The Care Quality Commission (CQC) has told University Hospitals Birmingham NHS Foundation Trust to make improvements, especially around its culture, following inspections in August and October.
An inspection was carried out to look at how well-led the trust was overall. It focussed on four specific areas following serious concerns raised by stakeholders and recent external culture reports. The areas included leadership, culture, governance, and management of risk, as well as issues with performance.
Following this inspection, University Hospitals Birmingham NHS Foundation Trust has been re-rated as requires improvement overall. Being safe and responsive has also been re-rated as requires improvement. Effective and caring have been re-rated as good. Well-led has declined from good to inadequate.
This inspection also looked at critical care services at the Queen Elizabeth Hospital Birmingham due to concerns received from whistleblowers around staffing levels and culture. Inspectors found that the service had low nursing and support staff vacancies and managers regularly reviewed and adjusted staffing levels and gave bank and agency staff a full induction. However, there were challenges to ensure all areas had staff with the right qualifications, skills, training, and experience to keep people safe from avoidable harm and to provide the right care and treatment.
Following this inspection critical care has declined from outstanding to requires improvement overall and for being well-led. It has dropped from good to requires improvement for being safe.
Charlotte Rudge, CQC deputy director of operations in the midlands, said:
"Our experience tells us that when a trust isn’t well-led, this has an effect on the standard of services being provided to people.
“Over the last year, there had been a number of staff changes at senior level, including a new chief executive, new directors and a number of new non-executive directors. Although there were the beginnings of change and recovery, and recognition of present and past concerns, there had not yet been sufficient time to demonstrate progress and for leaders to show they were dealing with the risks, issues, and challenges in the service and how to resolve them effectively. This particularly related to matters of staff safety, unchallenged or hidden bullying cultures, and a fear of speaking up. Throughout the organisation, not all leaders demonstrated they had the skills to be effective leaders and to protect staff from discrimination.
“Although there were genuine efforts to learn and improve, there were still a worrying number of staff across the organisation who felt the trust didn’t have an open culture where they could raise concerns without fear of blame or punishment. Also, some staff didn’t feel safe and protected from bullying and harassment, which had a negative effect on their wellbeing. This is completely unacceptable and must be addressed by leaders as a priority to enable staff to feel supported and be able to provide the best possible care to people.
“I want to thank the staff who came forward to give feedback, I know speaking up in these circumstances isn’t easy, but it’s really important because it helps us understand where organisations may need to focus its attention to identify and address any issues.
“However, despite these issues, staff were still focused on the needs of people receiving care and on providing the best treatment they could. We also heard positive comments from many staff about the support offered by their managers and the good teamworking that they experienced.
“We will continue to monitor the trust and will return to carry out another inspection, to ensure the necessary improvements have been made and embedded so people receive the safe care they deserve.”
Inspectors found trust wide:
- Staff across the organisation felt they were not always supported, safe, respected, and valued
- A number of staff who had approached the office of the Freedom to Speak Up Guardian (FSUG), felt the process of speaking up through the official route was not well supported by the trust
- CQC were told by some staff from ethnic minority groups that the organisation did not always promote equality and diversity in daily work and provide opportunities for career development
- Throughout the organisation, not all leaders demonstrated they had the skills to be effective leaders and to protect staff from discrimination.
However:
- The trust’s wellbeing arrangements for staff experiencing hardship, including food parcels, food banks, clothes or school uniform swaps, psychological first aid, financial support, and support for staff experiencing temporary homelessness, were recognised as outstanding
- Improvements and transformation programmes for governance were in progress. We met with almost all the trust non-executive directors and found a committed and caring group of people from a wide range of backgrounds with a vast range of experience and knowledge to carry out this function. They recognised the organisation was moving at a fast pace to implement change and particularly the new structure of governance
- There also were notable improvements in senior leaders becoming more visible and approachable in the trust for people and staff.
Inspectors found in critical care:
- The service had low nursing and support staff vacancies and managers regularly reviewed and adjusted staffing levels. However, there were challenges to ensure all areas had staff with the right qualifications, skills, training, and experience to keep people safe from avoidable harm and to provide the right care and treatment
- The service did not always control infection risk well. Staff used equipment and control measures to protect people, themselves, and others from infection. However, they did not always keep equipment and premises visibly clean and free from clutter
- Staff did not always complete and update risk assessments for each person in a timely manner which removed or minimised risks.
However:
- Staff understood how to protect people 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
- Staff kept detailed records of people’s care and treatment. Records were clear, up to date, stored securely and easily available to all staff providing care.