Birmingham Community Healthcare NHS Foundation Trust

Updated 28 July 2023

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

• We rated the trust as requires improvement overall. We rated caring as outstanding, effective as good, and safe, responsive and well-led as requirement improvement.
• We rated five of the six trust’s services as good and one as requires improvement. In rating the trust, we took into account the current ratings of the two services not inspected this time.
• Although we recognised that the trust had made significant improvements and the board had improved many of its systems, including the vision, values and strategy, there was further work to be improved and completed. However, we were assured that the board and the trust was on a trajectory of positive change that would improve the experience of patients, families, the local population and staff.
• Staffing levels of health visitors remained low and staff in these teams were carrying high caseloads. Morale remained low in these teams and staff did not feel that leaders effectively engaged with them. This continued to be a problem that was seen at the previous inspections in 2018 and 2019. However, the trust had improved governance arrangements to address these problems and were working with external stakeholders to recruit into these posts and had a clear trajectory of improving staffing levels up to and including 2021.
• People could not always access the service when they needed it and did not always receive the right care in a timely way. Children and families were waiting too long for a neurodevelopmental assessment, including 147 weeks for the paediatric Attention Deficit Hyperactivity Disorder (ADHD) service, and 127 weeks for the paediatric physiotherapy service.
• There was further work to embed IT systems across the trust to ensure staff were using them effectively to monitor and plan care to patients. Not all clinical information was kept in the same place and staff required further support to ensure care plans were used effectively and were up to date.
• There was further work to engage with all staff groups to fully embed the vision and values of the trust. The staff survey in 2019 showed that less staff engaged with the process than in 2018, and although there were improvements in some areas of staff feedback there were areas that required immediate attention, such as equality, diversity and inclusion, and providing a safe environment for staff. Overall, the trust performed worse in the staff survey compared to comparable trusts nationally.
• Although the experience of staff from a black, Asian and minority ethnic background had improved since 2018, there was further work to undertake to recruit into senior leaders roles, including band 8A and above.
• Not all staff were following infection control practice in accordance with infection control standards.
• There was a need to strengthen learning across the organisation to ensure it was shared across all front-line services.
• We were not assured that opportunities were in place for the five divisions to learn from each other to drive development and opportunities of front-line services.
• The trust did not have a defined quality improvement methodology however, we recognised that the trust had plans in place for improvement.
• The trust did not always respond in a timely way to freedom of information requests.

However;

• The service had enough staff in most services to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well in most services. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• 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 care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and in most services, did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Most staff understood the service’s vision and values, and how to apply them in their work. The majority of staff felt respected, supported and valued. Leaders had improved staff access to clinical supervision. Staff were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 27 May 2020

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

Updated 28 July 2023

Birmingham Community Healthcare NHS Foundation Trust provides community-based healthcare to people of all ages across Birmingham, covering a population of approximately one million people and a geographical area of 103 square miles across Birmingham, Sandwell, Dudley and Walsall. It also provides specialist rehabilitation services including regional rehabilitation services to assist people manage disabilities, and at Birmingham dental hospital for people of the wider West Midlands region, including Warwickshire, Staffordshire, Worcestershire, Shropshire and Herefordshire.

The trust provides services in people’s homes, primary care premises and community inpatient facilities. The trust provides care for people in over 300 locations and approximately 100 of these are managed by the trust.

The trust provides;

• Adult community services – including community nursing and therapy services, Early Intervention intermediate care teams and specialist community services for people with a long-term condition;

• Adult specialist and rehabilitation services – including 300 intermediate care beds, regional rehabilitation services and prison healthcare;

• Children & families – including universal and specialist community children’s services for Birmingham;

• Learning disabilities – services for adults with learning disabilities in Birmingham;

• Dental – tertiary and secondary dental services at the Birmingham Dental Hospital and community dental services for Birmingham, Sandwell, Dudley and Walsall.

At this inspection we inspected the community health services for children and young people in Birmingham. We inspected as we had received information about low staffing numbers particularly in the health visiting service.

We previously inspected this core service in January 2020 when we rated the service as Requires improvement overall, requires improvement for Safe, Effective and Well led, Inadequate for Responsive and Good for Caring. We told the trust it must make the following improvements:

• The trust must ensure that all health visiting teams have safe staffing levels to provide children and their families with the care, treatment, support and advice they need. Regulation 18 HSCA (RA) Regulations 2014 Staffing

• The trust must ensure that all staff are supported at work to reduce the stress they are reporting. Regulation 18 HSCA (RA) Regulations 2014 Staffing

• The trust must ensure it reduces the waiting times for children and families to access neurodevelopmental services for an assessment. Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment.

• The trust must continue to ensure it has effective governance systems and processes in place to identify, assess, monitor and mitigate risk within the children’s community services it provides. Regulation 17 HSCA (RA) Regulations 2014 Good governance.

We found at this inspection that these requirements have been met.

What people who use the service say:

Parents said staff were approachable, friendly and they were happy with support given. Parents had used the ‘Hub’ when they had concerns about their baby and had found the advice given useful.

Parents said that health visitors listened to them and were helpful in giving them advice.

Parents said the health visiting service had improved since they had their other children and they felt well supported.

Parents said that staff were very supportive, were amazing and brilliant.

Overall summary of this inspection:

• The service had enough staff to care for children, young people and families to keep them safe.
• Staff had training in key skills, understood how to protect children, young people and their families from abuse, and managed safety well.
• The service managed and controlled infection and prevention risks well. [EN1]
• Staff assessed risks to children, young people and families, acted on them and kept good care records.
• Where staff gave medicines, these were managed well.
• The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment to children, young people and families in a holistic way.
• Managers monitored the effectiveness of the service and made sure staff were competent.
• Staff worked well together for the benefit of children, young people and their families, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated children, young people and their families with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided social, emotional and practical support to children and young people, and families.
• The service planned care to meet the needs of local people and took account of people’s individual needs.
• People could access the service in a flexible way.
• Leaders ran the service well using reliable information systems and supported staff to develop their skills.
• Staff understood the service’s vision and values, and how to apply them in their work.
• Staff felt respected, supported and valued. They were focused on the needs of children, young people and families. Staff were clear about their roles and accountabilities.
• The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Staff in some offices did not know where the defibrillator was kept.
• Staff did not always make it easy for people to give feedback.
• Staff did not always have time to keep children’s and young peoples records up to date.

Updated 30 September 2014

The dental services directorate had an open culture and encouraged the reporting of incidents, accidents and near misses. However; staff highlighted concerns regarding the decontamination process and cleanliness and the management of cleaning at Birmingham Dental Hospital. The dental services directorate and the trust were aware of these concerns, had addressed some of them and continued to monitor these issues.

Dental services focused on the needs of patients to ensure their care was effective and in line with best practice. However; staff raised concerns with us regarding the IT system used to record patient information and notes in the combined community dental services. A working group had been established to address and improve the reliability, functionality and sustainability of the IT system.

Patients and their representatives were mostly positive about the care they had received. We observed that patients were treated with dignity and respect whilst receiving treatment. However, some told us they found it difficult to get an appointment or to contact the Birmingham Dental Hospital by telephone.

The dental services directorate was responsive to the needs of patients, including the needs of specific groups of patients with more complex dental care needs.

The trust’s dental services directorate was well-led. Staff told us they felt valued, listened to and supported in their roles and that managers, both within the dental service and the trust, were approachable and visible. Staff we spoke with and observed were passionate and proud of the care they provided to patients in the Birmingham Dental Hospital and combined community dental services.    

Updated 15 October 2018

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

• Patient risks were assessed and managed appropriately and incidents were managed and lessons learned as a result. Staffing levels were planned and managed to ensure patients and staff needs were managed safely.
• Staff used evidence based interventions and best practice guidelines to ensure positive outcomes for those using the services. They regularly audited their practice and made changes when appropriate. Teams were made up of staff from a wide range of disciplines to meet the needs of the patient groups they worked with. Staff were supported in ensuring they were reflective in their practice and identified learning and skills areas for improvement. Staff understood that patients should have their needs met based on their consent. They understood the principles relating to mental capacity and restrictions placed on the patient’s liberty. As such they ensured they practiced in their patient’s best interests.
• Staff worked compassionately and displayed a caring attitude to those they worked with and those who were involved in patient care. Staff demonstrated a patient centred approach and were emotionally supportive which was relayed to us by those who used the services.
• All services were delivered with the rehabilitation, wellbeing and comfort of patients at its heart. Patients found services accessible, adjustments were made and resources provided if required. All key stakeholders were involved to ensure everyone’s needs were met. Peoples’ views were encouraged and used to make changes to improve on accessibility and outcomes.
• Leaders were efficient at managing resources and providing a supportive environment for staff. Staff were supported in their learning and development and there were opportunities to reflect and be supported in professional growth as well as staff wellbeing. Information was shared, staff engaged in service development and research. Governance arrangements were in place and staff understood their responsibilities. There was a culture of putting patients first and staff feeling they played a valuable role in contributing to positive outcomes.

However:

• The service provided mandatory training in key skills to all staff but did not make sure everyone completed it. This meant the service could not assure itself that staff working in the inpatient units had the skills essential and necessary for the safe and efficient delivery of services.
• Staff we spoke with understood how to protect patients from abuse, however, not all eligible staff had completed training on how to recognise and report abuse. The trust had not provided staff with child protection level 2 training as mandated in the safeguarding intercollegiate document. When we raised our concerns with the trust appropriate and timely action plans were put in place immediately.
• There was work to be done on building the strategy, vision and values of the service. This was because of change in the direction of the organisation and new leadership.

Updated 27 May 2020

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

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment, checked patients ate and drank enough to stay healthy, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information.
• 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 care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 30 September 2014

End of life services were good within the trust, we identified some excellent care.  Staff demonstrated a level of compassion and willingness to ‘go the extra mile’ for patients and families. We saw that innovative work was undertaken by the service, where staff had identified areas where their input resulted in improved outcomes for the patients and or their families.

We found the service to be safe. The trust undertook via each division and department audits which enabled conclusions to be drawn about activities. Where improvement or learning was required this was undertaken and shared appropriately with staff and relatives if need be.

We found the service was effective at meeting the needs of the patients on an end of life care plan. The services were highly personalised and holistic. The trust had developed a tool called the Supportive Care Plan for use with patients with a life limiting disease to help them achieve this. Multi-disciplinary team working was used to good effect for patients. 

The end of life service was caring. We found evidence of a level of care which demonstrated excellence.  Staff anticipated patients and family needs. We found that other staff within the team worked to an equally high standard.

The service was responsive to patient needs. The trust understood the needs of its client base, ensuring for example that translation services were readily available to patients whose first language was not English.  We saw that religious practices informed staff interactions so not to cause offence and so they were able to offer advice with these customs in mind.

We found the end of life service to be well-led. At team level staff were well supported, line managers knew their staff well and effectively managed them. Information was shared about the individual services and the trust as a whole. Staff felt they were part of the trust and represented the vision and strategy of the service.  Senior management was effective; governance arrangements were in place to plan for service provision and ensured that actions were disseminated appropriately.     

Updated 27 May 2020

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

• The service provided safe care. Clinical premises where patients were seen were safe and clean. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented plans of care 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.
• The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
• Staff understood the principles underpinning capacity, competence and consent 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.
• The service was easy to access and staff and managers managed waiting lists and caseloads well. The criteria for referral to the service did not exclude patients who would have benefitted from care. Staff assessed and initiated care for patients who required urgent care promptly and those who did not require urgent care did not wait too long to receive help.
• The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.