Archived: British Red Cross Birmingham

British Red Cross Birmingham is operated by British Red Cross Society. The British Red Cross Birmingham provides urgent and emergency care.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 26 March 2019, along with staff interviews on Wednesday 5 June 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this service was urgent and emergency care.

We rated it as Requires improvement overall.

We found the following issues that the service provider needs to improve:

• The service did not follow best practice when prescribing, giving, recording and storing medicines. However, patients received the right medication at the right dose at the right time.

• Staff did not always keep detailed records of patients’ care and treatment. However, records were clear, up-to-date, stored securely and easily available to all staff providing care.

• Staff did not consistently complete full risk assessments for each patient swiftly or repeat these as required. However, staff identified and quickly acted upon patients at risk of deterioration.

• Managers did not robustly monitor the effectiveness of care and treatment and use the findings to improve them. They did not compare local results with those of other services to learn from them.

• Managers did not appraise staff’s work performance or hold supervision meetings with them to provide support and monitor the effectiveness of the service. However, the service made sure staff were competent for their roles.

• The provider did not collect patient outcome data and analyse it to improve the quality of care. Staff could not find data they needed to understand performance and make improvements to the quality of care. However, the information systems in place were integrated and secure. Staff had access to the information needed to undertake their roles.

• Staff had limited information on how to support the care of mental health conditions.

• The service did not monitor response times or use this information to improve patient outcomes.

• The service did not have robust procedures for supporting staff development and challenging poor practice and behaviour.

• The service had limited engagement with the public to help shape services.

However, we found the following areas of good practice:

• The service managed patient safety incidents well. Staff recognised incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team, the wider service and partner organisations. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.

• The service provided mandatory training in key skills, including life support training to all staff, and made sure everyone completed it.

• 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-controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.

• The design, maintenance and use of facilities, premises, vehicles and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.

• The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

• The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.

• Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

• Staff had the information needed to make the decisions about the right pathway of care for patients.

• All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.

• Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

• Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.

• Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

• The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.

• The service was inclusive and took account of patients’ individual needs and preferences. The service made reasonable adjustments to help patients access services.

• People could access the service when they needed it and received the right care in a timely way.

• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff, including those in partner organisations.

• Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.

• The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders understood and knew how to apply them and monitor progress

• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

• Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

• Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.

• Leaders and staff actively and openly engaged with staff.

• All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

Following this inspection, 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 two requirement notices that affected urgent and emergency care. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals