Birmingham Women's and Children's NHS Foundation Trust

Updated 14 June 2024

The emergency department at Birmingham Children’s Hospital provides a 24-hour, 7 day a week service to children and young people in the local area and beyond. The service is a member of a regional trauma network and a designated trauma unit for children and young people. The department can provide care for a wide range of medical conditions, minor illnesses, and injuries through to major trauma.

From March 2021 to February 2022, the emergency department saw over 62,957 children and young people. Children, young people and their parents/carers were referred by 999 calls, their GPs or attended ‘self-referring’ walking into the reception area. There were 5 beds and a cubicle in the observation area, 10 cubicles, 3 resuscitation beds, 19 bedded paediatric assessment unit and the clinical decision unit had 11 beds for GP, specialty referrals and for accommodating patients waiting for admission. The minor injury area consisted of a treatment room, 5 bed spaces and a seating area.

We inspected the service on the 23 and 24 January 2024. The inspection team comprised an operations manager, 2 inspectors, 3 specialist advisors which included a consultant in paediatric emergency medicine, a modern matron and a Child and Adolescent Mental Health Service specialist advisor. An operations manager oversaw the inspection.

During our inspection, we visited all areas within the children’s emergency department including paediatric assessment unit.

Throughout our inspection we spoke with 34 staff including doctors, nursing staff of various grades, healthcare support workers, advanced nurse practitioners and managers.

We reviewed a total of 26 patient records and spoke with 12 children, young people and their relatives.

You can find further information about how we carry out our inspections on our website.

Our rating of the service went down. We rated it as requires improvement because:

• The service provided mandatory training in key skills but not all staff completed it. The service did not provide training to care for patients with complex needs. Not all relevant staff were trained to the appropriate level of life support training. The service did not always control infection risk well. Staff did not always use control measures to protect patients from infection. The design and use of facilities and premises did not always keep people safe. There was limited provision for specialist mental health assessment for patients presenting with acute mental health needs. Controlled drug recording did not always follow the Misuse of Drugs regulations 2001. Learning from serious incidents was not always embedded to improve patient safety.
• Not all staff knew how to protect the rights of patients subject to the Mental Health Act 1983. Not all staff understood their responsibilities in managing patients experiencing mental ill health. The service did not always monitor the effectiveness of care and treatment. Not all staff had received training in consent, Mental Capacity Act and Deprivation of Liberty safeguards.
• The service was inclusive but did not always take account of patients’ individual needs and preferences. People did not always receive the right care promptly.
• The service did not always collect reliable data to enable them to analyse it to inform performance monitoring and future improvements. Information systems were not all integrated. Implementation of quality and safety improvements was not always timely. Arrangements were in place with partners and third-party providers, but these were not always effective.

However:

• Staff-maintained equipment well and were trained to use it. Staff quickly acted on patients at risk of deterioration. Managers regularly reviewed staffing levels and skill mix, and gave bank staff a full induction. Staff kept detailed records of patients’ care and treatment. Records were clear, up to date, stored securely and easily available to all staff providing care. The service managed patient safety incidents well.
• The service provided care and treatment based on national guidance and evidence-based practice. Staff gave patients enough food and drink to meet their needs. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. The service made sure staff were competent for their roles. Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. Key services were available 7 days a week to support timely patient care. Staff gave patients practical support and advice to lead healthier lives.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned and provided care in a way that met the needs of local people. People could generally access the service when they needed it. It was easy for people to give feedback and raise concerns about care received.
• Leaders had the skills and abilities to run the service. They were visible and approachable. The service had a vision for what it wanted to achieve and a strategy to turn it into action. Staff felt respected, supported and valued. Leaders and staff actively and openly engaged with patients, staff and equality groups. They collaborated with partner organisations to help improve services for patients.

Updated 3 March 2023

Updated 15 December 2023

We carried out this short time announced focused inspection because at our previous inspection we rated the mental health services at the trust overall as Inadequate. We rated Safe, Responsive and Well-led as Inadequate and Effective and Caring as Requires Improvement.

At our previous inspection we rated this core service of Specialist Community Mental Health Services for Children and Young People as Inadequate overall; we rated Safe, Responsive, and Well-led as Inadequate and Effective and Caring as Requires improvement.

Birmingham Women's and Children's NHS Foundation Trust is responsible for managing Forward-Thinking Birmingham. The Trust was created following a merger of Birmingham Women's NHS Foundation Trust with Birmingham Children's Hospital NHS Foundation Trust in February 2017. The trust is one of five trusts within the Birmingham and Solihull Integrated Care System (ICS).

Forward Thinking Birmingham is registered by the Care Quality Commission (CQC) to provide the following regulated activities: Assessment or medical treatment for persons detained under the Mental Health Act 1983, Diagnostic and screening procedures and Treatment of disease, disorder or injury.

Forward Thinking Birmingham is one of the largest Child and Adolescent Mental Health Services in England. It has a dedicated inpatient eating disorder and acute assessment unit for regional referrals of children and young people with the most serious mental health concerns s (Tier 4) and provides community mental health service for 0–25-year-olds.

This was a core service inspection of the specialist community mental health services for children and young people at the Parkview clinic location. We visited all the sites where this core service operated from:

South Hub, Oaklands Centre Raddlebarn Road, Selly Oak Birmingham

East Hub, Blakesley Centre, 102 Blakesley Road, Yardley, Birmingham

North Hub, Finch Road, 2 Finch Road, Lozells Birmingham

West Hub, Finch Road, 2 Finch Road, Lozells Birmingham

At this inspection our rating of this core service ​improved​. We rated them as ​requires improvement​ because:

• Although there had been improvements in how staff assessed and managed the individual risks of children and young people, managers did not always take timely action to ensure clinical premises where people were seen were safe and well maintained. Clinical premises were not maintained and monitored in a way that mitigated all identified risks.

• The trust had taken some action since the previous inspection to ensure premises were fit for purpose. However, staff raised concerns about disabled access to the sites, inability to control temperature, child and adults shared facilities, lack of clinical space, and some necessary equipment was obsolete. Following this inspection, the trust told us of the plans to move the East Hub early in 2024 to a more suitable location. The trust was aware of the environmental risks and this was reflected in the trust’s estate strategy. Providing alterative accommodation is dependent on capital funding and regional approval processes which we will monitor through our engagement with the trust. All environmental concerns identified on the audits were included as open risks on the trust risk register and monitored through the trust’s non – clinical risk committee.

• Children and young people’s privacy and dignity were not always protected and promoted. Not all interview rooms in the service had sound proofing to protect privacy and confidentiality.

• The teams did not include or have access to the full range of specialists required to meet the needs of the patients. There were nursing, multidisciplinary team and consultant vacancies. These vacancies had an impact on the internal waiting lists for allocation of these specialists.

• Managers had not ensured that all staff had accessed supervision, and appraisal.

• Staff with more limited experience supported patients and were included in the duty cover system. However, they were supported by a lead clinician who was accountable for the clinical caseloads and the duty cover system.

• Although there had been a recent reduction in some waiting lists, the service was not always easy to access. Some children and young people were waiting over 18 weeks to access services or interventions that they needed.

• Our findings from the other key questions demonstrated that governance processes did not always operate effectively at team and trust level to ensure that performance and risk was well managed.

• Mental Health Act and Mental Capacity Act training were combined. At this inspection overall only 73% of staff had received training for Mental Health Act and Mental Capacity Act and at East Hub this was lower at 66%.

• The service had not acted on feedback from children and young people about the environment at the East Hub including the waiting area, hallways and entrance, and therapy rooms.

However:

• Managers and staff had made some improvements to the service following our previous inspection. We saw improvement in how staff assessed and managed individual risk concerns, identified, managed and shared learning from risk incidents, and in multidisciplinary and multiagency working, including safeguarding.

• The trust used systems to help them monitor waiting lists and staff assessed and treated patients who required urgent care promptly. The criteria for referral to the service did not exclude children and young people who would have benefitted from care. Managers monitored caseloads and had improved processes to ensure people were not ‘lost to follow up’ and that staff contacted children and young people who did not attend appointments.

• Staff worked well together as a multidisciplinary team and with relevant services outside the trust. Staff assessed and managed risk well and followed good practice with respect to safeguarding. Specialist safeguarding nurses offered enhanced support across sites.

• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.

• Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

• A family therapist at South Hub told us they involved an expert by experience in groups to assist with therapeutic support. (An expert by experience is a person who has personal experience of using services).

• We observed compassionate, kind, and caring interactions between staff, children and young people’s families and carers.

What people who use the service say

We spoke with 13 children and young people and received mixed feedback about the service.

One person said their care coordinator kept changing. Some people told us some staff were rude. One person said some staff were not helpful. Another person said there was a lack of communication.

Three people said staff did not always signpost them to other groups and services. They picked up leaflets about support groups in Hub reception areas, but the staff did not know anything about the group.

Four people said when leaving a telephone message for staff, they did not always respond quickly.

One person said they liked the staff; they are all very good. None of their appointments had been cancelled, but if they had to rebook, it was no problem.

We received feedback about medicines management. 12 of the 13 people spoken with were positive about the management of their medicines. However, one person said they had fortnightly prescriptions which were never ready. They had to ring to order and ring to ask when ready and when they arrived to pick up it wasn’t ready. One person said there had been problems with repeat prescriptions, but this had improved.

We spoke with people about the environment of the hubs they visited for their appointments. One person said the trust needed to brighten up the reception area at East Hub Blakesley Centre, as it made them feel depressed and worse.

Another person said, "The service helped me to get a job. If you asked me a year ago if I would be working, I would have said, no way. I am grateful."

Updated 3 March 2023