clinical oversight of the service, above the radiology professional manager level, and the divisional leadership team was entirely detached from the service. They had no awareness of the significant challenges the departmental team faced and rarely visited the department. During or weekend unannounced inspection, the most senior person in the hospital though the department was closed and was unaware staff were running a full list. This was demonstrative of the lack of engagement between the trust and the department.

However, we also found areas of good practice:

• Most areas that required improvement related only to the radiology/scan department. The early pregnancy assessment unit (EPAU) had more robust safety and governance systems in place.
• Staff in the EPAU had developed extensive local practices for safeguarding that had resulted in improved safety for a number of patients not previously known to be at risk.
• The EPAU team had developed a range of communication tools to help deliver more effective care for patients living with a learning disability.
• Staff engaged well with patients and there was evidence they were able to shape the service and its development.
• The radiology team was responsive to our concerns and we received assurance of immediate improvements in a number of standards. This could be sustainable with more engaged and robust leadership.

The EPAU had more established, robust leadership, systems and processes than the radiology department. Our inspection framework required us to report on both services, with ratings that reflect standards of practice in each. However, as radiology provided the greater proportion of scanning services, our summary statement and ratings reflect this proportionately. Where standards of practice relate to the EPAU team, we note this explicitly.

Updated 14 November 2019

The Birmingham Women’s Hospital became part of The Birmingham Women’s and Children’s Hospitals NHS Foundation Trust in February 2017. This meant our ratings from the last inspection of this hospital in 2016, no longer applied at the time of this 2019 inspection.

We rated it as good because:

• Safeguarding adults, children and young people was given sufficient priority. Staff took a proactive approach to safeguarding and focused on early identification.
• Women who used services had good outcomes because they received care and treatment that met their needs.
• Women who used services were supported, treated with dignity and respect, and were mostly involved as partners in their care.
• Most women’s individual needs were met through the way services were organised and delivered.
• The local leadership, governance and culture promoted the delivery of high-quality, person-centred care.
• There were good safety process, systems and procedures to keep people safe. This included infection, prevention and control, servicing and maintenance of equipment, and storage of medicines and intravenous fluids.
• Staff competency within the termination of pregnancy service were good. Staff were trained and had professional development in the management of physical and emotional aspects of late terminations.
• The perception of the priority given to gynaecology services within the wider trust was equal to maternity services. Developments and improvements to the service and addressing risk was carried out in a timely manner.

However;

• Women were not always protected from avoidable harm. Systems, processes and procedures were not always consistently implemented across the service.

Updated 14 November 2019

The Birmingham Women’s Hospital became part of The Birmingham Women’s and Children’s Hospitals NHS Foundation Trust in February 2017. This meant our ratings from the last inspection of this hospital in 2016, no longer applied at the time of this 2019 inspection.

We rated it as good because:

• The service had enough maternity staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment.
• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses.
• The service provided care and treatment based on national guidance and evidence-based practice.
• Staff monitored the effectiveness of care and treatment.
• Staff treated women with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
• Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for women and staff. They supported staff to develop their skills and take on more senior roles.

Updated 14 November 2019

We rated the service as good because:

• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• The service had suitable premises and equipment and looked after them well.
• Staff completed and updated risk assessments for each neonate. They kept clear records and asked for support when necessary.
• An effective early warning system was in place to identify deteriorating neonates and appropriate action was taken in response to this.
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.
• Staff kept detailed records of neonates’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
• The service followed best practice when prescribing, giving, recording and storing medicines. Neonates received the right medication at the right dose at the right time.
• The service managed neonate safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave parents honest information and suitable support.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• Staff gave neonates enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary.
• Staff assessed and monitored neonates regularly to see if they were in pain and gave pain relief to ease pain.
• Managers monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
• Staff of different disciplines worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Arrangements were in place to ensure neonates could access medical support seven days a week.
• Parents were supported to manage their neonates’ specialist care and wellbeing needs where appropriate to enable them to live healthier lives.
• Parental consent was sought in line with the Children’s Act 1989 and 2004. Staff understood how and when to assess whether a parent had the capacity to make decisions about a neonates’ care and followed current legislation, trust policy and procedures when a parent could not give consent.
• Staff cared for neonates and their families with compassion. Feedback from parents confirmed that staff treated them and their neonates well and with kindness.
• Staff provided emotional support to neonates and their families to minimise their distress.
• Staff involved parents in decisions about their neonates’ care and treatment.
• The trust planned and provided services in a way that met the needs of local people.
• The service took account of the individual needs of neonates and their families.
• People could mostly access the service when they needed it. Arrangements to admit, treat and discharge neonates were in line with good practice.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
• Managers at all levels had the right skills and abilities to run a service providing high quality sustainable care.
• The service had a vision for what it wanted to achieve. However, a formal neonate strategy was not yet in place to outline how this vision could be attained.
• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The service used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
• The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
• The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
• The service engaged well with parents and staff to plan and manage appropriate services effectively.
• The service was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

However:

• The trust’s training compliance targets were not always met.
• Many policies and procedures relating to neonatal care had exceeded their review date which meant we could not be assured that policies and procedures were based on the most up to date areas of best practice.
• Ward rounds were not always completed in a manner that promoted privacy.
• Some staff were unaware of any formal arrangements to ensure the psychological needs of parents were met in the absence of a psychologist.

Updated 30 June 2023