Archived: Birmingham Chest Clinic

Birmingham Chest Clinic is located in Birmingham City centre, and is part of the Heart of England NHS Foundation Trust. The clinic forms part of the trusts respiratory medicine directorate, providing specialist outpatient services and imaging services.

We conducted this inspection as part of the comprehensive short notice announced inspection of the Heart of England NHS Foundation Trust on 20 October 2016.

We rated Birmingham Chest Clinic as good overall.

• Staff were appropriately skilled and had completed mandatory training.
• Premises were clean and tidy, cleaning schedules were available which staff followed, ensuring all areas were appropriately covered.
• Medicines were stored and administered safely
• Incidents were recorded, reviewed and learning was shared.
• The trust participated in national clinical audits. We saw how staff used audit outcomes to review their performance and policies. Although the trust performed well in the chronic obstructive pulmonary disease (COPD) audit when compared with other providers; they reviewed the results and identified areas where they could make further improvements. They had created and implemented an action plan.
• Tuberculosis services had introduced systems and working practices, which increased engagement with patients; reducing the number of Did Not Attend (DNA) appointments.
• We saw compassionate and caring attitude displayed by all staff. This included support staff who we observed during telephone conversations with patients.
• Patients told us they had wonderful service from staff and felt like a visit to the clinic was like a visit to family.
• Staff had the training and skills to support patients who might be given bad news about their condition.
• Tuberculosis staff, helped patients understand that TB was simply a disease, reducing the stigma which some patients felt.
• Tuberculosis (TB) services had provided satellite sites where patients who found it difficult to access the city centre could attend for treatment or screening.
• TB staff followed up patients who had missed appointments by phone or by personal visit to encourage continued engagement with the service.
• Adult and paediatric clinics were timed to allow families to attend together reducing the need for multiple appointments and multiple journeys for families with children.
• Imaging services provided a very efficient service with little or no waiting. This included patients using the Chest Clinic and also walk-in patients from other locations in the trust and from GP requests.
• Governance processes ensured that staff were supported to provide services.
• Managers and supervisors were approachable and knowledgeable. Working collaboratively across specialities in managing their staff.
• Executive level managers visited regularly and understood the needs of the service.
• Risks to the service caused by the suitability of the location had been identified and alternative locations were being considered.

However:

• We found that whilst adjustments had been made to accommodate patients with mobility issues; for example the waiting room wheelchair lift, if these were not functioning as was the case on the day of our inspection, there was no safe alternative for patients to use.
• Imaging services throughout the trust, including those at The Birmingham Chest Clinic did not participate in the Imaging Services Accreditation Scheme (ISAS).
• Specialist clinics only operated on certain days in the week and predominantly during working hours. This meant that some patients had limited opportunity to attend without disruption to their work or personal commitments.
• Patient comments about waiting times were not recorded and no analysis had been done to see if improvements could be made.
• We found some opportunities to review the quality of service and make improvements were not being identified.
• Lack of engagement by diagnostic imaging services with Imaging Services Accreditation Scheme (ISAS); reduced the options available to managers to monitor performance and access comparative information.
• The premises were old and although adapted to meet current legislation in terms of accessibility, left patients at risk when equipment such as wheelchair lifts broke down.

We saw several areas of outstanding practice including:

• Tuberculosis services received national recognition for their work in decreasing the number of failed appointments and improving engagement of patients from certain minority groups.
• The lead nurse had written best practice article, which appeared as best practice guidance on the Royal College of Nursing website.

However, there were also areas of poor practice where the trust needs to make improvements.

The trust should:

• The trust should ensure that patient comments such as excessive waiting times are recorded and reviewed to enable opportunities for improvement to be identified.
• The trust should consider improving the environment for children in the waiting areas and treatment rooms as these were not child friendly.
• The trust should consider making more activities available for very young children to help distract them whilst waiting to be seen.

Professor Sir Mike Richards

Chief Inspector of Hospitals