Queen Elizabeth Hospital Birmingham

Updated 8 March 2024

The Queen Elizabeth Hospital Birmingham (QEHB) is part of the University Hospitals Birmingham NHS Foundation Trust which is one of the largest teaching hospital trusts in England, serving a regional, national, and international population. The hospital is a 1,215 bed, tertiary NHS and military hospital in the Edgbaston area of Birmingham, situated close to the University of Birmingham. The hospital provides a range of services. The hospital has the largest solid organ transplantation programme in Europe. It has the largest renal transplant programme in the United Kingdom, and is a national specialist centre for liver, heart, and lung transplantation, as well as cancer studies. It is also a regional centre for trauma and burns.

Updated 14 February 2024

Updated 13 February 2019

Our rating of this service stayed the same. We rated it as good because:

• The safeguarding team and senior ward staff maintained consistent standards of safeguarding. Teams thoroughly investigated safeguarding incidents and implemented learning that improved practice and patient safety.
• Standards of infection control practice, such as hand hygiene, were consistently good during our inspection. Infection control was audited and monitored by a dedicated team and housekeepers with extended training.
• A range of systems and strategies were in place to assess patient risk. This included electronic deterioration monitoring systems, out of hours senior medical cover and advanced training for staff in managing acutely unwell patients.
• Antimicrobial stewardship and sepsis programmes were well established with a rolling, comprehensive programme of audits and substantive training programmes for staff and doctors.
• Shared learning was a significant focus for staff and there was extensive evidence of detailed, multidisciplinary investigations of incidents and complaints that led to improved practice and training.
• Staff delivered care and treatment in line with national and international standards and clinical guidance. Systems were in place to ensure this remained current and specialities were demonstrably motivated to achieve accreditation status with professional bodies.
• Medical care services had a significant research profile and staff were supported to develop projects that placed them on the leading edge of current knowledge in their specialty.
• Allied health professionals were highly active in audit, benchmarking and research and led numerous projects that positively impacted medical care services. One project, relating to dietary management in radiotherapy patients, resulted in 88 saved bed days.
• Pain services were multidisciplinary, comprehensive and led by audit and research benchmarking.
• Audits to drive service improvement and to improve understanding of patient behaviour were embedded across medical specialties. Staff were passionate and motivated in the development of audit plans, such as in recent examples of a wide-ranging falls review project and a health promotion focus on alcohol and tobacco reduction.
• Multidisciplinary specialist teams facilitated a wide range of education, learning and development opportunities for staff. This focused on future service sustainability, the development of a highly specialised in-house workforce and the retention of staff through internal development.
• Staff demonstrated resourcefulness and resilience when managing highly complex situations that involved multiple agencies and organisations.
• There was extensive evidence of staff going beyond their responsibilities to deliver individualised, compassionate care that made a significant difference to patients and others living in challenging circumstances.
• Teams had developed processes and communication strategies to increase the involvement of patients in their care planning. This was reflected in new handover processes, consistently good documentation of conversations with patients in medical records and positive results in the NHS Services Seven Days a Week Forum's seven-day services priority standards for patient involvement.
• Staff continually looked for new ways to further meet patients’ needs to improve their experience and ensure the service maintained momentum.
• Staff were dedicated to safely reducing the length of stay for inpatients, reducing delayed discharges and improving flow and capacity. Multiple innovative projects and trials contributed to this, reflecting efforts from different groups of staff, including clinical teams, allied health professionals and divisional groups.
• Ward teams and specialties were responsive to learning from complaints and implemented changes and improvements as a result of learning.
• Divisional governance and leadership structures were clearly embedded in the operation of clinical services and leadership teams had developed effective systems of quality and performance improvement.

However, we also found areas for improvement:

• There were significant shortfalls in some elements of medicines management, including in storage and disposal, that had not been addressed by pharmacy teams.
• Staff described their greatest challenge and cause of staff as persistent shortages in nursing teams.

Updated 8 March 2024

Updated 15 May 2015

Overall we rated end of life care services as ‘good’. Staff provided compassionate care for patients. Services were very responsive to patients’ individual needs and those of their families and next of kin. We saw and heard about many examples where practical, emotional and spiritual needs were considered and met.

Although the trust did not take part in national audits, data from their own survey showed that relatives were positive about the quality of care and their experience of the service. We observed comprehensive and dynamic multidisciplinary working taking place, which covered all aspects of care. The trust’s electronic information system ensured that do not attempt cardio-pulmonary resuscitation (DNACPR) records were managed safely. Medicines were prescribed and administered in a safe way and there was guidance available for anticipatory medications.

At the time of our inspection, the service was on the cusp of significant change which the trust believed would enhance and improve the service. It was clear that leaders of end of life care services worked collaboratively across the hospital and their commitment to delivering a good quality service was evident.

Updated 14 February 2024

Updated 13 February 2019

We previously inspected outpatients jointly with diagnostic imaging so we cannot compare our new ratings directly with our previous rating.

We rated it as good because:

• Staff were clear on how to report incidents and received feedback from investigations. The service had a clear process to investigate and learn from incidents through root cause analysis. It communicated any findings across the services and to patients and families in line with the Duty of Candour
• Arrangements were in place to minimise risk to patients and these were supported by policies and procedures. Risks to outpatients awaiting a follow up appointment were appropriately managed. Nurses and clinicians had a high level of awareness of how to care for vulnerable patients. The service was delivering an enhanced level of safeguarding training to level 3 to ensure all nursing staff were trained to safeguard children
• Since our last inspection, governance, risk management and performance management in outpatients and cancer service had improved. Task and finish groups addressed specific improvement projects in outpatient services, and risk and quality were managed at specialty and divisional level.
• Action planning to drive performance had improved since our last inspection. Outpatients and cancer specialties developed action plans and trajectories to address underperformance and recover backlogs. They recruited to areas where they lacked capacity and used locums where necessary. There were specialty level, divisional level and corporate meetings to monitor performance and progress on action plans in outpatients and cancer services
• Patient list monitoring processes were in place, supported by technology which enabled staff and leaders to clearly identify where patients were on their treatment pathway
• Access and flow in the service improved since our last inspection. It had the technology to monitor patients waiting times in clinics and investigated the root cause when patients had waited more than 60 minutes. This led to a problem-solving approach to delays, and shorter wait times
• The service had tailored consultation times to the needs of outpatients with complex conditions. It had increased the facilities available for them by moving more specialist clinics to other buildings, in response to the overcrowding we found in our last inspection. This allowed more complex outpatients to have longer consultations. Specialities also reviewed templates and consultation times within the Queen Elizabeth outpatient clinics and developed action plans to make improvements
• Leadership had strengthened around performance improvement. Meetings at appropriate levels within specialties and weekly RTT and RCA assurance meetings meant that leaders took decisions to improve performance, requested action plans and monitored them
• Outpatient specialities responded to local needs and were adapting services to meet increasing demand. The services responded to unmet need and this was leading to new types of clinic. Specialties were working in partnership with HGS and commissioners to deliver new services in the community, and using new technology such as virtual clinics
• Outpatient specialties demonstrated a strong approach to working with other services to deliver joined-up holistic treatment for patients. The cancer service had 24 multidisciplinary teams which meant they tailored treatment to the individual patient as much as possible. Highly trained clinical nurse specialists ran clinics which gave outpatients practical support and increased access to services
• The service ensured that unqualified and qualified nursing staff were competent to work in clinics. Staff were encouraged to develop their skills and this was supported by the outpatient clinical educator role, and mentoring from experienced nurses. The outpatient service did not use agency nursing staff, instead preferring to use in-house bank staff with the appropriate level of training if there was a staff shortage
• Clinicians and nurse were kind and reassuring with outpatients. They displayed understanding of the needs of older patients, people living with dementia and learning difficulties
• The service supported outpatients well. Clinical nurse specialists provided good emotional support to patients with life changing diagnoses in outpatients and cancer services. For example, an Eye Clinic Liaison Officer gave practical help to patients adjusting to sight loss and clinical nurse specialists talked through diagnoses with cancer patients
• The service adapted to the needs of some patients for example, there were bariatric chairs in waiting areas and access to interpreting services for those who did not speak English as a first language. Specialist liver nurses visited liver clinic patients in prisons.
• Many of the outpatients and cancer services were innovative. For example, the cancer service was active in the 100,000 Genomes project and had tumour boards in place. The ophthalmology specialty was nominated in the UK Ophthalmology Awards for its Uveitis service.

However:

• For the period July 2017 to June 2018 the trust performed worse than the 85% operational standard with a rate of 76.0% for patients receiving their first treatment within 62 days of an urgent GP referral. The England average for this time was 82.1%. Trust performance was 79.6% in August 2018. At this hospital 65.3% of patients referred by their GPs were treated within 62 days
• The service did not have a systematic approach to identifying and planning for the access and communication needs of diverse groups of patients. For example, it was not always easy for older people to find their way to the appropriate waiting area because there was no visually accessible internal plan of the hospital provided with the appointment letter
• Procedures around checking resuscitation trolleys and fridges were not sufficiently embedded and we found examples of non-compliance
• Flow did not always work smoothly for patients. The queuing system before arrival at fracture clinic meant that frail or injured outpatients had to stand for up to 20 minutes before proceeding to x-ray
• Patient privacy was not always maintained. A drugs storage room doubled as a room where staff took blood samples from patients and this process was interrupted by members of staff entering to remove supplies
• Services did not work seven days a week, although some clinics offered appointments at the weekend or during the evening

Updated 15 May 2015

Staff received mandatory and specialist training to meet patients’ needs. Staff were knowledgeable about incident reporting and received feedback on lessons learned Infection control procedures were being followed. Medicines were being stored appropriately.

Evidence-based care was provided by competent staff and in accordance with national guidelines. An annual schedule of national and local audits took place to monitor the effectiveness of treatment. The results were regularly monitored within governance meetings and reported back to staff to implement changes to practice where required.

We found the sexual health services to be caring. Patients spoke highly of the staff and the service they had received. Patients were treated with dignity and respect. Patients felt supported and were given clear explanations about their care and treatment.

There was flexible access to clinics with booked and walk-in appointments. Early morning and evening appointments were available to accommodate people who worked during the day. Clinics were situated across Birmingham to provide more local services.

 Some nursing staff who had previously worked in sexual and reproductive health service felt unsupported, undermined and not valued by management. However, there was a disparity between staff groups as medical staff and nursing staff who had previously worked in genitourinary medicine did feel well-supported. Medical staff who previously worked in sexual and reproductive health service felt the same. We acknowledged that this was a newly integrated service but improvements were needed to ensure that all staff felt supported.

Updated 8 October 2021

Updated 14 February 2024