The Care Quality Commission
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Sandwell General Hospital

Overall: Requires improvement read more about inspection ratings

Lyndon, West Bromwich, West Midlands, B71 4HJ (0121) 553 1831

Provided and run by:
Sandwell and West Birmingham Hospitals NHS Trust

All Inspections

4 and 5 September, 11 and 12 September, 18 and 19 September, 19 and 20 September, 9, 10 and 11 October

During a routine inspection

Our rating of services stayed the same. We rated it them as requires improvement because:

  • Our rating of safe was requires improvement overall. Nursing and medical staff were not always available in sufficient numbers to provide safe care and treatment. Mandatory for some nursing and medical staff did not meet trust targets. Systems for protecting patients from the risk of the spread of infection were not robust. Patients records were not always updated or kept securely.
  • Our rating of effective went down to requires improvement overall. Staff did not always understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. Not all staff were appraised, staff work performance and supervision meetings were not always held
  • Our rating of caring remained as good overall. Staff treated patients with compassion and kindness.
  • Our rating of responsive improved to good overall. The trust did not always plan and provide services in a way that met the needs of local people. Not all services always took into account the individual needs of patients. People could not always access services when they needed to.
  • Our rating of well-led remained as requires improvement overall. Managers did not always have the dedicated time and skills to lead services. There was not effective systems for identifying risks managing and planning to mitigate or reduce them. Processes were not always in place to promote learning and continuous improvement. The IT systems in place were fragile and did not support staff to deliver patient care.

28-30 March 2017

During a routine inspection

Sandwell General hospital is a major hospital located in Birmingham, England operated by Sandwell and West Birmingham Hospitals NHS Trust, serving a population of around half a million people. There are two main acute locations, City Hospital and Sandwell General Hospital. The trust also provides community services in the form of inpatients, alongside other community services such as district nursing and community palliative care. All community services are offered in the Sandwell area.

Sandwell General Hospital is an acute teaching hospital and provides range of general and specialist hospital services. The trust was established on 1 April 2002 following approval given by the Secretary of State for Health to amalgamate Sandwell Healthcare NHS Trust and City Hospital NHS Trust.

We carried out an unannounced inspection at Sandwell General Hospital where we only visited the medical service on 16 February 2017. This was followed by a short notice focussed announced inspection on 28 - 30 March 2017, with further unannounced visits on 6 and 11-13 April 2017.

We have made judgements about five core services within Sandwell General Hospital and rated each one individually. However, we have not provided an overall rating for Sandwell General Hospital as this does not form part of our regulatory process for focussed inspections.

Our key findings were as follows:

  • Incidents were reported, investigated and learned from to improve safety and staff were committed to being open and honest with patients when things went wrong.

  • The trust had an identified clinical audit lead for the urgent and emergency care department.

  • Urgent and emergency care service trust wide met the RCEM standard of patients being treated within one hour of arriving.

  • The trust’s monthly average total time in ED for all patients was consistently lower than other English trusts and this was a stable trend.

  • The hospital routinely collected and monitored information about patient care and treatment and their outcomes.

  • There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.

  • Multi-disciplinary team (MDT) working was evident throughout the hospital.

  • There was a holistic approach to patient, care was tailored to meet patient’s individual specific needs. The service regularly reviewed the complex care needs of patients to promote coordinated, safe, and effective palliative and end of life care.

  • The mortuary on both had improved its flooring and condition since inspection 2014

  • The service provided access to care and treatment 24 hours a day, seven days a week.

  • An IR(ME)R committee monitored, analysed and reported incidents in the diagnostic imaging department. All IR(ME)R documentation was in place a vast improvement since inspection 2014.

We saw several areas of outstanding practice including:

End Of Life Care

  • The palliative and end of life care service ensured that patients and their families were involved in their care and their choices and preferences were upheld, including where they would prefer to be for their care and when they died.

  • The palliative and end of life care service integrated coordination hub acted as one single point of access for patients and health professionals to coordinate end of life services for patients.

  • The service provided access to care and treatment in both acute hospitals and in the community, seven days a week 24 hours a day.

  • The service reacted speedily to referrals by providing an urgent response team in order to meet patient’s needs quickly.

  • Staff went the extra mile to ensure patients received the right care in the right place at the right time.

  • Staff showed great compassion, empathy and an understanding of patient’s needs and preferences.

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

Importantly, the trust must:

Action the hospital MUST take to improve

Emergency Department

  • Storage and availability arrangements of emergency medicines required for resuscitation follow Resus Council Guidance and robust arrangements are put in place to manage the risk and ensure that medicines for resuscitation were protected from tampering.

  • Improve the standard of records completed by doctors when patients are admitted to wards from the ED.

  • Patients in the ED receive treatment within one hour of arriving in line with the Royal College of Emergency Medicine (RCEM) recommendation.

  • Staff identify patients at risk of sepsis and follow the sepsis pathway in place.

  • Doctors use the appropriate proforma in place for effective clinical pathways.

  • Sufficient substantive registrar cover overnight for the safety of patients.

  • Ensure there is a designated appropriately safe room available within which to care for patients with mental ill health

  • Ensure the security and safety of staff working in the ED at all times.

  • Unplanned re-attendance rate to the ED within seven days is reduced.

  • Information about patients’ assessment and condition recorded by consultants and doctors is sufficiently detailed, precise and legible.

  • Patients are treated within one hour of arriving.

  • Patients are admitted, transferred or discharged within four hours of arrival in the ED.

  • Take effective action to mitigate the increasing risks to patients from overcrowding in the ED and respond effectively to risks identified and escalated by ED local leaders.

Medical Care service

  • All staff across medical services are up-to-date with basic life supporting training.

  • Temporary staff being used are competent to fulfil the role.

  • Resuscitation medicines and equipment are stored in a way to protect from tampering and that storage and availability is consistent across all areas within the medical service.

  • Guidance from the Resuscitation Council (November 2016) is being followed.

  • Sufficient storage for equipment on medical wards to avoid delay in relevant equipment being received by ward staff, and to avoid out of service and in service equipment being stored together.

  • Sufficient staffing and skill mix to meet safe staffing requirements on medical wards.

Surgery

  • Measures are in place to prevent further Never Events to protect patient’s safety.

  • Records of care and treatment provided to patients are accurate and complete.

Outpatient Department and Diagnostic Imaging

  • Resuscitation trolleys are checked daily, medications and fluid bags are stored appropriately and trolleys are secure and tamperproof.

  • All staff are up to date with their safeguarding mandatory training

  • All staff undergo regular assessments to ensure they are competent and confident to carry out their roles.

Action the hospital SHOULD take to improve

Emergency Department

  • Consider reviewing arrangements in place to support the number of newly qualified nurses allocated to the ED.

  • Reviewing arrangements in place in order to successfully rotate staff between Sandwell Hospital and City Hospital ED sites.

  • Consider reviewing arrangements in place for Human Resources support to the ED staff team and leaders.

Medical Care service

  • Using a consistent approach for documentation across the medical service. We saw variations in fridge temperature documentation and patient records.

  • Staff are knowledgeable and understand the policies in place to prevent and control infection.

  • Updating the disinfectant solution log to ensure it reflects clearly how long a solution has been pre-made for.

  • Staff are consistently completing relevant risk assessment documentation.

  • All staff are confident with procedures and up to date with relevant training for emergency events, such as fires.

  • All staff are clear about Deprivation of Liberty Safeguards (2007) and when it is appropriate to make an application to authorise a deprivation of liberty.

  • Continue with improvements made to reduce waiting times and average length of stay for some specialities.

  • Continue with improvements to gain JAG accreditation for the endoscopy unit

Surgery

  • Review the system of pooling surgical patients to ensure that patients are not put at risk.

  • Identify a non-executive board member to champion theatres issues at board level and support the service.

  • Repair work surfaces in theatres to comply with infection prevention and control guidance.

  • All junior doctors are familiar with escalation process should patients treatment or discharge be delayed by imaging department issues.

  • Safety thermometer information is displayed on the wards. Staff members should be aware of their ward scores.

  • Competencies for nursing staff working in surgical specialisms should be revisited after their initial competency ‘sign off’ stage.

  • Wider learning is promoted through complaint trends being shared across all areas of the trust.

    Outpatient Department and Diagnostic Imaging

  • System and environment for taking children’s bloods is child friendly including a children’s phlebotomist.

  • Staff in the phlebotomy department confirm the time when numbing cream has been applied by the children’s outpatients department prior to taking any blood samples.

  • Patients are given the opportunity to be weighed in private.

  • Prescriptions for controlled drugs (FP10’s) are stored securely at all times in accordance with trust policy.

  • Hand hygiene compliance is regularly monitored and recorded in the outpatients department.

  • Staff have an understanding of their responsibilities in relation to the Mental Capacity Act, 2005.

  • Patients' notes are kept securely at all times in the outpatients department.

  • Staff know who the safeguarding leads are at the trust.

  • Staff appraisals are up-to-date.

  • Equipment and furniture in the outpatients department is moved regularly to enable a thorough clean.

End Of Life Care

  • Updated ‘Anticipatory Medication Guidelines’. We could not be assured staff were following the most up-to-date guidelines.

  • Mandatory training for mortuary staff includes infection control training.

  • Medical staff document reviews of patients care on their specialist care plans when these are being used.

Ted Baker

Chief Inspector of Hospitals

14 - 17 October 2014

During a routine inspection

Sandwell and West Birmingham Hospitals NHS Trust is a provider of both acute hospital and community services for the west of Birmingham and six towns in Sandwell. Serving a population of around half a million people. There are two main acute locations; City Hospital and Sandwell General Hospital, on the City site is also Birmingham Treatment Centre. The trust also provides community services in the form of inpatients at Leasowes Intermediate Care and Rowley Regis Community Hospitals. Alongside other community services such as district nursing and community palliative care. All community services are offered in the Sandwell area.

We carried out this comprehensive inspection because the trust is known as an aspirational trust wanting to become a foundation trust. The inspection took place between 14 and 17 October 2014 and unannounced inspections visit took place between on 25 and 30 October.

Overall, this trust requires improvement. We rated it good for caring for patients and effective care but it requires improvement in being responsive to patients’ needs and being well-led. We rated the safe domain as inadequate.

Our key findings were as follows:

  • Staff were caring and compassionate and treated patients with dignity and respect.
  • Incident reporting shared learning needed to be improved across the organisation.
  • Infection control practices were good but with pockets of poor practice which needed to be addressed.
  • Medicines management was inconsistent. Pharmacy support was good and staff valued the input of the pharmacists. However, the safe storage of medicines was not as robust, which we saw across the trust. This was area in which the trust failed to meet its targets for 2012-2013.
  • The trust has consistently not met the national target for treating 95% of patients attending A/E within four hours.
  • Generally community services were good with the exception of safe which we rated as requiring improvement
  • We were concerned about wards D26 and D11 at City Hospital which was not meeting basic care needs for patients.
  • The trust had recognised that end of life care was an area for development for them the Bradbury Day Hospice
  • The mortuary on both sites had longstanding environmental issues which needed to be addressed.

We saw several areas of outstanding practice including:

  • The iCares service within the community and the diabetic service were outstanding and had received national recognition. Critical care services were good overall having both staff and patients feeling well supported.
  • The compassionate and caring dedication for end of life care with regard to a minor was rated as outstanding, especially how the service utilised the wider healthcare team to meet the needs of the individual. We were confident in a similar situation this level of support would be repeated.

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

Importantly, the trust must:

  • The trust must review the levels of nursing staff across all wards and departments to ensure they are safe and meet the requirements of the service.
  • The trust must ensure that all staff are consistently reporting incidents and that staff receive feedback on all incidents raised so that service development and learning can take place.
  • The trust must ensure that all patient identifiable information is handled and stored securely.
  • The trust must follow through from findings of safety audit data and follow up absence of safety audit data.
  • The trust must address systemic gaps in patient assessment records.
  • The trust must take steps to improve staff understanding of isolation procedures.

There were also areas of practice where the trust should take action which are identified in the report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

27, 28 June 2013

During a routine inspection

This inspection was conducted by a compliance manager, seven inspectors and an expert by experience. During the inspection we visited nine wards. Spoke with 74 people who were in patients, 26 relatives and 34 ward staff of various grades. In addition we spoke with a number of senior managers.

Everyone using the service that we spoke with told us that their privacy and dignity had been maintained during their stay in hospital. One person told us, 'The curtains are always pulled round me when we talk and I have been treated really well. People always introduce themselves before talking to me.' We found that people's privacy, dignity and independence were respected.

All the people that we spoke with told us that before they were asked for their consent, treatment was discussed with them in a way that they understood. This included the risks and benefits of the treatment. One person said, 'The situation was explained and I understood what was said.' At our last inspection we found that the trust did not always act in accordance with regulations in determining people's capacity to make decisions for themselves. In addition we had received concerns that key decisions about people's end of life care were being made, without discussion with relatives. We spoke with people and their relatives about this and we looked at 16 records where these decisions had been made. We found that, there had been significant improvements in how these decisions were taken.

With the exception of one person's relatives, all of the other people who were in-patients and their relatives that we spoke with told us that their medical and nursing needs were being met. One person told us, 'The care I have had here is excellent.' 'I have been well looked after.' On all the wards that we visited, we saw that staff were generally caring and committed to their work. We found that people experienced care, treatment and support that met their needs and protected their rights.

The overwhelming majority of people that we spoke with during the inspection, told us that they were happy with the quality of service they received. One person told us, 'I don't think that anything could be done better.' At our last inspection we identified that complaints were not responded to in a timely manner, staffing ratios were not at a level that would enable a quality service to be maintained. In addition we had identified that appropriate systems were not in place to ensure that learning from incidents informed staff's practice. During this inspection we found that there had been significant improvements in this area. Whilst we acknowledge that there were on-going areas for improvements, such as staffing and completing the reorganisation of the complaints process, the trust had plans in place to support this. We therefore found that there was an effective system to regularly assess and monitor the quality of service that people received.

28 September and 1 October 2012

During a routine inspection

During this inspection we visited three departments. We spoke with ten people who were using the service on the day and 19 staff.

People felt that they were able to give their consent before being treated or examined. One person said 'Yes, they tell you what they are about to do, for example take blood.' We found that improvement was needed to show how the trust determined that people lacked the capacity to make some decisions for themselves.

People told us that their medical and nursing needs were met. One person told us that they had been seen immediately on arrival at the emergency department due to their condition. This person said they had been to the hospital before with the same complaint they told us that, 'Both times they have been excellent. I can't fault the staff.'

People said that all their records had been transferred with them when they moved between departments. Staff we spoke with said they had good access to people's medical information.

Everyone who used the service that we spoke with felt they had received safe care. Staff knew how to report concerns about people's safety and welfare should they need to.

People we spoke with spoke highly of the staff. We found that overall staff received the training and support they needed to do their job.

Most people we spoke with said they did not know how to complain. However we found that there was a robust system in place for investigating complaints.

9 July 2012

During an inspection in response to concerns

We had received information that people were not always treated with respect and dignity. People had told us that they were not always kept informed about what was happening and that staff were not always helpful.

We visited wards Priory 4 and Lyndon 4. No one knew we would be visiting that day. We spoke with six members of staff and five people who were receiving care and treatment. A number of people on these wards had dementia care needs and were not able to tell us about their experiences. We spent some time observing their care and interactions from the staff. We were unable to speak to relatives as visiting hours had not commenced at the time of our visit.

We saw that staff treated people with respect and dignity. One person said 'They pull the curtains around, they only have to see a sight crack in them and they are there to pull them together, there is no indecency here, nothing like that'.

People told us that they knew who was looking after them. They told us that they knew what was happening with their care and that staff answered their questions. People told us that they made their own decisions and we saw staff offering people choices.

All of the people we spoke with told us that they were satisfied with the care and treatment they had received. One person said "The care has been excellent, I could not fault it, it's not their specialty on here but they found out and answered all my questions'.

Staff received a range of training so that they had up to date knowledge and skills in order to support people's individual needs.

Staff were motivated and wanted to tell us what they did well and how they had improved since our last visit. They also told us about things they wanted to improve further.

During an inspection looking at part of the service

We reviewed the progress the Trust had made since our review of compliance in July 2011.

We found that there had been a significant amount of work undertaken in order to address the large backlog of complaints. This work has now been completed and the Trust is able to respond in a timely manner to all people who contact their complaints department.

We spoke with people who were waiting in this backlog for a response from the Trust. They told us they had been contacted. They said 'it has taken a while for them to contact me but once they did they were very helpful and progress has been made'. Another person said, 'the people who contacted me were very clear with their information about what was happening, this made me feel that I was being listened to. I'm still waiting for resolution to my complaint but at least I know that someone is looking at my issues now', and 'my issues are not yet resolved, I've had so many problems trying to get a response from them that things only moved forward when I contacted the Chief Executive in person'.

We considered the statistical information the Trust sent to us following the last review of compliance. We also spent time speaking with the Trust's complaints and litigation manager and the head of the Patient Advise and Liaison Service (PALS).

16 December 2011

During an inspection looking at part of the service

Sandwell General Hospital is part of Sandwell and West Birmingham Hospitals NHS Trust (the trust). In March 2011 and August 2011 we carried out reviews of Sandwell General Hospital. These reviews were part of a targeted inspection programme in acute National Health Service (NHS) hospitals to assess how well older people are treated during their hospital stay. In particular we focused on whether people were treated with dignity and respect and whether people's nutritional needs were being met. Both our March 2011 and August 2011 reviews showed that Sandwell General Hospital was not compliant with the outcome areas we assessed which were:

Outcome 01- Respecting and involving people who use services (we assessed that there were moderate concerns in this area both in March and August 2011).

Outcome 05- Meeting nutritional needs (we assessed that there were major concerns in this area in March 2011 and minor concerns in August 2011).

Following our August 2011 review the trust closed a ward called Newton 4 as this is the ward where we identified shortfalls and concerns.The trust have kept us updated with their plans to make improvements.

We carried out this December 2011 review to check whether Sandwell General Hospital had made improvements. The wide range of evidence that we gathered during this review confirmed compliance with both outcome areas.

A reconfiguration of wards and stroke provision has taken place. There are two dedicated wards to care for people who have suffered a stroke. Newton 1 is the acute assessment ward and Newton 4 is dedicated to stroke rehabilitation.

We assessed both of these wards as part of our review. Staff told us how the reconfiguration of wards had benefitted people in terms of there being clear stroke care pathways from the time they arrive at accident and emergency through to assessment, rehabilitation and discharge.

Staff wanted to speak with us. They wanted to tell us about the improvements that had been made. They told us how these improvements and changes were having a positive impact on the people that were being cared for on their wards.

All of the staff we spoke with highlighted the importance of "team working" and how everyone had an important role in making sure that people received a good standard of care. Staff were enthusiastic about the changes and improvements that they had made. Staff at all levels were aware of the need to continue with the work they had undertaken to make sure that improvements are furthered and sustained. Below are a few comments staff made;

"Things are where they should be now it was terrible before. It has taken a lot of hard work to get where we are now but things are a lot better".

"Staffing levels are better and leadership is better. There have been great improvements since March".

"There have been a lot of changes since August. Newton 4 was very busy and people were heavily dependant. Staff did not understand expectations. We have put a lot of processes into place to improve and improvements have been made".

"We have more time to spend with people to give them reassurance".

On both wards we spent time observing. We observed staff engaging with people. We listened to find out if staff gave people choices and spoke with them politely. We watched staff to see how they supported people to eat their meals. We looked at records to make sure that the care delivered was personalised and effective. Our findings from these observations demonstrated improvement and compliance.

We spoke with people to find out their views on the care provided. In total we spoke with twelve people across both wards.

People were complimentary about the care and service they had received. People made positive comments about their treatment and the staff. Below are a few comments people made;

"Everyone has been extremely kind to me".

"Have been treated well here, can't better it".

"Nothing could be improved".

"The staff are absolutely wonderful, I can't fault them at all. They do everything they can for me".

"Honestly, I can not complain about anything".

"The food is nice. We have choices every meal time".

"The food is not a problem".

3 August 2011

During an inspection looking at part of the service

Sandwell General Hospital is part of Sandwell and West Birmingham Hospitals NHS Trust (the trust). In March 2011 we carried out a review of Sandwell General Hospital. This review was part of a targeted inspection programme in acute National Health Service (NHS) hospitals to assess how well older people are treated during their hospital stay. In particular we focused on whether they were treated with dignity and respect and whether their nutritional needs were met. Our March 2011 review showed that Sandwell General Hospital was not compliant with the outcome areas we assessed which were:

Outcome 01- Respecting and involving people who use services (we assessed that there were moderate concerns in this area).

Outcome 05- Meeting nutritional needs (we assessed that there were major concerns in this area).

We carried out this review to check whether Sandwell General Hospital had made improvements in respect of these two outcome areas.

We assessed two wards during our inspection; the Emergency Assessment Unit (EAU) and Newton 4 (which provides care to people primarily who have had a stroke). In total we spoke with eleven people. However, out of these eleven, due to individual conditions and communication levels only nine people could answer our questions in detail.

Overall people who were able to talk with us were happy with their care and treatment. People also made positive comments about the food and drink provided. Below are some of the comments they made:

'I am very pleased with everything on EAU. All staff including the doctors keep me informed and they always ask how I am feeling or if there is anything I need'. This person further stated 'Nothing could be improved on EAU'.

'They are very good'.

'I am informed of my situation. The staff are very good and they are polite. Overall everything is OK, better than when I was in another hospital ten years ago'.

'The food is very good. I am more than happy with it. In fact I was going to fill a comments form in'.

On both wards we spent time observing the care provided to people and looking at records, an example being, records of diet and fluid intake. Our observations showed that although improvements have been made since our March 2011 inspection there was still non-compliance particularly regarding how staff protect and/or promote people's dignity. We observed situations that could have been avoided. The outcome for the people involved was that their dignity was not maintained. We also found that further improvements are needed so that people can be assured that their nutritional and hydration needs are met.

Following our inspection the trust informed us that they had taken the decision to close Newton 4 and replace it with two separate units for acute stroke and stroke rehabilitation. The trust told us that the ward would be closed in September 2011 and general medical admissions to the ward would cease immediately.

28 March 2011

During a themed inspection looking at Dignity and Nutrition

Patients we spoke with gave mixed views about their experiences of care and treatment. A number stated that they were kept informed and were involved in making decisions about treatment. Some patients told us that they had their care needs met and had been treated respectfully. One patient told us that their experience could not have been better. They described one ward as being 'marvellous'. They said; 'Staff come and talk to you, have time and give you a hug if you are feeling down'. Other comments made by patients were; 'Not really listened to. Some staff just seem to do their own thing regardless of what I say'. Staff can be gruff and miserable. Doctors talk down to you. Nursing staff are rushed when caring because there are not enough'. One patient told us; 'not very nice' being placed in a bay, on a ward with patients of opposite gender.

'NHS choices' is a NHS national and local information giving website which also enables people to make comments about NHS services they have received. There were six positive comments submitted to NHS choices between March 2010 and January 2011 for Sandwell and West Birmingham Hospitals NHS Trust (the trust) overall. These detailed encounters with attentive, caring staff who treated patients with respect. There were also six negative comments three of which made reference to rude or disrespectful behaviour by some staff.

Some patients we spoke with were happy about their experiences of mealtimes. They commented that there was a good choice of food. However, some were not happy with the quality of food provided and felt that it could be improved. A patient commented 'give you menu food, horrible. Good food wasted. I feel sorry for those who have to be fed'.