Sandwell and West Birmingham Hospitals NHS Trust

Updated 5 April 2019

Not used

Updated 5 April 2019

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

• The Sandwell General Hospital and City Hospital were rated as requires improvement.
• In many services, safe was rated as requires improvement and in six services well-led was rated as requires improvement.
• Well-led for services for children and young people was rated inadequate.

Updated 5 April 2019

Updated 5 April 2019

Updated 26 March 2015

We saw good evidence of learning from incidents, but could not be assured that it was universal.

At Rowley Regis Hospital we found prescription medicines that were not appropriately stored, together with out-of-date clinical equipment.

Staff were competent to carry out their role, and identified and responded to patient risk in a way that ensured patient safety. There were vacancies across the service, which meant caseloads were increased for some nursing and therapy teams. Staff told us that they were happy to come to work, and spoke positively of the contribution they made to patient care.

The service was effective and caring. Care and treatment was evidence-based, and staff followed current best practice recommendations. There were positive examples of multidisciplinary working across internal services, and between local healthcare organisations. All patients and carers spoke positively about the care provided, and we observed staff delivering compassionate care.

The service was responsive to patient need, and patients were treated in their own homes or community clinics where possible. Services engaged with patients to gain feedback and improve service provision.

Many services had practices in place to prevent unnecessary hospital admissions. An example of this was the integrated care services (iCARES), an open access integrated care service that managed adults with long-term conditions.

Staff felt that hospital services and senior managers did not understand the role of community services, and many staff felt that community services were the 'poor relation' compared to acute services.

There were notable examples of innovation; these included the community alcohol service that had integrated into the trust, and the Cape Hill district nursing team, who participated in an 'Aspiring to Clinical Excellence' project. The service promoted clinical audits, projects and research pilots.

We saw good evidence of learning from incidents, but could not be assured that it was universal.

At Rowley Regis Hospital we found prescription medicines that were not appropriately stored, together with out-of-date clinical equipment.

Staff were competent to carry out their role, and identified and responded to patient risk in a way that ensured patient safety. There were vacancies across the service, which meant caseloads were increased for some nursing and therapy teams. Staff told us that they were happy to come to work, and spoke positively of the contribution they made to patient care.

The service was effective and caring. Care and treatment was evidence-based, and staff followed current best practice recommendations. There were positive examples of multidisciplinary working across internal services, and between local healthcare organisations. All patients and carers spoke positively about the care provided, and we observed staff delivering compassionate care.

The service was responsive to patient need, and patients were treated in their own homes or community clinics where possible. Services engaged with patients to gain feedback and improve service provision.

Many services had practices in place to prevent unnecessary hospital admissions. An example of this was the integrated care services (iCARES), an open access integrated care service that managed adults with long-term conditions.

Staff felt that hospital services and senior managers did not understand the role of community services, and many staff felt that community services were the 'poor relation' compared to acute services.

There were notable examples of innovation; these included the community alcohol service that had integrated into the trust, and the Cape Hill district nursing team, who participated in an 'Aspiring to Clinical Excellence' project. The service promoted clinical audits, projects and research pilots.

Updated 17 November 2015

Children and young people (CYP) services was rated outstanding overall. During the inspection we met with managers, staff, children and parents in a range of community settings. We observed care being delivered in mainstream and special schools, clinics and in children’s own homes. We saw excellent innovations in practice to improve care and treatment for children and young people for example a ‘tactile cue’ called ‘TaSSeLs’ and a computer ‘app’ to help children learn and develop. CYP Staff worked with other professionals and external organisations such as CAMHs (child and adolescent mental health services) and social services.

There was evidence that the services for children and young people were delivered in line with best practice guidance and local agreement. Staff were dedicated, professional and well supported. We saw strong local leadership across all community CYP services. Staff told us that they were a valued member of their respective teams. We saw that care was child centred and individualised across all CYP services.

There was an effective system in place to report and learn from adverse incidents, errors, near misses and complaints. We saw care was delivered to promote dignity and respect, and found staff were very responsive to children and their families’ needs.

There was a robust safeguarding process in place and infection control audits demonstrated that infection control guidance was effective. We saw infection control practices across CYP services was good. Environmental observations and reviews of records showed there was a high level of cleanliness across the sites and the availability of safe, clean equipment was generally good.

Generally, staffing levels across CYP services were good, we saw the trust had on going challenges with recruitment of health visitors, and no assessment of ‘fine motor skills’ for children with complex needs by occupational therapists due to a capacity issue. However, this did not adversely affect patient satisfaction and the trust had a robust recruitment plan in place.

Management of medicines were in line with trust policy. The trust supported staff to ensure that their mandatory training needs were met and individual training needs identified. Staff were given supervision and annual appraisals. Staff expressed satisfaction with the levels of support from their local managers.

The leadership of CYP services was supportive and nurturing, senior managers were visible and well liked. Staff told us they thought the executive team “did a good job” in leading the trust and there was strong communication networks throughout CYP services with staff feeling well informed.

We saw local and senior managers encouraged and supported staff to be creative with innovations in practice. CYP services received few complaints, and people we spoke to during the inspection were very complimentary about the staff and the quality of the service they received.

Updated 5 April 2019

Our rating of this service improved. We rated it as requires improvement because:

• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. The service used information to improve the service.
• The service mostly controlled infection risk well. Staff generally kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
• The service had suitable premises and equipment and looked after them well.
• Staff kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other preferences.
• The service monitored the effectiveness of care and treatment and used the findings to improve them. They compared local results with those of other services to learn from them.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance.
• Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
• Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. All staff had access to an electronic records system that they could all update.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Staff involved patients and those close to them in decisions about their care and treatment.
• Staff provided emotional support to patients to minimise their distress.
• The trust planned and provided services in a way that met the needs of local people.
• People could access the service when they needed it. Waiting times from treatment were and arrangements to admit, treat and discharge patients were in line with good practice.
• The service took account of patients’ individual needs.
• The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
• The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
• Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish.
• The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
• The trust collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
• The trust engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
• The trust was committed to improving services by learning from when things go well and when they go wrong, promoting training, research and innovation.

However,

• The service provided mandatory training in key skills to all staff, however not all staff were fully compliant in training the trust deemed essential for safe and efficient service delivery and personal safety.
• Emergency resuscitation trolleys had no security tags on the drawers to alert staff to tampering with the content. Resuscitation trollies were therefor not tamperproof
• Staff did not achieve uniformly high standards in recording and communicating decisions about CPR and that DNACPR forms in line with best practice.
• When monitoring and scoring vital signs nurses did not always take urgent action to review the care of the patient and call for specialist help when necessary.
• Mental capacity assessments completed by staff were not always detailed, compliant with legislation and best practice, or undertaken in a way and at a time that recognised patient’s abilities.
• Most but not all staff were up to date with their yearly appraisal.
• Care plans did not describe the care needs in an individualised way.
• Although the service treated concerns and complaints seriously, the time taken to investigate complaints was not in line with trust policy.
• Ward risk registers did not reflect all risks staff identified in the area.

Updated 31 October 2017

Palliative and end of life services at within Sandwell & City Hospitals NHS Trust provides an integrated service within both within Sandwell & City Hospitals and the community. The community include patients own homes, home from home beds, home from hospice beds and the Heart of Sandwell Day Hospice in Rowley Regis Hospital.

We have rated end of life services overall as outstanding. We rated the safe domain as good and effective, responsive, caring and well led domains as outstanding. This is because:

• Experienced staff provided a compassionate and responsive evidence based service for end of life care patients.

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

• The service followed evidenced based guidance incorporating NICE Guidance including NICE QS13 End of Life Care for Adults (Nov 2001/updated Mar 2017) and The Five Priorities for Care of the Dying Person (Leadership Alliance 2015).

• Staff were knowledgeable about the trust’s incident reporting process and we saw concerns were investigated and learning shared.

• The service had one single point of access for patients and health professionals to coordinate end of life care services for patients known as the Hub. This meant patients received the right care at the right time in the right place.

• The palliative and end of life care service was very well developed across the trust and held in high regard both by staff within the trust and other agencies.

• End of life and palliative care was a priority for the trust. The service was well developed, staffed, and managed as part of the iCARES directorate.

• There was a clear governance structure from community services and department level up to board level. Good governance was a high priority for the service and was monitored at regular governance meetings.

• Staff were proud of their service, and spoke highly about their roles and responsibilities, to provide high levels of care to end of life patients.

• Patients were involved in their care and were enabled to make choices. This included choosing the place where they wished to receive palliative care and where they would prefer to die. The palliative and end of life care team ensured that arrangements weremade quickly so they could be within their preferred place of care.

• Advanced Care Plans and Supportive Care Plans (SCP) were used across the trust for end of life patients. They were used as a person centred individual care record to include all the needs and wishes of a patient and their family.

However:

• The trust’s ‘Anticipatory Medication Guidelines’ was due for review in September 2016 but no updated guidance was available. We could not be assured staff were following the most up-to-date guidelines.