The Care Quality Commission
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University Hospitals Birmingham NHS Foundation Trust

This is an organisation that runs the health and social care services we inspect

Overall: Requires improvement read more about inspection ratings
Important: Services have been transferred to this provider from another provider

All Inspections

29 August 2023, 24-26 October 2023.

During a routine inspection

University Hospitals Birmingham NHS Foundation Trust is one of the largest teaching hospital trusts in England, serving a regional, national and international population. It includes running four major hospitals: Birmingham Heartlands Hospital, the Queen Elizabeth Hospital Birmingham, Solihull Hospital, and Good Hope Hospital. It also runs a number of community services, including the Birmingham Chest Clinic, the Norman Power Centre and the Washwood Heath Community Diagnostic Centre.

The trust sees and treats more than 2.2 million people every year and employs around 24,600 members of staff.

The trust is a regional centre for cancer, trauma, renal dialysis, burns and plastics, HIV and AIDS, as well as respiratory conditions like cystic fibrosis. It also provides services in premature baby care, bone marrow transplants and thoracic surgery and has the largest solid organ transplantation programme in Europe. It also provides specialist cardiac, liver and neurosurgery services to patients from across the UK.

The Queen Elizabeth Hospital Birmingham has been designated both a level 1 trauma centre and host of the UK’s National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC).

This was a trust which had been through a period of substantial change in recent years. This has included the merger (by acquisition) in 2018 of two large NHS Birmingham-based trusts to form University Hospitals Birmingham NHS Foundation Trust. A new Chief Executive Officer took the interim role in January 2023 and was confirmed into post in July 2023. Other executives have left the organisation this year, or will leave in the course of 2023. There is therefore a relatively new and changing board of directors and a number of the non-executive directors are recent appointments. A new Chief Operating Officer has been appointed but not yet taken up their post. A couple of the long-standing non-executive directors are coming to the end of their term, so more new appointments are expected. The Chief Medical Officer will step down from their role to take up a nephrology and research role in the trust later in 2023 and recruitment was underway for their replacement.

To add to these changes, the trust is at the beginning of a major transformation of its operating model. The trust board recognised that the governance of a trust of this size being based around seven cross-cutting divisional structures needed to be revised. The trust is now in the early stages of the new structure, rolled out in phase one at the start of October 2023. This will place the responsibility for local governance, quality and safety with a hospital-based leadership model. Each hospital will have its own senior leadership team, led by an executive director. These teams will have devolved responsibilities from the main trust board (to be known as the ‘group’ board) to run and manage most clinical services at site level. Some teams will remain reporting through to the group board and not devolved to hospital level with some services remaining on a shared-service basis such as pharmacy and pathology.

The trust has been subject to some intense media scrutiny in the past couple of years, mostly around areas of culture, bullying and harassment. This culminated in the recent publication (September 2023) of a culture review by an external company commissioned by the trust chair.

The trust has undergone an extensive capital investment programme including seven new hospital wards, a new cardiology daycase unit at Good Hope Hospital, and a treatment centre at Heartlands Hospital for 1,500 patients to be treated every day. It has opened an improved treatment centre in Solihull and a diagnostic centre in Washwood Heath, due to open in January 2024.

Our inspection in August and October 2023 included a focused review of critical care services at the Queen Elizabeth Hospital Birmingham, and a focused review of well-led. Critical care was limited to the key lines of enquiry around safety and leadership (well-led). Our well-led inspection focused on four of our key lines of enquiry, namely leadership; culture; governance; and management of risk, issues and performance. We recognise the trust would have provided evidence of groundbreaking and innovative care and treatment had we explored our other key lines of enquiry. However, this review was limited to these four specific areas following serious concerns raised by stakeholders and recent culture reports.

We carried out core-service inspections between February and July 2023 in maternity services, urgent and emergency care, medical care, and two focused inspections of specialist services (cancer and neurological services). In these inspections we rated as follows:

At the Queen Elizabeth Hospital Birmingham we inspected and rated:

  • Urgent and emergency care rated as requires improvement overall with an inadequate rating for safe. Effective, responsive and well-led were requires improvement and caring was good.
  • Neurological services rated as requires improvement overall with an inadequate rating for well-led. Safe, effective and responsive were requires improvement, and caring was good.
  • Cancer services (focused inspection) rated as require improvement overall. We inspected safe and well-led, both of which were rated as requires improvement.
  • Critical care (focused inspection) rated as requires improvement overall. We inspected safe and well-led, both of which were rated as requires improvement.

At Birmingham Heartlands Hospital:

  • Urgent and emergency care rated as requires improvement overall (revised from an inadequate rating) with an inadequate rating remaining for safe. Effective, responsive and well-led were requires improvement and caring was good (improved from requires improvement).
  • Maternity services (focused inspection) rated as inadequate overall. This was a follow-up inspection from a warning notice served and did not change the ratings.

At Good Hope Hospital:

  • Urgent and emergency care rated as inadequate overall with inadequate ratings for safe and well-led. Effective, caring and responsive were requires improvement.
  • Medical care (focused inspection) rated as inadequate overall with inadequate ratings for safety and well-led. Well-led was revised from requires improvement to inadequate at this inspection.

During our focused well-led inspection, we spoke with many of the trust executive directors, almost all of the non-executive directors, in a group call, and held focus groups and interviews with staff and network leaders. A number of staff contacted us both prior to, during and after the inspection with information of concern. However, despite this inspection being announced several weeks in advance, we were disappointed with the number of staff who chose to come and meet with us, either face-to-face or on a web-based call. We were told by the staff we did meet, that many of their colleagues were not aware of the meetings or they had been unable to join due to it clashing with other responsibilities. A number of staff also told us they did not have access to computers or an office where they could have a private conversation. Nevertheless, we recognised staff were busy, may have been unable to make one of the limited times on offer, and we were also only available face-to-face on one site due to time and resource pressures.

How we carried out the inspection

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection

24-26 April 2023, 11 May 2023, 18 May 2023, 13 June 2023 and 4 July 2023.

During a routine inspection

University Hospitals Birmingham NHS Foundation Trust is one of the largest teaching hospitals in England, serving a regional, national and international population.

In September 2016 the trust announced plans to merge with the Heart of England NHS Foundation Trust. The merger by acquistion took place on 1 April 2018. The combined organisation has a turnover of around £1.6 billion and provides acute and community services across a number of locations, however there are 4 main hospital locations:

  • The Queen Elizabeth Hospital Birmingham
  • Birmingham Heartland Hospital
  • Good Hope Hospital
  • Solihull Hospital

The trust also runs Birmingham Chest Clinic, a range of community services and a number of satellite units allowing people to be treated closer to home.

The trust has 2,366 in-patient beds across over 105 wards. In addition to this there are 115 children's beds and 145 day case beds. The trust operated over 7,100 outpatients and 300 community clinics per week.

The trust employs over 20,000 members of staff.

We carried out an unannounced inspection of the following acute services provided by the trust:

  • Urgent and Emergency care at Queen Elizabeth Hospital Birmingham, Birmingham Heartlands Hospital and Good Hope Hospital because we had concerns about the quality of services,
  • Neurosurgery at Queen Elizabeth Hospital Birmingham because we had concerns about the quality of services,
  • Cancer services (focused) at Queen Elizabeth Hospital Birmingham because we received information of concern about the service.
  • The Section 29A Warning Notice was followed up in relation to the medical services at Good Hope Hospital.
  • The Section 29A Warning Notice was followed up in relation to the maternity services at Birmingham Heartlands Hospital.

We were due to inspect the well-led key question however this was postponed due to the trust undergoing a well-led review by a partner organisation. This will now be completed later in the year allowing the trust the opportunity to implement any improvements and recommendations which were identified.

We did not inspect several services previously rated as requires improvement because this inspection was focused only on services where we had concerns or where significant concerns were previously identified and improvements were required. We are monitoring the progress of improvements to services and will re-inspect them as appropriate.

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

• We rated 4 out of the 6 services we inspected as requires improvement and 2 as inadequate overall. We did not re-rate maternity.

• The well-led is the overall trust-wide rating, not an aggregation of services ratings. This therefore did not change from the good rating awarded in 2021.

• We have not taken the previous ratings of services at the Heart of England NHS Foundation Trust into account when aggregating the trust's overall rating. This is because we are still to inspect services at Birmingham Heartlands Hospital, Good Hope Hospital and Solihull and therefore we cannot include these ratings for the trust overall rating.

• Patients were not always protected from harm. There were serious concerns relating to safeguarding practices within the emergency departments. Services did not manage medicines well. Not all staff had received mandatory and safeguarding training, including training which became a legal requirement. Staffing remained a significant concern across the trust, especially within the medical services at Good Hope Hospital.

• Individual needs were not always met, the trust had still not implemented the Accessible Information Standard. People could not always access the service when they needed it or receive the right care promptly.

• Staff did not always feel respected, supported and valued. Leaders did not always run services well and did not always manage risk effectively. Governance systems were not always effective.

However:

• There had been some improvements identified within the maternity services at Birmingham Heartlands Hospital, women were being seen in a more timely manner by medical and midwifery staff.

• Service generally provided care and treatment based on national guidance and evidence-based practice. Staff monitored the effectiveness of care and treatment. The service made sure staff were competent for their roles. Staff worked together as a team to benefit patients. Key services were available to support patient care.

• Staff predominantly treated patients with compassion and kindness. Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.

How we carried out the inspection

We carried out this inspection on various days throughout April and May 2023. We also revisited the ED at Birmingham Heartlands Hospital in July 2023.

We visited areas relevant to each of the core services inspected and spoke with a number of patients and staff. On our inspections, there were teams of inspectors, including inspectors with specialisms in mental health and pharmacy, specialist advisors, operations managers and deputy directors.

During the inspection we visited 7 areas for cancer services at Queen Elizabeth Hospital Birmingham, 9 for medical services at Good Hope Hospital, 7 areas for neurosurgery services at Queen Elizabeth Hospital, 4 areas for urgent and emergency care at Good Hope Hospital, 5 areas for urgent and emergency care at Birmingham Heartlands Hospital and 3 areas for urgent and emergency care at Queen Elizabeth Hospital Birmingham.

We spoke with 167 staff members of various specialities and professions including (but not limited to) consultants, doctors, radiotherapists, matrons, nurses, midwives, midwifery and healthcare support workers, pharmacists, operating department practitioners, domestic staff and administrators.

We spoke with 66 patients throughout the departments and 20 relatives and carers. We also reviewed 75 patient records.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

7, 8, 9, 10, 14, 15, 24, 25, 28, 30 June 2021

During a routine inspection

University Hospitals Birmingham NHS Foundation Trust is one of the largest teaching hospital trusts in England, serving a regional, national and international population.

In September 2016 the trust announced plans to merge with the Heart of England NHS Foundation Trust. The merger by acquisition took place on 1 April 2018. The combined organisation has a turnover of £1.6 billion and provides acute and community services across four main hospitals:

  • The Queen Elizabeth Hospital Birmingham
  • Birmingham Heartlands Hospital
  • Good Hope Hospital
  • Solihull Hospital

The trust also runs Birmingham Chest Clinic, a range of community services and a number of smaller satellite units, allowing people to be treated as close to home as possible.

The trust has 2,366 in-patient beds over 105 wards in addition to 115 children’s beds and 145 day case beds. The trust operates 7,127 outpatients’ and 304 community clinics per week.

The trust has over 20,000 members of staff.

The trust had experienced significant challenges over the past 18 months due to the COVID-19 pandemic. The trust had treated over 14,000 COVID-19 positive patients, of those 2,830 were COVID-19 related deaths. Over 1,500 staff were redeployed from substantive roles to care for the most acutely ill patients and support staff in critical areas. Services had to be redesigned and moved at short notice.

At the time of our inspection, the number of patients admitted to the trust with COVID-19 had significantly reduced. Although throughout the three weeks of core service inspections, the number of patients admitted with COVID-19 had started to increase again.

We carried out an unannounced inspection of the following acute services provided by the trust:

  • Urgent and emergency care at Good Hope Hospital, Birmingham Heartlands Hospital and Queen Elizabeth Hospital Birmingham because we had concerns about the quality of services,
  • Medicine at Good Hope Hospital because we received information giving us concerns about the safety and quality of the services,
  • Cancer services because we received information giving us concerns about the safety and quality of the services. This core service is not aggregated to form the overall trust ratings.
  • Surgery (focused) at Queen Elizabeth Hospital Birmingham because we had concerns about the quality of services.

We also inspected the well-led key question for the trust overall.

We did not inspect several services previously rated requires improvement because this inspection was focused only on services where we had concerns. We are monitoring the progress of improvements to services and will re-inspect them as appropriate. Services previously rated as requires improvement and not inspected this time include:

Birmingham Heartlands Hospital

  • Medical care (including older people’s care)
  • Surgery
  • Maternity

Good Hope Hospital

  • Surgery

Solihull Hospital

  • Urgent and emergency services

Community Health Services

  • Community health services for children and young people
  • Community end of life care

Our rating of services went down. We rated them as requires improvement because:

  • We rated effective, caring and well-led as good and safe and responsive as requires improvement. Well-led is the overall trust-wide rating, not an aggregation of services ratings.
  • We rated two out of six services inspected as good, three as requires improvement and one as inadequate.
  • We have not taken the previous ratings of services at the Heart of England NHS Foundation Trust into account when aggregating the trust's overall rating. This is because we only inspected one core service at Birmingham Heartlands Hospital and two at Good Hope Hospital, therefore it would not be proportionate.
  • Patients were not always protected from harm. There were significant handover delays for patients arriving by ambulance and for those who self-presented to the department. Services did not manage medicines well. Not all staff had received mandatory and safeguarding training, however work was ongoing to improve this.
  • Individual needs were not always met. People could not always access the service when they needed it and received the right care promptly.
  • Staff did not always feel respected, supported and valued. Leaders did not always run services well and did not always manage risk effectively.

However:

  • Service generally provided care and treatment based on national guidance and evidence-based practice. Staff monitored the effectiveness of care and treatment. The service made sure staff were competent for their roles. Staff worked together as a team to benefit patients. Key services were available to support patient care.
  • Staff predominantly treated patients with compassion and kindness. Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported patients, families and carers to understand their condition and make decisions about their care and treatment.

How we carried out the inspection

We carried out this inspection on various days throughout June and July 2021. We visited areas relevant to each of the core services inspected and spoke with a number of patients and staff, as well as holding focus groups.

During the inspection we visited 10 areas for cancer services at Queen Elizabeth Hospital Birmingham, 13 for medical services at Good Hope Hospital, 13 for surgery services at Queen Elizabeth Hospital, four for urgent and emergency care at Good Hope Hospital, five for urgent and emergency care at Birmingham Heartlands Hospital and three for urgent and emergency care at Queen Elizabeth Hospital Birmingham.

We spoke with 210 staff members of various speciality and profession including, consultants, doctors, radiotherapists, nurses, healthcare support workers, pharmacists, patient experience, domestic staff and administrators.

We spoke with 56 patients throughout the departments and reviewed 95 patient records.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

8 October to 29 November 2018

During a routine inspection

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

  • We rated safe, effective, caring and responsive as good and well led as outstanding.
  • We rated nine of the core services we inspected at this inspection good overall and eight as requires improvement.

8 October to 29 November 2018

During an inspection of Community health services for children, young people and families

This is the first inspection of this service. We rated it as requires improvement because:

  • Staff had not recognised or reported incidents which meant appropriate investigation and learning had not been undertaken.
  • Robust arrangements were not in place for administration of non-prescription and as required medicines.
  • Essential equipment to weigh children and young people was not available.
  • Whilst most of services had sufficient staff, long term staff absence within the learning disability nursing service had impacted adversely on children’s access to care and treatment.
  • There was a need to ensure transition arrangements between children’s and adults services met best practice.
  • The referral to treatment wait for the special assessment service, autism service and occupational therapy service had consistently exceeded the required waiting time and were not in line with good practice.
  • There was a need for greater insight and engagement from more senior managers within the trust to ensure safe, high-quality and sustainable service was provided.
  • Arrangements for governance and performance management did not always operate effectively.

However:

  • Staff went beyond expectations to treat children, young people and their loved ones with kindness and compassion.
  • Children, young people, and their loved ones were active partners in their or their children’s care.
  • The service provided mandatory training in key skills for staff and most staff had completed it.
  • The service monitored the effectiveness of care and treatment and used the findings to improve them.
  • Staff understood how to protect patients from abuse and had training on how to recognise and report abuse and they knew how to apply it.
  • Staff had the qualifications, skills and experience and ongoing training and their competence was monitored appropriately.
  • There was effective multidisciplinary working to provide high quality and effective care.
  • The service was responsive to the individual needs of children, young people and their families.
  • The service and its staff were committed to improving and developing services and learning when things go well.

8 October to 29 November 2018

During an inspection of Community end of life care

For this inspection, we rated end of life care services as Good for safe, caring and responsive. We rated the service as Requires Improvement for effective and well led.

Overall, we rated the service as requires improvement because:

  • Patient outcomes were not regularly monitored and reviewed to ensure the end of life care service was meeting the needs of patients.
  • There were no audits to identify the ratio of cancer to non-cancer patients treated by the service.
  • The service did not monitor or audit patients preferred place of care or death. However, they did provide a rapid response team to support patients to be discharged.
  • Two of the five of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders we viewed were not completed correctly as they did not include a mental capacity assessment, despite stating the patient ‘lacked capacity’. We were therefore not assured that the Mental Capacity Act legal requirements were always implemented for people who had DNACPR orders.
  • There was no end of life care strategy for community end of life care services.
  • The trust did not have a specific strategy for end of life care which incorporated planning to meet the needs of the local population.
  • The trust did not have a service improvement lead for community end of life care services.
  • There was no end of life care regional steering group.

However:

  • Staff had a good understanding of how to protect patients from abuse and could describe what safeguarding was and the process to refer alerts.

  • Overall, we found the standards of cleanliness and hygiene were good and staff demonstrated a good knowledge of procedures for the management, storage and disposal of clinical waste, environmental cleanliness and the prevention of healthcare acquired infection.

  • Comprehensive risk assessments were carried out for patients and risk management plans

developed in line with national guidance.

  • We saw good examples of good multi-disciplinary working and involvement of other agencies and support services.

  • From to , the trust reported no never events in community health services for end of life care.

  • All patients, their relatives and care givers told us they were fully included in discussions around their plan of care.

  • There were systems in place to ensure that staff affected by the experience of caring for patient at end of life were supported. For example, members of the SPCT had access to a clinical psychologist based at the local hospice, through a self-referral system as well as a psychologist who provided clinical supervision to individuals or groups, as required.

27 - 30 January 2015

During a routine inspection

University Hospitals Birmingham NHS Foundation Trust is large teaching hospital with a reputation for quality of care, information technology, clinical training and research. It provides care from the Queen Elizabeth Medical Centre which is a new hospital on the site of the original. At the time of our inspection some wards in the old Queen Elizabeth hospital building were open. The trust also provides sexual health services from a number of locations across Birmingham.

The new Queen Elizabeth Medical Centre opened in June 2010 and was constructed under the public sector private finance initiative.

The Trust provides direct clinical services to over 900,000 patients every year, serving a regional, national and international population. It is a level 1 trauma centre, and is a regional centre for cancer, trauma, renal dialysis, burns and plastics; and provides a series of highly specialist cardiac, liver, oncology and neurosurgery services to patients from across the UK.

We inspected this service in January 2015 as part of the comprehensive inspection programme.

We visited the trust on 28, 29 and 30 January 2015 as part of our announced inspection. We also visited unannounced to the trust until Friday 13 February. This included visits to critical care and Medical Care services.

We inspected all core services provided by the trust (note the trust does not provide maternity nor children’s services). We also inspected sexual health services under our community services methodology.

We saw that Leadership of services at the trust was outstanding at both a local and an executive level.

Overall we saw that services were caring and responsive to patient’s needs. We saw services that were effective.

We saw a number of areas that required improvement for them to be assessed as safe.

Overall we have rated this trust as Good. We saw a number of areas that we rated as outstanding in the services they provided.

Our key findings were as follows:

  • Services in the trust had strong clinical and managerial leadership at many levels.
    • Staff were highly engaged with the trust and felt valued. This gave them a strong sense of purpose during their clinical interactions with patients.
    • A culture of local and national audit and analysis was encouraged. This led to change and improvements in practice and care.
    • The trust did not have a safeguarding children’s lead at the time of our inspection.

We saw several areas of outstanding practice including:

  • We saw that the trust had robust governance processes.
  • We saw a powerful culture of innovation which encouraged staff to take opportunities to enhance the services provided by the trust.
  • We saw strong recruitment practices, where teams were encouraged to over recruit when good candidates presented at interview to secure capable individuals when they were available
  • We saw examples of where the trust had engaged with patients over previous problems and changed practice; such as complementary hearing aid boxes and sleep masks and ear plugs provide to all inpatients.
  • We considered the use of theatre technicians to support trauma teams in the Emergency Department as an example of outstanding practice and indicative of the trust wide multidisciplinary working. The practice provided support to the duty anaesthetist for more complex patients and allowed learning between disciplines and departments.
  • The Emergency Department clinical quality and safety newsletter enabled safety and governance messages to be passed to staff in the department in one concise document which provided a summary of relevant points and hyperlinks to original documents or sources of information. The system reduced the number of emails to staff freeing up time.

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

Importantly, the trust must:

  • Improve infection control and hygiene, particularly in Urgent and Emergency Care services.
  • Investigate and resolve the long waiting times in outpatient services.
  • Ensure sufficient consultation time is available for patients with complex conditions
  • Review progress on its 31 day cancer target, especially where radiotherapy is part of the pathway.
  • Ensure appointment to the Children’s safeguarding lead post is made.

Professor Sir Mike Richards

Chief Inspector of Hospitals

Use of resources

These reports look at how NHS hospital trusts use resources, and give recommendations for improvement where needed. They are based on assessments carried out by NHS Improvement, alongside scheduled inspections led by CQC. We’re currently piloting how we work together to confirm the findings of these assessments and present the reports and ratings alongside our other inspection information. The Use of Resources reports include a ‘shadow’ (indicative) rating for the trust’s use of resources.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up. Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.