Birmingham Community Healthcare NHS Foundation Trust

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.

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

• The health visiting service did not have enough staff to care for children and young people and keep them safe and staff did not always manage control of infection risk well.
• The trust’s new models of planning and delivering care to meet the needs of local people had not been fully implemented and staff were not always aware of how these new ways of working could improve their planning and delivery of care locally.
• People could not always access the service when they needed it and sometimes waited too long for treatment, in particular, children and families waited far too long for a neurodevelopment assessment.
• Staff did not always feel respected, supported and valued by senior managers and were not always clear about their roles and accountabilities within the new models of planning and delivering care.

However;

• Staff had training in key skills, understood how to protect children, young people and their families from abuse, and managed safety well.
• Staff assessed risks to children and young people, 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, gave children and young people enough to eat and drink, 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 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 emotional support to children and young people, families and carers.
• Senior managers 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 engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually. They were focused on the needs of children and young people receiving care.

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

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.

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.

Birmingham Community Healthcare NHS Foundation Trust delivers community-based healthcare services to the1.1 million residents of Birmingham. In addition, the trust provides universal and specialist services to 5.5 million people across 103 square miles of the wider West Midlands region, including Sandwell, Dudley and Walsall.

Over 100 clinical services are delivered from hospitals, health centres, clinics and peoples’ own homes.

We carried out an unannounced focused inspection of the children, young people and families’ service at Birmingham Community Healthcare NHS Foundation Trust on 13 June 2019, to review the assurances we had received relating to a Section 29A Warning Notice, particularly looking into caseload sizes and staffing levels within the health visiting service.

We did not inspect any other core services of Birmingham Community Healthcare NHS Foundation Trust.

We inspected using our focused inspection methodology, particularly looking at the safe domain. We did not cover all key lines of enquiry and we did not rate this service at this inspection.

This was a focused inspection to review evidence of assurance relating to the community health services for children and young people, particularly focussing on health visiting. It took place between 9am and 5pm on 13 June 2019.

We did not inspect the whole core service therefore there are no ratings associated with this inspection.

There were areas of poor practice where we told the trust they need to make improvements.

• The service must ensure it reduces its health visiting caseload sizes to meet the trust target and work towards the national guidance.

• The service must ensure it reduces its complex health visiting caseload sizes to meet the trust target.

• The service must ensure cases involving potentially vulnerable children are handed over in a timely manner when they need to be.

• The service must ensure that when risks are identified cases are correctly categorised when additional health visitor input is required.

• The service must ensure that risks are always recorded and appropriate alerts are raised in care records.

• The service must ensure that the system to maintain a duty health visitor is followed across the service.

• The service must ensure that it has safe staffing levels.

In addition the trust should:

• The service should ensure it assesses the impact the geographical working has had on its health visiting staff.

Following this inspection, we sent a letter raising our concerns. In response to our letter, the provider took some immediate actions to address the concerns we raised.

We told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with a Section 31 notice to the trust which is an ‘urgent notice of decision to impose conditions on their registration as a service provider in respect of a regulated activity’. Details are at the end of the report.

Nigel Acheson

Deputy Chief Inspector of Hospitals